Monitoring shows prison health care provider NaphCare, Arizona still noncompliant after 2022 suit

In 2022, Judge Roslyn Silver ruled that Arizona was violating
prisoner’s rights by not providing proper care and that health-care
faults were causing preventable deaths in Arizona prisons. That case,
Jensen v. Thornell, led to the Arizona Department of Corrections
Rehabilitation & Reentry implementing changes to its quality of care
up to bring it to constitutional standards via changes in staffing,
higher quality physical care and access to mental health care.

However, the case didn’t end the issues. In 2023, the Arizona
district court issued another injunction to speed up the process,
ordering the state to improve its health-care staffing, bring in
additional physicians and hit benchmarks laid out by the court. In 2024,
though, the problems remain.

“They’re still enormous problems, and some of them haven’t improved
at all,” said Donna Leone Hamm, director of Middle Ground Prison Reform,
an Arizona nonprofit.

There is a stalemate between the Department of Corrections, provider
NaphCare and Arizona courts. The court battle has raged for more than a
decade. And in the eyes of the courts, only marginal improvements have
been made.

Independent court monitor reports filed in July claim many objectives
had not been met as of April. Noncompliant or overdue areas include
hiring enough of psychiatric staff and additional physicians and having
proper medical facilities to house no less than 200 patients. The
reports also claim that the prison system is not compliant with rules
about emergency response equipment, including automated external
defibrillators or oxygen.

However, NaphCare claims to be making improvements on providing proper care and staffing to its facilities.

“NaphCare is continuing to innovate and enhance health-care services
within Arizona prisons by enhancing the TechCare system, expanding staff
training, increasing patient digital engagement, and developing
specialized care programs like opioid treatment. These initiatives aim
to elevate compliance and set national benchmarks in correctional
health-care quality,” a NaphCare spokesperson said in a statement.

The Corrections Department began a pilot project in July at a prison
in Yuma to test staffing levels and establish a plan for future
staffing. However, the department has also paused hiring until contract
amendments with the state have been signed.

“One of the things that the court experts told Judge Silver in their
report was that there’s all this new staff that needed to be hired, and
NaphCare would not do it for months because they said their contract
with the state needed to be amended first before they would even try to
recruit more staff,” said Corene Kendrick, deputy director of the
American Civil Liberties Union National Prison Project. “And so that’s
kind of a problem if the company isn’t willing to do things that ADCRR
is asking them to do and that are relevant to court orders until the
amendment gets them.”

The state, the department and NaphCare are still attempting to
resolve all the issues by hiring staff and increasing inmates’ access to
care.

“The bottom line is, on a daily basis, day to day, people are
suffering because of inadequate medical care,” Hamm said. “We’ve got
cancer patients. I’ve got a guy who’s had parasites all over his head
and arms and in his eyes, and they’ve been ignoring the real problem
for, he says, two years, and they still haven’t scheduled him for a
specialist. And you can only do so much with creams and ointments.”

NaphCare has faced lawsuits across the country, including in Arizona.
In Pima County, the company has been docked around $3.1 million in
financial penalties due to its failure to meet contractual obligations,
according to reports from Arizona Luminaria. The 2022 per-capita deaths in the county jail were four times the national average, according to a report from the Tucson Sentinel.

“Right now, what the department is still doing is cooperating with
the private health-care provider and saying, ‘OK, here’s what the court
told us to do,’” Hamm said, noting that the fines NaphCare and other
providers have received haven’t seemed to speed up compliance. “They’re
making so much money in profits that it doesn’t hurt them to be fined,
they make a sufficient profit that being fined apparently doesn’t harm
their bottom line that much.”

In a document from NaphCare, the company claimed to have
“successfully staffed all critical aspects of patient care” and that
“the NaphCare mental health team has implemented a process to complete
comprehensive mental health evaluations at reception/intake for patients
transitioning from jail to prison.”

NaphCare has also implemented other programs to address Arizona
health outcomes, such as a gender-identity director to provide care to
transgender inmates and implementation of statewide Hepatitis C
treatment, according to the document.

The Corrections Department has also reported some progress in its
efforts to mitigate the issues the injunction addresses. The department
declined to answer questions but, in its Jensen Injunction Progress report
published in September, the department reported an increase in
residential care units and employees. It has also lowered the number of
people in maximum custody, Arizona’s version of solitary confinement,
which has been shown to put inmates at severe mental health risks. The
department has lowered the number from 356 in January 2023 to 256 in
August 2024.

A recent study from National Alliance on Mental Illness
found that any time in solitary confinement increases risk of death in
the first year of release, with suicide listed as the most common cause.

The court views these improvements as marginal. Silver said in March
the conditions still remain “fundamentally lacking,” and improvements
must be made to avoid a third contempt of court case.

The ACLU and other groups have been calling for receivership to put
the care of the prisoners under the court’s authority rather than the
Corrections Department.

“Over the years in the litigation, in this case, we have asked the
judge to appoint a receiver to take over the management of delivery of
health care to the incarcerated people in Arizona.

So far, she has not done so,” Kendrick said. “It appears that her
thinking to date on it has just been that she wanted to kind of see how
things went for the department and their health-care vendors to
implement the reforms.”