PHOENIX (AP) - A judge ruled Arizona has been violating the constitutional rights of incarcerated people in state-run prisons by providing them with inadequate medical and mental health care, saying the state has known about the problem for years but refused to correct its failures.
In a blistering verdict Thursday, U.S. District Judge Roslyn Silver concluded the state’s inaction showed it is acting with "deliberate indifference" to the risks of inadequate care and said the state has adopted a health care system for prisoners that has led to preventable deaths.
She said there aren’t enough health employees to care for the roughly 25,000 incarcerated people housed in state-run prisons and that corrections officials have made no significant attempts to fix the understaffing problem.
The judge criticized Corrections Director David Shinn for pressing the state’s prison health care contractor hard enough to better staff its operations and for testifying that prisoners often have greater access to health service than people who aren’t locked up.
Shinn’s claim that access to care is greater in state prisons "is completely detached from reality," Silver wrote. "Given the overwhelming evidence and repeated instances of insufficient care leading to suffering and death, Defendant Shinn could not possibly believe prisoners have the same access to care as people in the community."
The ruling said prisoners aren’t getting timely access to emergency treatment, medications, treatment for chronic diseases and specialty care. Under the current system, nurses are the first — and often the only -- medical professionals available to see prisoners. Sometimes the nurses, who may be insufficiently trained to diagnose and treat a given condition, miss obvious signs that should lead to a referral to a higher level provider, Silver wrote.
The judge is expected to order remedies in response to the constitutional violations. Lawyers representing prisoners have previously asked Silver to set up a receivership where the court would take over health care operations in state prisons and appoint an official to run those services there.
The Arizona Department of Corrections, Rehabilitation and Re-entry, which has denied allegations that it provided inadequate care, issued a statement Friday saying: "We remain committed to working collaboratively with the Court, Plaintiffs’ counsel, and appointed experts to meet the healthcare needs of those in our custody and care. We will continue to actively look for opportunities to enhance healthcare delivery methods and protocols, and to upgrade the electronic medical record system."
C.J Karamargin, a spokesman for Gov. Doug Ducey, who hired Shinn, said the state didn’t yet have any plans for an appeal. "It’s a lengthy ruling, and we are analyzing it closely now," Karamargin said.
Corene Kendrick, an American Civil Liberties Union attorney who represented prisoners in the case, said Silver affirmed the bedrock principle that prisoners are entitled to basic health care under the Eighth Amendment.
"The department has abdicated its responsibility under the Constitution to provide minimal protections to the people it locks up," Kendrick said.
The case was tried late last year after Silver threw a 6-year-old settlement over prison health care, saying the state showed little interest in making many of the improvements it promised under the deal. Silver also said that $2.5 million in contempt of court fines against the state didn’t motivate authorities to comply with the settlement.
After Silver threatened yet another round of contempt fines, Shinn wrote a February 2020 letter to the state’s prison health care contractor to say the state expected the company to provide enough resources to meet the settlement’s requirements for care. The corrections director also wrote that the company would be on the hook for costs associated with noncompliance.
In Thursday’s ruling, Silver chided Shinn for not knowing whether the contractor had reallocated staff within Arizona.
"The only possible conclusion to draw is that Defendant Shinn had little interest in changing the underlying reality," Silver wrote. "Rather, his letter appears to have been nothing more than a half-hearted effort to generate a piece of paper he could cite to avoid contempt. Obviously, the Court expected Defendant Shinn to take more direct action than signing a letter."
In the past, receiverships similar to the one being proposed by the Arizona prisoners have been ordered for prisons in other states, including California.
In 2005, a federal judge seized control of California’s prison medical system after finding that an average of one inmate a week was dying of medical neglect or malpractice. He appointed a receiver, who retains control of the medical system, although operations at individual prisons are gradually being returned to the state’s responsibility.
The lawsuit that prompted the change in California and a similar suit over poor mental health treatment of inmates led a panel of judges to declare that record prison crowding was making it impossible to improve conditions to constitutional standards.
The judges put a cap on California’s prison population that forced a dramatic drop in the number of people in prison as the state eased criminal penalties, kept lower-level offenders in county jails and increased opportunities for parole.