Key points:

• A court-appointed official will take over Arizona’s prison healthcare system on Oct. 19

• The change follows a long-running lawsuit alleging inferior healthcare in the system

• Advocates hope the takeover will lead to improvements, while the state says it has already made progress and is continuing to fight it

A long-awaited outside takeover of Arizona’s prison healthcare system is set to begin this month, putting a court-appointed receiver in charge of a prison system the state has spent years defending and inmates have condemned as constitutionally inadequate. 

Annette Chambers-Smith, a former Ohio prison official, was appointed in July to assume control of the healthcare system in the Arizona Department of Corrections, Rehabilitation and Reentry. Her takeover is scheduled to start Oct. 19.

State officials are asking the U.S. Court of Appeals for the Ninth Circuit to delay the takeover, though their request is unlikely to be approved given that courts, including the U.S. Supreme Court, have three times turned down similar requests.

The receivership is the latest development in a case that began in 2012 and has repeatedly returned to the courts over disputes about Arizona’s medical and mental health treatment of its prisoners.

As receiver, Chambers-Smith will have broad authority over the system’s budget, healthcare contracts, staffing and delivery of services. Any system changes, expected to begin this month, could potentially reshape how the state’s prison healthcare is managed for years to come.

While the state continues to challenge the takeover, advocates for inmates say they believe an outside manager is now necessary after years of efforts to bring the system into compliance with court orders.

“This is a remedy that shouldn’t be paused,” said Sophie Hart, managing attorney for the Prison Law Office, which is representing inmates who brought the case. “We’ve been working on this case for more than a decade and have twice agreed with the defendants about the terms that are needed to solve the problems in the prison system. Neither time have they implemented those changes. At this point, we are quite confident a receiver is what’s needed.” 

Corrections department officials did not respond to requests for an interview this week. 

Gov. Katie Hobbs, a Democrat, disagrees with the court’s decision ordering the receivership.

Hobbs, who took office in 2023 and is running for reelection, inherited a prison system that had been mismanaged for years and has worked with Corrections Department Director Ryan Thornell to improve it, spokesperson Christian Slater said.

“A receiver is an impractical use of Arizona taxpayer dollars with zero accountability,” Slater said in an email. “The court ordered the state to pay the receiver an annual salary of $500,000 and gave the receiver a blank check to spend taxpayer money. 

“The governor secured four bipartisan budgets since [a 2023] injunction was ordered, which have helped ADCRR make significant progress towards compliance over the last three years. Now, a court-imposed receiver will have at least five years to accomplish what Director Thornell and the administration were given only three years to do.” 

How will operations change?

According to the July order from Arizona District Court Judge Roslyn Silver, Chambers-Smith will be tasked with leadership and management of the prison system’s healthcare, including budgeting and accounting, delivery of services and overseeing contracts with providers. 

She will be paid $500,000 a year and establish a new Office of the Receiver. The arrangement is set to last five years but could be extended, according to court records. 

Chambers-Smith will have six months to develop a long-term plan but, in the meantime, can implement “short-term measures essential for immediately improving critical healthcare issues” and can begin restructuring the healthcare system, according to the order. 

Attempts to reach Chambers-Smith for an interview were unsuccessful. According to court records, she has already started shaping the office. In a letter to Silver Monday, Chambers-Smith requested approval to hire Kellie Wasko, a nurse and corrections official, as chief of healthcare operations in the Office of the Receiver. 

Silver ruled that she would grant the request pending any objections from the state, which has until the end of the week to weigh in. 

Chambers-Smith previously served as director of the Ohio Department of Rehabilitation and Corrections from 2019 to 2026.

“She has extensive experience in correctional healthcare specifically and in coming into compliance with consent decrees,” Hart said. “We’re confident from our due diligence and our interviewing of her, and looking into the work she did in Ohio, that she has the skills needed to make the changes in Arizona.” 

It’s unclear exactly how much the changes will cost, or if there’s enough state funding to pay for them. A 2025 order from Silver requiring the department to add 557 healthcare workers was estimated by the state to cost more than $100 million per year. 

The Legislature and Hobbs included only about half of those costs in the budget they approved in June. 

Why is this happening?

The receivership stems from a 2012 lawsuit Arizona inmates and their advocates filed. They alleged the state’s prison health care system failed to meet constitutional standards.

The case included allegations of serious delays and lapses in medical care.

In one instance, a man waited more than three years for a biopsy of a nodule on his prostate. The biopsy, once it was finally conducted in late 2009, revealed he had aggressive Stage 2 cancer. According to the lawsuit, the man also experienced gaps as long as two months in getting medications prescribed by outside urologists, causing him “harm and permanent injuries.”

In another case, a man who suffered eye injuries and face fractures from an assault by another inmate had to wait almost a year before he could see an ophthalmologist, the suit said. He reported chronic pain and waited months to learn if pain medications would be approved and provided. 

The two sides reached a settlement in 2014, but Silver rescinded her approval in 2021, saying the state failed to meet its obligations to provide adequate healthcare. 

In 2025, attorneys for inmates asked Silver to appoint a receiver, citing a 2024 report from a court-appointed doctor assigned to monitor the prison system. The report found that five suicides in state prisons that year could have likely been prevented had the state adhered to a 2023 injunction for healthcare requirements. 

What are both sides saying? 

Corrections reform advocates and the inmates’ attorneys initially said they viewed a receiver as a last resort, but argued the department had not come close to complying with court orders for improvements, making it a necessary next step. 

“No remedies other than receivership have a realistic hope of righting this foundering ship,” they wrote in court records.  

The department, meanwhile, disputed advocates’ account of the care being provided. 

“While the plaintiffs may not be interested in drawing attention to the significant progress being made by the department to improve the delivery and expansion of health care services across prisons, the department certainly is,” the department said in a February 2025 statement. “Instead of recognizing the irrefutable change happening across the ADCRR, the plaintiffs continue to move the goalpost.”

The state has continued to oppose the takeover and appealed Silver’s decision to grant the receiver to the U.S. Court of Appeals for the Ninth Circuit. It argued that the order should be reversed because substantial progress is already being made to improve healthcare. 

After the U.S. Supreme Court denied a request to delay the takeover last week, the state made a last-minute request with a panel of judges in the Ninth Circuit on Wednesday. Officials are arguing that the status quo should be preserved when oral arguments in the appeal are only a few weeks away, in December.

“Against that modest delay, the harms of denying a stay are irreversible: a federal receiver will assume ‘[a]ll duties and authorities vested by law in the Director of ADCRR relating to the health care of the class members,’  and the state will begin paying ‘[a]ll costs incurred during the receivership’ 1-ER-11) with funds the state cannot recover if the orders are reversed,” they wrote.

If the request is denied, the changes will begin on Oct. 19 – which is likely given that courts have three times denied requests to delay the takeover.

Advocates said they are hopeful about what comes next. 

“The severity of harm and the fact that we all know what needs to be done to address it is frustrating,” Hart said. “But I’m optimistic that the receiver is the thing that is finally needed to improve care and end this case.”