On March 6, 2012, the Phoenix-based Arizona Center for Disability Law (ACDL) and the American Civil Liberties Union Foundation of Arizona (Arizona ACLU) with the assistance of the Berkeley, California-based Prison Law Office, filed a 42 U.S.C. § 1983 class-action civil-rights lawsuit in federal court alleging inadequate medical, dental and mental health services and other unconstitutional prison conditions prevail in the Arizona Department of Corrections (DOC). The lawsuit alleges that DOC prisoners are in danger of serious and preventable injury, amputation, disfigurement and death due to these conditions. It also alleges that prisoners with mental health issues are routinely subjected to solitary confinement in windowless cells, which are often filthy and smeared with feces, under conditions of social isolation and sensory deprivation with little or no access to mental health care providers.

"The prison conditions in Arizona are among the worst I've ever seen," said Donald Specter, the executive director of the Prison Law Office who was the lead counsel in the seminal Brown v. Plata case in which the Supreme Court held that California prisoners were being Given unconstitutionally-inadequate health care. "Prisoners have a constitutional right to receive adequate health care, and it is unconscionable for them to be left to suffer and die in the face of neglect and deliberate indifference."

The specific facts raised about the treatment of the 14 named plaintiffs are gruesome. For instance, in the case of Shawn Jensen, a prisoner in the DOC's Tucson complex who had a history of prostate cancer, a biopsy was delayed for 33 months after Prostate Antigen tests indicated the possible presence of cancer. When the biopsy was finally performed, it revealed Stage 2 aggressive prostate cancer, yet surgery was delayed another 5 months. After he returned to prison from the surgery, a nursing assistant, attempting to irrigate a Foley catheter, a procedure for which he had no training, ruptured Jensen's bladder, causing him great pain. Jensen had to suffer multiple surgeries in a failed attempt to save the bladder, which had been irreparably damaged.

Jensen's case is not unique. There were multiple cases of prisoners suffering from life-threatening medical conditions, such as cancer or heart attacks, being "put on bold" and told to wait for months for treatment. When they finally received treatment, it was often from untrained personnel, such as nursing assistants or medication dispensers. Frequently, these personnel, or even guards, acted as gatekeepers of a prison's medical services despite the fact that they nad no medical training for this function. Prisoners submitting requests for health care services might be told to "be patient," or that "it's all in your head" or to "pray" to be cured. The result was that prisoners with serious conditions were often denied medical treatment and suffered permanent injuries or death.

Prisoners with dental issues, such as fillings that cracked or fell cut or damaged teeth, were usually told that the only thing the dentist could do was pull the teeth. If a prisoner declined to have a tooth pulled and persisted in requesting care, a filling might be forthcoming, in a few months, but the filling would be a temporary one and would fail within three or four months. To get a permanent filling took years. Other dental restoration work took longer.

The plight of prisoners with, mental health issues was just as bad. Often they would be placed in physical and social isolation in a Special Management Unit (SMU). There they deteriorated under conditions that could and did destroy the mental health of prisoners who initially had no mental health issues. Taunted by guards who controlled the access to medical and mental health professionals, the mentally ill were allowed to deteriorate out of sight in feces-smeared cells and out of the minds of the prison administrators.

"Faced with such gross indifference on the part of prison officials to the needs of prisoners with mental illness in their care, it was essential we get involved," said ACDL staff attorney Jennifer Alwelt. "Prisoners with mental illnesses can be particularly vulnerable, and we must do everything we can to ensure their mental health needs are met while incarcerated."

In this case, "everything, we can de" included ACDL becoming a plaintiff in the suit. ACDL is designated as Arizona's authorized protection and advocacy agency under the Protection and Advocacy for Individuals with Mental Illness Act, 42 U.S.C. § 10801, et seq. which gives it the authority to bring legal actions to protect individuals with mental illness.

A major cause of the delays in medical, dental and mental health treatment is the lack of adequate staffing. Arizona has cut its budget for providing such services in prison. To accomplish this, it reduced the number of staff and the pay for medical services contracting, which is the method by which the DOC receives specialist medical services, to the state's !Medicaid rate. As of November 2011, four of the six prisons designated for seriously mentally ill prisoners had no staff psychiatrist. For most of 2009 and 2010, no outside contractor would provide specialist medical services to the DOC.

The resulting medical care has been abysmal for Arizona prisoners. With no physicians to prescribe medication, lower-level staff have been doing so, or physicians have prescribed medications without seeing,, the patient, who might be located at a distant prison. The results have sometimes been disastrous. Rather than address these issues, which were often raised by DOC medical staff to their superiors, the DOC chose to cover them up.

"Arizona has used the absence of transparency to callously ignore the basic needs of persons entrusted to its care, at times with deadly results," according to David J. Pochoda, legal director of the Arizona ACLU.

The plaintiffs are represented by attorneys Daniel J. Pochoda and James Duff Lyall of the Arizona ACLU; Donald Specter, Allison Hardy, Sara Norman and Corenc Kendrick of the Prison Law Office, and Jennifer Alewelt and Ruth Szanto of the ACDL. One can only hope that this suit vindicates the constitutional rights of Arizona's prisoners before more lives are lost. See: Gamez v. Ryan, U.S.D.C.-D.Ariz., No. CV-10-2070-PHX-JWS (NEA).

Additional source: ACLU Press Release dated March 6, 2012.

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