US judge issues order in Arizona prison health care case

PHOENIX (AP) - A U.S. District Court judge has made permanent an order that aims to improve the way Arizona delivers health care to incarcerated people in state-run prisons.

The injunction issued Friday by Judge Roslyn Silver is the latest effort to ensure Arizona prisons meet constitutional standards. She initially ruled last year that Arizona had been violating the rights of incarcerated people by providing them with inadequate medical and mental health care, saying the state knew about the problem for years but refused to correct its failures.

The case has dragged on for nearly a decade. Silver took the unprecedented step of throwing out a previous settlement agreement after finding years of court monitoring had not compelled the state to make improvements and held a new trial in 2021.

The injunction issued on Friday is Silver’s response to the findings from the trial, The Arizona Republic reported.

The permanent injunction contains much of the same language as a draft issued in January.

“Defendants’ basic model for medical and mental healthcare and staffing decisions that flow from that model create an unconstitutional substantial risk of serious harm to plaintiffs,” Silver wrote. “Therefore, the changes necessary to redress the failings will be substantial.”

The injunction, among other things, calls for quicker follow-up appointments and diagnostic tests, patient confidentiality, having more experience for staff in supervisory roles, monitoring health care trends among patients, timely delivery of medications and planning for when inmates are released back into society.

The injunction gives the Arizona Department of Corrections, Rehabilitation & Reentry three months to hire more people to support the health care staff.

Silver also specifically ordered the department to hire seven additional physicians to be allocated at the state prisons based on patient need.

The judge also ordered the state to fix essential equipment or structures in cells that are in disrepair.

“As a matter of common decency, an order should not be required to prompt defendants to repair leaking pipes, repair inoperative toilets, or collect trash,” Silver said in a footnote. “However, defendants’ conduct throughout this litigation demonstrated defendants cannot be relied upon to perform such basic tasks.”

The building upgrades, staffing increases, studies and monitoring work must all be paid for by the department, which is funded by taxpayers at a cost of more $1.5 billion annually.

If the department doesn't comply, Silver noted that the court has the ability to change the requirements and ultimately could place the prison health care system under the control of the federal government.

Silver's order also addresses the amount of time prisoners can be kept in their cells.

The state’s compliance with the injunction will be monitored by court-appointed experts and attorneys representing incarcerated people.

The department did not immediately respond to a request for comment about Friday's order.

In January, incoming Gov. Katie Hobbs announced the creation of a commission to study problems in Arizona’s prisons, including staffing levels and the health care offered to those behind bars.

Newly appointed prisons Director Ryan Thornell said in a previous interview with The Republic that improving health care was a priority and that the state would come into compliance.

David Fathi, ACLU National Prison Project director, called the injunction a major step toward creating healthier and safer prisons.

NaphCare, the state’s prison health care contractor, said it was reviewing the order. The company noted that it already has made significant changes to address many of the issues.