On April 11, 2016, the Prison Law Office and the ACLU National Prison Project filed in federal court in Arizona a motion to enforce the year-old settlement between the Arizona Department of Corrections (ADC) and prisoners in the case of Parsons v. Ryan.  The motion seeks an order requiring ADC to hire more healthcare staff to prevent further injury and death.

ADC’s own audits reveal a dismal failure to meet the requirements of the settlement.    As a direct result of these well-documented systemic deficiencies, patients needlessly suffer serious injury, illness and, in some cases, death.  Medical and mental health experts who reviewed files and toured the prisons both concluded that the key root cause of the system-wide failure is the failure by ADC and its for-profit health care contractor, Corizon Health, Inc., to allocate an adequate number of health care staff at all positions to deal with the needs of the patients.  Many healthcare positions are vacant, for example, since April 2015, no more than 52% of psychologist positions and 49% of mental health nurse practitioner positions have been filled.

The motions asks the judge to order ADC to submit a plan to the court within 45 days that explains how ADC will comply with the terms of the settlement agreement, including to reduce the vacancy rate for all positions to less than 10%.  The motion also asks that a neutral expert on correctional health care conduct a detailed staffing analysis as to how many positions are needed at each prison, and that ADC abide by the expert’s recommendations.

Dr. Todd Wilcox, M.D., M.B.A., the 2015 President of the American College of Correctional Physicians, reviewed prisoners’ medical records and visited one of the largest prisons for three days to speak to staff and patients.  His report in support of the prisoners concludes there are gross systemic deficiencies in the medical care provided to prisoners, with the result that they suffer grave harm, injury, and death.  One of the most chilling examples he describes involved a 59-year-old man at the Yuma prison who had been diagnosed with end-stage liver disease with complications including massive fluid retention, groin wounds, and sepsis.  Despite the man’s serious condition, the nursing staff repeatedly failed to respond to the man’s multiple desperate requests for medical care.  For example, he submitted a health needs request (HNR) stating that “my legs were bleeding with open weeping wounds sticking to my prescription socks. I am in severe pain. I cannot wear my socks nor get them on. I am in pain.”  The man filed multiple HNRs in subsequent days reporting similar symptoms, and his deteriorating condition, but still he was not seen by a provider.  His fluid retention worsened to the point that his skin on his body split open and became infected with oozing pus.  Three weeks after describing these open wounds, he filed a HNR stating that his lesions now were swarmed by flies, but shockingly, the nurse reviewing this request for care decided he still did not need to be seen.  In his review, Dr. Wilcox concluded that “the flies were attracted to his massively infected wounds and proved to be a harbinger of his death.”  The prisoner subsequently died weeks later due to complications from the massive infection.  ADC’s own Mortality Review Committee determined there were multiple mistakes made by nurses that impeded and delayed care for this person.

Dr. Pablo Stewart, M.D., a psychiatrist and a Clinical Professor at University of California, San Francisco School of Medicine with extensive experience with correctional mental health systems, reviewed the mental health records of Arizona prisoners, including several who committed suicide, and describes his personal observations and interactions with persons who were floridly psychotic and not receiving care.  His report in support of the prisoners also concludes that a chaotic recordkeeping system and lack of mental health staff combine to create system-wide problems such that seriously mentally ill prisoners are not seen regularly, and experience delays in receiving psychotropic medications, or are not receiving their medication.  One example was a 34 year old prisoner with chronic psychosis and prior suicide attempts, classified by ADC as seriously mentally ill, who deteriorated dramatically over a period of several weeks in July and August 2015.  Staff noted that he was naked, urinating and defecating on the floor, and eating his own feces, and characterized him as “psychotic,” “unstable,” and “delusional.”  He was repeatedly placed on and removed from suicide watch. Throughout this entire period, when he was displaying floridly psychotic behavior, there is no indication that he was ever seen by a psychiatrist, evaluated for medication changes, or considered for inpatient care.

At the present time, a hearing on the motion has not been set by the Court.