Confronting deliberate indifference: Parsons v Ryan settlement reached.

 EDITED OCT 14, 2014 3:48pm

This first press release is just in from the ACLU of Arizona. I think the DOC is getting off easy without having a public trial, but it saves money and time to do this instead. They were definitely going to lose...

The second press release is from the head of the AZ DOC, Charles Ryan, the guy who was named in the suit. Sounds like he won the lawsuit or something. These are vastly different accounts of the settlement. My bet is that the AZ DOC put the most spin on their version, but it concerns me that they say the following:


" “This is positive news,” said ADC Director Charles Ryan.  “On the eve of trial, the plaintiffs in this case have essentially agreed that the department’s current policies and practices, along with recent enhancements to programming opportunities, adequately addresses the plaintiffs’ concerns relating to constitutional healthcare and conditions of confinement for maximum custody and mentally ill inmates. "

AND:
 
" ADC will monitor its own compliance, thus avoiding costly court oversight, and the Plaintiffs’ attorneys, through record review and on-site tours will confirm compliance, as well."

Say what??? No way!!!

I'm going to have to read the settlement docs myself and get back to you all with another analysis..

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Arizona Agrees to Major Improvements in Prison Health Care, Crucial Limits on Solitary Confinement in Landmark Settlement

For Immediate Release
October 14, 2014

CONTACT:

Alexandra Ringe, American Civil Liberties Union, media@aclu.org, 212-549-2666
Steve Kilar, ACLU of Arizona, skilar@acluaz.org, 602-773-6007
Don Specter and Corene Kendrick, Prison Law Office, dspecter@prisonlaw.com and ckendrick@prisonlaw.com, 510-280-2621

PHOENIX – The American Civil Liberties Union, the ACLU of Arizona, the Prison Law Office, and co-counsel today filed a settlement agreement in their class-action suit on behalf of more than 33,000 prisoners in Arizona’s state prisons. Under the settlement, the Arizona Department of Corrections must fix a broken health care system plagued by long-term and systemic problems that caused numerous deaths and preventable injuries. The settlement will also allow prisoners in solitary confinement who have serious mental illnesses to have more mental health treatment and time outside their cells, and will make other critical reforms in prison conditions.

“The Arizona Department of Corrections worked with us on a settlement that shows a commitment to protecting prisoners’ physical and mental health,” said David Fathi, the Director of the ACLU’s National Prison Project. “We hope other states will now find ways to provide adequate medical, mental health, and dental care to their prisoners.”

“The Arizona Department of Corrections has agreed to changes that will save lives,” said Don Specter, Director of the Prison Law Office. “This settlement will bring more humane treatment for prisoners with serious health care needs, and the potential for their conditions to improve rather than worsen.”

The settlement in Parsons v. Ryan requires the Arizona Department of Corrections (ADC) to meet more than 100 health care performance measures, covering issues such as monitoring of prisoners with diabetes, hypertension, and other chronic conditions; care for pregnant prisoners; and dental care.

The settlement also requires ADC to overhaul the rules for prisoners with serious mental illnesses in solitary confinement. Instead of spending all but six hours a week in their cells, such prisoners will now have a minimum of 19 hours a week outside the cell, and this time must include mental health treatment and other programming. ADC must also restrict guards’ use of pepper spray on these prisoners, using it only as a last resort when necessary to prevent serious injury or escape.

The settlement provides for ongoing monitoring and oversight by the prisoners’ lawyers to make sure the state is complying with its terms.

The groups filed the federal lawsuit in 2012, challenging years of inattention to the health needs of state prisoners and improper and excessive use of solitary confinement, resulting in serious harm and unnecessary deaths. Judge Neil V. Wake of the U.S. District Court in Phoenix certified the case as a class action in March 2013, and the U.S. Court of Appeals for the Ninth Circuit affirmed that ruling in June 2014. Last month, the groups filed reports by nationally recognized experts in corrections and in medical, mental health, and dental care, showing system-wide problems with the prisons’ health care and excessive use of solitary confinement.

In addition to the ACLU and the Prison Law Office, other attorneys on the case are Perkins Coie, Jones Day, and the Arizona Center for Disability Law, which is also a plaintiff in the case.

Click here for a copy of the SETTLEMENT stipulation filed today with the court. 

Click here for a copy of the EXHIBITS to the stipulation.

For more information about Parsons v. Ryan:

aclu.org/prisoners-rights/parsons-v-ryan

For information about the ACLU’s National Prison Project:
https://www.aclu.org/prisoners-rights

For information about the Prison Law Office:
www.prisonlaw.com

For information about the Arizona Center for Disability Law:
http://www.acdl.com/

---now for the official state version----

ARIZONA DEPARTMENT OF CORRECTIONS

1601 W. JEFFERSON

PHOENIX, ARIZONA 85007

(602) 542-3133

www.azcorrections.gov    

JANICE K. BREWER                                                  CHARLES L. RYAN GOVERNOR                                                                            DIRECTOR

For more information contact: Doug Nick dnick@azcorrections.gov Bill Lamoreaux blamorea@azcorrections.gov

Tuesday, October 14, 2014

Parties reach settlement agreement

and seek to vacate Parsons v. Ryan trial

PHOENIX (Tuesday, October 14, 2014) – The Arizona Department of Corrections (ADC) has reached a settlement agreement in collaboration with the ACLU, Prison Law Office and ACDL prior to the pending trial.

The parties have agreed to approximately 100 performance measures applicable to medical, mental health, dental and conditions of confinement.

“This is positive news,” said ADC Director Charles Ryan.  “On the eve of trial, the plaintiffs in this case have essentially agreed that the department’s current policies and practices, along with recent enhancements to programming opportunities, adequately addresses the plaintiffs’ concerns relating to constitutional healthcare and conditions of confinement for maximum custody and mentally ill inmates.

“In regards to those issues, the settlement notwithstanding, it’s unfortunate that the plaintiffs continue to use rhetoric such as ‘solitary confinement’ to describe housing for some inmates.  No such confinement exists in our institutions.  The Department of Corrections has always followed nationally-accredited standards for housing single-cell inmates that include requirements for natural daylight and contact with others, and out-of-cell time.

“Additionally, it should be noted that Arizona’s inmate mortality rates, including incidents of suicide, are within the national average for corrections departments.  In 2012, the most recent year for which statistics are available, Arizona reported 215 deaths per 100,000 inmates, compared to the national average of 254 per 100,000.  Additionally, Arizona averaged 17 inmate suicides per 100,000, which is in line with the national average of 16 per 100,000.

“By avoiding a costly trial, the Department saves significant resources that can be further directed towards continuing to provide constitutional healthcare and structured programming to support successful community reintegration.  This is especially relevant in light of the fact that despite the state of California spending nearly $18,000 per inmate for health care costs due to two decades of litigation by the same plaintiffs in the Parsons case, California is still under court supervision and the inmate mortality rate there exceeds that of Arizona. 

By contrast, Arizona spends nearly $3,800 per inmate in health care costs.

ADC will monitor its own compliance, thus avoiding costly court oversight, and the Plaintiffs’ attorneys, through record review and on-site tours will confirm compliance, as well. ADC, through its contracted vendor, must meet specific compliance thresholds at its facilities. Within two years, monitoring of performance measures automatically terminates when those performance measures meet agreed-upon thresholds.  ADC can petition the court to terminate the entire settlement agreement after four years.

Execution by Deliberate Indifference: Killing Robert W. Murray.

UPDATED JULY 1 2014: There's nothing new about this, sadly - the AZ DOC has been executing prisoners all along by way of failing to treat their critical  medical and psychiatric conditions. Three death row prisoners in just over  a year have also committed suicide...

You must be a subscriber to see Gary Grado's newest article at the Capitol Times  about the above notice of Robert Murray's death -  if you can afford it,  check it out. Below is the original piece on Murray's cancer last fall, also by Grado, along with my post at the time. Not sure anything more needs to be said, except condolences to anyone who might have cared about this prisoner, as well as to the loved ones of his victims, for whom this will be an emotional time as well. 

----------------

SOS from Arizona's living dead: 
Deliberate indifference to life on death row
(originally posted to arizonaprisonwatch.org on September 26, 2013 7am)

 one of many letters received at AZ Prison Watch re: 

prisoner frustration over difficulty accessing medical care.

A big thanks goes out to Gary Grado at the AZ Capitol Times for interviewing this prisoner, and to the publication for making this particular article accessible to non-subscribers. Prisoners don't make sympathetic news subjects - especially not those on death row. A lot of folks would just as soon let Murray die of throat cancer untreated, in favor of putting those health care resources into the community (as if the state would actually re-direct "savings" there, instead of into the private pockets of profiteers). 

All I can say is that withholding medical care from Murray because the state plans to kill him anyway is akin to choosing to execute him by applying acid to his throat in small doses over the course of  9 months or so, letting it eat slowly away at his ability to  swallow, speak, and breathe, knowing this will not only kill him, but will make him suffer horribly as he dies. This has nothing to do with one's feeling about the death penalty - it's a question of whether or not you are for the constitution and against torture. If you believe in the rule of law, and that we should not torture our prisoners, then you have to support the provision of a basic standard of medical and mental health care to them.

The other thing is that prisoner health IS public health, and if we don't treat them inside, they come out with high rates of chronic illness, infectious disease, psychiatric disability, and so on. The imprisoned population is especially high-risk, medically, and many live marginally once back in the community, where they are more likely to lack access to health care than most non-felons. In prison they're frequently exposed to things like Hepatitis C (at least 40% of prisoners are believed to be infected), but as a captive patient population, they would be more likely than not to follow up on treatments and regimens that lower their mortality and long term health risks considerably, if their dietary plans and health care provider will offer them.

But that's not what appears to be happening. Deliberate indifference to human suffering is the absolute worst cancer there is in a society, and it's metasticized from the head of the AZ DOC to the agency's extremities. I hear stories like Murray's all the time, sadly - and it's not just the guys on death row. Remember Benny Joe Roseland? I've written to him a few times, but haven't heard back from him since writing that post. DOC says he's still alive, but that's all I can get from them.

Furthermore, as Dan Pochoda points out below, how we treat our prisoners says a lot about our society. The conditions in Arizona's prisons - from the medical neglect to the prevalence of heroin, the dominance of criminal gangs, and the rampant racialized violence - are among the worst in the country. There was a brief spell of progressive vision a the AZ DOC while Dora Schriro was director, under then-governor Janet Napolitano, but she was often mocked as being a "thug-hugger" for favoring rehabilitative programs over punishments, and her efforts were frequently undermined by the Good Old Boys network of DOC administrators and officers.

According to prisoners and former employees, things at the AZ DOC got dramatically worse as soon as Jan Brewer became governor, bringing Charles Ryan out of retirement to be her chief disciplinarian at the AZ DOC. The culture of contempt for prisoners and human rights that permeates that institution has actually been decades in the making, much of it under the direction of the younger Chuck Ryan, so all the bad stuff began to flourish again once he took over the reins there. 

I don't understand that man at all, I have to say. He's spent his career climbing that ladder, but now there, he appears to have utterly ceded control of his prisons to the gangs and profiteers - either that, or he's knowingly and intelligently aiding and abetting them. In either case,  his directorship  should be an embarassment to the Governor's office - for some reason Jan still stands by her man, though. 

Check out the other work the Capitol Times has been doing on the prison system here. If you're a subscriber, this is a pretty good piece that just came out about the class action lawsuit over health care, also by Gary Grado:

Exhibit in class-action lawsuit details failings of prison health system

-------from the AZ Capitol Times (9/16/13)--------

Prison ordeal

Death row inmate struggles with cancer

By Gary Grado

Published: September 16, 2013 at 8:41 am

A lab discovered death-row inmate Robert Murray had cancer the same day a Scottsdale surgeon removed his tonsils, but his disease went unknown to him and untreated for seven more months.

As Murray, 48, and his lawyers try to figure out what went wrong with his medical treatment, one thing is certain. The breakdown coincided with the turmoil surrounding the Department of Corrections’ transition to a private health care provider for Arizona prisoners, and his situation didn’t improve after the first company parted ways with DOC and a new company came under contract.

Murray endured long, painful delays between doctor’s appointments, a misdiagnosis, and a time in which blood from a burst abscess on his tonsil gushed from his mouth. He came to learn he had cancer when the surgeon he hadn’t seen in months asked him if he was finished with radiation to treat the illness, a treatment he never had.

Despite the delays, the cancer didn’t spread. Murray said an oncologist told him that although the situation could have become grave, he should have a full recovery with proper treatment.

“It was prayer, luck it just didn’t explode like it could have,” Murray said in a 21-minute interview from death row in Arizona State Prison Complex-Florence, where he’s been locked up since October 1992.

Such allegations aren’t unusual. A class-action lawsuit alleging DOC has provided inadequate health care for years offers other medical horror stories. And a suit recently filed by the survivors of an inmate who died in October 2012 alleges employees of Wexford Health Sources Inc. of Pittsburgh refused to treat him while he convulsed on the floor. Wexford is a company that provides prisoner health care in Arizona and elsewhere.

“We get weekly at least one letter that is equivalent, literally, to this fellow on death row,” said Dan Pochoda, the legal director for ACLU-Arizona.

Pochoda is one of more than 20 lawyers involved in the class action suit. He said the medical hardships of prisoners don’t resonate with the public, but they should because the state has a heavy obligation to provide adequate health care once it takes control of someone’s life.

“To paraphrase Dostoevsky, the test of a society is how they treat persons in prison,” Pochoda said.

Pleas for help

Murray and his brother, Roger Murray, are on death row for convictions in the May 14, 1991, robbery and murders of Dean Morrison, 65, and Jacqueline Appelhans, 60, at their store in Grasshopper Junction in Mohave County.

Morrison and Appelhans were found face down in their bathrobes, shot several times each in the head with shotguns and handguns. Appelhans was clutching Morrison’s arm.

Murray wrote a book titled “Life on Death Row” in which he denied committing the murders.

He has contended with an assortment of health problems during his 21 years in prison, and it was during an examination in February 2012 that he first complained of a lump in his throat.

Murray’s tonsils were becoming swollen and sore by April 2012, which was one of the final months that DOC provided medical care. Murray saw a DOC doctor in May and was diagnosed with an infected tonsil and given antibiotics.

Just days before his appointment, DOC and Wexford Health Solutions announced the company had been awarded a five-year contract to provide onsite medical, dental, pharmacy and mental health care, as well as the administration of third-party services.

Murray claims in a nine-page affidavit that the antibiotics had no effect and his many requests over the next month to see a doctor went unfulfilled as the swelling worsened and swallowing became difficult.

“His neck and face were visibly deformed,” said Murray’s attorney, Jennifer Garcia, a deputy federal public defender.

Wexford took over on July 1, 2012, and the company informed Murray he was on a waiting list to see a doctor, even as he continued to submit medical requests pleading for help.

“At least once during this period I overheard RX delivery nurses state that ‘Wexford has no available doctors for (the infirmary),’” Murray wrote.

In a Cure Notification, a letter to Wexford to outline how it wasn’t complying with the contract, DOC said the company’s staffing shortage created “inappropriate scheduling gaps in on-site medical coverage.”

In his requests to see a doctor, Murray writes about shooting pains in his ear, choking and coughing and difficulty breathing. He saw a nurse practitioner on July 20, 2012, who became alarmed by his condition and prescribed “magic mouthwash,” a formula of various medicines used to treat ulcers in the mouth.
Four days later the abscess burst.

“A warm fluid gushed into my mouth, I thought I may be vomiting and hurried to my sink,” he wrote.

He was rushed to the hospital, but he didn’t see a surgeon until September and wasn’t on the operating table until Nov. 19, 2012.

DOC, meanwhile, was already unhappy with Wexford’s performance, stating in the Cure Notification that the company was inadequately staffed, administered medication incorrectly, inconsistently and incompletely, and lacked a sense of urgency in addressing crisis situations.

DOC referred to several incidents in which it said Wexford did not comply with the terms of the contract, including not giving medication to a mentally ill inmate who hanged himself and a nurse who contaminated diabetes insulin with syringe tainted with Hepatitis C and continued to inject inmates with it.

Wexford responded with a letter of its own explaining that “the majority of the problems Wexford now faces are long-standing issues, embedded into (DOC) health care policy and philosophy, and which existed well before Wexford Health Sources assumed responsibility of the program.”

Wexford also alleged that DOC kept key information hidden during the procurement process.

An aggressive form of cancer

Dr. Joel Cohen of the Allergy Ear Nose and Throat Center in Scottsdale removed Murray’s tonsils on Nov. 19 and sent them to a nearby lab. The lab confirmed he had cancer and phoned the results to Cohen the next day, according to the pathology report.

Dr. Sun Yi, a University of Arizona professor who specializes in cancers of the head and neck, said that after diagnosis, blood work and scans would be done to determine the severity, or stage, of the cancer, a process that generally takes a few months.

From there, the patient would be referred to various oncologists.

“With malignancy, the more time you wait the more time the tumor has to continue to populate and grow,” said Yi, who is not involved in the case. “The worst case scenario is the cat’s out of the bag situation where it metastasizes and becomes phase four and for most cancers incurable at that point.”

Yi said cancer in the throat is extremely aggressive.

There are no records of any of the steps Yi described in Murray’s medical file.

Murray said Cohen wanted to see him 14 to 21 days after the surgery, but “ADOC-Wexford failed to take action.”

Cohen said he reported the cancer by telephone to a doctor at DOC on Nov. 20, 2012, and recommended treatment.

The doctor said he regularly treats prisoners and he understands there are all sorts of prison protocol that must be followed for each visit. He typically wants to see a patient for post-operative visit in 10 to 14 days.

“The prisoners can’t always come back when they’re told to come back,” Cohen said.

He said it is not his responsibility to prescribe the cancer treatment.

A spokesman for DOC and spokeswoman for Wexford declined to comment for this story. The agency and company agreed Jan. 30 to end the contract and DOC signed a new one with St. Louis-based Corizon Health Inc., which took over services on March 4.

Murray’s throat was still irritated and swollen in the meantime, and he got an appointment with Cohen on May 14.

“He’s talking to Corizon all the time about this problem and no one seems to be addressing them for months either,” Garcia said. “It doesn’t seem to me things have been measurably better under Corizon.”

Murray said Cohen asked him about his radiation treatment, which he never had, but the doctor still didn’t tell him about the cancer.

Records indicate Murray was prescribed radiation and a CT scan that day, but there is nothing in the record explaining why. When Murray returned to the doctor’s office on June 7 he saw Lee, Cohen’s associate.

“He said, ‘You have cancer, you didn’t know,’” Murray said. “It was kind of an astounding moment, surreal.

I kind of expected something was not right.”

Ray Norris, a medical malpractice attorney with the firm Gallagher and Kennedy, said medical negligence is determined by whether a doctor fell below the standard of care.

Norris, who is not involved in Murray’s case, said standard of care is measured by what an ordinary, prudent, and reasonable health care provider would do under the same circumstance.

“If there was a breach of the standard of care, the question then becomes causation, or in other words, what difference did it make,” Norris said.

Murray’s theory is he thinks Cohen expected him to return for a follow up visit within a few weeks and was going to inform him then about the cancer, but when Wexford failed to schedule the appointment Cohen never followed up. “I think it was probably just an accident, but an accident can be easily overlooked,” Murray said.

Murray is still undergoing treatment, and while it isn’t going at the pace he would prefer, he said he’s been assured it is normal pace for treating such a cancer. He said he is still considering his options on filing a lawsuit and looking for a civil lawyer.

Health Decline

May 2012: Inmate Robert Murray diagnosed with possible infected tonsils and given antibiotics. Wexford Health Solutions is awarded $349 million contract to provide health services to Arizona prisoners.

June 2012: Swelling in neck worsens.

July 1, 2012: Wexford takes over medical services.

July 24, 2012: Abscess in neck bursts and Murray rushed to hospital.

Aug. 17, 2012:  In an incident not related to Murray, Wexford nurses are accused of improperly administer medication by making inmates lick powdered medication from hands.

Aug. 23, 2012: Mentally ill inmate who didn’t receive psychiatric medication for weeks found hanged in cell.

Aug. 27, 2012: Wexford nurse allegedly contaminates diabetes insulin with syringe tainted with Hepatitis C.

Sept. 21, 2012: Arizona Department of Corrections informs Wexford of assorted contract breaches.

Nov. 19, 2012: Murray, whose face is deformed from swelling, undergoes tonsillectomy and lab results show he has cancer.

January 2013: Murray’s requests for follow up with surgeon unfulfilled, problems and pain with neck persist. Wexford and DOC agree to cancel contract. Corizon becomes new contractor.

June 7, 2013: Murray informed he has cancer that went untreated for seven months.

Corizon HealthScare: Another death row suicide.

Most Arizonans probably think "good riddance" whenever a death row prisoner commits suicide. I've seen such remarks on comments following articles posting about young drug offenders hanging themselves in jail or prison, too, however, suggesting a particular public callousness towards all prisoners of the state, as well as their survivors. What I've seen in the wake of these suicides, though, has been the grief of the survivors, who dont deserve the community's abuse or ridicule when searching news articles for answers, and I know that in cases where a killer dies, it brings up all sorts of feelings for the survivors of victims as well. Condolences to all of you whose grief is triggered by this news.

That said, this is to announce that another condemned prisoner has beaten the state to the punch and taken his own life: that's three from death row in less than nine months. Gregory Dickens, 48, was preceeded by Dale Hausner in June and Milo Stanley in May of 2013. 

 
The deaths of these condemned men is part of a streak of suicides and suspicious, premature deaths that have happened since Corizon took over the contract to provide medical and psychiatric services for AZ DOC prisoners in March 2013. To make a sweet profit at less than the state would have provided such services for, they're cutting corners wherever they can - apparently mostly for prisoners they think the public doesn't care about anyway, like these guys held in AZ DOC's supermax prison complex, ASPC-Eyman, which includes death row.  Say what you will about the evils some of them may have perpetrated, but we are condoning torture through gross medical neglect.

Like medical care, psychiatric "treatment" under corizon has been streamlined to maximize efficiency and company profit. This May 2013 letter from advocate Donna Hamm to DOC Director Charles Ryan illustrates the kind of "care" prisoners at the Supermax are getting from Corizon. Keep in mind that many of these men were imprisoned in the first place or sent off to Supermax because of poorly treated psychiatric conditions - and that most male suicides are occurring in these maximum custody and solitary confinement cells. 

Ms. Hamm was soon put on notice about other troubling practices and policies put in place by Corizon for evaluating and treating serious mental illness, as indicated in this October email to the DOC director. Mr. Ryan's responses to her letter are embedded in the email in bold letters.

Note that Mr. Ryan asserts all these men received "private consulations with the provider". That's not what the men say, though, as evidenced by this email from a mother a month ago:

"He did try to get mental health when during his time in the minimum unit but he was never called in. When he was in medium security unit he was finally called in for evaluation, he was woken up at 2am, handcuffed, and taken to Central unit. At that time, as no-one was telling him what was going on, and he thought, he was gong to get moved there and he could get executed. The visit was a "telemedical" visit and he had to speak with someone over the TV. Obviously, he did not like the fact he had to speak in front of other inmates about his issues. The frequency of his anxiety attacks increased significantly immediately after and he declined further care...."  


Given that at least ten prisoners now (perhaps more, as many young recent deaths have been noted by DOC as due to "unknown causes") have killed themselves in less than a year with Corizon HealthScare, it seems as if its' time for the DOC to seriously re-evaluate that contract. 

AZ legislators who ordered DOC to privatize the health care for prisoners should be less worried about assuring corporate profits to Corizon and more concerned with public health consequqneces of mass incarceration and poor prison health care. Keep in mind that 95% of these prisoners will someday return to the community - over 40% of whom are infected with Hepatitis C now, due to rampant heroin addiction in the prisons and an obscene lack of substance abuse treatment services (only 4% of state prisoners are able to access help for their addictions in a given year). Prisoner health IS public health.

From: Middle Ground Prison Reform

Sent: Friday, October 11, 2013 10:30 AM

To: RYAN, CHARLES; Kim Ives, Litigation Manager; NORTHUP, DAWN; GROSS, ARTHUR; PRATT, RICHARD

Subject: Unprofessional Treatment of Mentally Ill Prisoners

 Mr. Ryan:

On or about October 3, 2013, about 20 men at the Meadows Unit (medium custody) were placed into shackles, chains and cuffs and transported to the Browning Unit (maximum custody) where they were placed in a holding cell, awaiting a video-conference with a psychologist.  Apparently, this is the imminently "professional" manner in which Corizon, with the cooperation of DOC security staff,  is conducting psychological evaluations for dispensing mental health medications.  During the entire time the men were inside the locked holding cell awaiting their turn for the videoconference, the shackles, chains and cuffs were not removed.  This exercise took approximately five (5) hours.  I do not have information about whether the men were fed during the five (5) hours, but I suspect they were not.  If they were, how does one eat  or drink when one's hands are attached to a belly chain?

It should not be surprising to you that these men were extremely upset with this procedure.  The failure to remove the shackles, chains and cuffs for medium custody inmates who were locked in a cell in a maximum custody cellblock is no doubt based upon pure institutional convenience -- another way of putting it would be to say that the guards were too lazy to go through the "effort" to remove security devices that would later be reapplied.  The security implements were not removed from the prisoners until they returned to the Meadows Unit.

Several of the affected inmates have stated to me  that they do not wish to continue on their psych meds if they are forced to go through this psychologically stressful and tortuous exercise in the future in order to be given an impersonal "interview" of very brief duration with someone who is dispensing medications via videoconferencing.

In addition to the reprehensible decision to leave these men in shackles, cuffs and chains, it is particularly important to take note of the fact that these men were transported for the purpose of having their psychotropic medications evaluated, approved or modified/renewed.  Because of the externally-caused psychological stress, it seems quite problematic for any psychiatric professional to be able to make an accurate determination of the patient's affect, response to current course of psychotropic treatment, and potential need for modification of medication or dosage when the patient is presenting under such externally negative conditions. 

It is noteworthy that if these men were so stressed by the procedure that was devised and utilized by the ADOC that they subsequently elect to withdraw from psychiatric treatment rather than be subjected to such an unprofessional and distressing course of action, then the entire "scheme" of psychiatric treatment for these men must be called into serious question.  The Department of Corrections cannot utilize a method that, in fact, directly interferes with the very diagnostic procedure that they are claiming to provide.  This is akin to giving 20 inmates a ride on a super high  roller-coaster and then lining them up to test to see if they need blood pressure medication.

Please answer the follow questions:

1.      Why are medium custody inmates transported to a maximum custody facility in the first place?  This would appear to be a violation of your own Classification Policy which prohibits mixing custody levels.

Browning Unit is the designated facility for tele-med in the Eyman Complex. Custody levels are not mixed during the process. However, it would be allowed by policy to occur since it is lower custody to higher.

2.   You only have two maximum custody facilities, but you have a host of lesser custody units at Florence.  Why not have videoconferencing facilities at each classification level so that custody levels do not have to be mixed?   IF YOU AND CORIZON ARE SAVING SO MUCH MONEY BY VIDEOCONFERENCING RATHER THAN BY PROVIDING PERSONAL CONTACT WITH A PSYCHOLOGIST, PSYCHIATRIST OR DOCTOR, THEN WHY ISN'T SOME OF THAT SAVINGS APPLIED TO INSTALLATION OF VIDEO CONFERENCING IN EACH UNIT?  Or at least at each administrative building in each unit?
 

The practice of tele-med has been in place in ADC for a number of years, long before privatization of health services. It is the practice to place the equipment in the highest custody unit at the complex as policy does not allow to transport to a lower custody unit. It does not preclude transport to a higher custody unit.  Your suggestion will be given due consideration.

3.Prior to chaining and transporting these men for five (5) hours and holding them in a locked cell for so long, were their medications (for other conditions) checked?  Were  diabetics or men with other conditions negatively affected by such conditions imposed for five (5) hours?

The total time of transport reported was 3 hours, not 5. Upon learning that the inmates were left in restraints during this time, the Deputy Warden issued a directive, prospectively, that the restraints will be removed once the inmate is secured in the holding area. All the inmates received their medications prior to the transport and those that had KOP’s were allowed to take theirs as well. The inmates were fed prior to the transport and did not miss any meals.

4.  If it is an inconvenience to apply and remove shackles, cuffs and chains for individual inmates, then why not eliminate all need for shackles, cuffs and chains by installing one more videoconferencing site in the unit -- or at least at a commensurate custody level unit --  where inmates will be cared for via video-conferencing?

Responded to this issue above in #2.

5.   Were each of the 20 men given a private consultation with the doctor, or were they given group consultations while chained, without privacy? 

All inmates that participated in this tele-med visit were provided with a private consultation with the provider.

Please respond in a timely manner.  I would like to insure that this procedure is not taking place at any unit in any prison for Arizona's prisoners.

This has been addressed appropriately throughout ADC.

Donna Leone Hamm, Judge (Ret.)

Director, Middle Ground Prison Reform

------------------------

Corizon's prisoners dying younger from suicide and "natural causes".

Prior to this latest suicide at Eyman, I was concerned about the number of successful suicides of late - most specifically, since Corizon took over. Take a look at what I found when I examined the DOC's death reports from January 2012- October 2013 (which encompasses 6 months of the DOC administering health care, then 8 months of wexford, and 8 months of Corizon). The average age of death is getting dramatically younger (even when controlled for suicides and homicides), and there are WAY more suicides now. Do the numbers yourself. And check out the AFSC-Tucson's report again: DEATH YARDS. There's a lot to it.

Most of the suicides are happening in single cells, and appear to be related to prisoenrs having a poorly managed serious mental illness and/or suiciding for fear of being on the GP yards - but those conclusions require more study, once investigations are complete and state records are available. 

I'm concerned about the suicides and the connection there may be between them and the frequent reports I've received that prisoners on psychiatric medications have had thier meds abruptly stopped by Corizon doctors, and have been changed to less effective meds than they were previously on, including some that really aren't even used  anymore in the free world due to their side effect profiles, like thorazine. 

In the meantime, Eyman prisoners' visits with their mental health professionals are being done by video-conferencing after theyr'e all herded - chained - into a big cell together. I can't tell if the mental health reivews are actually then conducted en masse, or if they are provided some smeblance of privacy but only get about 5 mins of the provider's time. I believe Donna Hamm is trying to sort out exactly how psychiatric evaluations are beign done for maximum security prisoners at Eyman. 

In any case, given the number of suicides at Eyman in the past year, I think they should re-evaluate the effectiveness of whatever it is they're doing there by way of mental health treatment...

-----------------

JAN 2012 - June 2012 : AZ DOC Health care

Jerry McCoy, 53, ADC #108159, died Jan 16 from complications of Hodgkin’s lymphoma
Alfonso Farmer, 23, ADC #219587 died Jan 22 from an apparent suicide
Alvin Rhodes, 64, ADC #264597, died Jan 22 from complications of cancer
Harry Gardner, 82, ADC #167824, died Jan 20 from complications of lung cancer
Forrest Day, 19, ADC #258301, died Jan 27 from a suspected suicide

Francisco Leon, 64, ADC #90634, died Feb 13 from end stage renal disease
James Toppin, 63, ADC #216346, died Feb 12  from apparent natural causes
Daniel Porter, 48, ADC #61424, died Feb 20 from water intoxication
Clifford Fritz, 41, ADC #129311, died Feb 23 from cancer.

Edward Baeza, 56, ADC #43508, died Mar 11 from apparent natural causes
Cesar Carbajal, 35, ADC #268481 died mar 15 from unknown causes
Nolan Pierce, 23, ADC #245734, died Mar 16 from a possible homicide
David Hunt, 34, ADC #109305, died Mar 25  from medication OD
George Bredemann, 69, ADC #83222, died Mar 31 from apparent natural causes

Shon Wilder, 33, ADC #129144, died April 20 from a possible homicide
Isabelle Trujillo, 61, ADC #076085, died April 24 from apparent natural causes
Joseph Venegas, 29, ADC #185473, died April 25 from unknown causes (pneumonia)
David Washburn, 69, ADC #098366, died April 27 from apparent natural causes

Robert Ginan, 69, ADC #220296, died May 7 from apparent natural causes
Owen Vilan, 54, ADC #242276, died May 8 from apparent natural causes
Enrique Orozco, 46, ADC #119841, died May 22 from apparent natural causes
Robert Charo, 61, ADC #049825, died May 23 from apparent natural causes
T Ray Washington, 41, ADC #240344, died May 25 from apparent natural causes
Candelario Baca, 69, ADC #039760, died May 30 from apparent natural causes

Louis Jernigan, 67, ADC #30249, died June 4 from apparent natural causes
Philip Hawes, 64, ADC #253330, died June 4 from apparent natural causes
George Phillips, 69, ADC #058612, died June 13 from apparent natural causes
Herbert Shockey, 77, ADC #025634, died June 21 from apparent natural causes
Xaxier Milea, 39, ADC #255646, died June 26 from apparent natural causes

JULY 2012 - MARCH 2013 : WEXFORD

Nelson Johnson, 31, ADC #143345 died July 1 from apparent suicide
Richard Johnsen, 58, ADC #052572, died July 16, from apparent natural causes
Daniel Salazar, 55, ADC #129065, died July 19 from apparent natural causes
Lawrence Tashquinth, 50, ADC #229672, died July 19  from apparent natural causes
Richard Olivas, 43, ADC #128627, died July 21 from apparent natural causes
Jose Garcia-Morfin, 33, ADC #233520, died July 24 from apparent natural causes
Richard Wojcik, 56, ADC #232593, died July 24 from apparent natural causes
Rock Hannaford, 56, ADC #261578, died July 30 from apparent natural causes

Gregg Large, 48, ADC #247449, died Aug 1 from apparent natural causes
Thomas Truitt, 48, ADC #047727, died Aug 4 from apparent natural causes
Robert Moss, 73, ADC #102474, died Aug 11 from apparent natural causes
Frank Brown, 65, ADC #149637, died Aug 13 from apparent natural causes
Sotero Delgado, 66, ADC #273820, died Aug 16 from apparent natural causes
James Gordon, 55, ADC #140687, died Aug 26 from apparent natural causes
Dixie Arguello, 51, ADC #269814, died Aug 27 from apparent natural causes
Nicholas Martinez, 33, ADC #171587, died Aug 30 from a possible overdose

Darrell Robertson, 33, ADC #258053, died Sept 10 from apparent natural causes
James Makal, 80, ADC #027216, died Sept 13 from apparent natural causes
Ronald Smith, 75, ADC #092788, died Sept 22 from apparent natural causes
Augustine Alvarez, 71, ADC #085367, died Sept 23 from apparent natural causes
Richard Johnson, 60, ADC #232783, died Sept 28 from apparent natural causes

Donald Wisto, 36, ADC #110526, died Oct 7 from unknown causes
Anthony Brown, 43, ADC #077701, died Oct 8 from apparent natural causes
Lonnie Prickett, 63, ADC #073521, died Oct 9 from apparent natural causes
Carroll Sanders, 56, ADC #196447, died Oct 9 from apparent natural causes
Michael Atkins, 48, ADC #263379, died Oct 18 from apparent natural causes
John Mihalec, 77, ADC #104669, died Oct 25 from apparent natural causes
Dallas Richie, 62, ADC #032104, died Oct 27 from apparent natural causes
Alan Cook, 65, ADC #155358, died Oct 28 from apparent natural causes
Cipriano Vigil, 73, ADC #107377, died Oct 31 from apparent natural causes

Timothy Ben, 29, ADC #186585, died Nov 5 from an apparent suicide
John Allie, 53, ADC #042977, died Nov 12 from apparent natural causes
John Beck, 64, ADC #104144, died Nov 14 from apparent natural causes
Jesus Sanchez, 39, ADC #092083, died November 19 from apparent natural causes
Gerald Anani, 58, ADC #269346, died Nov 25 from apparent natural causes
Shane Moulton, 44, ADC #112871, died Nov 25 from apparent natural causes

Monty Hanan, 63, ADC #136053, died Dec 1 from apparent natural causes
Arnold Toliver, 48, ADC #125678, died Dec 5 from apparent natural causes
David Anthony, 64, ADC #184113, died Dec 7 from apparent natural causes
John Ruelas, 46, ADC #059693, died Dec 7 from apparent natural causes
Donald McKay, 57, ADC #270224, died Dec 20 from apparent natural causes
Darryl Gray, 65, ADC #032890, died Dec 25 from apparent natural causes

Richard Glassel, 74, ADC #172967, died Jan 15 from apparent natural causes
William Horton, 48, ADC #062422, died Jan 12 from apparent natural causes
Gary Dixon, 50, ADC #106531, died Jan 28 from apparent natural causes
Nathan Hartman, 36, ADC #156838, died Jan 28 from apparent natural causes
Charles Dawson, 56, ADC #067938, died Jan 29 from unknown causes
Gary Pierce, 69, ADC #041952, died Jan 30 from unknown causes

Robert Akers, 70, ADC #242962, died Feb 1 from unknown causes
Christina Black, 52, ADC #145562, died Feb 12 from an apparent suicide
Robert Sweepe, 63, ADC #093822, died Feb 17 from unknown causes
Bobby Crockett, 49, ADC #106800, died Feb 18  from apparent natural causes
Ernie Lopez, 55, ADC #133681, died Feb 18 from apparent natural causes
Christian Frost, 38, ADC #130811, died Feb 22 from a possible homicide
Rowdy Ferns, 43, ADC #143370, died February 26 from apparent natural causes

MARCH - October 2013 : CORIZON

Vernon Davidson, 58, ADC #127734, died March 3 from apparent natural causes
Rafael Guevara, 23, ADC #254097, died March 11 from heroin overdose
Scott Broadhead, 57, ADC #035145, died March 17 from unknown causes
Kevin Pate, 54, ADC #091377, died March 14 from unknown causes
Jesse Cornejo, 24, ADC #246859, died March 16 from unknown causes
Johnny Lopez, 52, ADC #079275, died March 17 from apparent natural causes
James Smith, 51, ADC #116912, died March 27 from apparent natural causes
William Driver, 72, ADC #162813, died March 29 from apparent natural causes

Kristian Brown, 49, ADC #182532, died April 1  from apparent natural causes
Gary Church, 53, ADC #039345, died April 1  from unknown causes
Billy Lee, 54, ADC #037490, died April 8 from apparent natural causes
Charles Jeffrey, 38, ADC #212819, died April 10 from apparent natural causes
Alberto Jimenez, 36, ADC #138779, died April 14 from apparent natural causes
Joaquin Tamayo, 41, ADC #106163, died April 22 from an apparent suicide
Russell Clark, 53, ADC #059997, died April 25 from apparent natural causes

Paul Henderson, 22, ADC #247636, died May 1 from an apparent suicide
Karl Narten, 82, ADC #024550, died May 6 from apparent natural causes
Milo Stanley, 50, ADC #064794, died May 10 from an apparent suicide
Anthony Martinez, 65, ADC #085596, died May 14 from apparent natural causes
Bobby Smith, 72, ADC #065084, died May 19 from apparent natural causes
Rose Hodges, 49, ADC #113364, died May 20 from apparent natural causes

Mackie McCabe, 57, ADC #049597, died June 2 from apparent natural causes
John Ray, 54, ADC #118850, died June 7 from apparent natural causes
John Jones, 63, ADC #054741, died June 17 from an apparent homicide
Fenton Skaggs, 38, ADC #198534, died June 17 from unknown causes
Dale Hausner, 40, ADC #240702, died June 19 from apparent suicide
Henry Billings, 80, ADC #218617, died June 23 from apparent natural causes

David Valenzuela, 56, ADC #063167, died July 1 from apparent natural causes
Theron Chambers, 72, ADC #040915, died July 3 from apparent natural causes
Galen Lindstrom, 62, ADC #075515, died July 10 from unknown causes
Thomas Herrera, 57, ADC #078507, died July 13 from apparent natural causes
Patrick Hoppes, 48, ADC #242119, died July 17 from an apparent suicide
Alvis Smith, 59, ADC #031588, died July 26 from apparent natural causes.

George Malone, 69, ADC #086899, died August 2 from apparent natural causes
Javier Gonzalez, 23, ADC #217498, died August 14 from an apparent suicide.
Van Branch, 53, ADC #072628, died August 14 from apparent natural causes
George Fierros, 58, ADC #058206, died August 22 from apparent natural causes
Miguel Sanchez, 28, ADC #270127, died August 27 from an apparent suicide.
Marco Chavez, 34, ADC #187239, died August 31 from apparent natural causes

Shawn Southworth, 37, ADC #257109, died September 23 from apparent natural causes
Harold Batista, 21, ADC #270988, died September 25 from unknown causes

Bennie Harris, 54, ADC #067481, died October 1 from apparent natural causes
Richard Hildenbrand, 80, ADC #140990, died October 2nd from apparent natural causes
Gregory Schlundt, 50, ADC #054406, died October 3rd from apparent natural causes
Kevin Wirts, 45, ADC #258690, died October 7th from apparent natural causes
Rusty Anderson, 42, ADC #222642, died October 9th from apparent natural causes
Kenneth Gifford, 48, ADC #128657, died October 9th from apparent natural causes
Michael Melendez, 52, ADC #102559, died October 10th from apparent natural causes
Emmanuel Arline, 28, ADC #198483, died October 18th from apparent natural causes
Steven Ensslin, 40, ADC #090119, died October 19th from unknown causes.
Roosevelt Foster, 68, ADC #051942, died October 19th from apparent natural causes
Todd Hoke, 22, ADC #253951, died October 21 from an apparent suicide
Robert Maxwell, 46, ADC #065789, died October 23rd from apparent natural causes
Woody Trisky, 75, ADC #165447, died October 24th from apparent natural causes
Avtar Sidhu, 51, ADC #278273, died October 28th from apparent natural causes

Parsons v Ryan: Wexford confirms AZ DOC class action allegations.

This was an interesting revelation this week. Big shout out to the foks at Wexford for doing us this service. And good for KJZZ for covering it and linking to the original court documents (linked to below) - which families who are fighting for your loved ones rights need to read.

-----from KJZZ Public Radio-----

Arizona Corrections Health System Broken, Says Former Service Provider

 

KJZZ 91.5

By: Al Macias on 09/25/2013

 

The company that once provided health care services for Arizona’s 33,000 inmates told state officials the corrections health system “is broken and does not provide a constitutional level of care.” That information came from records unsealed by a federal court on Tuesday.

Wexford Health Sources was hired in July 2012 by the Corrections Department to provide health care for the state prison system. The legislature had ordered the department to privatize prisoner health care in an effort to reduce costs. At the time the state was, and still is, facing a class action lawsuit filed on behalf of inmates who alleged the state was not providing adequate health care.

After a review of the prison system’s health care program Wexford found “the current class action lawsuit to be accurate.”

Dan Pochoda is an attorney with the American Civil Liberties Union representing the inmates.

"They specifically said there were four areas that were required for constitutional care and minimally adequate care, and in all four areas the Arizona Department of Corrections failed," Pochoda said.

Inadequate staffing, training and poor record keeping were among Wexford’s complaints. Two months after the assessment, Wexford and the Department of Corrections agreed to sever the 3 year $349 million contract.

At the time corrections officials blamed Wexford for a variety of problems. DOC spokesman Doug Nick would not elaborate.

 "The delivery of health care of comprehensive health care is the subject of ongoing litigation, and the department’s response to any specific allegations will be addressed through the legal process," Nick said.

Meanwhile another provider was hired to serve the inmates, but the ACLU said health care has not improved. It may be several months before the court issues a decision on the lawsuit against the Corrections Department.

View court Exhibit 1 and Exhibit 2, presentation information compiled by Wexford Health Sources.

SOS from Arizona's living dead: Deliberate indifference to life on death row.

 one of many letters received at AZ Prison Watch re: 

prisoner frustration over difficulty accessing medical care.

A big thanks goes out to Gary Grado at the AZ Capitol Times for interviewing this prisoner, and to the publication for making this particular article accessible to non-subscribers. Prisoners don't make sympathetic news subjects - especially not those on death row. A lot of folks would just as soon let Murray die of throat cancer untreated, in favor of putting those health care resources into the community (as if the state would actually re-direct "savings" there, instead of into the private pockets of profiteers). 

All I can say is that withholding medical care from Murray because the state plans to kill him anyway is akin to choosing to execute him by applying acid to his throat in small doses over the course of  9 months or so, letting it eat slowly away at his ability to  swallow, speak, and breathe, knowing this will not only kill him, but will make him suffer horribly as he dies. This has nothing to do with one's feeling about the death penalty - it's a question of whether or not you are for the constitution and against torture. If you believe in the rule of law, and that we should not torture our prisoners, then you have to support the provision of a basic standard of medical and mental health care to them.

The other thing is that prisoner health IS public health, and if we don't treat them inside, they come out with high rates of chronic illness, infectious disease, psychiatric disability, and so on. The imprisoned population is especially high-risk, medically, and many live marginally once back in the community, where they are more likely to lack access to health care than most non-felons. In prison they're frequently exposed to things like Hepatitis C (at least 40% of prisoners are believed to be infected), but as a captive patient population, they would be more likely than not to follow up on treatments and regimens that lower their mortality and long term health risks considerably, if their dietary plans and health care provider will offer them.

But that's not what appears to be happening. Deliberate indifference to human suffering is the absolute worst cancer there is in a society, and it's metasticized from the head of the AZ DOC to the agency's extremities. I hear stories like Murray's all the time, sadly - and it's not just the guys on death row. Remember Benny Joe Roseland? I've written to him a few times, but haven't heard back from him since writing that post. DOC says he's still alive, but that's all I can get from them.

Furthermore, as Dan Pochoda points out below, how we treat our prisoners says a lot about our society. The conditions in Arizona's prisons - from the medical neglect to the prevalence of heroin, the dominance of criminal gangs, and the rampant racialized violence - are among the worst in the country. There was a brief spell of progressive vision a the AZ DOC while Dora Schriro was director, under then-governor Janet Napolitano, but she was often mocked as being a "thug-hugger" for favoring rehabilitative programs over punishments, and her efforts were frequently undermined by the Good Old Boys network of DOC administrators and officers.

According to prisoners and former employees, things at the AZ DOC got dramatically worse as soon as Jan Brewer became governor, bringing Charles Ryan out of retirement to be her chief disciplinarian at the AZ DOC. The culture of contempt for prisoners and human rights that permeates that institution has actually been decades in the making, much of it under the direction of the younger Chuck Ryan, so all the bad stuff began to flourish again once he took over the reins there. 

I don't understand that man at all, I have to say. He's spent his career climbing that ladder, but now there, he appears to have utterly ceded control of his prisons to the gangs and profiteers - either that, or he's knowingly and intelligently aiding and abetting them. In either case,  his directorship  should be an embarassment to the Governor's office - for some reason Jan still stands by her man, though. 

Check out the other work the Capitol Times has been doing on the prison system here. If you're a subscriber, this is a pretty good piece that just came out about the class action lawsuit over health care, also by Gary Grado:

Exhibit in class-action lawsuit details failings of prison health system

-------from the AZ Capitol Times--------

Prison ordeal

Death row inmate struggles with cancer

By Gary Grado - gary.grado@azcapitoltimes.com


Published: September 16, 2013 at 8:41 am

A lab discovered death-row inmate Robert Murray had cancer the same day a Scottsdale surgeon removed his tonsils, but his disease went unknown to him and untreated for seven more months.

As Murray, 48, and his lawyers try to figure out what went wrong with his medical treatment, one thing is certain. The breakdown coincided with the turmoil surrounding the Department of Corrections’ transition to a private health care provider for Arizona prisoners, and his situation didn’t improve after the first company parted ways with DOC and a new company came under contract.

Murray endured long, painful delays between doctor’s appointments, a misdiagnosis, and a time in which blood from a burst abscess on his tonsil gushed from his mouth. He came to learn he had cancer when the surgeon he hadn’t seen in months asked him if he was finished with radiation to treat the illness, a treatment he never had.

Despite the delays, the cancer didn’t spread. Murray said an oncologist told him that although the situation could have become grave, he should have a full recovery with proper treatment.

“It was prayer, luck it just didn’t explode like it could have,” Murray said in a 21-minute interview from death row in Arizona State Prison Complex-Florence, where he’s been locked up since October 1992.

Such allegations aren’t unusual. A class-action lawsuit alleging DOC has provided inadequate health care for years offers other medical horror stories. And a suit recently filed by the survivors of an inmate who died in October 2012 alleges employees of Wexford Health Sources Inc. of Pittsburgh refused to treat him while he convulsed on the floor. Wexford is a company that provides prisoner health care in Arizona and elsewhere.

“We get weekly at least one letter that is equivalent, literally, to this fellow on death row,” said Dan Pochoda, the legal director for ACLU-Arizona.

Pochoda is one of more than 20 lawyers involved in the class action suit. He said the medical hardships of prisoners don’t resonate with the public, but they should because the state has a heavy obligation to provide adequate health care once it takes control of someone’s life.

“To paraphrase Dostoevsky, the test of a society is how they treat persons in prison,” Pochoda said.

Pleas for help

Murray and his brother, Roger Murray, are on death row for convictions in the May 14, 1991, robbery and murders of Dean Morrison, 65, and Jacqueline Appelhans, 60, at their store in Grasshopper Junction in Mohave County.

Morrison and Appelhans were found face down in their bathrobes, shot several times each in the head with shotguns and handguns. Appelhans was clutching Morrison’s arm.

Murray wrote a book titled “Life on Death Row” in which he denied committing the murders.

He has contended with an assortment of health problems during his 21 years in prison, and it was during an examination in February 2012 that he first complained of a lump in his throat.

Murray’s tonsils were becoming swollen and sore by April 2012, which was one of the final months that DOC provided medical care. Murray saw a DOC doctor in May and was diagnosed with an infected tonsil and given antibiotics.

Just days before his appointment, DOC and Wexford Health Solutions announced the company had been awarded a five-year contract to provide onsite medical, dental, pharmacy and mental health care, as well as the administration of third-party services.

Murray claims in a nine-page affidavit that the antibiotics had no effect and his many requests over the next month to see a doctor went unfulfilled as the swelling worsened and swallowing became difficult.

“His neck and face were visibly deformed,” said Murray’s attorney, Jennifer Garcia, a deputy federal public defender.

Wexford took over on July 1, 2012, and the company informed Murray he was on a waiting list to see a doctor, even as he continued to submit medical requests pleading for help.

“At least once during this period I overheard RX delivery nurses state that ‘Wexford has no available doctors for (the infirmary),’” Murray wrote.

In a Cure Notification, a letter to Wexford to outline how it wasn’t complying with the contract, DOC said the company’s staffing shortage created “inappropriate scheduling gaps in on-site medical coverage.”

In his requests to see a doctor, Murray writes about shooting pains in his ear, choking and coughing and difficulty breathing. He saw a nurse practitioner on July 20, 2012, who became alarmed by his condition and prescribed “magic mouthwash,” a formula of various medicines used to treat ulcers in the mouth.
Four days later the abscess burst.

“A warm fluid gushed into my mouth, I thought I may be vomiting and hurried to my sink,” he wrote.

He was rushed to the hospital, but he didn’t see a surgeon until September and wasn’t on the operating table until Nov. 19, 2012.

DOC, meanwhile, was already unhappy with Wexford’s performance, stating in the Cure Notification that the company was inadequately staffed, administered medication incorrectly, inconsistently and incompletely, and lacked a sense of urgency in addressing crisis situations.

DOC referred to several incidents in which it said Wexford did not comply with the terms of the contract, including not giving medication to a mentally ill inmate who hanged himself and a nurse who contaminated diabetes insulin with syringe tainted with Hepatitis C and continued to inject inmates with it.

Wexford responded with a letter of its own explaining that “the majority of the problems Wexford now faces are long-standing issues, embedded into (DOC) health care policy and philosophy, and which existed well before Wexford Health Sources assumed responsibility of the program.”

Wexford also alleged that DOC kept key information hidden during the procurement process.

An aggressive form of cancer

Dr. Joel Cohen of the Allergy Ear Nose and Throat Center in Scottsdale removed Murray’s tonsils on Nov. 19 and sent them to a nearby lab. The lab confirmed he had cancer and phoned the results to Cohen the next day, according to the pathology report.

Dr. Sun Yi, a University of Arizona professor who specializes in cancers of the head and neck, said that after diagnosis, blood work and scans would be done to determine the severity, or stage, of the cancer, a process that generally takes a few months.

From there, the patient would be referred to various oncologists.

“With malignancy, the more time you wait the more time the tumor has to continue to populate and grow,” said Yi, who is not involved in the case. “The worst case scenario is the cat’s out of the bag situation where it metastasizes and becomes phase four and for most cancers incurable at that point.”

Yi said cancer in the throat is extremely aggressive.

There are no records of any of the steps Yi described in Murray’s medical file.

Murray said Cohen wanted to see him 14 to 21 days after the surgery, but “ADOC-Wexford failed to take action.”

Cohen said he reported the cancer by telephone to a doctor at DOC on Nov. 20, 2012, and recommended treatment.

The doctor said he regularly treats prisoners and he understands there are all sorts of prison protocol that must be followed for each visit. He typically wants to see a patient for post-operative visit in 10 to 14 days.

“The prisoners can’t always come back when they’re told to come back,” Cohen said.

He said it is not his responsibility to prescribe the cancer treatment.

A spokesman for DOC and spokeswoman for Wexford declined to comment for this story. The agency and company agreed Jan. 30 to end the contract and DOC signed a new one with St. Louis-based Corizon Health Inc., which took over services on March 4.

Murray’s throat was still irritated and swollen in the meantime, and he got an appointment with Cohen on May 14.

“He’s talking to Corizon all the time about this problem and no one seems to be addressing them for months either,” Garcia said. “It doesn’t seem to me things have been measurably better under Corizon.”

Murray said Cohen asked him about his radiation treatment, which he never had, but the doctor still didn’t tell him about the cancer.

Records indicate Murray was prescribed radiation and a CT scan that day, but there is nothing in the record explaining why. When Murray returned to the doctor’s office on June 7 he saw Lee, Cohen’s associate.

“He said, ‘You have cancer, you didn’t know,’” Murray said. “It was kind of an astounding moment, surreal.

I kind of expected something was not right.”

Ray Norris, a medical malpractice attorney with the firm Gallagher and Kennedy, said medical negligence is determined by whether a doctor fell below the standard of care.

Norris, who is not involved in Murray’s case, said standard of care is measured by what an ordinary, prudent, and reasonable health care provider would do under the same circumstance.

“If there was a breach of the standard of care, the question then becomes causation, or in other words, what difference did it make,” Norris said.

Murray’s theory is he thinks Cohen expected him to return for a follow up visit within a few weeks and was going to inform him then about the cancer, but when Wexford failed to schedule the appointment Cohen never followed up. “I think it was probably just an accident, but an accident can be easily overlooked,” Murray said.

Murray is still undergoing treatment, and while it isn’t going at the pace he would prefer, he said he’s been assured it is normal pace for treating such a cancer. He said he is still considering his options on filing a lawsuit and looking for a civil lawyer.

Health Decline

May 2012: Inmate Robert Murray diagnosed with possible infected tonsils and given antibiotics. Wexford Health Solutions is awarded $349 million contract to provide health services to Arizona prisoners.

June 2012: Swelling in neck worsens.

July 1, 2012: Wexford takes over medical services.

July 24, 2012: Abscess in neck bursts and Murray rushed to hospital.

Aug. 17, 2012:  In an incident not related to Murray, Wexford nurses are accused of improperly administer medication by making inmates lick powdered medication from hands.

Aug. 23, 2012: Mentally ill inmate who didn’t receive psychiatric medication for weeks found hanged in cell.

Aug. 27, 2012: Wexford nurse allegedly contaminates diabetes insulin with syringe tainted with Hepatitis C.

Sept. 21, 2012: Arizona Department of Corrections informs Wexford of assorted contract breaches.

Nov. 19, 2012: Murray, whose face is deformed from swelling, undergoes tonsillectomy and lab results show he has cancer.

January 2013: Murray’s requests for follow up with surgeon unfulfilled, problems and pain with neck persist. Wexford and DOC agree to cancel contract. Corizon becomes new contractor.

June 7, 2013: Murray informed he has cancer that went untreated for seven months.