‘I probably would have died at Pulaski State Prison’

Finally, she lost so much blood she passed out and was transported to a hospital. There, a colonoscopy revealed she had cancer. Soon, the news would get worse. The cancer had spread to many of her organs.

That was three years ago, when Cavender was at Pulaski State Prison, living in the honors dorm and trying to make it through a sentence of at least 15 years for methamphetamine trafficking.

Cavender is one of three former Pulaski inmates battling cancer who shared their stories with The Atlanta Journal-Constitution. All described how their illnesses went undiagnosed by the prison’s former medical director, Dr. Yvon Nazaire, despite symptoms that experts say would require immediate action. They spoke out, they said, in hopes that what happened to them doesn’t happen to anyone else.

“There are some bad people in prison, but 99 percent are just people who have made bad decisions,” Cavender said. “They do not deserve to have a death sentence put on them because the doctor is incompetent.”

In telling their stories, the ex-inmates provide compelling new evidence of dangerous dysfunction in the medical treatment at the Hawkinsville facility, Georgia’s second largest prison for women, as officials investigate how women have died there in Nazaire’s care.

Cavender said she bled so profusely when she used the toilet that, in her words, “it looked like somebody had opened a bag.” The bleeding was so bad, she said, that she had to clean up afterward with bleach she obtained from another inmate who used it to clean prison offices.

Yet every time she visited the medical unit, Nazaire or others working under his supervision would recommend remedies that ran the gamut from Tylenol to iron pills, none of which helped, she said.

“They have this mentality that everybody is a crook, everybody is lying because they want pain medicine,” she said. “I didn’t need any damn pain medicine. I needed a doctor.”

Angela Tripp Watts said she noticed a lump in her right breast while she was at Pulaski and underwent two mammograms and an ultrasound. She said she inquired about the results and was told she had no reason to be concerned.

When she was released three months later, she had the lump checked again. This time, a biopsy was recommended. It revealed that the mass was malignant.

Watts said her oncologist was stunned when he learned how the matter had been handled at the prison.

“He threw my files down on the table and said, `Surely, God protects the innocent, because if this would have been an aggressive type of cancer, you would not be alive today,’” she said.

Vivian Welker, a 56-year-old former smoker, said she went to the Pulaski medical unit after she began to cough up blood. She was told she had acid reflux.

About a month later, she was released and quickly made an appointment to see her regular physician. Within days, she said, she learned she had small cell lung cancer, a rare form of the disease that can spread quickly.

Had she not been released, she said, “I probably would have died at Pulaski State Prison.”

Nazaire, who was the medical director at Pulaski for nine years, did not respond to text and voicemail messages seeking comment for this story.

The medical care he provided women at Pulaski has been under scrutiny since the AJC reported in July that at least seven inmates had died agonizing deaths without getting treatment that might have saved or prolonged their lives. The AJC previously detailed how two inmates had died at another prison where Nazaire oversaw the medical unit, Emanuel Women's Facility in Swainsboro, after their symptoms went untreated for weeks.

The questionable deaths occurred as Nazaire earned praise from his supervisors for his efforts to cut costs by limiting outside consultations.

After the AJC's July story, Nazaire's employer, Georgia Regents University, initiated a review of Georgia Correctional Health Care, the branch of the university that contracts with the Department of Corrections to provide physicians and other medical personnel for the state prison system.

Nazaire was fired in September after the inquiry found that he had lied about his work history. On his employment application, he stated that he was then working in the emergency rooms of three New York hospitals when in fact he was unemployed.

GRU spokeswoman Christen Carter, citing the ongoing nature of the investigation, said the school, currently in the midst of changing its name to Augusta University, would not comment for this article.

Joan Heath, a spokeswoman for the Department of Corrections, said the department could not make anyone available to comment. However, in an email, she said the DOC has “continued confidence” in its partnership with GRU and Georgia Correctional Health Care “as they review their procedures.”

`No need’ for colonoscopy

The problems that bedeviled Cavender, 49, began in the summer of 2012 and continued until she was hospitalized in late October.

As the pain became more intense and the blood in her stool became thicker and heavier, she began going regularly to the medical unit to see if a colonoscopy was possible, but she said Nazaire would always tell her no.

“He said there was no need for a colonoscopy because it was not my colon that was the problem, it was my stomach,” she said.

The discussions became so heated, Cavender said, that at one point Nazaire summoned guards to remove her from his office.

“I told him to his face, `You son of a bitch, you’re not gonna kill me. You might kill all these other women, but you’re not gonna kill me,’” she said. “He started yelling, `Police! Police!’”

In the emails Cavender wrote to her sister, Terri Trask, that frustration was evident.

“They laid hands on me in Bible study and the bleeding stopped so I will let you know tomorrow,” she wrote in August 2012. “It still hurts so bad I can hardly stand it but one way or another they are going to fix it. God has my back and you are my everything!”

A month later, she wrote: “I am feeling all right but the bleeding is back today. I am putting in another sick call. I am so tired of all this… I just need to know what the problem is.”

And then a month after that: “Well, it’s Sunday and I’m feeling like crap again. I hope that this colonoscopy is sometime this week. The bleeding seems to be better but the pain still sucks!”

According to the emails, Cavender was told at various times that she was suffering from kidney stones, a colon polyp, hemorrhoids, irritable bowel syndrome, an intestinal infection, diverticulitis and Crohn’s disease.

Dr. Joseph Feuerstein, a Boston physician who specializes in gastroenterology and teaches at the Harvard Medical School, said patients with prolonged and heavy rectal bleeding would in almost every instance require a colonoscopy to check for several serious illnesses, including cancer, without delay.

“That’s a no-brainer,” he said. “Those patients should have a colonoscopy, regardless of age.”

Cavender said she thought she might have to “do a Scarlet O’Hara” and pass out in front of the warden before her own anemic condition did the job, forcing a trip to Taylor Regional Hospital in Hawkinsville.

After receiving a series of transfusions and a colonoscopy there, she was moved to Atlanta Medical Center, where surgery showed the cancer had spread. She then had another operation to remove her gall bladder, appendix, uterus, ovaries and a portion of her liver.

In early 2013, because of her failing health, Cavender was released, allowing her to return to the home she shares with her husband, Andy, in LaGrange. She then began undergoing chemotherapy, but that has been halted in favor of a treatment that sends tiny pellets of radiation directly to her liver.

Ironically, Cavender remains in the care of the oncologist, Dr. Torey Clark, she saw while in the custody of the DOC. She speaks glowingly of Clark, drawing the contrast to what she experienced at Pulaski.

“I’m tough,” Cavender said. “I’ve been through a lot in my life. But that broke me down. I’ve never been so scared in my life, worrying that they were going to let me die.”

`Your test is normal’

Watts, a 46-year-old with four children and seven grandchildren, was serving an eight-year sentence for violating the terms of her probation for cocaine possession when in February 2013 she discovered the lump in her right breast.

She said she immediately reported the mass, about the size of a half dollar, to the medical unit, but it was five months before she had a mammogram and another five months before the ultrasound.

After the ultrasound, Watts said, she made a special trip to the infirmary to ask about the result. She said a nurse whose name she did not know told her there was no reason to be concerned.

“The nurse came out and told me, `Well, if you haven’t heard anything, then your test is normal,’” she said.

Watts said she never felt comfortable with that answer, so, soon after she was paroled in March 2014, she sought a second opinion.

Back in her home town of Ashburn, she contacted the Turner County Health Department, which arranged for her to have another mammogram as well as an ultrasound. She was then referred to a surgeon in Tifton, who ordered a biopsy.

In August 2014, she learned that she had cancer. Two months later, she underwent a partial mastectomy. That was followed by 33 radiation treatments.

Watts, who proudly proclaims herself “four years, five months clean and sober,” said hearing her diagnosis was particuarly stunning, given what she had been told at Pulaski.

“I still get emotional when I talk about it, especially when I think of what could have happened if it had been a more aggressive (form of the disease),” she said.

After being contacted by the AJC in August, Watts obtained the results of the ultrasound that was conducted at Pulaski from the Tallahassee, Fla., company that provided the service.

According to the radiologist's report, the ultrasound showed an "irregularly marginated" hypoechocic — or solid — mass, a finding that, according to multiple experts contacted by the AJC, can indicate a malignancy and would require a biopsy.

“Not all of them turn out to be cancerous, but you’ve got to do a biopsy,” said Dr. Otis Brawley, the Emory University professor who serves as chief medical officer for the American Cancer Society.

The report of Watts’ ultrasound also contains a note in Nazaire’s handwriting. Dated two days after the examination, it refers to an August mammogram and contains the words “normal” and “discussed with patient.”

Watts said she had a mammogram in August of that year but never had a conversation with Nazaire in which he said that or any other examination had come back normal.

According to Watts, the only time Nazaire spoke to her about her condition was to tell her after the first mammogram that he would order more tests. When she asked why, she said, he told her not to ask questions.

“He never talked to me again,” she said.

Diagnosis: Acid reflux

Welker, known to other inmates as “Miss Vivian,” said last fall she began to notice a persistent cough that would occasionally bring up blood.

Then serving a two-year sentence for violating the terms of her probation for drug and other offenses, she said she didn’t consider the matter serious until officers saw the blood and suggested she seek medical attention.

Welker said that sometime later in the year she went to the medical unit to have the problem evaluated and was examined by a nurse practitioner and a physician’s assistant, both of whom worked under Nazaire’s supervision.

Although she had been a smoker most of her life — a fact that would have been noted in her medical records — she said she didn’t receive a chest X-ray. Instead, she said she was told she was suffering from acid reflux and prescribed medication for it as well as cough syrup.

Blood in the mucous of a smoker over 50 is “one of the more ominous” signs of possible lung cancer, said Dr. Albert Rizzo, a Delaware pulmonary specialist who serves as a senior advisor to the American Lung Association. If he were to see such a patient, he said, he would immediately order a CT scan.

“Someone comes in with symptoms — coughing up blood, chest pain — I want a regular CT scan, a diagnostic scan, full dose (of radiation), to help figure out what’s going on,” he said.

A few days after her release in February, Welker visited her own physician in Rome, who ordered a chest X-ray. Days later, she was told she had cancer, now in remission after chemotherapy and radiation, she said.

“That saved my life,” she said. “How else would I get to see a doctor so fast and get that kind of treatment?”

Welker, who lives with her son in Norcross and recently became a grandmother, said her worry now is for those who remain at Pulaski under conditions she believes are making sick women sicker.

“I can’t answer why they don’t do what they need to do,” she said. “But those (women) who are still there, they’re the ones who need help. I mean, I’m out now and I’m getting the best care I can possibly get. But the ones who are still there … they’re like cows being herded through.”

Warning signs

Cancer experts say these symptoms require further tests:

Breast cancer: A lump that has an irregular border or a star-burst appearance raises concern, and a biopsy is usually recommended.

Lung cancer: A cough that doesn’t go away, coughing up blood and chest pain are among the most common symptoms. Common diagnosis tests include chest X-rays, CT scans and bronchoscopy.

Colon cancer: Rectal bleeding or blood in the stool, crampign or abdominal pain, weakness and fatigue and a change in bowel habits can be signs of colon cancer. A biopsy during a colonoscopy can diagnose cancer.