SEATTLE — Wayne Lankhaar felt like he was dying.
Pain in his abdomen made him fall to his knees and brought tears to his eyes. An alarming amount of blood came out when he went to the bathroom. He could barely eat.
Yet no matter how hard he tried, Lankhaar, incarcerated at the federal detention center in SeaTac, couldn’t see a doctor. The facility, which holds pre- and post-trial defendants facing federal criminal charges, didn’t have one available, he said he was told in response to near-daily requests.
His lawyer, David Hammerstad, emailed officials four times with urgent appeals, warning the institution’s “indifference” to Lankhaar’s medical needs was “courting legal liability.”
After two months, a court order released Lankhaar in fall 2022 to a drug-treatment center while awaiting trial on charges of drug possession with intent to distribute. Waiting for a meal there, he collapsed, was taken to the emergency room and was diagnosed with terminal colon cancer that had spread to his lungs.
Now undergoing chemotherapy at a Bellingham hospital, the 62-year-old said of the detention center: “I know for certain I would have died if I had been there even a few days longer.”
Like state and county governments maintaining jails and prisons, the federal government is legally responsible for the health care of people in its custody. Violations of that duty can be deemed “cruel and unusual punishment” and therefore unconstitutional.
A sentence of, say, five years means the loss of liberty for that amount of time, said Dr. Marc Stern, a former health official with the state corrections department and a consultant for federal agencies. “The sentence doesn’t include that you’re going to lose your life.”
But many held at the SeaTac detention center fear exactly that. Interviews and written statements from more than 20 people currently or formerly incarcerated there, accounts from lawyers and court records and other documents indicate medical care is severely lacking, leaving serious health conditions undiagnosed and untreated.
In one case, U.S. District Judge Richard Jones weighed in. “This man needs medical care and treatment now,” Jones said of Chris Frick, whom the judge temporarily released so the pretrial defendant could attend to several painful health conditions. At the detention center, Jones said, there was a “complete absence of any specific care and treatment.”
The Federal Bureau of Prisons declined an interview but said in a statement that all of its facilities provide “essential medical, dental, and mental health services in a manner consistent with accepted community standards for a correctional environment.”
“All incarcerated individuals have daily access to medical care and appointments, and medical staff conduct daily rounds throughout each facility,” the statement continued.
By “daily rounds,” a spokesperson made clear, the bureau means what incarcerated people call “pill lines,” in which nurses dispense medication and collect requests to be seen.
While the agency defends its health care, it also acknowledges chronic medical staffing shortages, largely due to uncompetitive pay. A decade ago, a dozen of its institutions had a medical staffing level of 71% or below. A former bureau health official called that a “crisis level,” according to a 2016 report by the Department of Justice’s Office of Inspector General.
The situation is now even worse at the SeaTac facility, with eight of 19 health care positions vacant, amounting to a 58% staffing level. The institution supplements its full-time staff with five contracted health care employees. For all but a full-time contracted pharmacist, the bureau declined to supply the number of hours they work.
The agency’s SeaTac employees include one doctor to serve nearly 800 people. Two full-time registered nurses also work there, as does one contracted nurse practitioner.
The medical staffing woes are part of the bureau’s larger recruiting and retention problem, exacerbated by burnout from the pandemic. Correctional officers are in especially short supply, with a 50% staffing level in SeaTac as of late last year. Union officials and other employees say the situation for existing staff, often required to work double shifts, is exhausting and dangerous.
Stressing the point, 17 Congress members, including Rep. Adam Smith, the Bellevue Democrat, wrote to the Justice Department in late January urging more oversight. Leading U.S. Senate Justice Committee members have asked for the same, specifically calling out inadequate medical care highlighted in a national NPR investigation last fall.
The Inspector General’s office has noted that low medical staffing can contribute to volatility among those incarcerated, raising prison safety concerns.
Last month, someone incarcerated at SeaTac assaulted two employees. The bureau said they didn’t require medical treatment and would give no further details pending ongoing investigations.
To some extent, the bureau’s hands may be tied by the federal government’s pay scale. But the 2016 inspector general’s report determined the agency had failed to develop a plan that prioritizes vacancies and makes better use of the U.S. Public Health Service, whose medical professionals work for a variety of federal agencies.
At the moment, the bureau might not even realize exactly where it’s going wrong. According to a 2022 audit of its contracts with one medical service provider, “the BOP did not have a reliable, consistent process in place to evaluate timeliness or quality of inmate healthcare.”
A common denominator: desperation
Over the past year, a dozen women sat down at the SeaTac detention center to document their health care experiences, hoping their handwritten letters would be seen by someone who could help.
Provided to The Seattle Times through a lawyer, they had one common denominator: desperation.
One woman said she was left bleeding on the concrete floor after falling from a top bunk. Another said she could see a psychiatrist only every three to four months because the provider was available just one day a week. Many discussed failing to receive medications they had been taking before entering the facility, worsening conditions like heart failure or seizure disorders.
“I am continuously told they are short-staffed and to be patient,” wrote one woman who said she couldn’t get medications. “I’m so scared if I have a heart attack, I’ll die here.”
At the time several were writing, they said there was no pharmacist on site. A pharmacist position still stands vacant, though a bureau spokesperson, pointing to the agency’s contracted pharmacist, said “medications are filled daily.”
Complaints about health care proliferate in state prisons and county jails too. Last month, Washington paid nearly $10 million in a settlement with a woman whose cervical cancer grew terminal while she was incarcerated in Gig Harbor.
But several people said their medical experiences while incarcerated in SeaTac were worse than at county or state institutions where they had served time before, with one woman saying she would now rate what she had thought had been a state prison’s bad health care as “five star.”
Some may exaggerate their illnesses in hopes of getting attention and may not be as sick as they fear. At the same time, they can face agonizing uncertainty without a diagnosis. Luke Thornhill, for instance, worried he had untreated colon cancer.
While previously serving time in an Idaho state prison, he was sent for a colonoscopy. Before seeing a doctor who could interpret lab results from two growths biopsied during the procedure, he was transferred to SeaTac on a federal drug possession with intent to distribute conviction.
Five months later, in January, he was still waiting to hear if the growths were malignant, and he was suffering from intense stomach pangs. He said he hadn’t seen a doctor at the detention center, beyond an initial screening.
“I am experiencing extreme pain,” he wrote in one request to be seen after four months at SeaTac. “Please help,” he said in another.
Stern, the previous state corrections health official, reviewed Thornhill’s biopsy results at The Seattle Times’ request, finding they showed a precancerous growth that presented no immediate risk but the need for another colonoscopy in three to five years.
“The standard of care would be to tell the patient all this,” said Stern, also a University of Washington assistant professor.
As for Thornhill’s stomach pain, he said that was likely a separate problem requiring an exam to diagnose. Depending on the severity of pain, Stern said, a reasonable amount of time to wait for a doctor’s appointment is anywhere from a few minutes to a few days — but definitely not five months.
Such stories “go on and on and on,” said Paula Olson, who sometimes serves as a court-appointed federal defense attorney.
One client in particular, Frick, stands out. The 50-year-old suffers from Crohn’s disease, a bowel condition that causes digestive tract inflammation.
Detained at SeaTac in 2021 while awaiting trial on a charge of drug possession with intent to distribute, Frick’s abdomen became so swollen and painful that he couldn’t sit without slouching. He had diarrhea that caused him to go to the bathroom as often as 13 times a day, but he didn’t get enough toilet paper and “was told to use a shirt if he runs out,” according to a court document Olson submitted.
On top of that, Frick had a broken tooth with an exposed nerve. During a visit with her client, Olson wrote in a declaration to the court, “he would speak a few words and then stop, put a hand on his mouth until the pain spasm passed. At one point, the pain was so sharp that tears ran down his cheeks.”
It was unbearable, Frick confirmed in an interview. He said he saw a dentist twice while incarcerated but was told he needed to see an outside specialist. “Well, months and months and months go by,” Frick said.
He also said he was taken to an outside health system for a colonoscopy to address his gastrointestinal problems. The night before, he was put in a segregation unit to go through the unpleasant pre-procedure routine of taking fluids that flush out the system.
But when Frick arrived for the procedure, the provider told him it couldn’t be done because detention center officials hadn’t sent his medical records.
In the shape Frick was in, Olson said she and a colleague couldn’t effectively discuss strategy with him, and they couldn’t fathom putting him on the stand. Arguing that his right to a fair trial was being compromised, they asked for his release.
Opposing the motion, federal prosecutors pointed out that Frick’s longstanding Crohn’s condition didn’t stop him from allegedly distributing drugs, including fentanyl, and previous drug-dealing for which he served a six-year sentence.
At a court hearing in December 2022, Assistant U.S. Attorney Casey Conzatti said Frick recently had a tooth extracted to comply with a judge’s order. “He is being seen,” Conzatti said, noting, “I understand it’s probably not at the speed and pace he would like.”
Kevin Posalski, a SeaTac health services administrator, added that Frick had seen a nurse practitioner and received a steroid to ease Crohn’s-related inflammation. Frick was also scheduled for a doctor’s visit but refused to be seen, Posalski said. (Frick said when interviewed that he ended the visit because the doctor asserted there was nothing wrong.)
The judge was unimpressed. After months of hearings, Jones said he was at a loss to understand why officials hadn’t done more to address Frick’s medical problems — or at least created a concrete treatment plan.
“Mr. Frick may be suffering from something that is far more complicated than anyone knows at the federal detention center,” Jones said as he ordered the defendant’s release.
Since then, Frick has seen an array of doctors, in part because he had a heart attack shortly after his release. He has also sued detention center officials for what he claims is indifference to his medical needs.
And he’s pleaded guilty to the pending drug charge, which will likely mean going back to federal prison for 10 years unless he can get a judge to lower his sentence because of his medical conditions.
The prospect is daunting.
“There’s no guarantee I’m going to come out of prison this time,” he said.
