The stories from Arizona prisons are horrifying.

A 43-year-old died from a staph infection. A 36-year-old died from delays in diagnosis and emergency care for an aortic dissection. Three men died from complications from metastatic cancer, which spread throughout their bodies due to delays in care. They all died excruciating deaths, their suffering aggravated by a failure to manage their pain properly.

Before these people died in 2017, they were among the 34,000 people housed in Arizona’s state prisons who are completely dependent upon the Arizona Department of Corrections (ADC) and its for-profit contractor, Corizon Health, for all medical and mental health care. ADC, in its own reviews, found that these deaths were “caused by or affected in a negative manner by healthcare personnel.” These findings came to light during a series of contempt hearings held earlier this year in federal court in Phoenix in Parsons v. Ryan, a case brought by the ACLU and the Prison Law Office.

But medical care is not the end of the horror for the people incarcerated in Arizona’s prisons. A lack of mental health care has been equally disastrous. In the spring of 2017, there were four suicides in three weeks in Arizona prisons, an astonishing rate of self-harm in a state prison system.

These deaths have occurred under the watch of the ADC in breach of a legal settlement reached more than three years ago in the Parsons case. The settlement was meant to protect the rights and health of incarcerated people, but ADC has not lived up to its requirements. The result: People in Arizona’s prisons are suffering and dying because of the state’s failures. Health care delayed can be, and often has been, a death sentence.

On June 22, 2018, the federal court issued a scathing order finding Arizona prison officials in contempt of court for ADC’s ongoing failure to provide basic health care to the people in its custody. U.S. Magistrate Judge David K. Duncan fined ADC more than $1.4 million for numerous violations of the settlement agreement. Judge Duncan also ordered the appointment of an independent monitor to oversee the state’s monitoring of compliance with the Parsons settlement and ordered that ADC hire independent experts to advise it on how to provide adequate medical care to our clients. “Defendants and their contractor are at times more interested in obtaining compliance with the Stipulation by playing a shell game than by providing care to the Plaintiff Class,” Judge Duncan wrote.

Prior to the issuance of the contempt order, Judge Duncan had warned the state in October 2017 that there were more than two dozen performance measures in the settlement agreement that they were chronically and profoundly noncompliant with. These included such basic requirements as ensuring that prisoners received their chronic care and psychotropic medications without interruption and that urgent outside specialist appointments be completed within 30 days of referral. Even after that warning, the state and Corizon were unable or unwilling to provide adequate health care.

Contempt is the strongest sanction available to a court. A judge turns to this tool only after all other efforts to enforce compliance have failed. Make no mistake: ADC has failed to comply, and contempt is how the court can bring it into line and protect Arizona prisoners. In his contempt order, Judge Duncan wrote: “The inescapable conclusion is that Defendants are missing the mark after four years of trying to get it right. Their repeated failed attempts, and too-late efforts, to take their obligation seriously demonstrate a half-hearted commitment that must be braced. … Accordingly, it appears the Court must do what Defendants will not: compel compliance with the [Parsons settlement]."

This contempt order came after years of reports to the court by the ACLU and the Prison Law Office of ADC’s continuing and flagrant noncompliance. In earlier reports to the court in 2015 and 2016, correctional health care experts documented grossly deficient medical care. Examples included a 44-year-old woman who bled to death after being given medication that was known to harm patients with her condition and a 59-year-old cancer patient whose massively infected wounds were swarmed by flies in the days before he died. Former Corizon employees have come forward to blow the whistle about the inadequate medical and mental health care provided to Arizona prisoners.

The contempt order is meant to force the Arizona Department of Corrections to follow the law and protect the lives and health of prisoners. Whether the department will finally do its duty and provide the people under its care with the health care they deserve is uncertain. But we’ll be watching to make sure department officials follow through, for now, and for good.