In an emphatic rebuke of Arizona’s privatized prison health care model, U.S. District Judge Roslyn Silver found that Arizona is denying the constitutional rights of people in state prisons by failing to provide minimally adequate health care.
In a ruling issued Thursday, Judge Silver also condemned the state for improperly detaining a subset of prisoners in solitary confinement.
“While this case involves an unusually large amount of evidence, there are only two
basic questions,” Silver wrote. “Are Defendants violating the constitutional rights of Arizona’s prisoners through the existing medical and mental health care system? And are Defendants violating the constitutional rights of a subset of Arizona’s prisoners by almost round-the-clock confinement in their cells? The answer is yes to both questions.”
Silver ordered injunctive relief in a form that is yet to be determined.
The ruling comes after Silver rescinded a long-standing settlement agreement reached in the Jensen v. Shinn prison health care lawsuit between prisoners and the state of Arizona.
In 2012, the federal court recognized a group of people in Arizona prisons who claimed their Eighth Amendment rights, against cruel and unusual punishment, were being violated. The class-action lawsuit was then named Parsons v. Ryan, after plaintiff Victor Parsons and then-director of the Arizona Department of Corrections Charles Ryan agreed to settle the case in 2014 and the settlement was certified in 2015.
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Since that time, federal courts overseeing the settlement have found the state has not been living up to the terms of the settlement agreement. Federal judges have twice held the Department in contempt, fining the agency millions of dollars. The case has outlasted judges, named plaintiffs and prison administrators. It is now known as Jensen v. Shinn, after plaintiff Shawn Jensen and current Arizona prisons Director David Shinn.
After rescinding the settlement agreement, Judge Silver presided over a weeks long trial in the fall of 2021, which featured damning testimony from prisoners describing a lack of proper health care, and contractors who said the state resisted attempts to properly staff the prisons.
“Defendants have failed to provide, and continue to refuse to provide, a constitutionally adequate medical care and mental health care system for all prisoners,” Silver wrote. “Defendants’ health care system is plainly grossly inadequate. Defendants have been aware of their failures for years and Defendants have refused to take necessary actions to remedy the failures. Defendants’ years of inaction, despite Court intervention and imposition of monetary sanctions, establish Defendants are acting with deliberate indifference to the substantial risk of serious harm posed by the lack of adequate medical and mental health care affecting all prisoners.”
Additionally, Silver wrote that Arizona keeps thousands of prisoners in restrictive housing units “where they are not provided adequate nutrition, nor are they provided meaningful out-of-cell time for exercise or social interaction.”
“Defendants’ treatment of prisoners in restrictive housing units results in the deprivation of basic human needs,” Silver wrote, again stating that Arizona showed deliberate indifference “to the substantial risk of serious harm posed to prisoners in restrictive housing units.”
The impact of Silver’s order on a recent five-year contract finalized between the Arizona Department of Corrections and correctional health care provider NaphCare remains uncertain. The contract was estimated to be worth more the $280 million annually, generating an estimated profit for NaphCare of nearly $10 million.
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ACLU national prison project Deputy Director Corene Kendrick said the ruling is a victory for the constitution and the rule of law and for the people in Arizona’s prisons.
“This is really a landmark and groundbreaking decision,” Kendrick said. “Because Judge Silver has affirmed the fact that people in Arizona prisons have a right to minimal health care and that a prison sentence should never be a death sentence for people with treatable medical and mental health conditions.”
Kendrick said she and attorneys for the prisoners will now nominate the names of correctional health care experts, per Silver’s ruling, who will advise her on crafting a remedial order which would address the violations incarcerated people are enduring.
“Judge Silver completely repudiates the state’s repeated claims that solitary confinement is not harmful to incarcerated people in her ruling,” Kendrick said. “She also did not find credible the defense by the states hired experts of the indefensible conditions in maximum custody housing units.”
Kendrick said attorneys for the prisoners have previously asked Silver to appoint an independent receiver to take over the care in state prisons, and they will continue to advocate for that outcome. Receivership would mean the entire Arizona prison health care system would be taken under control of the federal government.
The Arizona Department of Corrections did not immediately return a request for comment about the ruling.
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How did receivership work in California?
In 2005, a District Court judge established receivership for the prison health care system in California after the state failed to comply with a settlement agreement — the result of a class-action lawsuit over prison health care neglect similar to the Jensen suit in Arizona.
“The judge appointed one person who was charged with all the authorities that the Secretary of corrections had under state law to provide medical care,” said Don Spector, a founder of the Prison Law Offices in San Francisco. “And so that person, the receiver, had the authority to develop policies and procedures and to hire the staff that’s necessary, and to monitor the conditions to ensure that the care is being provided.”
Spector represents the people incarcerated in Arizona prisons in the Jensen lawsuit. The law firm also represents people in California prisons.
He said all of the receiver’s actions were subject to review by the district court, as would be the case in Arizona.
Control over the prison health care system in California was transitioned back to the state in 2012.
Spector said receivership resulted in “much better care” for prisoners in California.
“It’s off the charts better care than they would have ever had before,” Spector said. “And that’s because the care was so bad. And now, the care in many places is decent. “It’s not Cadillac care or anything like that, but it’s decent care.”
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He believes this is due to the receiver offering higher pay rates and hiring more qualified health care professionals to work in the prison system. The receiver was also able to bring the time it took to be seen by a nurse down from several days to less than 24 hours.
“He hired a lot more people of all categories,” Spector said of the California receiver. “And he developed contracts with outside hospitals. And if those didn’t work out, you know, he changed them.”
Despite having many disagreements with the receiver over the years, like what he should focus on and how fast new policies should be implemented, Spector said the results were clearly beneficial.
“Over time, the death rate, instances of medical malpractice, and preventable deaths dropped significantly. So that was really strong evidence that the receiver his ship has been effective,” Spector said. “It’s been a remarkable turnaround. I’m certain he’s saved hundreds if not thousands of lives.”
Spector said he believes receivership is the only way prisoners in Arizona would ever get constitutionally adequate healthcare, because no other judicial remedy has worked.
“The state has shown over the last almost decade, that it really isn’t committed to providing people with decent care,” Spector said. “And so contempt hasn’t been enough of an incentive, even when it’s in millions of dollars. Orders telling them to comply with the promises that they made when they settled the case haven’t been enough. Hearings haven’t been enough in front of the court. And as we saw in the trial, they don’t believe that there’s anything inadequate about the care that my clients are receiving.”
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What happens next
“Because the Court has determined by a preponderance of the evidence that Defendants are deliberately indifferent to a substantial risk of serious harm, it must fashion an appropriate remedy,” Silver wrote in her ruling. “In this case, there is no question remedial measures are necessary to correct constitutional deficiencies and the Court will meet its constitutional obligations. Thus, the Court will employ an expert to assist with crafting an injunction that remedies the constitutional violations—no more and no less.”
Attorneys for the state and for the prisoners have 14 days to nominate experts who will assist the court with crafting an injunction. Judge Silver said she would consider the nominees and appoint an expert on or before August 15th.
Have a news tip on Arizona prisons? Reach the reporter at firstname.lastname@example.org or at 812-243-5582. Follow him on Twitter @JimmyJenkins.
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