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Peter is speaking publicly about the quality of care received at Wolston Correctional Centre in early 2017. He exhibited flu-like symptoms for more than four months before it was eventually diagnosed as a metastatic tumour.

How this prisoner's tumour grew unnoticed for months

News Corp Australia

AS A deadly tumour grew undetected in his nasal cavity, Peter fought and failed to get the mystery condition diagnosed for months inside Queensland's overburdened prison system.

The former prisoner, whose real name cannot legally be used, first experienced flu-like symptoms in January 2017.
His nose was stuffed. His left ear was blocked. His voice changed and never changed back. He had extreme fatigue.

At the time, the white-haired offender had been inside Wolston Correctional Centre, between Ipswich and Brisbane, for more than a year.

He already had kidney cancer, having been diagnosed while on parole three years earlier. His right kidney had been removed and 10% of his left kidney was resected while serving time. The disease left him with complex care needs, a history of tumours and malnourishment.

He also had other illnesses such as Meniere's disease affecting his ear, Scheuermann's disease in his spine, the heart condition mitral valve prolapse and at one point an infected abscess on his back.

All this meant he had been in and out of the health centre at Wolston ever since he returned to prison in October 2015 for violating parole.

He's now out of prison and likely will die at home in the country town of Lowood. 

Four months after first seeking a diagnosis, treating staff finally discovered the cause of his perpetual stuffy nose.

It was a rapidly growing 5cm-wide tumour that had already begun to extend into his throat. That tumour, and the others riddled throughout his body, will kill him.

Before he dies, Peter wanted to publicly challenge staffing levels and the standard of medical care delivered to the more than 8000 people locked inside Queensland prisons on any given day.

Peter went to several lengths during his last 18 months in prison to raise concerns about his health care.

His partner wrote to Premier Annastacia Palaszczuk and prison management. Peter made a formal complaint to the Health Ombudsman, which prompted an inconclusive investigation. He also wrote to Minister for Corrective Services Mark Ryan, as did his partner. His partner also approached the press when Peter was forced to sleep on a mattress on the floor in the general prison population.

Facilities like Wolston are in the grip of an overcrowding crisis, prompted partly by the increase of prisoners, like Peter, being returned to incarceration for violating parole.

Dressed in a blue knit jumper and jeans, he told News Corp what he went through to get diagnosed inside Wolston, one of the busiest correctional centres in the state.

The path to treatment:

Peter's requests for treatment during his months in Wolston are detailed in a five-page investigation compiled by the Health Ombudsman.

The investigation started after Peter made a complaint about the delay in getting a doctor's appointment and his access to painkillers.

The ombudsman's report shows Peter first reported his extreme fatigue to the dietician on staff at Wolston's medical centre on February 10 this year. Unspecified tests and a review two months later were requested.

Twelve days later on February 22, he put in a health services request form to see the doctor over his "two-month" cold and fatigue.

"I sleep all night as well as most of the day. I am badly fatigued," Peter wrote.

A registered nurse wrote on the form that Peter "would be seen by the doctor asap".

There was no action for several weeks until March 16, when the nurse unit manager at Wolston's health centre received a letter from Ms Palaszczuk's office.

His partner had written to the office complaining about his health care, and the Premier's office had contacted the prison as a result. 

In a separate response to his partner's letter, the Premier's office wrote to her that Peter's health was regularly assessed.

"Following investigation, it has been confirmed that (prisoners) are receiving appropriate medical care and treatment in the centre," the letter, dated March 3, said.

Four days after that, on March 20, the nurse unit manager reviewed Peter and noted his blocked nose, chest pains and fatigue.

She referred him to the nurse practitioner, who ordered a chest X-ray as well as other unspecified tests. Staff believed Peter had a viral infection.

Another fortnight later, on April 3, Peter refused to go to the hospital for the scheduled chest X-ray. He told News Corp it was because he was not fit enough to travel between the prison and the hospital. The ombudsman report doesn't list a reason.

It was also on April 3 he wrote a letter to the ombudsman complaining about the quality of his care.

A week after that Peter finally saw the doctor, more than six weeks after formally seeking an appointment.

"On April 10, 2017 the complainant was reviewed by (the doctor) who considered the complainant's background, symptoms, and requested additional tests," the ombudsman report notes.

The doctor told Peter to try a course of oral antibiotics, and the drug Prednisone if his symptoms didn't get better. He was also treated on the same day for the abscess on his back, which was incised and drained. The doctor prescribed oral antibiotics.

Six days later, he was back in the medical centre.

Health staff told the ombudsman that on April 16, Peter was asked how he was feeling and if he had concerns. The information they supplied shows he responded "No, I'm fine."

He was also asked about his symptoms, and reported he still had a blocked nose. Now he also had a blocked ear.

He didn't have a cough, or any phlegm, and a test came back negative for the flu.

Staff prescribed him nasal spray, which had no effect on his nose.

Almost a month later, on May 5, the ombudsman received another letter from Peter about his treatment.

"On the 10 May, 2017, it will be three months since I was put down to see the doctor and it will be just about four months since I first started getting symptoms," he wrote.

A portion of one of the letter's Peter wrote to the Health Ombudsman.
A portion of one of the letter's Peter wrote to the Health Ombudsman.

"This matter has not improved and treatment is not being carried out that has been ordered.

"I am tired, frustrated and at my wits' end trying to get treatment."

Four days after the ombudsman received his letter, Peter was back in the health centre - still asking for treatment for the same symptoms he'd complained about since February.

This time, his treatment was escalated. Staff ordered a CT scan. They also put in another order for a chest X-ray. He also got another nasal spray and a different antibiotic. The report doesn't note if Peter ever received these treatments.

That's the end of the ombudsman's investigation into Peter's care.

The final report, dated June 9, acknowledges a delay in care for his symptoms but said there was no indication the treatment was unreasonable.

It determined no further action was required.

Discovering the tumour:

By June 9, Peter was lying in a secure hospital bed in the full knowledge he was dying.

He had collapsed in Wolston more than a week earlier, on June 1, and was taken to the 12-bed secure unit at Brisbane's Princess Alexandra Hospital in an ambulance.

While they treated the medication side effects that caused his collapse, Peter complained to PA staff about his blocked nose.

It took one CT scan, taken less than 24 hours after he was admitted, to find the aggressive tumour that had taken over the space behind his nose.

"The doctors came in and said 'Sorry, but we can't treat this any more'," Peter said.

"He said, you know, 'What were you told about this?'."

"I said 'I was told there's only so much you'll cut out and then they'll say no more'.

"That's when he said 'That time's come now'."

Scans also found tumours in his spine, pancreas and abdomen. It also found the existing tumour in his right adrenal gland had grown too. 

Discharge papers from the PA show Peter was in significant pain. He couldn't stand or walk at the time. His muscles were wasting and his weight had dropped from 76kg to 71kg.

He spent just over a fortnight in the PA's secure ward, from June 1 to June 15. In capital letters on page three of his discharge papers, PA staff made it clear he had to have access to painkillers suitable for palliative patients at night when he returned to prison.

"(Peter) has extensive intra-abdominal metastatic deposits causing him significant pain," PA staff wrote.

"Please consider appropriate accommodation to ensure his needs are met within this facility."

Once discharged, he was sent back to Wolston to serve out the week that remained on his sentence. He was released on his full-time date on June 23 this year.

Prison vans ramping at the PA Hospital. Photo: The Courier Mail
Prison vans ramping at the PA Hospital. Photo: The Courier Mail

Survival:

The tumour was probably always going to kill Peter and earlier detection probably wouldn't have helped his long-term survival.

Tests performed at the PA determined the tumour was likely the result of metastatic renal cell carcinoma - his existing cancer spreading.

Studies on metastasised RCC tumours in the head and neck show survival rates are dismal. One study puts long-term survival for patients with Peter's condition, which is rare, at mere months.

Peter's frustration is not the lost chance of a longer life. His complaint centres around the care given to him in those few months, particularly in the use of painkillers and the delay in diagnosis.

In the months the tumour grew, Peter said it changed his breathing and ability to talk.

"I couldn't talk, I couldn't breathe, I couldn't swallow my medication," he said.

"The whole system knew I previously had cancer. Not at one time … not even the doctor … she didn't even consider that might have been what it was."

News Corp understands the Wolston health centre is not manned after 8pm, and prisoners cannot usually access medication even as simple as Panadol unless a nurse administers it.

Peter was weaned off the Schedule 8 painkiller Targin several months before the new tumour was discovered, in August 2016, despite the PA medical records showing he was in severe pain. 

Schedule 8 drugs include addictive opioids, a drug with currency inside prisons.

The ombudsman's investigation shows health staff did not document any concerns from Peter about his access to painkillers, despite it forming part of his complaint.

He said he did raise concerns to prison health staff about being weaned off the Oxycodone-containing Targin.

"I put up that much of a fuss that an officer was called in," he said. "I was told to calm down."

Once his new tumour was discovered, Peter was prescribed his regular Oxycodone and a new 5mg tablet to be taken every four hours.

Peter said Wolston staff managed to deliver this pain medication for all but one night once he returned from the PA.

Prison health care:

Healthcare inside prisons is delivered by Queensland Health, and in south-east Queensland it is primarily the responsibility of West Moreton Hospital and Health Service.

Department of Corrections referred all health questions to West Moreton HHS, which declined to answer questions about Peter's case because of privacy concerns.

West Moreton HHS spokeswoman Dr Leanne Geppert did release figures about the number of prisoners the service treats.

She said more than 2200 prisoners, including young people in the juvenile justice system, were treated by West Moreton HHS.

Staff delivered close to 22,400 'occasions of service' to prisoners inside Wolston in 2016-17, to a population that usually hovers about 750 prisoners.

Occasions of service include appointments with staff such as doctors, nurses, dieticians, dentists, optometrists and referrals to specialists or hospitals.

As of August 23, there were seven prisoners inside Wolston being treated for cancer. It is the leading cause of death in Australian prisons, with the latest public data showing it accounted for one in five deaths in 2011-12 and 2012-13.

As executive director of mental health and specialised services, Dr Geppert said West Moreton HHS took its role treating prisoners very seriously.

She said the service was determined to provide a level of care to prisoners commensurate with what they would receive in the community.

"In some circumstances, the medical care and treatment required by prisoners can be more complex than others," she said.

West Moreton HHS did not answer questions about staffing levels in the Wolston health centre.

Department of Corrections said only that prisoners who required care beyond what was available at the centre would be taken to hospital.

Wolston Correctional Centre:

Wolston Correctional Centre is notorious for the criminals housed there.

 

Prison-issue clothing and utensils
Prison-issue clothing and utensils Alistair Brightman

Child killer Brett Peter Cowan is there, as are the killers Gerard Baden-Clay and triple murderer Max Sica. Rapist and murderer James McGrane continues to serve a sentence there after repeatedly being denied parole.

Peter declined to reveal the original crime that put him in prison. He said he was sentenced to 16 years and served nine of those in Townsville Correctional Centre before he was granted parole. He was encouraged to complete a sexual offending maintenance program when his parole was suspended.

He remained on parole without incident until October 2015. A late-night incident with his new girlfriend, now his long-term partner, prompted a call to 000.

Police imposed a domestic violence order on Peter. A few days later, parole officers decided to suspend his parole and put him back in prison to serve the rest of his sentence. They determined he could no longer live with his partner.

He was not charged with breaching a DVO, and he said he didn't re-offend while on parole. The conditions of the DVO did not prevent the pair from living with each other.

They live with each other now, still under the conditions of the DVO. It will likely remain in place until Peter dies.

He was returned to Brisbane Correctional Centre in October 2015 and was eventually transferred to Wolston in December to serve the rest of his jail sentence.

The centre has continuously suffered from overcrowding and is built to hold only 600 people - 150 fewer than the average population of 750. Its officers threatened to strike earlier this year over under-staffing issues, particularly at night.

A portion of the overcrowding is a result of parole suspensions. A total of 17-20% of Queensland prisoners are there because their parole was suspended.

The parole system is undergoing its biggest overhaul in decades thanks to a review led by Walter Sofronoff QC.

The horrific murder of Townsville's Elizabeth Kippen by a parolee who had been released only seven hours earlier prompted the review.

The review found serious systemic issues, under-resourcing and a lack of treatments and resources available to prisoners who may be at risk of reoffending.

Peter said under Sofronoff's recommendations, he would not have been returned to prison.

"My parole officer would've come down and seen me, which is what should be happening," he said.

"That is going to go a long way in stopping people from coming back."