An inmate who developed a life-threatening abdominal condition while incarcerated in 2011 and required emergency surgery to remove his colon says the prison’s negligence led to the crisis.

And the then-medical director at Halawa Correctional Facility, where Thomas Lauro still is serving time for shoplifting about $300 in merchandise, told the Hawaii Paroling Authority that the crisis never should have happened.

For reasons that were unclear, Lauro didn’t get a needed medical consultation for his abdominal problem, Dr. Steven DeWitt testified at Lauro’s October 2011 parole hearing.

Lauro subsequently developed a disorder that DeWitt said he had never seen before "because it doesn’t happen to people given appropriate care," according to a transcript of DeWitt’s testimony that Lauro included in a November lawsuit he filed against the state.

The Lauro case underscores what some advocates say is a longstanding problem within Hawaii’s prison system: Inmates, especially those with more complicated medical cases or those who need to be seen by outside specialists, have difficulty getting necessary and timely care.

"There’s always been delays and problems," said attorney Eric Seitz, who has represented multiple inmates who have reached out-of-court settlements with the state over allegations of substandard care.

The problem can cost taxpayers big bucks.

In the Lauro case, the state’s Medical Claims Conciliation Panel, which reviews malpractice claims and is known for its conservative rulings, in September recommended that the state pay Lauro $5 million in damages. The panel’s rulings are advisory.

A recommendation of that magnitude "is very rare," said Seitz, who is not involved with the case.

Representatives from the attorney general’s office and the Department of Public Safety, which runs the prison system and is named as a defendant in the Lauro lawsuit, declined comment on the case, citing the pending litigation.

But DPS spokeswoman Toni Schwartz defended the overall level of medical care in the prisons.

"We recognize our responsibility to provide medical care on a timely basis for everyone in our prison population," Schwartz said in a statement to the Star-Advertiser. "We take their health care seriously. A majority of our prison population (who) need medical care come in with pre-existing medical conditions that require advanced care, and we address them accordingly. Outside specialist services are used on a regular basis for this population."

The Star-Advertiser recently received a letter from Lauro, who said he has been retaliated against because of the lawsuit and his medical condition. Lauro, 51, who is serving a five-year term for second-degree theft, a Class C felony, said he has spent the past 10 months in the prison’s psychiatric ward in solitary confinement.

In his letter and federal lawsuit, Lauro, also known as Thomas Reyes, said he has been subjected to abuse and torture, being left in unsanitary conditions because of frequent leakage of his colostomy bag. For three weeks following his surgery, for instance, Lauro was left in solitary confinement, wallowing in a feces-stained cell, according to the lawsuit.

In addition to the negligence-related allegations, Lauro is accusing the state of cruel and unusual punishment and is seeking unspecified damages in the court case. Lauro is represented by Kaneohe attorneys Joseph Ahuna Jr. and Ahuna’s son, David Ahuna.

The state, in court documents, has denied Lauro’s allegations.

The state is obligated under the law to provide prisoners with the same minimum standard of care that is available to the rest of the community.

But Kat Brady of the Community Alliance on Prisons said inmates sometimes can’t get even the minimum level.

"People are treated inhumanely," Brady said. "I think a lot happens that we don’t hear about."

Seitz said the state tries to save money by holding off on referring inmates to outside specialists for as long as possible.

"It’s not that they don’t want to," Seitz said. "It’s that they’re understaffed and underfunded."

Over the past five years, Seitz said, he’s had at least a half-dozen cases involving Halawa inmates. The last one involved a man who had trouble breathing after breaking his nose in a prison fight, according to Seitz.

Despite the inmate’s pleas, the state did not refer the case to a specialist for a year, and when the inmate eventually was examined, he had surgery immediately to clear a blockage, Seitz said.

Jack Tonaki, the state’s public defender, agreed that getting timely care from specialists is a problem. But he’s not sure of the reasons.

One possible cause may be beyond the department’s control, Tonaki said. Private physicians might be reluctant to have shackled inmates and prison guards walking through patient waiting rooms, Tonaki said.

In the Lauro case, DeWitt told the parole board in 2011 that the inmate’s situation "should never have happened with appropriate medical care," according to the transcript quoted in the lawsuit.

Lauro, who previously had been diagnosed with ulcerative colitis, a type of inflammatory bowel disease, began experiencing symptoms of a flare-up in January 2011, according to the lawsuit. The symptoms included abdominal pain and diarrhea.

When the prison obtained Lauro’s hospital records showing the previous diagnosis, the records noted that Lauro should be seen by a gastroenterologist — a doctor specializing in digestive disorders — if a flare-up occurs and have a colonoscopy performed, according to the lawsuit.

But even though Lauro complained of persistent and worsening symptoms over the next several months, including bloody stools, he did not see a gastroenterologist nor was a colonoscopy performed by the time he became acutely ill in late June 2011 and was rushed to the Queen’s Medical Center, according to the lawsuit. During that period, Lauro was seen several times by prison doctors and other medical personnel.

At Queen’s, Lauro was diagnosed with toxic megacolon, a life-threatening abdominal condition, and had his colon removed. A colostomy bag was attached to his outer abdomen to capture waste.

DeWitt told the paroling authority at Lauro’s 2011 hearing that he had never before seen a case of toxic megacolon.

Because of what happened, Lauro was going to "pay a big price" living with the consequences, and the department also was "going to pay a big price," DeWitt was quoted as saying.

DeWitt, who died roughly a year later, told the board that the prison was planning to change policies and procedures in the wake of the Lauro case. DeWitt didn’t elaborate on the planned changes, according to the transcript, and Schwartz would not comment.

Lauro, who has multiple misdemeanor and petty misdemeanor convictions, was released from prison in December 2011 to a clean-and-sober house. But he was reimprisoned a few weeks later after missing an appointment with his parole officer.

On the outside, Lauro had difficulty dealing with his condition, which was exacerbated by the state’s negligence, the lawsuit alleges.

In July 2012, Lauro had a second emergency surgery and almost died, according to the lawsuit.

Since the first surgery two years ago, three hospitals where Lauro was treated have told prison officials that he needed to be seen by a colorectal surgeon, according to the lawsuit.

To this day, he has not been seen by one, his attorneys say.