Federal judge taps official to oversee Arizona’s prison healthcare system

A federal judge has appointed someone to oversee the state prison healthcare system for the next five years.

In a new order, Judge Roslyn Silver tapped Annette Chambers-Smith, the former director of Ohio’s prison system.

Silver said the state has failed to bring care for inmates up to constitutional standards, despite various promises to do better to address the claims filed in a 2012 lawsuit and having to pay multi-million-dollar fines since then.

Those shortcomings, the judge said, include chronic understaffing, care that should be handled by doctors going to nurses, failing to make referrals of complex conditions, and “inadequate resources, including funding and facilities."

“Accordingly, the court found that only a receiver with the powers and authority necessary to address each of the systemic failures would adequately remedy the failure of healthcare," she wrote.

Silver directed the state to pay Chambers-Smith a salary of $500,000 a year.

The judge's directive most immediately strips Ryan Thornell, director of the Department of Corrections, Rehabilitation, and Reentry, of all of his powers to control healthcare for inmates and gives it to the receiver, subject only to Silver's own review.

Those powers are broad, including hiring, firing, suspending, supervising, promoting, transferring, disciplining and deciding how much to pay — and not just the prison system's own staff.

Chambers-Smith also has the power to unilaterally end the contracts the state has signed with private companies whose employees have been providing much of the direct care — the care that Silver has found wanting.

Corene Kendrick, deputy director of the National Prison Project for the ACLU, said that could remedy what she believes was a bad decision by state lawmakers years ago to farm out healthcare to for-profit companies — versus hiring their own staff — and doing it in a way that she says was designed to produce the worst possible healthcare.

“This is 14 years coming," Kendrick said. “The state needs to look into the mirror and figure out did they back themselves into this mess."

The judge also made it clear that after 14 years of trying to get this resolved, she now wants quick action.

She directed Chambers-Smith to prepare a plan within 180 days to deal with each of the unconstitutional deficiencies in the healthcare system and then set up a schedule for resolving each of the problems. And she gave the receiver the power to hire staff and consultants to make all this happen as well as to demand “sufficient office space" within the headquarters of the prison system.

Absent an order from a higher court, Chambers-Smith could be working within weeks.

That still leaves the question of cost to bring the prison healthcare system into constitutional compliance. The judge also agreed to give Chambers-Smith access to $2.2 million that remains from earlier fines paid by the state after Silver issued previous contempt citations.

There was no immediate comment on the new order from Arizona Gov. Katie Hobbs.

In the past, she has said this was a problem she inherited from her predecessors.

The move to appoint Chambers-Smith isn't going to come without a fight.

“I would certainly want to appeal," said Senate Majority Leader John Kavanagh.

The Fountain Hills Republican acknowledged there are shortcomings in the level of care provided. But he said that the prison system is doing what it can, saying it's often hard to find professional medical staff given “the depressing environment to work in" and the rural location of the state's largest prisons.

Kendrick said none of that is a legal excuse to fail to provide constitutionally required care.

In a previous filing, the state told Silver it should be excused from the requirement in a 2023 injunction requiring that it find board-certified doctors to work in the prison system. That argument did not impress the judge.

“Obviously, the failure to fill points to the need to increase the salaries, not reduce the required qualifications of staff and, by extension, the quality of care," the judge wrote just a week earlier.

Kavanagh said he's not convinced more money will incentivize more high-quality doctors to want to live and work in rural communities.

“But it was also the prisoners' decision to commit crimes that got them into prison in the first place – not that I'm saying they don't deserve medical care," he said.

The original lawsuit was filed in 2012 by the ACLU, the Prison Law Office, and Disability Rights Arizona on behalf of inmates. The state agreed to a settlement which was signed in 2015, promising to do better.

The state was then fined $1.4 million in 2018 for failing to live up to the performance measures to which it had agreed, with Silver imposing another $1.1 million penalty in 2021.

In a 200-page 2022 order, Silver said the care provided by the state at prison is "plainly grossly inadequate" and state officials are acting "with deliberate indifference" to the substantial risk of harm to inmates. Silver said the facts show not only were top prison officials aware of conditions that resulted in serious and unnecessary physical injury and death to inmates, but that they actively ignored the problems.

“After nearly 14 years of litigation with defendants having not gained compliance, or even a semblance of compliance with the injunction and the Constitution, this approach has not only failed completely but, if continued, would be nothing short of judicial indulgence of deeply entrenched unconstitutional conduct,"' the judge wrote.

The judge repeated that theme in her latest order, writing the receivership “was ordered by the court as a last resort." And Silver said she is hoping that finally is the beginning of the end to the problems.

“The court is in full alignment with the legal principle that a receivership will not extend beyond what is essential to accomplish constitutionally adequate healthcare," she said.

Silver said she looks forward to eventually returning control of the prison health system “upon a finding that the unconstitutional violations have been remedies and the unconstitutional healthcare existing in the state of Arizona prison system has ceased."