To stave off a lawsuit, Arizona's Department of Corrections has agreed to investigate scores of complaints by inmates that they are routinely denied medical care for weeks or months even for severe, life-threatening conditions. Inmates who have lost sight, had body parts amputated or been severely disfigured, among other gruesome examples, say proper medical care could have prevented needless suffering.

Based on those allegations, a legal coalition has accused the state of chronically and systemically denying medical and mental-health care to inmates, violating state and federal laws and the U.S. Constitution.



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The Prison Law Office, a legal-advocacy group for prisoners nationwide, also charges that lack of care may contribute to a prison suicide rate in Arizona that is more than double the national average, with 14 reported suicides in the fiscal year that ended last June.

Interviews with current and former prisoners and dozens of inmate letters of complaint obtained by The Arizona Republic raise similar concerns.

Corrections officials say they have found no evidence of systemic problems, although they say that pending plans to privatize prison health care have made it harder to fill medical-staff vacancies and that rule changes two years ago that cut payment levels to outside contractors also crimped access to care.

But prisoner advocates say the problems are longer-standing.

Allegations made by inmates, prisoner advocates and attorneys include:

A diabetic prisoner, while waiting months for insulin, lost sight completely in one eye and partially in the other.

An epileptic who wasn't given his medications suffered repeated seizures for weeks.

A man with a growth on his penis was denied medical treatment for two years. Doctors ultimately diagnosed a cancerous tumor on his penis; the organ had to be amputated, and doctors told him the cancer had spread to his stomach.

An inmate with a cancerous growth on his lip waited seven months for treatment. Most of his lip and mouth were removed, leaving him permanently disfigured.

Prison medical staff members have repeatedly denied treatment to Tucson inmate Horace Sublett for Kaposi's sarcoma, a cancer, despite documentation, including from the VA hospital in Phoenix and other outside doctors confirming that the Navy veteran, 82, has the disease.

Prisoners with emphysema, end-state renal disease and other illnesses reported being denied treatment or medication, leading to complications and permanent side effects.

Corrections officials maintain that they provided appropriate care in these cases. Karyn Klausner, the department's general counsel, said inmates' loss of sight, amputation of the penis and disfiguring facial surgery were not related to any delays in treatment.

Donald Specter, executive director of the San Quentin, Calif.-based Prison Law Office, described his group's concerns in an Oct. 12 letter to state Corrections Director Charles Ryan.

"State prison officials are deliberately indifferent to the serious health-care needs of prisoners and to the prisoners' unnecessary and significant pain, suffering and even deaths," Specter wrote.

That letter, which lists dozens of specific allegations without naming the inmates affected and which has been obtained by The Republic, asked Ryan to agree to a court injunction to address problems as a way of avoiding a lawsuit in federal court.

In May, Specter and the Prison Law Office won landmark litigation against the California Department of Corrections. In a 5-4 decision, the U.S. Supreme Court required California to release about 30,000 prisoners to alleviate unconstitutional prison overcrowding.

On Nov. 17, Arizona's Department of Corrections signed an agreement to investigate the medical claims, and the California group agreed to delay any lawsuit for three months.

But, so far, Ryan said, "We don't see any systemic indication of problems or evidence of deliberate indifference."

Ryan added that the department demanded the group provide inmates' names so it could verify or disprove the claims.

Specter said his group is asking inmates whether they are willing to be identified. Many prisoners fear retaliation for speaking out.

The department doesn't deny there are problems.

"Are there instances where an inmate didn't receive medications or treatment in a timely fashion? Yes," Klausner said. "But is it systemic? No."

The Prison Law Office noted that in 2009, the Arizona State Prison Complex-Eyman in Florence had only one half-time psychiatrist for more than 1,000 patients who were on mental-health medications. As of last month, that position was vacant.

Earlier this year, inmates at the Arizona State Prison Complex-Perryville often weren't seen by mental-health staff for six months or more, according to staff quoted in the group's letter.

"We're out of compliance with our own policies," Michael Breslow, then- deputy medical director for psychiatry, warned Ryan in a Sept. 13, 2009, e-mail obtained by the law group through an Information Act request. "The lack of treatment represents an escalating danger to the community, the staff and the inmates," Breslow said.

Staff shortages also affect medical care. Both the Arizona State Prison Complex-Tucson and the Eyman unit, which house more than 5,100 prisoners each, are supposed to have five doctors on staff. In April, Eyman had two doctors and a third working half-time; Tucson had two, according to department staffing reports.

Ryan and Klausner said Corrections has improved mental-health and medical care in recent months. Ryan said Corrections provided six hours of training in suicide prevention, crisis intervention and emergency response to 8,806 staff members who have direct contact with inmates.

That training follows, among other incidents, the July 2010 suicide of Tony Lester, a mentally ill inmate at the Tucson prison. An internal investigation found that officers stood by for 23 minutes without intervening after Lester slit his throat, wrists and groin with razor blades that he wasn't supposed to have.

Ryan also said Corrections has filled 172 health-care and mental-health positions since June 23 -- including vacancies for doctors at the Eyman and Tucson prisons.

However, the overall medical-staff vacancy rate has barely budged. In April, 23 percent of positions were unfilled. As of the end of November, 22 percent were unfilled, according to staffing reports.

Ryan said the department also has reduced the waiting time for inmates who require medical treatment outside the prisons -- from an average of 77 days early last year to an average of 49 days as of this month.

But inmates say months-long waits for care and denials of prescribed medicine and medical supplies continue to be routine.

"It's a real big problem, and they're keeping it hush-hush," former inmate Eric Wright said in an interview. Wright was released from the state prison in Tucson last month after serving more than four years on drug charges. Wright said a doctor prescribed back surgery in 2008 for an injury he suffered in prison.

"Nothing in my sentence called for the death penalty," said former inmate Martin Feldman, 67, who also had difficulties receiving timely prison medical care for osteomyelitis (a chronic bone infection) and obstructed coronary arteries. Feldman recently was released after serving nearly two years for a drug violation.

Corrections spokesman Barrett Marson declined to comment on Wright's and Feldman's cases, saying Corrections had to retrieve their medical records from archives.

Some of the shortfall in medical care stemmed from legislation lawmakers advocated as cutting costs.

In mid-2009, the Republican-led Arizona Legislature passed laws requiring Corrections to privatize prison medical care and to pay providers at a rate no higher than that paid by the Arizona Health Care Cost Containment System, the state's Medicare provider.

According to Corrections officials, within months of that law's passage, there were negative repercussions:

Health-care employees, figuring their jobs were on the chopping block, started leaving in droves. Corrections spent $5.3 million less on full-time health-care staff salaries this past fiscal year than two years earlier, a 13.5 percent drop. The department has used temporary, part-time workers to partially close that gap. And many contract providers such as Carondelet Health Network stopped doing business with Corrections, saying the reimbursement rates were too low. Ryan said the department eventually found other providers.

These issues are not new. In January 2009, well before lawmakers acted, more than one in four health-care positions was vacant, and the waiting time for outside medical care averaged 11 weeks, according to the department.

In the fiscal year ending last June, Corrections spent $111.3 million, or an average of $3,258 per inmate, on health care, down 27 percent from $140.5 million, or an average of $4,482 per inmate, two years earlier.

In recent years, inmates have reported scores of incidents to prisoner advocates such as the Arizona Justice Project, which helps inmates with wrongful convictions; Middle Ground Prison Reform, a prisoner-rights group; Lynn Nau, who runs a prison ministry for Faith Lutheran Church in Phoenix; Margaret Plews, a Phoenix activist who monitors treatment of prisoners; and Rep. Cecil Ash, a Republican lawmaker from Mesa who is involved in sentencing and correctional issues.

Ash said some of the letters he has received "really give me cause for worry ... that the state could have some serious lawsuits on its hands."

Many alleged incidents also suggest that often, denying basic care not only causes prolonged pain and suffering but makes it far more expensive once doctors treat the patients.

Carlos Archuleta, a Tucson inmate, said he begged repeatedly for help after being bitten in the groin by a spider last June. After four days, he was transported to a hospital for an emergency operation to remove infected fluid and tissue. Doctors had to resuscitate him after his heart stopped during the operation, and Archuleta was kept in the hospital six days.

"The doctor said if they'd left it one more day, he'd be dead. Just because they're inmates doesn't mean you should treat them this way," said his mother, Guadalupe Lopez. She added, "If he'd gotten proper medical care on day one, taxpayers wouldn't have had to pay for an emergency surgery and the hospital stay."

Corrections' spokesman Marson said "appropriate care was provided" to Archuleta.

The bottom line isn't just that prisoners, like anyone else, should have access to adequate medical care, said Caroline Isaacs, director of the American Friends Service Committee's Tucson office, which monitors state prisons. "Ninety percent of them will get out of prison, so treating HIV or hepatitis C or whatever they have prevents a public- health risk, or they'll get out and get on AHCCCS and we're paying for it anyway."