Arizona prisons chief seeks inmate healthcare takeover delay

In a new court filing, Ryan Thornell acknowledges that it has been nearly 14 years since inmates filed suit alleging unconstitutional neglect in the physical and mental health care provided at the Arizona Department of Corrections, Rehabilitation, and Reentry.

After a series of court orders and fines did not work, Judge Roslyn Silver issued a 200-page order in 2022 finding that the care provided "is plainly grossly inadequate'' and that state officials were acting "with deliberate indifference'' to the substantial risk of harm to inmates. And that resulted in an April 2023 injunction directing the state to remedy the problems.

But attorney Mary O'Grady, hired by the state to defend Thornell, told the judge she should recognize all that has been done since 2023, including spending more on inmate health care. So now she wants Silver to delay the order she just issued appointing a receiver to actually take over and run the health care system for the next five years — a receiver who was given virtually unlimited rights to make changes to not just staffing but how the money is spent.

That claim of things getting better, however, is drawing derision from Sophie Hart, an attorney for the Prison Law Office, which, along with the American Civil Liberties Union, is representing inmates. She told Silver that the state and Thornell — the hand-picked selection of Gov. Katie Hobbs to run the system when she took office in 2023 — "oversell their post-2023 'progress.' ''

"Defendants' own data demonstrate either that defendants still have not allocated sufficient resources, or that those resources are not being managed in such a way to comply with the requirements of the (2023) injunction,'' Hart said. "The evidence of harm was overwhelming and was largely unrebutted by defendants.''

What the state wants, she said, is for Silver to accept Thornell's assurances that things will get better than they are now — and that he will do better.

"They essentially argue that their hoped-for leadership capacity moving forward is what counts,'' Hart said.

"But, as described ... current leadership has failed to implement the necessary reforms,'' she said. And their "continued promises about what they intend to do in the future'' are insufficient to leave Thornell in charge of the health care system.

Ultimately, Hart told the judge, any claims the state will be harmed by wresting control of health care from Thornell are outweighed by what will happen if she doesn't.

"Plaintiffs face the risk of injury up to and including death ''harm that is happening now, and has been ongoing for over a decade precisely because of defendants' inability to make meaningful improvement to their healthcare program,” Hart wrote.

The question now for the judge is whether, after all these years, it is too little, too late.

There has been no lack of warnings.

After the lawsuit was filed in 2012, the state agreed to a settlement to improve care.

But federal judges overseeing the case ruled repeatedly, starting in 2014, that mental and physical healthcare provided to prisoners failed to live up to basic constitutional standards. The judges also twice found the state in contempt and issued multi-million dollar fines.

In 2015, state officials entered into a settlement, promising to do better.

But Silver threw that out in 2021 because of the ADCCR's "pervasive material breaches'' of the agreement. And during a 15-day trial before Silver later that year, attorneys for inmates presented evidence of what they said were "repeated and horrific consequences'' inmates suffered due to poor or inadequate healthcare.

That resulted in the 2022 ruling about "grossly inadequate'' care in the prisons and "deliberate indifference'' by prison officials, and, ultimately, the 2023 injunction laying out what the prison system must do to bring care up to constitutional standards.

It required the state to overhaul how it provided care to inmates, vastly increase the number of doctors and nurses to set levels, and provide better access to specialists. Other parts of the injunction included limits on putting inmates in isolation and requirements to treat opioid addiction and Hepatitis infections among the inmate population.

O'Grady told Silver she should look at all that has been done since 2023.

"The department has more than doubled its healthcare spending, increased healthcare staffing by more than 50%, opened new healthcare facilities, improved existing facilities, increased access to specialty care,'' the attorney wrote. She also said the department has increased the capacity for mental health treatment, ensured that all psychiatrists working for the state are board-certified, and established a task force to develop and track suicide prevention efforts.

"The receivership order largely disregards this progress,'' O'Grady said. "Instead, it emphasizes the department's shortcoming regarding compliance.''

There are places O'Grady acknowledged where the agency has fallen short, like complying with a staffing plan set just last year. Still, she said, the improvements that have been made "factor against a receiver.''

But there are some facts working against her arguments -- including the unwillingness of state lawmakers to fund what the governor said is necessary.

In preparing her budget in January, Hobbs asked for the cash to fund 615 more prison healthcare workers in the new fiscal year that began July 1 to comply with the judge's order to dramatically boost staffing so it could provide constitutionally adequate care to inmates.

But the Democratic governor got less than half the money needed to fund those new posts in a budget deal she cut with Republicans who control the state House and Senate. That provided the cash to pay for slightly less than 42% of the workers the judge said in a 2025 order are needed.

Hart told the judge there is other evidence that, even years after the injunction, the state isn't complying on its own with what it was ordered to do.

Yes, she said, it is true that NaphCare, the private firm contracted to provide inmate care, has filled more of its vacant positions. But Hart pointed out to the judge that one third of the positions she ordered to be filled still remain vacant.

Here, too, Hart said, none of this should now come as a surprise.

"Defendants were on notice that they would be required to significantly increase staffing when they stipulated to the injunction in 2023,'' she told Silver.

In seeking a delay of the receiver taking over, O'Grady advances another argument. She said Silver has jumped the gun by taking that step.

"The court did not attempt less extreme measures to ensure speedier compliance,'' O'Grady said.

Not true, Hart said.

She said it started with the state's 2015 promise to do better, the court's decision to appoint experts to examine conditions, the imposition of more than $2 million in contempt citations, and, ultimately, the 2023 injunction "which offered defendants a hoped-for final opportunity to remedy their constitutional violations.''

"Given defendants' blatant failure to rectify the provisions of unconstitutional healthcare after nearly 15 years, this court's appointment of a receiver is hardly an abuse of discretion,'' Hart said.