a takeover of the state prison healthcare system

After 14 years of litigation, two contempt findings, millions of dollars in fines, a 15-day trial and repeated violations of a permanent injunction, a federal judge decided Thursday she has no choice but to take the “drastic” step of placing Arizona’s prison health care system into receivership to remedy an “systemically unconstitutional” system.

The order covers all 10 Arizona Department of Corrections, Rehabilitation and Reentry prisons and every incarcerated person in Arizona state custody — a population of roughly 34,000 people.

U.S. District Court Judge Roslyn Silver pummeled the the state in her 128-page order as she detailed all the ways the Corrections Department had repeatedly failed to comply with court orders, “unreasonably” misread the court’s directives and went to great lengths to “exploit any ambiguity to the maximum extent possible.”

“Ordering the implementation of a receivership is extraordinary, and the Court has exercised caution and critical reflection in making the decision,” Silver wrote. “But… after nearly 14 years of litigation with Defendants having not gained compliance, or even a semblance of compliance with the Injunction and the Constitution, this approach has not only failed completely, but, if continued, would be nothing short of judicial indulgence of deeply entrenched unconstitutional conduct.”

Silver was appointed to the bench by Bill Clinton in 1994.

David Fathi, director of the American Civil Liberty Union’s National Prison Project, praised the order as a “critical step” to protect the rights of the prisoners that the ACLU has represented throughout the litigation.

“This decision means that an independent authority will be able to implement the systemic changes necessary to ensure that medical and mental health care meets constitutional standards,” he said in a written statement. “This is a life-saving intervention, and it brings hope that the preventable suffering and deaths that have haunted Arizona’s prison system for over a decade can finally end.”

The Department of Corrections, Rehabilitation and Reentry said it will “aggressively pursue an appeal” of Silver’s receivership order.

“If this decision stands, an exorbitantly expensive, unnecessary receiver risks disrupting the significant progress we have made in our prisons, all with no time clock on its authority,” Corrections Department Director Ryan Thornell said in a written statement. “We will be promptly appealing the decision while continuing our work to comply with the Court’s orders and running a secure, safe, and accountable prison system.”

In a post on the social media site X, Gov. Katie Hobbs wrote that she was “deeply disappointed” in the decision, which she said “fails to recognize the immense strides” the Corrections Department made in complying with prior court orders, including increasing staffing and “drastically improv(ing) health care outcomes” for inmates.

“We will keep making improvements, doing the work that others — including the two previous governors — refused to do for far too long,” she wrote.

The class-action lawsuit stretches back to 2012, when prisoners sued the department and alleged that its shoddy health care violated their Eighth Amendment right against “cruel and unusual punishment.” The 14 years since have been marked by escalating judicial intervention, culminating in Silver ordering the prison health care system into receivership.

In 2014, the prisoners and the state reached a 103-point agreement on health care performance. But when the Corrections Department repeatedly failed to comply with those standards, the court twice held the agency in contempt and levied fines totaling more than $2.5 million. 

Following a 15-day bench trial in 2022, the court issued a 200-page findings-of-fact order declaring the health care system “pervasively and systemically unconstitutional.” The next year, a permanent injunction was issued with 154 specific “quality indicators” to assess how the prison system was complying with the court’s directives.

In 2024 and 2025, Silver wrote, the state repeatedly and flagrantly violated those orders, and a pilot program aimed at testing a new model for prison health care failed disastrously — it was only partially implemented at one of the two test sites, and was only in place for eight days before it was scrapped.

Earlier this month, attorneys for the prisoners returned to court and asked Silver to turn control of the system over to a receiver.

“The Court’s patience has run out. Too many individuals are needlessly suffering while Defendants have deployed many delay tactics,” Silver wrote. “The Court has exercised restraint for much of this litigation, to the point that anymore tolerance of unconstitutional healthcare becomes judicial indulgence.”

Silver found that the state failed to comply with 131 of the 154 “quality indicators” in the permanent injunction. The most repeated grievance in a sprawling compliance chart that catalogued violations across every major category of care was that the Corrections Department was letting nurses serve as the primary providers for complex patients.

The court also slammed the state for chronic understaffing. The injunction required an equivalent to nearly 28 full-time doctors to staff the 10 prisons. While the state claimed it had 18 in place, court-appointed monitors said only 11 were actually board-certified or eligible to practice medicine in Arizona.

And only 3% of orders referring ill prisoners to off-site specialists were made in a timely fashion, meaning 97% of “critical referrals” were either made far too late — or weren’t issued at all.

Now that receivership has been ordered, all of the parties and court monitors have 60 days to submit up to five candidates to be the receiver who will take over day-to-day management of medical and mental health care across Arizona’s prison system.

The receiver will have total authority over the prison health care system, including the power to hire and fire staff, renegotiate or terminate the existing $300 million contract with NaphCare, set salaries, reconfigure facilities and override department administrators. 

Prison health care will almost certainly cost significantly more under receivership than it did with the Corrections Department overseeing things. The state repeatedly cited budget limitations and the need for legislative appropriations as reasons for its failure to comply. But Silver flatly rejected those arguments as legally invalid defenses to constitutional violations. The receivership will likely force spending that the Legislature has so far declined to authorize.

***UPDATED: This story has been updated with comments from Gov. Katie Hobbs and ADCRR Director Ryan Thornell.