PHOENIX (CN) - A year after an agreement was supposed to improve health care in Arizona prisons, doctors described an understaffed system in which an inmate died with infected lesions swarmed by flies, a man who ate his own feces was never seen by a psychiatrist, and a woman swallowed razor blades while allegedly under constant watch.
The two physician experts on Monday filed declarations detailing the Arizona Department of Corrections' (ADC) alleged lack of progress in implementing court-ordered reforms to its health care system.
Also Monday, plaintiffs in the class action alleging unconstitutional treatment in the state's prisons filed a motion to enforce the stipulated agreement approved by a federal judge in February 2015.
Inadequate health care in Arizona prisons still results in needless deaths from treatable diseases and preventable suicides by inmates who were not properly monitored, according to the experts' reports.
The biggest problem is a chronic shortage of qualified doctors and nurses, according to the statements from Dr. Pablo Stewart , a clinical professor at the University of California, San Francisco's School of Medicine, and Dr. Todd Wilcox , president of the American College of Correctional Physicians.
Both doctors spent time in Arizona prisons in late 2015, interviewing inmates and staff and reviewing patient records, in their roles as paid experts under the settlement agreement in Parsons v. Ryan .
"It is readily apparent that ADC has failed to comply with a number of critically important mental health performance measures," Stewart wrote. "This failure has already harmed a number of ADC prisoners ... and it creates a substantial risk of serious future harm to others."
A "recurrent theme" in Stewart's his reviews of mental health care in Arizona prisons since 2012 has been "that patients are not being seen by a psychiatrist as required by their clinical condition and by the performance measures."
"For example, in the ten full days I have spent inspecting mental health care in seven ADC prisons, I do not believe I have ever seen a psychiatrist," he wrote. "This is extraordinary and completely unprecedented in my professional experience."
Medical and mental health staffing levels are below the national standards, the experts found. The ADC provides seven psychiatrists and 11 mental health nurse practitioners for 35,000 prisoners - a ratio of 1,800 to 1. A similar prison health system in Colorado has a ratio of 531 to 1, according to Stewart.
Stewart found that since April 2015 no more than 52 percent of psychologist positions and 49 percent of mental health nurse practitioner positions have been filled in Arizona, and that the position of psychiatric director has been vacant since the settlement was approved.
"When you look at their own records, which show that for the last year they have never had more than 60 percent of their psychologist positions full; they've never had more than 50 percent of their mental health nurse practitioner positions full.
"When you see a problem going on for that long and not getting any better, it suggests that perhaps someone isn't trying very hard," said David Fathi, director of the ACLU's National Prison Project, in a telephone interview on Tuesday.
