Key Points: 

• Federal court mulls appointing receiver over prison health care 

• Plaintiffs claim continued harm, inadequate care necessitates takeover 

• Department of Corrections asks for more time to reach compliance 

A federal judge is considering whether to place the Arizona Department of Corrections, Rehabilitation and Reentry’s health care system under receivership after more than a decade of litigation and two years after the court set a final bar for compliance. 

The hearing on Sept. 10 came after another report from court-appointed monitors found continued systemic failings in the delivery and quality of health care to the state’s incarcerated population. 

“A receiver is the only option with a realistic chance of success,” said Sophie Hart, an attorney with Prison Law Office, who represents the plaintiffs. 

Judge Roslyn Silver told parties at the start of the hearing that she had departed from her typical practice by declining to issue a proposed opinion prior to the hearing. 

But, she still wanted to give the parties “at least a few ideas” on where she stood on a receivership and sent a list of specific questions to address at the hearing instead. 

Silver asked the plaintiffs for specific duties to be taken over by the receiver, the cost to the state and the potential or need for the receiver to suspend state laws in the name of compliance. 

Hart told Silver a receiver would take on duties parallel to those of a similar California prison class action — Plata v. Newsom — which includes authority over staff, contracts and budgets, and a mandate to bring the department’s medical care into compliance with constitutional standards. 

As for the cost of receivership, Hart referred to the Plata case, putting the figure at about $3 million a year, with the caveat being that the court would determine the approval of costs and salaries of any prospective receiver. 

There was also the question of whether the receiver planned to suspend state law, specifically a measure that requires the privatization of carceral health care. 

Since the start of litigation, the department has had a revolving door of health care contractors and most recently contracted with NaphCare. 

Hart said the plaintiffs are not yet asking for the court to affirmatively grant a waiver of state law, but a receiver could petition the court in the future if it became necessary. 

The defendants, meanwhile, answered inquiries on the specific outcomes of increased expenditure on health care, the true weight of “new leadership” under Director Ryan Thornell and actions by the department to enforce NaphCare’s compliance with the contract.  

“I have a little trouble understanding how those sums of money, as they’ve increased every year, have improved health care,” Silver said, “We are many millions of dollars in, and, so, of that additional number of millions of dollars, what has that paid for?” 

Mary O’Grady, attorney for the department said that, as a general matter, “it’s hard to say here’s a dollar, here’s a better outcome.” Though she did point to some examples, including an increase in the number of health care providers, expanded programs and added capacity for care for the special needs unit. 

O’Grady said the department would continue to advocate for additional funding, with dollars going to additional full-time employees to comply with staffing portions of the injunction. 

As it stands now, the department’s FY2027 budget request asks for $9.5 million to comply with the injunction requirements, with a placeholder for hiring contracted staff.

O’Grady added that the work is far from complete, but the department is continuing to do it. 

“We are not in a state of paralysis in Arizona,” O’Grady said. 

In turning to the question of the state’s confidence in Thornell, O’Grady said, “Why should the court accept this promise now? They are committed to complying with this court’s order, they are committing to doing this work to comply with the court’s order. They are maybe two years older and wiser in how complex and challenging this work is.”

Silver pressed on whether the department was holding NaphCare accountable by way of sanctions and reported contract violations. O’Grady said the department would follow up in writing. 

In wrapping up her argument, O’Grady argued against a receivership, noting it to be a “last resort when nothing else works,” nor a “quick fix.”

Silver acknowledged as much, but again pointed out that the permanent injunction, which required immediate compliance, has been in place for two years, with a long way to go from compliance. 

Hart, throughout her argument and in closing, pulled from a long list of incarcerated patients who were denied adequate care and lost their lives as a result. She referred, too, to the continued string of reports from court monitors finding systemic failings in care. 

In the most recent quarterly report, lead monitor Marc Stern found the department “remains non-compliant with the vast majority, with slow (or little) progress toward achieving substantial compliance” and found “striking evidence of how multiple system level failings in ADCRR’s health care operations persist and how preventable errors likely contributed to the deaths.”

The report found the department failed to recognize and fix errors in health care delivery, continues to experience understaffing in medical and custody personnel and has not significantly moved the needle in adopting the patient-centered care model. 

“The system changes required by the Injunction to protect human life and limb and prevent suffering are still broken, and ADCRR is still struggling to identify and prioritize the changes it needs to make, let alone actually make those changes,” Stern wrote.

Silver similarly noted past mortality reports showed “significant problems” and stressed the need to see compliance across the board.

“It’s not just a matter of numerical compliance,” Silver said. “That’s not going to do it, it has to be 100%.” 

Silver took the matter under advisement.