Sunday, June 8, 2014

Arizona's Other Health Care Scandal: Prisons

       Military veterans in Arizona got the nation’s undivided attention over the past few weeks after it was learned that hundreds of them had to wait for weeks or even months for appointments with doctors in the Veterans Administration’s health care system. Now, let’s see whether the 33,000 inmates in Arizona state prisons can get the same amount of attention over evidence that some of them have had to wait for months or even years for medical attention to severe, even life-threatening health conditions.
       The allegations of inadequate health care come in a class action lawsuit that a federal appeals court cleared for trial last week [June 5]. The worst of the examples cited in the 63-page opinion from the Ninth U.S. Circuit Court of Appeals make the vets’ complaints seem almost trivial by comparison. Consider these alleged incidents:
       * A male inmate waited two years for a biopsy of a mass in his prostate because contracts with outside providers had been canceled. By the time of the biopsy, the cancer had advanced, resulting in more invasive surgery than would have been necessary with earlier care and after the surgery permanent catheterization.
       * A female prisoner, four months pregnant, was referred to a medical unit after suffering bleeding and severe contractions, but was told the problems were all in her head. She was sent back to her cell, where she suffered a miscarriage less than two hours later.
      * A mentally ill inmate bled to death in July 2010 after his second suicide attempt as correctional officers stood by and watched. In the ensuing investigation, one of the officers said he had called the inmate’s name but elicited no reaction.
      Along with specific examples such as those, the inmates’ 74-page complaint filed in March 2012 included broad allegations that the prison system provided inadequate medical, mental health, and dental care and failed to provide timely emergency medical treatment or sufficient medications or medical supplies. Incontinent inmates, for example, were limited to one diaper per day.
      Those are only allegations, but the complaint was sufficiently detailed and the allegations sufficiently serious to persuade U.S. District Court Judge Neil Wake to allow the 13 named plaintiffs to broaden the case to a class action on behalf of all Arizona prisoners. The allegations “are not merely isolated instances but, rather, examples of systemic deficiencies that expose all inmates to a substantial risk of serious harm,” Wake wrote in his March 2013 ruling.
      Wake, a Republican appointed to the bench in 2004 by President George W. Bush, said a broad ruling would be needed to raise the level of care and medical resources for all inmates, not just the individual plaintiffs who brought the suit. Wake also approved a class action on behalf of some 2,200 inmates contesting the state prison system’s use of solitary confinement: isolating some prisoners for 22 hours a day over extended periods.
      The allegations of inadequate medical care for inmates come as no surprise to state officials. The prison system’s director of medical services was quoted in 2009 as telling a prison physician that the system was “probably” violating inmates’ rights. “I do think that there would be numerous experts in the field that would opine that deliberate indifference has occurred,” the director reportedly stated.
      On appeal, the state did not contest the allegations, but attacked Wake’s decision to certify the case as a class action on grounds the inmates’ various allegations were not sufficiently similar to be tried together. In its decision, the Ninth Circuit panel found that Wake had properly identified 10 alleged practices or policies of the prison system that affected inmates generally, not just individual prisoners. Those policies, Judge Stephen Reinhardt wrote for the panel, are enough “glue” to hold a class action together. Reinhardt, a veteran liberal jurist, was joined in the opinion by Judges John Noonan, a conservative appointed by President Ronald Reagan, and Paul Watford, named by President Obama in 2012.
      Arizona has the distinction of having the highest share of its population behind bars of any state in the West and one of the highest in the country, according to The Arizona Republic. The newspaper’s ongoing coverage has documented a host of controversies over prison conditions, including the controversial use of private prisons. Murder and assault rates in the system are higher than the national average, the newspaper reported in July 2012. Officials responded to the newspaper by minimizing the statistics and in any event blaming the incidents on staffing cuts.
      Trial of the case is now set for October, according to the American Civil Liberties Union’s Prison Rights Project, which is coordinating the litigation. But the state could delay the trial by asking the U.S. Supreme Court to overturn the class certification order.
      In a similar case, however, the court in 2011 allowed California inmates to proceed with companion class actions contesting overcrowding and inadequate health care in that state’s prison system (Brown v. Plata). A three-judge court continues to supervise the state’s compliance with orders to reduce the prison population and improve medical care.
      Arizona faces the prospect of a similar court order, but the wheels of justice grind slowly: a final decision could still be years away. In an ideal world, perhaps public indignation would force changes in the meantime, but prisoners — unlike veterans — are easy for the public to put out of mind.


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