Key Points: 

• Judge orders five-year prison healthcare receivership, appoints candidate

• Receiver gains broad healthcare authority; department plans immediate appeal

• Court aims to quell unconstitutional care after 14 years of litigation

A federal judge set the stage Friday for a five-year takeover of the state prison healthcare system.

Judge Roslyn Silver officially appointed Annette Chambers-Smith, former director of the Ohio Department of Rehabilitation and Correction, as receiver and tasked her with righting unconstitutional medical care in the state prison system over the next five years.

The Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) remains in staunch opposition to the receivership of prison medical care and plans to appeal and ask for a temporary block on the order.

ADCRR did not immediately respond to a request for comment, but previously expressed plans to appeal and seek to stay the final receivership order.

With this in mind, Silver set the effective date of the receivership order for 21 days after the resolution of the motion to stay.

Attorneys for inmates in state prisons, meanwhile, want the receiver to begin as soon as possible, citing a now-14-year history of litigation.

“Our clients have been waiting for minimally adequate healthcare for years,” said David Fathi, director of the American Civil Liberties Union National Prison Project. “We think our clients have waited long enough.”

In February, Silver issued an order agreeing to take the reins from the department and hand control over the prison medical system to a third party.

ADCRR and attorneys for the plaintiffs agreed on Chambers-Smith’s appointment, but the two presented clashing proposals on the scope, powers and duties of the receivership.

Attorneys for the plaintiffs argued that the receiver should wield powers on par with the ADCRR director’s when it comes to healthcare staff, operations, policies and contracts – all with unfettered access to the department.

ADCRR sought a three-year takeover with consistent auditing of the receiver and checks by the director on access to certain staff members.

In her order, Silver acknowledged the “entrenched systemic failures” by the department. She listed issues such as chronic understaffing, failure to enforce contractual obligations with the private healthcare vendor Naphcare, lack of care from physicians, referral failures, data collection and reporting shortfalls, and lackluster resources and facilities.

Silver maintains the duties of the receiver are “narrowly drawn and extend no further than necessary to remedy the ongoing constitutional violations and are the least intrusive means to correct the ongoing constitutional violations.”

With this in mind, Silver granted Chambers-Smith the authority to oversee and direct all ADCRR staff involved in, and relevant to, the delivery of healthcare. Though Silver directs Chambers-Smith to utilize employees currently working in the department, she does maintain explicit control over hiring, firing, discipline and compensation.

Chambers-Smith will also seize control over healthcare operations, policies and programs. And she’ll be responsible for formulating and establishing the annual healthcare budget and proffering policy recommendations to the governor and the Legislature.

Any budget disputes or shortfalls identified by the receiver must first be addressed by the department, then raised with the Legislature and Governor’s office. If the parties fail to find consensus, Silver offers resolutions through the courts.

Silver also granted authority akin to the director’s to negotiate, enforce, and terminate the contract with the private vendor Naphcare.

The receiver will not have control over correctional officers or security, though she must ensure necessary security and control of inmates. And the order allows the receiver “unrestricted access” to ADCRR records and facilities, with or without notice.

Within 180 days, Chambers-Smith must prepare an operational plan outlining the path to compliance with the long list of constitutional requirements set out in the original injunction, as well as the staffing plans ordered by the court.

But Silver ordered Chambers-Smith to start working toward short-term measures to improve health care immediately. The order also requires annual reports to the court and declines to order a monthly audit of the receiver.

All costs will be fronted by the department and the state, with Chambers-Smith awarded an annual salary of $500,000 and cleared to hire staff and set up an office to get started.

Silver set an initial five-year timeline on receivership.

“The Court genuinely welcomes the eventual return to the State of Arizona of the operational control of the health care relating to the class members,” Silver wrote in the order, “… upon a finding that the unconstitutional violations have been remedied and the unconstitutional health care existing in the State of Arizona prison system has ceased.”