There are cuts to health care and there are health care cuts. At least one Arizona prisoner has personal knowledge of the unfortunate difference.

Prisoners and their advocates have accused the Arizona Department of Corrections (ADC) of being so obsessed with reducing costs that prison officials routinely deny medical care for serious, even life-threatening conditions.

A diabetic prisoner alleged that he lost sight in one eye and partial sight in the other after waiting months for his insulin injections. Another claimed he was denied medication for epilepsy and suffered repeated seizures for weeks. And one prisoner’s face was permanently disfigured after medical staff failed to treat a cancerous growth on his lip for seven months; consequently, doctors had to remove most of his lip and mouth.

But arguably the worst cut occurred after a prisoner discovered a growth on his penis which then went untreated for two years. The growth was ultimately diagnosed as a cancerous tumor, forcing the amputation of his penis. The cancer then spread to his stomach.

Coupled with Arizona’s prisoner suicide rate, which is more than double the national average (14 suicides were reported in fiscal year 2011), critics such as Arizona Prison Watch point to these allegations of inadequate medical care as evidence of a failure in leadership under ADC Director Charles Ryan.

The Prison Law Office (PLO), a legal-advocacy group based in San Quentin, California, addressed its concerns to Ryan in an October 2011 letter.

“State prison officials are deliberately indifferent to the serious health care needs of prisoners and to the prisoners’ unnecessary and significant pain, suffering and even deaths,” wrote PLO executive director Donald Specter.

To fend off the threat of litigation by the PLO, Ryan agreed on November 17, 2011 to investigate the allegations. The ADC apparently considered the PLO’s threat to be legitimate, especially given the Prison Law Office’s landmark victory in May 2011 against the California Department of Corrections and Rehabilitation. The U.S. Supreme Court decided, 5-4, that California was required to release about 40,000 prisoners to mitigate unconstitutional prison overcrowding that resulted in deficient medical care. [See: PLN, July 2011, p.1].

According to a December 2011 report in The Arizona Republic, however, Ryan’s initial investigation did not uncover any widespread intentional negligence in denying medical care to prisoners. “We don’t see any systemic indication of problems or evidence of deliberate indifference,” he stated.

ADC’s general counsel, Karyn Klausner, advanced the department’s defense further, saying that in the cases involving a prisoner’s loss of sight, another’s disfiguring facial surgery and the penis amputation, prison medical staff had provided appropriate care. Delays in treatment, she said, were not the cause.

“Are there instances where [a prisoner] didn’t receive medications or treatment in a timely fashion? Yes,” Klausner acknowledged. “But is it systemic? No.”

Some critics point to laws passed in 2009 by Arizona’s Republican-led legislature as being responsible for the decline in prison health care. That year, lawmakers voted to privatize the ADC’s medical system and to pay providers at a rate no higher than what they would be paid by the Arizona Health Care Cost Containment System, the state’s Medicare provider. Lawmakers advocated the shift to privatization as a cost-cutting measure, and the state’s spending on prison health care dropped 27 percent from fiscal year 2009 to 2011.

According to ADC officials, the legislation created a domino effect throughout the system. Prison medical employees across the state began quitting en masse in anticipation of layoffs. Contract providers such as Carondelet Health Network cut ties with the ADC because their reimbursement rates were too low.

Even before the 2009 legislation passed, more than 25% of correctional health care positions were vacant and the average wait time for outside medical treatment was 11 weeks.

According to prisoner advocates, those numbers have only gotten worse. Both the Eyman prison complex in Florence and the Tucson prison complex, which house more than 5,000 prisoners each, are supposed to have five doctors on staff. But as of April 2011, Eyman had only two doctors and a third working “half-time,” while Tucson employed just two. And at the state’s women’s prison in Perryville, prisoners are forced to wait six months or longer to receive mental health services.

“The delays are just incredible,” said Donna Hamm, a former judge and director of Middle Ground Prison Reform, based in Tempe, Arizona. “I’ve advocated for people who’ve been diagnosed with a lump or growth and who are sup-posed to be biopsied and have to wait six months, eight months, extraordinary amounts of time before being diagnosed.”

What is most distressing to Arizona Prison Watch – which has tracked more than 30 suicides in the state’s prisons since January 2009 – is what it calls the ADC’s “outrageous neglect.”

“These are not just isolated incidents or the consequences of budget cuts made years ago,” according to an Arizona Prison Watch posting in November 2011. “It is no wonder that so many prisoners have grown so demoralized that they’ve killed themselves in [ADC] custody in record numbers.”

Ryan and Klausner defended the ADC, however, saying the department had improved both mental health and medical care – providing six hours of training in suicide prevention to more than 8,800 staff members and filling 172 health care positions since June 2011, including the vacancies at both the Eyman and Tucson complexes.

The Prison Law Office had agreed to delay filing any lawsuit for three months from November 2011, when Ryan said he would conduct an investigation into inadequate prison health care. Apparently, however, the ADC failed to make good faith efforts to improve medical treatment for prisoners during that time period.

For example, ADC prisoner Ferdinand Dix had requested care for symptoms that included a chronic cough and shortness of breath. A prison doctor told him to drink energy shakes.
After Dix’s liver swelled to four times its normal size and his abdomen became grossly distended, he was taken to an outside hospital where he was diagnosed with advanced lung cancer. He died in February 2012; he had been serving a five-year sentence that turned into a death sentence due to grossly inadequate medical care.

On March 6, 2012, attorneys with the PLO, the ACLU Foundation of Arizona, the law firm of Perkins Coie, LLP and the Arizona Center for Disability Law filed a 78-page amended complaint in an existing federal lawsuit, alleging that the health care provided by the ADC was “grossly inadequate and subjects all prisoners to a substantial risk of serious harm, including unnecessary pain and suffering, preventable injury, amputation, disfigurement, and death.”

The amended complaint claimed that some prisoners had begged for medical treatment but were told by prison officials to “be patient,” that “it’s all in your head,” or that they should pray. The suit further challenged the ADC’s use of solitary confinement “in conditions of extreme social isolation and sensory deprivation, leading to serious physical and psychological harm.” See: Gamez v. Ryan, U.S.D.C. (D. Ariz.), Case No. 2:10-cv-02070-PHX-JWS (MEA).

“The prison conditions in Arizona are among the worst I’ve ever seen,” said PLO director Donald Specter. “Prisoners have a constitutional right to receive adequate health care, and it is unconscionable for them to be left to suffer and die in the face of neglect and deliberate indifference.”

The lawsuit was dismissed 15 days after the amended complaint was filed, however, after the judge held that the original plaintiff did not have the court’s permission to add additional plaintiffs or seek class-action status. The suit was re-filed as a separate case the next day, and remains pending. See: Parsons v. Ryan, U.S.D.C. (D. Ariz.), Case No. 2:12-cv-00601-NVW.

Meanwhile, Wexford Health Sources, a for-profit company, won a contract in April 2012 to provide medical care for ADC prisoners systemwide. [See: PLN, May 2012, p.36].
Under the contract, which went into effect on June 1, 2012, Wexford is required to increase medical employee staffing; provide nursing staff at all prisons 24 hours a day, seven days a week; train guards on how to deal with mentally ill prisoners; and provide mental health services to prisoners held in solitary confinement, among other provisions.
Wexford will receive $116.3 million a year for taking over the ADC’s health care services.

Unfortunately, like other private prison medical care companies, Wexford has a poor track record in terms of placing profits over adequate treatment for prisoners. [See: PLN, June 2011, p.12; Dec. 2010, p.27; Nov. 2009, p.16].

“There are reasons for great skepticism,” said Caroline Isaacs, director of the American Friends Service Committee’s office in Tucson. “One is that Wexford has a clear pattern of not living up to its commitments in other contracts.” Indeed, in documents provided to Arizona officials, Wexford listed 20 contracts in other jurisdictions in which it lost a rebid or did not submit a rebid, in some cases due to poor performance by the company.

Wexford acknowledged, for example, that it had been fined numerous times for failure to meet contractual obligations, including a $106,000 fine in Ohio in 2009 for contract violations, a $50,000 fine in Virginia in 2006 for insufficient staffing, and $273,000 in fines in Florida in 2005 for “service-delivery issues.”

None of which bodes well for Arizona prisoners who require medical care.

Sources: The Arizona Republic, www.azcentral.com, Arizona Prison Watch, www.aclu.org

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