Centurion VP makes 'damning admission' on last day of Arizona prison health care trial

Prisoners, wardens, psychologists, correctional experts and medical specialists testified over the course of four weeks in the Jensen v. Shinn prison health care trial in Arizona. They described their personal experiences and observations in Arizona prisons in a legal challenge in which prisoners allege the state is providing unconstitutional levels of health care.

But on the last day of the trial on Wednesday, Dec. 8, the court heard “damning” testimony from the state’s prison health care provider, Centurion of Arizona, that may undermine the state’s entire defense.

Tom Dolan, Centurion Vice President for the Arizona prison contract, took the witness stand to discuss his company’s performance since it took over from the previous provider, Corizon Health, in 2019.

“We learned early on that, in order to meet the needs of our clients, some facilities needed additional staff,” Dolan said.

Dolan testified that the health care staffing levels in the Arizona prison system were set by the Department in a 2019 request for proposals. The contract requires Centurion to have 1,052.75 full-time equivalent positions.

But soon after it took over in July of 2019, Dolan said Centurion did its own independent evaluation to determine if that number was sufficient. He said the company worked with the 10 state-run prison sites to identify what additional positions they needed in order to provide services that lived up to the performance measures agreed to in the Jensen v. Shinn lawsuit, which was still under a settlement agreement at the time.

“We look at all of the statistics that we collect each month,” Dolan said. “We look at provider visits, nurse lines, number of HNRs, med passes, number of meds that patients are on. We look at man-down encounters per facility. We look at the overall facility and then build the staffing on the data.”

Dolan said Centurion used that information to submit a proposal to the Department to amend the staffing matrix. In an email sent in January of 2020 to an administrator at the Arizona Department of Corrections health services contract monitoring bureau, Dolan outlined what he referred to as a staffing “wish list.”

According to an attorney for the Department, Dolan was responding to a request from DOC “to review the staffing matrix and submit a staffing proposal without budget constraints.”

Dolan’s staffing proposal called for 161.5 additional positions than were in the 2019 Centurion contract. The additional staff included administrators, nursing directors, regional directors, records clerks, nurses, physicians, and special “man down” teams dedicated to emergencies. 

But Dolan testified that after he submitted the staffing proposal, the Department of Corrections did nothing with it. Dolan said the Department was not open to amending the contract to add the additional FTEs, and they were not included when the Centurion contract was extended in July 2021. He testified that the current Department staffing matrix is still the same as the one provided in the original 2019 contract.

ACLU National Prison Project Deputy Director Corene Kendrick, representing the prisoners in the lawsuit, called the staffing proposal a “damning admission.”

“The legal analysis for this type of case is something called deliberate indifference,” Kendrick said. “This document is the epitome of deliberate indifference. Prison officials were told in Jan 2020 that they needed to increase health care staff by 15 percent and nothing happened. Instead, what happened over the next year and half is that many, many people died preventable deaths because of the failure to provide basic medical care and mental health care.”

“I think what it shows is that Centurion’s leadership recognized that the current staffing model that the state has dictated to them is not adequate to provide basic health care,” Kendrick said. 

Health care trial highlights

In 2012, the federal court recognized a group of people in Arizona prisons who claimed their Eighth Amendment rights against cruel and unusual punishment were being violated. The class action lawsuit was then named Parsons v. Ryan, after named plaintiff Victor Parsons and then-director Charles Ryan. Arizona agreed to settle the case in 2014 and it was certified in 2015. 

But since that time, the federal courts overseeing the settlement have found the state was not living up to the terms of the settlement agreement. Federal judges have twice held the Department in contempt, fining the agency millions of dollars. The case has outlasted judges, named plaintiffs and prison administrators. In 2021, it is now known as Jensen v. Shinn.

In July, Judge Roslyn Silver took the drastic measure of rescinding the settlement and ordering a bench trial, which began on Nov. 1.

During the four-week trial, the court heard testimony from several currently incarcerated people who claimed they had suffered due to lack of medical and mental health care.

More: Daily updates from the landmark Arizona prison health care trial

Kendall Johnson, a witness for the plaintiffs incarcerated in the Perryville Women’s Prison, said she entered prison at age 19 in 2004 as a healthy young woman. In 2017, she started to experience numbness in her legs and feet. She repeatedly requested medical treatment for several years as her symptoms progressed. She said she experienced several falls that resulted in broken bones and eventually lost the ability to write and walk. In 2020, she was diagnosed with multiple sclerosis.

Johnson wrote health needs requests begging for proper treatment, but she didn’t get it until May 2021. She told the court she is now confined to a special needs medical unit at the prison where she spends her days “counting the ceiling tiles.”

She is nearly immobile and has trouble speaking. “I tried to get help but it was like hitting my head against the wall,” she said. 

Dustin Brislan, a named plaintiff, testified from the Tucson prison. He provided the names of more than 10 officers he accused of taunting him and encouraging him to self-harm, a tactic known in the prisons as “kickstarting.”

"Kickstarting is where an officer or mental health staff push your buttons — they know your triggers — and get you to react,” he said. “It happened many times."

Brislan said he would often cut himself with rust from the isolation cells while on constant suicide watch, while correctional officers were watching and encouraging him to do so. He said the officer would watch him and not act to stop him.

"The officers actually encourage me to cut myself,” he said. “They say they want to see how bad I can get. They heard stories about me and wanted to see how seriously I could hurt myself. They know exactly how serious I am. There's a lot of them that do it."

Like previous testimony from incarcerated people with severe mental illness, Brislan told the court officers used force against him while on constant suicide watch. He said they used several cans of pepper spray which he called "foggers."

Brislan told the court he was testifying as a named plaintiff despite a fear of retaliation.

"I am a voice for other people who can't defend themselves,” he said. “I feel that I need to speak up for those who don’t know their rights. I feel obligated as a human being to do this."

Rahim Muhammad, diagnosed with PTSD and schizophrenia and currently incarcerated at the Tucson prison, testified about how living in a maximum custody unit impacted his mental health. “I'm all screwed up,” he said. Muhammad told the court the conditions he lived in were “appalling and inhumane. I feel less than.”

Muhammad said he has been at the highest, most restrictive custody level since 2014, despite good behavior. He said in some prisons he was only allowed to have recreation time once a week and allowed to shower twice a week.

Muhammad has spent most of his time in prison in isolation, which he says has had a negative impact on his mental health: "If I can't interact and socialize with anyone, I can't keep the voices in my head away."

Testifying to the brutality of his treatment in isolation cells, Muhammad said he was pepper-sprayed more than 40 times. Plaintiff attorneys showed the court videos of Corrections officers repeatedly gassing him with pepper spray and shooting him with pepper ball guns.

For subscribers: Officers pepper-sprayed mentally ill prisoner more than 40 times

Shinn: 'One of the most challenging assignments I have ever had'

Despite years of failing to live up to court ordered standards, repeated court sanctions totaling millions of dollars, and weeks of testimony from prisoners to the contrary, Arizona Department of Corrections Director David Shinn testified he believed the prison health care system provides greater access to care than services that are available to people in the community. 

“They often have greater access to care than I do as a private citizen,” he said of the people in Arizona state prisons.

Shinn described corrections as a “challenging business.” He was appointed Director by Governor Doug Ducey in 2019 after the retirement of former director Charles Ryan, who left the job shortly after a corrections officer leaked videos that exposed a failing security system at the Lewis prison.

Shinn testified running the Arizona prison system was “by far one of the most challenging assignments I have ever had” in a professional career that began as a corrections officer in 1991. But Shinn said he had a “tremendous willingness to achieve success and make the lives of the men and women in our custody better.”

When asked what he had done to increase the quality of health care in the prisons, Shinn pointed to the addition of staff to the state’s health care monitoring bureau, which oversees the state’s contract with Centurion of Arizona.

Despite their history of performance failures in Arizona, Shinn spoke glowingly of Centurion, saying they had done “an extraordinary job” in general, and specifically during the pandemic.

Of Centurion, Shinn said, “There is virtually nothing we will not do to help them succeed.” But when asked how the Director was holding the company accountable to live up to its contractual obligations, he had no answers.

Under cross examination, Shinn admitted that shortages of corrections officers and health care staff were impacting the delivery of care, but he said he was focused on total systemic improvements, instead of individual facilities. 

“There’s a myth that we need to have x amount of employees at certain locations,” Shinn said of the state prison complexes. “There are desirable and undesirable locations. They are in places you may not want to raise a family. And we are not going to try to force people into locations where it’s totally unnecessary.”

Shinn said the Department was working with Centurion to improve recruitment and utilizing telehealth options to serve prison populations in locations away from the state’s major metropolitan areas. But he acknowledged that wifi connectivity problems in the prisons might be a barrier for the expansion of telehealth services.

“From a technological perspective, we are somewhat behind the curve in a number of areas,” he said.

He pointed to millions of dollars in additional funding the Department has paid to Centurion, on top of the state’s $216 million annual contract, to incentivize more health care staff recruitment.

While Shinn said overall health care staffing was a priority, he acknowledged that Centurion had never achieved full staffing as outlined in its contract.

Shinn admitted that health care costs for the Department had nearly doubled since the privatization of services more than a decade ago, while the prison population has declined. He said the state currently spends approximately $7,700 per prisoner, per year on health care.

The corrections director described the difficulties of providing prison health care as “almost a battlefield health care method — it’s under stress and challenging conditions.”

What comes next?

Judge Silver could order receivership, in which a federal monitor who answered to the courts would be in charge of the health care services for state prisons. Silver could also order Centurion to hire more prison health care workers, or she could order the state to resume direct operations of the health care in state prisons as opposed to hiring a contractor.

If the ruling is unfavorable to the Department, it will almost certainly be appealed, as has been the strategy of the defense team in most other instances in response to orders from the court in the Jensen lawsuit.

Attorneys representing the Arizona Department of Corrections did not return a request to comment on the trial.

Kendrick said she feels optimistic about their case.

“We presented testimony from multiple experts and people who actually still work there, Kendrick said. “We showed that the conditions in isolation units and the medical and mental health care are abysmal.”

“We hope that Judge Silver will find that the department has been violating the rights of incarcerated people,” Kendrick said. “We’ve asked her in the past to appoint someone independent to oversee the delivery of health care. And we’ve asked her to place very strict limits on the use of solitary confinement, including banning its use on people with serious mental illness, pregnant people and juveniles.”

The parties must now file findings of fact and conclusions of law by Jan. 21. Responses to those filings are due Feb. 11, meaning the ruling might not happen until March. 

Have a news tip on Arizona prisons? Reach the reporter at jjenkins@arizonarepublic.com or at 812-243-5582. Follow him on Twitter @JimmyJenkins.

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