Key Points:

• Federal judge to appoint receiver for Arizona’s prison healthcare system

• Receiver to oversee care for over 25,000 state inmates

• Arizona’s prison healthcare system is understaffed and underfunded

The federal judge who ordered the takeover of Arizona’s prison healthcare system earlier this year is looking to quickly appoint a receiver to oversee the care of more than 25,000 state inmates.

Having a receiver in place soon is critical, U.S. District Judge Roslyn Silver noted, because she wants that person to participate in negotiations between Gov. Katie Hobbs and Republican lawmakers for the next fiscal year starting on July 1.

The goal is to ensure that the new budget has enough money to bring inmate care up to minimum standards demanded by the U.S. Constitution.

Silver issued an order last week telling attorneys for the Arizona Department of Corrections, Rehabilitation and Reentry and lawyers for the inmates who sued to interview the former Ohio corrections director and agree on whether she should get the job by the end of this month.

Silver said she wants the lawyers’ written reports on Annette Chambers-Smith by June 1 and said she’ll also interview her as part of her due diligence in picking someone for the job.

Chambers-Smith was the only person recommended to be receiver by the Department of Corrections. The inmates’ attorneys recommended two people as possible receivers, both former state corrections directors, but agreed to support Chambers-Smith.

Democratic Gov. Katie Hobbs wants the Legislature to add $108 million to the prison healthcare budget this coming year to help it comply with Silver’s orders on staffing and healthcare.

But the Republican-controlled Legislature passed a budget earlier this month that largely ignored Hobbs’ executive budget and did not include the extra money to help comply with the judge’s order. Hobbs promptly vetoed that spending plan.

Senate Majority Leader John Kavanagh. R-Fountain Hills, declined to say on Friday why Republican lawmakers didn’t include new money to deal with the prison healthcare case, other than to say the state is appealing and it may be premature.

“Since the courts are involved, no,” Kavanagh said. “We’ll seek legal advice.”

He did call Silver’s February decision to appoint a receiver to oversee healthcare “a federal usurpation of state government.”

Hobbs herself issued a lengthy statement after the receiver decision, saying she “strongly disagrees” with it and arguing that it “overlooks the significant progress the Arizona Department of Corrections, Rehabilitation, and Reentry has made in recent years.”

The case was originally filed in 2012 on behalf of Arizona inmates by attorneys with the American Civil Liberties Union, the Prison Law Office and other prisoner rights groups.

It alleged grossly inadequate care that harmed and even killed inmates. The state agreed to a settlement in 2014.

But in the following years, federal judges overseeing the case ruled repeatedly that mental and physical healthcare provided to prisoners failed to live up to basic constitutional standards and amounted to cruel and unusual punishment. They twice found the state in contempt and issued multi-million-dollar fines.

Five years ago, Silver finally had enough.

She threw out the settlement because of the ADCCR’s “pervasive material breaches” of the agreement. And during a 15-day trial under Silver in late 2021, attorneys for prisoners presented evidence of repeated and horrific consequences suffered due to poor or inadequate healthcare.

In a sweeping 2022 ruling, the judge said care provided by the state at prisons is “plainly, grossly inadequate” and state officials were acting “with deliberate indifference” to the substantial risk of harm to inmates.

The following year, Silver issued an injunction requiring the state to vastly improve its prisoner healthcare system. And while there have been improvements, the state still isn’t providing adequate care. Last year, attorneys sought a court takeover of the system, and Silver agreed to appoint a receiver to run the system in February.

In the 83-page order giving control of the prison healthcare system to a receiver, the judge detailed complaints about continued inadequate physical and mental healthcare at the nine prison complexes across the state.

“But now, after nearly 14 years of litigation with defendants having not gained compliance, or even a semblance of compliance with the injunction and the Constitution, this approach has not only failed completely but, if continued, would be nothing short of judicial indulgence of deeply entrenched unconstitutional conduct,” the judge wrote.

Hobbs has not denied that history but instead insisted, in a February statement, that things are getting better.

“This system was in crisis for a decade, and we’ve worked tirelessly to turn things around,” her statement said. “While progress is not achieved overnight, the improvements we’ve made in a short amount of time are undeniable.”

She said the state had made over $1 billion in new investments over the last three years to improve inmate healthcare, tripling the number of physicians and taking multiple other steps to improve the system. And the governor said Silver’s decision “imposes unrealistic demands and timelines that fail to account for the complexity of these challenges,” pointing to recruiting and hiring challenges.

“Real, lasting change takes time, and we are committed to continuing the progress we’ve made. Arizona’s corrections system is on the right path, and we will not let this decision derail the important work being done to improve outcomes for those in our care,” Hobbs said.

It’s unclear what the governor is prepared to do in budget negotiations to get new inmate healthcare funding.

Hobbs spokesman Christian Slater didn’t respond to numerous messages seeking comment on whether the governor would sign a state budget without the prison healthcare funding she sought in January.

The state filed a notice of appeal on the receiver decision, but has agreed to wait until a one is actually appointed to move ahead.

In the meantime, a panel of the 9th Circuit Court of Appeals is set to hear arguments May 18 on a separate appeal of another of Silver’s orders, the one from June 2025 that set minimum staffing levels for doctors, nurses and other providers.

Although she hasn’t yet laid out in detail the receiver’s powers and responsibilities, the judge said in the May 11 order that they would be sweeping.

The most important task for whoever is ultimately appointed will be “correcting the systemic constitutional failures that have plagued defendants’ healthcare delivery for over a decade,” Silver wrote.

They include fixing chronic understaffing and the state’s failure to enforce its contract with the private company overseeing inmate care, ensuring inmates are treated by physicians instead of nurses, addressing persistent failures in system of patient referrals, data collection and reporting and ensuring the medical system has the needed funding and facilities to care for ill inmates.

“Critically, the receiver must have the powers and authorities necessary to address each of these areas,” Silver wrote.

And the judge left no doubt as to how far that extends, saying the receiver “shall be granted all powers vested by law in the Director of the ADCRR, as they relate to the administration, control, management, operation, and financing of the provision of health care services to class members.

“This authority will embrace the power to negotiate, enforce, terminate, or renegotiate contracts in accordance with the law; implement permanent policy changes; manage resource(s), participate fully in budgeting processes; and make recommendations and requests to the Court,” Silver’s order said.

Finally, the receiver will have the job of developing objectives the prison healthcare system must meet before court oversight ends.

Chambers-Smith ran the Ohio Department of Rehabilitations and Corrections from 2019 through March, when she left the director’s job and began working with Gov. Mike DeWine on criminal justice policy issues.

As corrections director, she was responsible for overseeing 28 prisons holding about 46,000 inmates. Three of the prisons were privately run.

She was also tasked with overseeing prisoner healthcare, with Ohio budgeting $375 million of the $1.5 billion prison budget for that use. And prior to being nominated as corrections director in 2019, she held other Ohio corrections posts for two decades, including overseeing prison healthcare.

Ohio faced a similar class action lawsuit filed on behalf of inmates in 2002, with the state eventually settling the case in federal court by agreeing to vastly improve its prison healthcare system.

As head of the state prison health bureau at the time, Smith-Chambers was the lead corrections official working with the plaintiffs’ lawyers to ensure changes were made, according to David Singleton, currently a professor of law at the University of the District of Columbia.

Singleton was executive director of the Ohio Justice & Policy Center, which filed the 2002 lawsuit, for 21 years and was intimately involved in ensuring the settlement agreement was carried out in full.

“She was pretty much the point person from the prison system standpoint, in terms of trying to make sure the reforms happened,” Singleton told Capitol Media Services. “It happened in a way that obviously was carrying out the settlement, making sure that incarcerated people got the healthcare they needed, but also responsive to the institution’s concerns. So a tough balancing act, but she was really terrific in that role.”

Singleton lavished praise on Smith-Chambers’ ability to juggle needed reforms with the realities of the prison system.

“I found her to be incredibly pragmatic, solutions-oriented,” he said.

“She’s one of the smartest people that I know, and not in an arrogant way,” Singleton said. “She is whip smart and is always trying to figure out … what is the evidence-based way to do something that is going to ensure that incarcerated people are treated like the human beings that they are as well as being sensitive to the needs of the state. So she walks that line very, very well.”

Arizona is spending about $380 million a year on inmate healthcare out of its $1.6 billion corrections budget for 2026 fiscal year, which ends June 30. The state has fewer prisoners than Ohio, with the latest report from March showing just over 34,000 inmates. About 25,200 are held in nine state prisons and the remaining 9,400 split among six private prisons. Private prisoners aren’t part of the current lawsuit.

Unlike Arizona, Ohio primarily uses state employees to provide care and is partnered with the Ohio State University Wexner Medical Center to provide surgeries and other acute care services.

Staffing reports filed with the court show Arizona is still struggling to fill positions as required by Silver.

The reports show Arizona’s prison health contractor, NaphCare, has just 14 of 34 required doctors on staff, 7.25 of 29.7 psychiatrists, 70 fewer registered nurses than the 372 it’s required to have, and just 28 of the 102 emergency medical technicians it should have. Other positions are closer to targets, but in all just three of 13 medical classifications are at or above target levels.

Corene Kendrick, an attorney for the American Civil Liberties Union who has worked on the case for more than a decade, said it’s well past time to see Arizona prisoners get the care they need. After years of failures, that means getting a receiver in place to make it happen.

She called inmate healthcare privatization, which siphons off money for profits that could be going to care, a big driver of the problem. Arizona privatized prison healthcare under a provision slipped into the 2009 state budget.

Unmet required staffing is a major reason that Silver decided to appoint a receiver who can unilaterally make changes.

“It’s done rarely, but, as (Judge Silver) said in her order in February …. she can’t just sit by and sit on her hands and watch the state of Arizona and the Department of Corrections ignore federal court orders and ignore the Constitution, and people are dying, and so she needed to act,” Kendrick said. “And so that’s where we are.”