Federal Magistrate Judge David Duncan heard arguments for and against sanctioning the Arizona Department of Corrections this week. ADC has been accused of permitting for-profit prison healthcare provider Corizon to provide healthcare so inadequate as to broach the question of cruel and unusual punishment—despite a 2015 settlement specifying benchmarks for improvement.
Arizona has placed the blame squarely on Corizon. The agreed-upon monetary penalties weren’t working! Well, no wonder: Corizon makes $400,000 a day from its Arizona contract, and monthly sanctions are capped at $90,000. Paying sanctions is cheaper than complying, and the state agreed to caps that mean the maximum fine is a drop in the bucket compared to profits. If it hadn’t, it would be entitled to $8.6 million from Corizon by October 2017.
Since the penalties weren't working, ADC decided to create incentives for Corizon to comply, totaling a staggering $3.5 million. Corizon’s already earned $2.5 million of that amount, and, in the end, it could come out having received more in incentive payments than it lost in sanctions.
These latest revelations seem likely to fuel Duncan’s ire. Jimmy Jenkins, a reporter at KJZZ in Phoenix, called the updates “really stunning stuff.” Duncan had already announced that he’s considering imposing harsher oversight and a $1 million fine. Now, it looks like he may contemplate an even higher fine. Which would make sense given the amount of money at stake—and the gravity of the allegations against Corizon.
As Beth Schwartzapfel, of The Marshall Project, reported of the case:
Parsons v. Ryan, which began in 2012, is one of several lawsuits across the country in which Corizon is accused of providing care so shoddy that it amounts to cruel and unusual punishment: delayed or denied treatment, too few doctors and nurses, referrals and medication refills that fall through the cracks.
These genteel general terms mask the tragedies these institutions caused and exacerbated. A doctor who served as the lone physician for 5,000 inmates for five months, Dr. Jan Watson, has detailed astonishing, systemic neglect.
“A gentleman came in with chest pain,” Watson said of an inmate. “He was known to have heart disease.”
His symptoms, combined with an EKG, made Watson think he was having a heart attack, but she says couldn’t get approval to go to the hospital for hours.
After the referral was finally approved, Watson’s fears were confirmed. The inmate had suffered a heart attack.
Watsons says her medical director, Dr. Rodney Stewart, reviewed the inmate’s test results from the hospital and conveyed the treatment plan to her and the inmate.
“He told me that’s what had happened with the patient. He had had a heart attack. None of his arteries could be bypassed and so there was nothing that could be done,” Watson said of her conversation with Stewart.
“I was told if he ever came in with chest pain again to just let him die, keep him comfortable, because there was nothing we could do about it,” Watson said.
Stewart’s gruesome instructions became even more appalling to Watson after she reviewed the patient’s record and found that Steward had lied about the prisoner’s condition. After she proposed a middle-ground approach—a medication with the potential to prevent or lessen heart attacks—she was deterred.
“It didn’t say none of the arteries could be bypassed,” Watson said. “It only said one couldn’t. One could. And another could benefit either from medical management and or a stint.”
Watson created a new plan. She prescribed the inmate nitroglycerine to take the next time he had chest pains. And she told him she wouldn’t let him die.
Shortly after she changed the inmate’s plan, Watson says she was called in to a meeting with Stewart and the area medical director.
“I was told I was not doing things ‘The Corizon way,’” Watson said. She says when asked what the “Corizon Way” was, she was given a list of don’ts.
“Don’t make so many referrals. Don’t order so many splints. And I had to be faster. Don’t talk so much to the inmates,” Watson said.
Another prisoner, Walter Jordan, who was diagnosed with skin cancer, went through months of hell before dying in prison.
Medical records show after months of seeing a dermatologist, Walter Jordan was finally referred to an oncologist. There referral came after a Corizon Health provider noted his rapidly deteriorating state. After evaluating a large wound on Jordan’s scalp, the provider wrote in all capital letters:
“THE WOUND IS HORRIFIC. PT IS EXPOSED TO THE ENVIRONMENT (DUST, DIRT, HEAT, FLIES) DIRTY HOUSING AND SHOWER FACILITIES …. I CANNOT STRESS HOW IMPORTANT IT IS THAT WE TAKE SOME SORT OF IMMEDIATE ACTION.”
[Reviewer Dr. Todd] Wilcox’s report says the medical records show by the time Walter Jordan received radiation therapy, the cancer had already penetrated his skull.
“It is difficult to fathom,” Wilcox writes, “how a squamous cell carcinoma could grow so large and so deep that it breached the skull and reached the brain, if the treating provider and the specialist dermatologist is vigilant and practicing within the standard of care.”
This all happened post-2015, after Corizon agreed to terms that should have forced reforms.
[I]n the Arizona case, the state arrived at an agreement with the prisoners that explicitly says that government officials “deny all the allegations.” In that agreement, struck in 2014, the state — and, by extension, Corizon — commits to meeting 103 standards governing everything from how quickly prescriptions are filled to how often those with mental illness see a counselor. Part of the agreement was that the state would measure how well it was meeting the standards and report the results back to the court.
For the first few years, according to the state’s own reports, it did not go well. Among other problems, the state was not providing urgent medication or specialty care quickly enough and prison doctors weren’t reviewing discharge orders for sick prisoners returning from the hospital. “You fundamentally have an obligation to provide these services to these inmates,” Duncan said at a 2016 hearing. “You failed to do it.” At one point the judge called the reports “chilling.”
Corizon was neither subtle nor sneaky in its efforts to dodge requirements.
Under the terms of the Arizona lawsuit, Corizon must ensure that patients who are referred to specialists see them within 30 days. But the story, by NPR station KJZZ, included an account by a physician who said Corizon asked her to cancel referrals if they weren’t completed in that time frame to avoid fines from the court. “After 30 days we get nailed for 1,000 bucks a day until they are seen,” read an email from a Corizon supervisor to the physician.
Corizon claims that Arizona-related staffing challenges are responsible for “limited’ failures to meet all 2015 conditions. Its legal struggles nationwide indicate otherwise.
Corizon, based in Brentwood, Tennessee, is one of the nation’s largest for-profit prison healthcare providers, with contracts in 30 local jails and eight state corrections systems, according to Harbin.
Allegations of mismanagement and poor patient care have recently caused Corizon to lose some high-profile and lucrative contracts. The company has been the target of thousands of lawsuits — including other large-scale class action suits ongoing in Idaho and Alabama.
Any prison or prison-based provider is inevitably going to be a target for legal action, in part because the courts are often prisoners’ only means of redress for grievances large and small. What’s striking about the recent cases, however, is their similarities.
The suits describe a multi-layered bureaucracy in which even routine medical referrals require approval from middle management; a crisis-level shortage of nurses, doctors, psychiatrists, and other medical staff; and serious but treatable illnesses that went untreated and turned deadly. The Arizona claim described a 59-year-old inmate who died after nurses “repeatedly ignored his desperate pleas for help…even after open weeping lesions on [his body] were swarmed by flies.”
Not all states even impose financial penalties on prison healthcare providers for violations. Arizona does that much, but to little effect.
In Arizona, the Department of Corrections has 33 employees in its “Health Services Contract Monitoring Bureau” tasked with keeping an eye on Corizon, and the contract includes financial penalties. The company has paid upwards of $3 million in fines for not having enough doctors and nurses on staff, according to the testimony of Charles Pratt, who oversees the Corizon contract for the state. But with a contract worth more than $150 million a year, even Judge Duncan was skeptical that these fines change the company’s calculus.
“Is it possible that they have made the economic decision that they are better off paying the fine than filling these positions?” he asked.
“It is,” Pratt replied.
An Idaho case against Corizon seems to prove that the firm’s enormous profits mean they would rather incur fines than fix problems.
In Idaho, where a class action lawsuit similar to the Parsons suit is ongoing, Corizon has been fined $178,000 since 2014 for not having enough staff and other problems, according to state officials. The contract there is worth more than $43 million a year.
Perhaps things will be different in Arizona:
Now Corizon faces $1 million or more in additional fines from the Arizona court as the judge considers holding them in contempt for their “pervasive and intractable failures” to meet the terms of the settlement. He could issue his ruling at a hearing on Tuesday.
These cases illustrate the need to instate monitors responsible for ensuring standards and agreements are enforced—and empower them.
In Idaho, the judge appointed an independent monitor, known as a special master, to evaluate how well the state was providing health and mental health care. Yet he was duped when the state “attempted to paper over and mislead the special master about the inadequacies of its mental health care system,” the judge later found.
The Arizona settlement has no special master. “In the settlement negotiations we pressed hard for an independent monitor, but the state was adamant that it would never agree to such a thing,” says the ACLU’s David Fathi, one of the attorneys representing the prisoners.
The agreement allows the state to monitor itself, which was at issue in the December hearing when the judge was so angry. “I had always been a little bit … concerned about the fact that the fox was guarding the hen house,” Judge Duncan said, noting that he may now appoint an independent auditor.
Hopefully Duncan assigns a steep fine to Corizon. Maybe a multi-million dollar precedent will be enough to finally spur prison reforms.
