by Joe Watson and Derek Gilna

Civil rights organizations hailed the settlement of a class-action lawsuit filed against the Arizona Department of Corrections (ADC) in the wake of scores of prisoner deaths and preventable injuries stemming from medical treatment so poor that one private prison healthcare company withdrew from its contract. A federal court in Phoenix approved the settlement on February 18, 2015, bringing an end to the suit filed by the American Civil Liberties Union (ACLU), Prison Law Office, Arizona Center for Disability Law and others on behalf of more than 33,000 Arizona state prisoners. [See: PLN, Sept. 2012, p.34].

“The Arizona Department of Corrections has agreed to changes that will save lives,” Prison Law Office director Don Specter said after the settlement agreement was first announced. “This settlement will bring more humane treatment for prisoners with serious healthcare needs, and the potential for their conditions to improve rather than worsen.”

“At last, the Arizona Department of Corrections will provide its prisoners with adequate medical, mental health, and dental care,” he continued. “This is what the Constitution and our consciences demand.”

However, ADC Director Charles L. Ryan issued a statement that seemed, on its face, to contradict allegations contained in the lawsuit.

“This is positive news,” he said. “On the eve of trial, the plaintiffs in this case have essentially agreed that the department’s current policies and practices, along with recent enhancements to programming opportunities, adequately addresses the plaintiffs’ concerns relating to constitutional healthcare and conditions of confinement for maximum custody and mentally ill inmates.”

The settlement in the class-action case establishes a mandate for the ADC to comply with more than 100 healthcare standards on a wide range of medical issues ranging from improved monitoring of prisoners with chronic conditions, such as diabetes and hypertension, prenatal care for pregnant prisoners and dental care. The settlement also includes provisions to limit the ADC’s use of solitary confinement for prisoners who are diagnosed with serious mental illnesses, and to provide a minimum of 19 hours weekly out of their cells, compared to only six hours weekly in the past.

Further, the settlement agreement calls for more mental health treatment and other programming for seriously mentally ill prisoners, restricts guards’ use of pepper spray on such prisoners except when necessary to prevent injury or escape, and makes other critical reforms in overall prison conditions.

Importantly, the ADC must allow ongoing monitoring and oversight by the prisoners’ attorneys to ensure that the state is complying with its obligations.

The settlement followed years of turmoil with respect to abysmal medical care for ADC prisoners, which came to light in federal court records unsealed in September 2013. According to a PowerPoint presentation contained in the records, Pittsburgh-based prison healthcare provider Wexford Health Sources, Inc. determined that the ADC’s level of medical care was so deficient that the company and the state cancelled their three-year, $349 million contract after only four months, due to “both parties encountering unforeseeable challenges.”

ACLU attorney Dan Pochoda noted that “[Wexford] specifically said there were four areas that were required for constitutional care and minimally adequate care, and in all four areas the Arizona Department of Corrections failed.”

According to PowerPoint slides from a meeting between Wexford executives and state prison officials, the baseline for “constitutionally mandated correctional healthcare” includes guaranteed access to and delivery of services to prisoners, cooperation between medical providers and prison security “to ensure safety and access to care,” policies in accordance with credentialed standards and “sound clinical practices.” The ADC “had none of these components functioning properly,” Wexford found.

The company also said the ADC had mismanaged prisoners with hepatitis and HIV, including administering hepatitis A and B vaccines inappropriately, subjecting “hundreds of patients to unnecessary and invasive liver biopsies” to detect hepatitis C, and “placing inmates at risk for med-resistant HIV.”

An audit of the ADC’s 15 prison complexes “found serious deficiencies at every facility,” Wexford reported, due mostly to the prison system’s nursing staff, which the company cited as the core of the problems. Arizona prison nurses, Wexford officials said, have “poor, under-developed skill sets” and lack accountability, professionalism, critical thinking skills, and time management and organizational skills – characteristics that have been “engrained within a dysfunctional organizational culture.”

Research conducted for an independent TV news investigation found that prisoner healthcare worsened when Tennessee-based Corizon Health, the nation’s largest private prison medical care provider, took over in January 2013 after Wexford withdrew from its contract. [See: PLN, July 2013, p.1].

According to records obtained by KPNX-TV, Corizon failed to provide timely medical care to Arizona prisoners at least 16,000 times during an eight-month period in 2013 and, from March 2013 through October 2013, frequently provided no care at all. Some of the company’s worst cases of neglect, the investigation found, included delivering no treatment to an HIV-positive prisoner at the Tucson complex and delaying chemotherapy for two other prisoners at the same facility, failing to renew psychotropic medications for mentally ill prisoners in Yuma and failing to reorder chronic-care medication for dozens of prisoners at the Eyman facility in Florence.

Another prisoner in Tucson was forced to undergo a craniotomy after he fell 33 times in the infirmary under zero supervision. Mentally ill prisoners in Yuma had not been seen by doctors since December 2012. And at the women’s prison in Perryville, there were long delays to see a physician even after prisoners were referred by nurses.

Teresa Short, a former Corizon patient care technician at the Tucson prison complex, resigned in March 2014 after the death of a prisoner due to what she alleged was the for-profit prison healthcare provider’s failure to provide proper treatment.

“They [Corizon] care about the bottom line, they care about the dollar,” she said.

Prisoner James Copeland, who had been diagnosed with dementia and kidney disease, had a vascular catheter inserted in his chest to receive dialysis treatment but was housed in the prison’s medical unit rather than a hospital. On Thanksgiving Day, November 28, 2013, alone in his cell, Copeland ripped off the catheter’s cap sometime during the early morning hours. Short found him lying on his bed in a pool of blood.

“When I walked into the room, I was stepping on blood clots that were the size of livers. I mean they were huge,” she said, adding there was blood on the walls and Copeland’s shoe print in blood near the cell door. “I felt like I failed him.”

Short noted that inadequate staffing levels at the infirmary were to blame.

“We’re the ones who have to carry the burden when something is preventable and we cannot prevent it because we don’t have enough people to supervise the ones that need supervision the most,” she said.

The KPNX-TV investigation also revealed allegations that many staff employed by Corizon lacked the necessary licenses to perform their jobs, and that some Arizona prisoners had been granted clemency, or “compassionate discharge” from prison, because they were in imminent danger of death due to Corizon’s negligent lack of care.

In response to the televised report, Corizon spokeswoman Susan Morgenstern wrote in an email that “HIPAA (the federal Health Insurance Portability and Accountability Act) prevents Corizon from discussing details of individual patient care,” but denied that any staff were unlicensed. “As a healthcare provider focused on quality,” she added, “we stand behind our dedicated medical professionals and the treatment plans they provide to patients.”

However, an October 2013 report prepared by the Tucson chapter of the American Friends Service Committee (AFSC) determined that the situation had worsened after Corizon replaced Wexford.

“The same problems,” the AFSC report noted, “[including] delays and denials of care, lack of timely emergency treatment, failure to provide medication and medical devices, low staffing levels, failure to provide care and protection from infectious disease, denial of specialty care and referrals, and insufficient mental health treatment, have continued and, arguably, worsened” under Corizon. “These problems are not isolated to one or two units, but clearly represent system-wide dysfunction,” the AFSC said.

In the first eight months of 2013, just before the printing of the AFSC report, there were 50 deaths – from cancer, cardiovascular disease, drug overdoses and a range of other causes – at 11 of the 15 ADC prison complexes statewide. According to the Arizona Republic, that compared to 37 deaths in state prisons during all of 2011 and 2012 combined.

The AFSC report, titled “Death Yards: Continuing Problems with Arizona’s Correctional Health Care,” described more than a dozen case studies of untreated, misdiagnosed and neglected prisoners, including Benny Joe Roseland, 59, incarcerated at the Central Unit facility in Florence. Roseland complained in a July 3, 2013 letter to Arizona Prison Watch that Corizon failed to diagnose him as having terminal cancer. Roseland wrote that he had requested an evaluation a year earlier after experiencing chest pain and vomiting.

“[T]he guards took me up to the main medical center on complex. They put me on an EKG, told me that my heart was good for someone my age, but that I had acid reflux and that’s why my chest was hurting.... I continued to throw up and the pain got worse...,” Roseland wrote. “[T]he following Wednesday after breakfast,” he continued, “I returned to the housing unit and threw up six times.”

Prison doctors finally sent Roseland to an outside hospital where, less than an hour after testing his blood, doctors gave him dire news: “I had a tumor (softball sized) in my left upper chest,” he told Arizona Prison Watch. “After more X-rays and a CAT scan, they took a biopsy.... They told me I have terminal cancer, with 2-6 months to live.”

On November 14, 2013, the AFSC announced it had been notified by Arizona Prison Watch that Benny Joe Roseland had died. The AFSC laid the blame for the ADC’s prison healthcare morass at the doorstep of privatization.

“Given the multiple examples of long-standing problems with both corporations (as well as any others that might bid on the contract), it is clear that privatization is not a solution to the serious deficiencies in medical care” in the ADC, the AFSC report charged. “If anything, privatization complicates the problem further by inserting an entire corporate culture and structure inside the existing state agency bureaucracy, providing both parties an opportunity to dodge responsibility and pass the buck. The result is more delays, less transparency, and little accountability.”

Dr. Robert Cohen, a medical expert with a history of overseeing prisoner healthcare systems, found that at least 13 of the 29 ADC prisoners whose cases he reviewed had received “grossly deficient” care. Cohen cited one instance of a prisoner who requested HIV testing twice being denied and later dying of that disease, and another case where a prisoner passed away after being refused treatment for Hodgkin’s lymphoma, which he termed “shocking.”

The ACLU’s class-action suit alleged that Arizona’s state prison healthcare system “provide[s] medical, mental health, and dental care [that] is grossly inadequate and subjects all prisoners to a substantial risk of serious harm, including unnecessary pain and suffering, preventable injury, amputation, disfigurement, and death.” Further, prisoners who complained were told to “be patient ... it’s all in your head ... [or] pray,” the complaint stated.

As part of the settlement, the state denied allegations of wrongdoing and denied liability, but was not released from any prisoner lawsuits still pending or as yet unfiled. The state may petition the district court after four years to terminate the settlement.

The ACLU, Prison Law Office and Arizona Center for Disability Law filed the lawsuit in 2012, and U.S. District Court Judge Neil V. Wake certified the case as a class-action in March 2013. The ADC challenged the certification, but the Ninth Circuit Court of Appeals affirmed the class-action status in June 2014.

In addition to approving the settlement, the district court awarded $4.9 million in attorneys’ fees and costs to class counsel, plus up to $250,000 per year for monitoring fees and expenses. Also representing the prisoner class members in the case were the law firms of Perkins Coie LLP, Jones Day and Eidenbach Law PC. See: Parsons v. Ryan, U.S.D.C. (D. Ariz.), Case No. 2:12-cv-00601-DKD.

Sources: www.kjzz.org; KPNX-TV Channel 12; www.azcentral.com; www.aclu.org; Wall Street Journal; “Death Yards: Continuing Problems with Arizona’s Correctional Health Care,” American Friends Service Committee (October 2013); www.afsc.org; www.tucsoncitizen.com; www.phoenixnewtimes.com

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