Federal court finds Arizona prison health care ‘plainly grossly inadequate,’ cites understaffing as key issue

On June 30th, US District Judge Roslyn Silver determined that Arizona’s prison health care is “plainly grossly inadequate” and “unconstitutional.”

 

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According to the the ACLU, the judge’s ruling held that the Arizona Department of Corrections, Rehabilitation, and Reentry (ADCRR) “systematically violates the constitutional rights of people incarcerated in the state’s prisons by failing to provide them minimally adequate medical and mental health care, and by subjecting them to harsh and degrading conditions in solitary confinement units.”

The lawsuit was originally filed in 2012 by the ACLU’s National Prison Project, the ACLU of Arizona, Prison Law Office, the Arizona Center for Disability Law, and Perkins Coie LLP. 

Corene Kendrick, Deputy Director of the ACLU’s National Prison Project, emphasized the significance of this ruling by the federal court.

“It really reiterates the point that people in prisons have a right to basic and adequate health care under the 8th Amendment, and that a prison sentence should never become a death sentence for people who have treatable medical or mental health conditions,” she said. “And it’s a vindication as well. These sorts of orders don’t come down very frequently from federal courts and so that in and of itself also makes it a landmark decision.”

Though the case was settled in 2014, with prison officials promising to improve health care conditions, Kendrick said the state and its attorneys instead fought the plaintiffs tooth and nail and tried to relitigate every aspect of the case. 

“What we experienced for 7 years was complete denial that these problems even existed, which made it difficult to remedy them,” she said.

Critics of Arizona’s prison health care largely attribute its inadequacy to the privatization of the correctional health care system. Under this privatized system, the companies are paid a flat per diem per prisoner, which started as $12 per day per prisoner, but has now gone up significantly. 

“What an independent expert appointed by the court said is when you have this perverse funding scheme, it incentivizes not providing care and not fully staffing the health care positions because basically every dollar that isn’t spent is kept as profit,” Kendrick said. “The correctional for-profit provider isn’t just reimbursed for actual expenses.” 

According to the judge’s findings and the medical expert’s report, much of the medical care provided in the prisons is provided by nurses who are oftentimes practicing outside of their scope of practice. The limited number of higher level medical and mental health providers cause long delays in prisoners accessing care, often to the point where treatable conditions significantly worsen. 

“One of the things that Judge Silva talks about is the fact that there’s so few physicians for the entire statewide prison system that they really need to get more health care staff and more health care staff that [are] qualified, versus asking nurses,” Kendrick said. “These nurses are often very hardworking and very well-intentioned, and they have a ridiculous number of patients that they’re trying to see.

But what they’re being expected to do is really [practice] outside the scope of their licenses. Over the years, there’s been multiple health care staff who have quit and said the reason they’re quitting is because they’re afraid of putting their nursing license at issue. And if they’re being asked to compromise their nursing license, they have an ethical duty to not be in that situation. So unfortunately, it kind of creates this vicious cycle where they’re asked to do things that they’re not qualified to do, but then if they quit, there’s even fewer people to do it.”

The ACLU of Arizona has asked the court to appoint a receiver to the corrections department to report directly to the federal judge, as well as to invalidate the state law that privatized the prison health care system. 

“They need to get rid of the privatization because of the perverse funding structure that’s involved with it,” Kendrick said. “They need to have leadership in the department that acknowledges that there is a problem and that they’re committed to actually addressing that versus spending millions of taxpayer dollars on attorneys who fight us in the district court at every turn.”

Kendrick added that members of the Arizona legislature have also been largely critical of ACDRR’s health care system.

The judge has asked the ACLU to submit the names of neutral experts she can consult with in crafting a final order that will be directed to the prison officials on how to overhaul their health care and isolation units.