Ex-inmate says undiagnosed penile cancer led to amputation


Keith Jackson spends his days dealing with phantom pains in his groin. He has to sit when he urinates. Sexual intercourse is a distant memory.

Jackson, 49, of Pender County, the owner of a small home-framing business, lost his penis to a rare form of cancer. It happened after he had spent 15 months in six North Carolina jails and two prisons with what he says had once been a small lesion that hadn’t been properly diagnosed.

By the time a surgeon operated on the cancer it was too late.

Jackson said he took responsibility for the gun charge that landed him in prison. He now wants the local jails, federal prison and health care providers to do the same over his care.

“Everybody should be accountable for this,” Jackson said. “And all I asked for was help.”

Jackson has filed two lawsuits in federal court. One is against officials and staff at the six jails that held him, two health-care providers that served three of the jails, the U.S. Marshals Service and the U.S. Bureau of Prisons. The other is against the federal government under the Federal Tort Claims Act.

Medical records from the jails show he had reported urinary tract infections numerous times and was in severe pain when the lesion caused his penis to swell and bleed as he sat in the Onslow and Pender county jails three months after his arrest. A doctor prescribed antibiotics. The records indicate the medical staff considered a sexually transmitted disease to be the likely cause.

Another three months passed. The medical records show the problems with the lesion persisted, as he was taken to the Pender County Health Department to examine a “sore” on his penis. He was prescribed more antibiotics.

“Through all this nobody took a sample (for a biopsy), nobody,” he said.

The medical records also indicate Jackson had little idea the lesion was dangerous. Several inmate health screening reports from the jails do not show him reporting the lesion as a serious issue. Shortly after he entered the federal prison in Beckley, he told medical staff he suspected herpes caused the lesion. By then, it wasn’t causing him pain or making it difficult to urinate, according to a prison doctor’s report.

In two of the jails, he said jailers or police roughed him up for complaining about not getting medical attention. A memo written by a nurse working in the Pender County jail noted that Jackson was guarding his ribs and right and left flank areas which were “red and swollen.” She asked why.

“Eventually, Mr. Jackson stated that he had been kicked by several guards, in his stomach, ribs, sides and groin,” she wrote in the memo, dated July 28, 2014. “He did not say how many guards had participated.”

A Pender County hospital report notes that he reported being kicked by Onslow County jailers. In his lawsuit, which was based on his memory of events in the jails, he said he was attacked by jailers or police in the Pender and Pamlico jails.

If Jackson’s allegations are true, several lockups that are required under state or federal law to screen incoming inmates for health issues and respond to requests for health care could be found to have showed a “deliberate indifference” to his condition. That could violate his federal Eighth Amendment right to be free of cruel and unusual punishment. He is also claiming medical staff and officials involved in his care committed malpractice.

State jail regulations require counties to have a written medical plan detailing inmate care. The regulations say the plan has to include health screenings for inmates entering the jails, and policies and procedures for routine care, emergency care, dispensation of medications and the “handling of inmates with chronic illnesses or known communicable diseases or conditions.” Jails also have to provide an opportunity “each day” for inmates to report health issues, and “qualified medical personnel” shall be made available to “evaluate” inmates’ medical needs.

Penile cancer is rare. The American Cancer Society reports roughly 2,320 cases are diagnosed each year. The cancer kills about 380 men annually. Nearly all of those cancers start in flat skin “squamous” cells.

In court papers, attorneys for the defendants say Jackson did not file his complaints before the expiration of a three-year statute of limitations in North Carolina and a two-year limit in West Virginia. They also say he received proper attention from staff and medical providers.

“Lay people . . . do not think and, general medical/primary care providers, do not know that a superficial skin lesion, described by Jackson as looking like a mosquito bite, is cancer,” Sharon Wilson, an assistant U.S. attorney, wrote. “The more common diagnosis of a penile lesions (sic) is a sexually a transmitted disease, which may be intermittently annoying, but generally is not deadly.”

Jackson is a convicted felon, with a criminal record in North Carolina that shows convictions more than a decade ago for crimes such as obtaining property through false pretenses, breaking and entering, and larceny. He was arrested on April 22, 2014, initially on a charge of unauthorized use of a motor vehicle and out-of-state warrants related to a theft charge in Alabama and a probation violation in Florida.

A month later, while still being held, more state charges were filed, this time over his possessing two rifles and a handgun as a convicted felon. Near the end of 2014, the case was taken over by federal authorities, and he eventually admitted to having the firearms. He was sentenced to three years and 10 months in federal prison. He said in an interview the firearms were for hunting.

He spent more than a year in New Hanover, Brunswick, Pender, Onslow, Pamlico and Pitt county jails before being sent to a federal inmate processing center in Oklahoma. Medical records show that a biopsy was done on the lesion about three weeks into his prison sentence at the Federal Correctional Institution in Beckley, W.Va. That was Aug. 7, 2015. Several days later, a doctor told him he had cancer.

Initially, doctors gave him imiquimod cream, which is used to treat skin cancer. He said it didn’t work, and the lesion eventually created a blockage that made going to the bathroom excruciating. He underwent surgery on Dec. 1, 2015.

Medical records show the urologist sought to save much of his penis, but when he awoke from surgery he discovered she had removed nearly all of it. It was an aggressive cancer, she told him.

“I cried for three days,” he said.

The N&O sought comment from representatives of the jails, the prisons, the marshals and the health care companies named in the lawsuits. Those who responded referred all comments to attorneys, who have not responded or would not talk about the case.

In legal papers, several of the defendants denied Jackson’s claims, but one of the jails confirmed he received care. Pender County officials said jailers observed he was suffering an “ailment or injury” and reported it to a nurse. They said Jackson was taken to “several health care providers for treatment or evaluation during the period of his detention.”

Jackson identified two health care companies based in Tennessee — Correct Care Solutions of Nashville and Southern Health Partners of Chattanooga — who provide care in North Carolina jails as defendants. Lawyers for both said in court papers that he received proper medical attention.

Federal authorities contract with local jails to house defendants as they await trial or sentencing. Those contracts are typically structured so that the local jail’s in-house medical care costs are part of the daily rate, but trips to outside hospitals or doctors are billed to the federal government.

Jackson said he sought help from U.S. Marshals and federal prison officials at the Federal Transfer Center in Oklahoma City for the growing lesion, but they told him it would be checked when he was moved to the federal prison in West Virginia.

Jackson filed suit in the Eastern District of North Carolina. The case is being heard by U.S. District Judge Louise Flanagan, who also handled his criminal case. Jackson said he informed the judge of his medical concerns at the time of his sentencing on April 9, 2015. He requested that he go to the Federal Correctional Complex in Butner, which also has a medical center.

Records reflect Flanagan advocated he be placed in Butner, though it makes no mention of his medical needs. Flanagan could not be reached for comment. A call to her office was referred to Peter Moore Jr., the U.S. Eastern District clerk of court, who said judges do not give interviews on active cases. Jackson was released from prison on Sept. 1, 2017.

Jackson faces significant hurdles. Those claiming medical malpractice in North Carolina are required to have lined up a medical expert to testify on their behalf. That can be costly, and North Carolina caps non-economic damages such as pain and suffering at $500,000. The money from those damages is often used to help pay attorneys’ contingency fees. There is an exception to the cap, however, for cases of disfigurement and the loss of use of part of the body.

State law also allows claims to be dismissed if plaintiffs’ negligence contributed to their condition, and defendants in Jackson’s case are raising that argument.

Jackson initially had a team of five lawyers representing him – four of them from the metropolitan areas of New York, Los Angeles and Washington. But in recent months, disputes over legal fees and communication difficulties took their toll. The lawyers asked to be dismissed from the case. Jackson is now representing himself while seeking new counsel.

One of those attorneys, EJ Hurst, who has offices in Durham and Lexington, Ky., had represented an inmate who lost his penis to cancer and sued the Federal Correctional Complex in Butner in 2011. That inmate lost his case against the prison after a federal judge found that any delays in treatment would have made no difference in the outcome.

Jackson said he grew up in a rough section of Wilmington and left home as a teen. He dropped out of high school, and began working construction jobs. He has a son he said he hasn’t seen in years from a prior marriage.

He said he is in a relationship with a woman who has been supportive, and accepting of his limitations. But his life has been irrevocably harmed, he said.

“When Valentine’s Day comes you and your wife get to spend a pleasurable moment together,” he said. “I don’t. I don’t because they messed up. If I want another child that won’t never ever happen. All because somebody wouldn’t do their job.”

Penile cancer is rare, but small warts, blisters, sores, ulcers, white patches or cauliflower-shaped growths on the penis could be an indicator. It’s important to have them checked. They aren’t always painful or itchy.

Often, the cause isn’t cancer, but if initial treatments don’t work, patients need follow-up testing. The typical procedure to identify the cancer is a biopsy, in which a small piece of the abnormal tissue is removed and tested.

Males who have contracted the human papillomavirus (also known as HPV) are at greater risk, as are males who are uncircumcised.

Like many cancers, early detection is important. If the cancer progresses, a penectomy may be needed to keep the cancer from spreading. Chances of survival range from 85 percent if the cancer is contained to the penis, and down to 11 percent if it has migrated to distant parts of the body, according to one study cited by the American Cancer Society.