A prisoner had his cancer ‘ignored’ despite losing six stone in six months and passing blood before dying in excruciating pain, an inquest heard.
Adrian Watts, a 43-year-old father, complained to doctors at Horfield Prison in Bristol about severe abdominal pain and even urged them to check whether he had cancer.
But instead of giving him an urgent scan, prison doctors dismissed it as gallstones.
By the time he was taken to Southmead Hospital for a proper diagnosis, tumours had grown in his pancreas, colon, kidney, liver, and his adrenal glands.
Hospital doctors gave him just a few weeks to live, but he died days after the diagnosis.
And because of his treatment for drug addiction, he could not be given the proper pain medication throughout the months before, reports Bristol Live .
Dr Rachel Royston, who was in charge of his care, told an inquest they did not know what was wrong with him less than a week before he passed away.
“He was getting sicker, and sicker and sicker, and we still did not have any answer,” she said.
“He was in an excruciating amount of pain and I remember that very, very vividly.”
Shortly before his death, he told doctors and his family he wanted to kill himself because of the pain.
By that point, his fellow prisoner told the court Mr Watts, who was 6ft 3in, had lost about six stone in weight.
He went from a bulky 16st, to a mere 10st in just six months.
He looked entirely different from nine months before, and could not even stand up to “make a cup of tea”, Dr Royston added.
An investigation by the Prison Ombudsman found “a number of deficiencies” in his care and that he should have been sent to a specialist earlier.
After the inquest, his family told the Bristol Post how his death had devastated the mental health of his eldest daughter, and she died nine months later.
Mr Watts was recalled to prison in June 2016 and started treatment for substance and alcohol detoxification.
Two months later, he told his daughter Naiidine he was feeling unwell and seemed “beaten and broken down”.
His physical appearance stayed the same, but in September he started complaining about severe pains in his stomach area.
“Dad had told me he wasn’t feeling well and that he didn’t want us to visit. During these phone calls, he told me he was in pain and he thought he was going to die,” Naiidine said.
“He told me that he was losing weight and he had told staff members he was losing weight but no one was taking any notice.
“During one of these phone calls, he told me it was stomach cancer and he begged the staff at prison for an ultrasound scan, but they wouldn’t do it. They always came up with an excuse as to why it couldn’t be done.”
In November, Mr Watts told a paramedic he had passed blood while visiting the toilet and had constant pain near his ribs. He suspected cancer and told the medic.
He was seen several times over the next few weeks.
A doctor found tenderness in his stomach, and diagnosed him with piles instead and prescribed a laxative.
Mr Watts continued to report increasing and persistent abdominal pain, constipation, diarrhoea and anxiety.
He told a doctor on December 12 he could feel a mass on the right of his stomach and that he had lost about 12 kilograms (kg) at that point.
Four days later, another doctor noted he had lost 7kg in just six weeks, and requested a scan on his gall bladder.
Mr Watts continued to tell doctors he thought he had cancer, and that he wanted further investigation.
But after six consultations, the prison doctors instead believed Mr Watts might have irritable bowel syndrome.
While waiting for his scan in January, he was left in “great pain and discomfort”, and had to sleep sitting upright because it was too much pain to lie down.
He had his first scan a few days later, and he was referred to Southmead Hospital with suspected upper gastrointestinal cancer.
Doctors told him about the tumour, and he was prescribed an energy drink and paracetamol.
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“Mr Watts continued to report he was in considerable pain, felt unwell and was unable to eat or drink fluids other than water,” the ombudsman said.
“He slept in a chair, as it was too painful to lie down. Doctors frequently reviewed and adjusted his pain relief, but the options were limited, as Mr Watts was on an opiate blocking dose of buprenorphine (subutex).”
After his pain was slightly relieved, he was sent back to prison and requests were made to kitchen staff for an appropriate diet.
It fell on deaf ears, and he was instead given burgers, chips, chicken cooked in cream and tuna mayo. The prison manager and chaplain spoke with catering staff, but nothing was done.
Mr Watts was given a CT scan on February 3, and although it showed possible cancer, the scan was only “sub-optimum”, the court heard.
It was thought he could have blood cancer, and staff believed it might be malignant. But nothing was done.
By February, he threatened to kill to kill himself twice because the pain became unbearable.
“As soon as I saw him, I was shocked by how thin he looked. I was able to put my arms all around him, and that wasn’t normal,” Naiidine told the court.
“His face was all drawn in and his skin looked dark and grey. His head looked too big for his body. You could see his jaw line and his collarbone.
“Dad told me he wanted to kill himself. He said the best thing about the visit was being called granddad by his grandchildren.”
By mid February, his weight started falling rapidly. He struggled to eat, or even stand because of the pain.
Doctors ordered him back to Southmead, but he was discharged soon after.
On March 1, Mr Watts was doubled up in pain and shivering. GPs suspected possible sepsis and he was taken to hospital five hours later.
After being given intravenous antibiotics and strong painkillers, he became slightly better.
But doctors at Southmead could not find the root cause.
They risked a CT scan, knowing it could cause complete renal failure and death.
What the doctors found shocked them. There were tumours everywhere – a huge one in his pancreas, his colon and it had spread to his right kidney, his liver and adrenal glands.
He also had blood cancer, and it was in its advanced stages. Doctors gave him a few short weeks.
“There was no option for treating him. If you are to undergo chemotherapy or radiotherapy you must be well enough to even make a cup of tea,” Dr Royston said.
“He was so weak he couldn’t even pull his boxer shorts up. Resuscitation was not possible, and he was put on end of life care.”
Surrounded by his three daughters – Nikita, Naiidine and Laura – Mr Watts passed away two days later in the early hours of March 17, 2017.
“Dad told me he was going to die today and he wanted me to look after everyone,” Naiidine told the court.
The guidelines for referral for suspected cancer was that adults over 40 years old with unexplained weight loss and abdominal pain should be given an urgent referral.
For those under 50, rectal bleeding should also be considered.
Mr Watts had reported all of the above several times, but prison healthcare staff did not treat the mass in his abdomen as a potential malignancy.
In total, he made two official complaints about his treatment in prison, but no one responded to it.
And when the investigator for the ombudsman asked staff and prisoners at HMP Bristol for relevant information, no one got back to her.
The ombudsman said: “Although earlier intervention is unlikely to have made a difference to the outcome for Mr Watts, as his cancer was well advanced by the time he reported his symptoms, it is important staff respond promptly to symptoms which might indicate cancer.”
In his findings, deputy prisons ombudsman Richard Pickering wrote: “When Mr Watts presented with concerning symptoms in early December, this should have prompted an urgent referral under the NHS pathway for suspected cancer. A prison GP referred him just over a month later.”
While waiting for test outcomes, he was not given “sufficient morphine” to deal with his pain and catering staff did not help him with an alternative died.
“Mr Watts’s care at Bristol [Prison] was not equivalent to that which he could have expected to receive in the community.
“We are not satisfied the risk assessment completed for Mr Watts’s final admission to hospital prison took sufficient account of his poor condition at that time and the impact on his risk.”
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