Death Yards
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Death Yards: Continuing Problems with Arizona’s Correctional Health Care

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On March 6, 2012, the American Civil Liberties Union (ACLU) filed suit against the Arizona Department of Corrections (ADC) charging that prisoners in the custody of the Arizona Department of Corrections receive such grossly inadequate medical, mental health and dental care that they are in grave danger of suffering serious and preventable injury, amputation, disfigurement and premature death.

This class action lawsuit has the potential to force the state of Arizona to improve its prison medical care. But legal battles are long and costly. The state is fighting tooth and nail, including an upcoming challenge to the suit’s class action status. The final resolution will likely take years.

But what has changed in the day-to-day provision of medical care to prisoners in Arizona? Have conditions improved in light of the charges brought by the suit? Has the transition in management of the medical care from one for-profit corporate contractor (Wexford) to another (Corizon) addressed any of the previous health care lapses?

Sadly, the answer appears to be no. Correspondence from prisoners; analysis of medical records, autopsy reports, and investigations; and interviews with anonymous prison staff and outside experts indicate that, if anything, things have gotten worse.

MAJOR FINDINGS

1. The same problems—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. This report contains 14 specific case studies to illustrate these issues.
2. There have been 50 deaths in Arizona Department of Corrections custody in just the first eight months of 2013. That is a dramatic increase from previous years. The Arizona Republic reported 37 deaths in 2011 and 2012 combined.
3. There were eight suicides in the first eight months of 2013. The majority (5) occurred in maximum security units.
4. One contributing factor appears to be the process of privatization of medical services. Delays and a reissue of the RFP made the process drag out for over two years. In the meantime, medical staffing levels plummeted and health care spending in prisons dropped by nearly $30 million. The hasty departure of Wexford, followed by the award of the contract to Corizon created additional upheaval, delays, and changes in staff, procedures, and medications.

These findings and the revealing case studies contained in the report are intended as a call to action for state leaders and to Arizona taxpayers. There appears to be no independent state or public oversight over the contracts, the performance of the contractor, or over the Department of Corrections.

The American Friends Service Committee is limited in its ability to access all the documents necessary to fully assess the scope of the problem and to identify solutions. Nevertheless, the issues documented in this report make a strong case that the situation in our state prisons has reached a crisis point and requires immediate intervention.

There is sufficient evidence to indicate that the problems are not limited to a few isolated locations, “bad apples,” or individuals. They are the result of policies, organizational culture, and an operating model that prioritizes cutting costs over delivering adequate and timely care. Contracting out the medical care at ADC has resulted in more bureaucracy, less communication, and increased healthcare risks for prisoners.

What is required to correct the problem is transparency and accountability. Privatization functions only to hinder those processes. Immediate intervention is required to correct these issues and prevent needless suffering and more deaths in the Arizona Department of Corrections.

Recommendations

1. That the Arizona Auditor General immediately initiate an audit and independent investigation into the issues raised in this report. The Auditor General should complete the report within six months, and this report should be made available to the public. In the future, such audits should be completed on a regular basis, at least biannually, to ensure that care remains at acceptable levels.
2. If the results of the Auditor General’s investigation confirm that there are systemic deficiencies in provision of medical and mental health care,
the Governor’s Office should act immediately to ensure these issues are immediately addressed and insist that ADC be in full compliance with established medical practices and standards of care. Any correctional or contract staff found to be responsible for these problems should be held accountable, including senior administration.
3. That the Arizona State Legislature permanently reinstate and reconstitute the Joint Select Committee on Corrections and expand its purview to any and all contracts held by the Department of Corrections and the contracting entities.
4. That the legislative requirement for privatization of medical care at ADC be immediately rescinded and any contracts cancelled as quickly as possible.

The findings in this report are intended as a call to action for state leaders and to Arizona taxpayers. While some may argue that those who commit crime are not deserving of quality medical and mental health care, the Constitution of the United States says otherwise. Governments and societies who choose to imprison their citizens then become responsible for their wellbeing.

While our society’s prevailing “throw away the key” attitude would have us forget about those serving time behind bars, the reality is that over 90% of prisoners come home. It is in the public’s interest to ensure that they return to our communities healthy, mentally sound, and able to reintegrate and become productive citizens once again.