Chris Chan Prison Letters

Chris Chan Prison Letters – This story was published in partnership with The Marshall Project, a nonprofit news organization that covers the U.S. criminal justice system. Sign up for their newsletter, or follow The Marshall Project on Facebook or Twitter.

In 2017, Walter Jordan wrote a memo to a federal judge at the Arizona State Prison Complex in Florence. “Future Death Notice,” he said with a trembling hand.

Chris Chan Prison Letters

Jordan told the judge that Arizona corrections officials and Corizon Health, the state’s prison system’s private health care contractor at the time, delayed treating his cancer so long that he “would be lucky to be alive for 30 days.” Jordan, 67, had a common type of skin cancer that was rarely life-threatening if caught early, but said he suffered memory loss and severe pain from the lack of attention. The other men in his unit were also denied treatment, he wrote, “everyone falling, screaming, screaming in pain.”

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After reviewing his medical records, Dr. Todd Wilcox, a physician hired by attorneys for state prisoners, agreed that Jordan’s death was preventable. Corizon’s treatment of Jordan’s “excruciatingly unnecessary pain” was “the antithesis of how cancer pain should be managed,” he said.

Wilcox will take the stand in a landmark trial that begins Monday in Phoenix, the latest chapter in a nearly decade-long battle to determine whether Arizona inmates receive the basic health care they are entitled to under the law.

The lawsuit pits Arizona against people detained in its prisons, who argue in a class-action lawsuit that the medical services they receive are so poor that they constitute cruel and unusual punishment. The state’s current health contractor, Centurion, is the latest in a string of companies that have failed to meet with the courts.

Walter Jordan was referred to a dermatologist instead of an oncologist. The treatment “burned a hole in the bone of his skull,” allowing the cancer to invade his brain. Courtesy of the Jordan family

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None of the companies have been named as defendants because, the claimants say, the state is ultimately responsible for their care. The lawsuit was filed in 2012, before private contractors took over Arizona prison medical services. But whether privatization can provide decent care is one of the biggest issues in the trial.

The Arizona Department of Corrections declined to comment on pending lawsuits. Centurion of Arizona and Corizon, which is based in Tennessee, did not respond to multiple requests for comment.

Arizona is one of two dozen states that use a private for-profit contractor to provide prison medical care, and nearly all of them have been sued. But a trial is rare, as most states settle to avoid that specific public scrutiny.

Health care in Arizona prisons is “grossly inadequate,” inmates said in court filings, with crisis-level staffing, delayed or denied treatments and unreliable access to medication.

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Lawyers chronicled a man who died after spreading his swollen legs, his wounds filled with weeping pus and flies; a man with mental illness, so distressed that he chewed off pieces of his fingers; a man entered prison with a small bump on his face that, left untreated, turned into an unsightly tumor the size of a baseball; and several people denied access to regular mental health care who later killed themselves.

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They have every incentive to delay treatment or provide minimal treatment, or count something as treatment when it really isn’t treatment.

The lawsuit could mean the end of privatized care in Arizona’s prisons, or, in an extreme outcome, the end of Arizona’s control over its own prison health entirely. U.S. District Court Judge Roslyn Silver could appoint an outside official to answer to her, or impose additional financial penalties against the state. At the end of the day, Silver must decide: how much reduction is too much when lives are at stake?

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While the trial won’t directly affect other state systems, experts say the results could show officials across the country that courts are serious about enforcing prison health standards, and that failing to provide adequate care can have real consequences.

The case is “a great example of how we got it all wrong,” said Homer Venters, a corrections health consultant who spent years as medical director of the New York prison system. Instead of a judge looking over administrators’ shoulders, “the prison should stop operations if conditions are inhumane or care is inadequate,” he said.

Few prison health systems receive high marks for quality care, whether services are provided by the government or a private company. At least 47 states have been the target of major lawsuits. A judge in a landmark case in California—before health care was privatized—was so impressed with prison medical services there that in 2006, he appointed an outside official to take over the state’s $1.2 billion prison health system.

But bringing for-profit companies into the mix poses additional problems, some experts warn, especially in an environment where patients have little control over their care. “They have every incentive to delay treatment or to provide minimal treatment, or to count something as treatment when it really isn’t treatment,” said Michele Deitch, a senior professor at the University of Texas who studies prison conditions. “It would be much cheaper to make things than to spend money on fighting.”

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Until the 1970s, each state provided medical care in its own prisons. But these services were “unavailable and often primitive,” said Douglas McDonald, a researcher at health consulting firm Abt Associates. There were few doctors on staff, and poor healthcare standards. Inmates without medical training pulled teeth, dispensed medication and performed minor surgeries on each other, according to a case in Alabama.

Then, in 1976, the Supreme Court found that “deliberate indifference by prison staff to a prisoner’s serious illness or injury” was cruel and unusual punishment, prohibited by the Eighth Amendment. Several cases in subsequent decades have made it clear that incarcerated persons have a right to routine and emergency medical, dental, and mental health care that is “adequate . . . commensurate with modern medical science.”

These court decisions forced prisons to hire hundreds of medical staff and pay for expensive hospital stays and procedures. Just as public health care began to rely on “managed care” to contain costs, some states began privatizing prison medical care, using small contractors to hire hard-to-reach staff and negotiate rates with hospitals, specialists and pharmacies, McDonald said.

Arizona began outsourcing its own prison health care in 2012, at a time when several of these small companies combined to form today’s major industry players.

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Newly merged and growing companies were an attractive investment for private equity, says Dan Mista, acting president of Community Oriented Correctional Health Services, a nonprofit that helps jails and prisons improve health care. Unlike hospitals and other settings subject to Medicare’s strict quality standards, Mistak said, prison health care is paid almost entirely out of state coffers, which eliminates many conditions that drive up cost and quality externally.

Arizona corrections officials are “trying to cut corners and save money instead of giving us the medication we need,” says Dustin Brislan. By Dustin Brislan

Medicare offers “rigorous accreditation processes and data transparency,” says Monik Jiménez, an epidemiologist at the Harvard T.H. Chan School of Public Health. In prisons, “we don’t have that with these private providers.”

Arizona has employed three prison health care contractors in the past decade: Wexford, then Corizon and now Centurion. The ongoing litigation – as well as allegations of poor care, disregard for court-ordered quality control measures and chronic staff shortages – has stuck with the three companies.

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An 11 percent reduction in medical staffing from 2012 to 2019, even as Arizona’s prison population remained relatively flat, left prisons with hundreds of fewer providers than needed, according to court documents. During its six-year tenure, Corizon paid more than $3 million in fines to the state for failing to hire enough doctors and nurses.

After years of fighting in court, in which the state denied all charges, officials agreed to settle the case on the eve of a 2014 trial. The Arizona Department of Corrections is committed to improving care by ensuring that its health care providers meet more than 100 benchmarks. including: providing adequate access to counseling and mental health care, providing timely referrals to specialists, and following the instructions of hospital doctors who discharge patients.

“When prison officials settle a case of this nature, it’s usually because they recognize there’s a problem, and there’s a commitment to fix it,” said David Fathi, director of the ACLU’s National Prison Project, which represents inmates who sue the state.

But the problems have persisted. Two judges have held the state in contempt and fined it $2.5 million for noncompliance.

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