The landmark trial Jensen v. Shinn began Monday in Phoenix, the latest chapter in an almost decade-long struggle to determine whether Arizona’s prisoners are getting the basic health care they are entitled to under the law.
The federal trial pits Arizona against the people held in its prisons, who argue in a class-action lawsuit that the medical services they receive are so poor, they constitute cruel and unusual punishment.
The state’s health care contractor, Centurion, is the latest in a string of companies that have failed to pass muster with the courts.
Here’s the latest:
Nov. 4: Who testified on Day 4 of the trial
Dr. Craig Haney
- Haney is a witness for the plaintiffs. He is a professor of psychology at the University of California, Santa Cruz, who studies the impact of solitary confinement and isolation in prisons. Haney was a lead researcher on the Stanford Prison Experiment.
What did he say?
- Haney called Arizona’s extensive use of solitary confinement and isolation “very harsh” and “among the most severe in the country.”
- Haney said mentally ill patients are especially at risk when subjected to isolation.
- Haney told the court that human beings are “wired to connect. Our connections with others provide us with a sense of identity; a sense of self.”
- “Isolated confinement is painful and it causes suffering. It can be damaging, irreversible and life-threatening because it can lead to self-harm and suicide.” He said that more than half of the suicides he reviewed from 2015 to 2021 took place in isolation housing units.
- Haney testified about recent tours of Arizona prisons and described isolation units at the Lewis and Eyman prisons with no windows and solid steel doors that prevent prisoners from communicating. He said prisoners live in these cells “more or less around the clock.” He documented that prisoners living in isolation at the Eyman prison had made “peanut butter traps” to catch roaches and rats in their cells.
- Haney described cages that prisoners are locked in while wearing restraints during sessions with mental health counselors at Eyman prison. He said prisoners often decline counseling sessions because they don’t want to be locked in the cage.
- Haney said prisoners refer to the brief mental health care encounters they receive as “drive-bys.” They told him counselors will often quickly pass their cell and ask for a thumbs up instead of spending time evaluating them.
- He said he spoke to juveniles committed to the Department of Corrections. They told him they had not been allowed to go outside for recreation for three weeks: “The Arizona Department of Corrections’ isolations practices create a very substantial risk of harm to juveniles … One told me he couldn’t sleep, another told me all he does is sleep. This is taking enormous risks with a young person’s psychological well-being.”
- Haney testified that most prisoners held in isolation units are not given much recreation time. When they are, it’s usually in a small concrete block pen.
- Haney said Arizona should adopt limits on the amount of time prisoners can be held in isolation. He found that many incarcerated people had been held in isolation for months or even years.
- Haney said prisoners who are seriously mentally ill, juveniles or pregnant should be completely excluded from isolation practices except in only emergency situations.
The quote
- “Prisoners in isolation sometimes tell me they are not sure if they exist anymore because they haven’t had any contact with others.”
Cross examination
- Defendant attorneys accused Haney of conflating custody classification levels and detention status levels in his discussion of conditions in the prisons.
- When attorneys asked Haney about the Stanford Prison Experiment, he said the study would not be done today because it would be deemed unethical.
- Defendant attorneys claimed the number of prisoners held in maximum custody has declined in recent years and faulted Haney for not reviewing that data.
- Defendant attorneys said prisoners in isolation can watch TV, use tablets and purchase commissary items, and they disputed the amount of out-of-cell time prisoners are given.
Why it matters
- Haney’s testimony highlighted one of the main plaintiff complaints, which is that Arizona uses isolation extensively on incarcerated people, causing specific harm to seriously mentally ill patients.
Rahim Muhammad
- Muhammad is a witness for the plaintiffs and is currently incarcerated at the Tucson prison. He has been diagnosed with PTSD and schizophrenia.
What did he say?
- When asked how has living in a maximum custody unit impacted his mental health, Muhammad replied: “I’m all screwed up.” He told the court the conditions he lived in were “appalling and inhumane. I feel less than.”
- Muhammad told the court 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.”
- Muhammad told the court he’s spent more than $200 requesting mental health treatment, because Arizona prisons charge incarcerated people $4 to submit a “health needs request” to receive health care.
- Testifying to the brutality of his treatment in isolation cells, Muhammad says he was pepper-sprayed more than 40 times. He accused COs of beating him, holding him down with a knee on his throat, making profane comments to him and saying things about the size of his genitalia.
- Plaintiff attorneys showed the court a video where correctional officers threatened to pepper spray Muhammad if he continued to self-harm while he was on constant mental health watch: “Muhammad if you bang your head again I’m going to spray you.” The video showed the COs pepper spraying him. Muhammad said he remembered none of what transpired in that video, telling the court he was “blacked out” and “very distraught.”
- Plaintiff attorneys presented another video of a different incident where correctional officers shot Muhammad with pepper balls at very close range through the food slot of his constant watch cell after ordering him to stop harming himself. In the video, Muhammad tells the officers that voices in his head tell him he has to hurt himself to prevent someone from raping his daughter. The officer responds: “You are choosing to bang your head against the wall. We will keep shooting you. We will gas you every day. These are behavioral choices you are making.”
The Quote
- “I hear voices that tell me to hurt myself and hurt others. I have aggression issues. I see things. I can’t sleep, sometimes I sleep too much.”
Cross examination
- Defense attorneys said since Muhammad has been at the Tucson prison for the past two months, he has had access to programming, recreation and counseling sessions.
- Muhammad told defense attorneys he is now on medication that allows him to be more stable, but that he “had to fight to get back on it.”
Why it matters
- Muhammad’s history of denial of care and the prison’s repeated use of force against him reinforces the plaintiff’s accusations that extensive use of isolation has detrimental impacts on seriously mentally ill patients.
— Jimmy Jenkins
Nov. 3: Who testified on Day 3 of the trial
Dr. Pablo Stewart
- Stewart is a witness for the plaintiffs. He is a psychiatrist and correctional psychiatry expert.
What did they say?
- Stewart said mental health staffing numbers are “grossly inadequate” at several Arizona prisons and told the court a shortage of correctional officers is also impacting health care.
- He said that many patients who had died by suicide had experienced very short mental health encounters before their death and said that a significant number of suicides occur in isolated housing units.
- “I was saddened but not surprised by the descriptions and photographs of the conditions at Eyman. Memorably, this included the graffiti within the entrance to the suicide watch unit, that read, ‘Don’t go suicidal. This place sucks. Please help me.'”
- Stewart said he observed people on suicide watch. One such patient, despite being on constant watch, was able to remove 10 surgical staples used to close a self-inflicted wound and swallow them, causing his colostomy bag to rupture.
- Stewart reviewed videos of an incarcerated person at the Eyman prison with serious mental illness. In his review, he said that staff used pepper spray or pepper balls on them for a period of 15 days in December 2020.
- Stewart said he reviewed emails between prison administrators showing employees of Centurion, Arizona’s prison health care contractor, approved this behavior and encouraged a prisoner to commit acts of self-harm.
- On a tour of the Eyman prison, Stewart discovered a cell for seriously mentally ill patients covered with blood. “The people living in the adjacent cells reported that the previous evening, the man in that cell cut both of his arms and perhaps his legs, and hit an artery.”
- Stewart reviewed a case where a corrections officer told a prisoner experiencing psychosis that his self-harming behavior was a choice, and the officer threatened to tase the patient if he continued banging his head against the wall.
- Echoing Tuesday’s testimony from Laura Redmond, an incarcerated woman, Stewart found there were no translators available for deaf patients, nor for Spanish-speaking patients.
The quote
- “It’s hard for me to adequately express how significantly mentally ill the patients I encountered are.”
Cross examination
- Defendant attorneys accused Stewart of selection bias and said previous court findings have characterized his work as speculation, containing errors. They also accused Stewart of not providing patients with a non-confidentiality warning before speaking with them, as required.
- Defendant attorneys said some staffing vacancies noted by Stewart are being filled by part-time workers and overtime work.
Why it matters
- Stewart’s testimony centered on a recurring theme at the trial: Arizona’s prison health care system is understaffed.
- Interviews Stewart conducted with prisoners and case files he reviewed of incarcerated patients supported the plaintiffs’ claims that people in Arizona prisons are subjected to substandard levels of mental health care.
- Stewart testified about the negative impacts associated with Arizona’s use of solitary confinement on seriously mentally ill prisoners.
Eyman Deputy Warden Travis Scott’s testimony was cut off again and is scheduled to resume on Thursday.
— Jimmy Jenkins
Nov. 2: Who testified on Day 2 of the trial
Ronald Slavin
- Slavin is a witness for the plaintiffs and is incarcerated at the Eyman prison. He is classified as seriously mentally ill, diagnosed with psychosis, bipolar disorder, schizophrenia, and major depression.
What did he say?
- Slavin told the court he started hearing voices when he was hit in the head by a car at age 6 and has suffered from auditory hallucinations his whole life.
- Slavin said he has access to counseling for just a half-hour, once a month, and has no access to mental health programming or group therapy. His repeated requests to transfer to a special unit for people with serious mental illness have been denied.
- Slavin’s prison counselor suggested he “listen to a podcast” to deal with his serious mental illness.
- Slavin told the court he wasn’t getting enough help to address his serious mental health issues.
The quote
- “I don’t mind listening to a counselor. I don’t mind taking meds. But to a certain extent, other treatment is needed.”
Cross examination
- Slavin said he has been provided medication but he continues to hear voices and still struggles with other mental health issues.
- When defendant attorneys accused Slavin of refusing treatment, he said it was because the counselors kept repeating the same ineffective advice over and over again.
Why it matters
- Slavin’s attorneys say the repeated denials to be transferred to a unit for prisoners with serious mental illness, as well as the substandard care he testified to, bolster their claims.
Laura Redmond
- Redmond is a witness for the plaintiffs and is incarcerated at the Perryville women’s prison. Classified as seriously mentally ill and has been diagnosed with schizophrenia and bipolar disorder.
- Redmond is deaf, and her primary language is American Sign Language.
What did she say?
- Redmond said she became deaf at 15 months old and is “profoundly deaf” in both ears.
- She said her medical care is poor because she generally does not have access to a sign language interpreter during healthcare appointments in the prisons. This has also prevented her from getting a cochlear implant.
- Redmond said she suffers from behavior issues and negative thinking and has a hard time sleeping: “I cry a lot”.
- Redmond testified remotely from the Perryville prison via teleconference, but the video call dropped several times.
The quote
- “I don’t understand what they’re saying to me. I’m always frustrated and I am not able to ask questions.”
Cross examination
- Defendant cited several instances in Redmond’s medical record where it had been recorded that a language interpreter was provided. Redmond disputed some of the records and said she didn’t remember being provided with an interpreter in the other instances.
- Redmond said some of her counseling sessions had been longer than the few minutes that she previously testified to.
- Defendant attorneys said that the doctors found she might not be a good candidate for a cochlear implant because she has been deaf since childhood.
Why it matters
- Plaintiff attorneys say Redmond was deprived of her right to be an active participant in her medical and mental health care.
- They say the lack of interpretation services during her healthcare encounters affected her ability to receive constitutionally adequate care.
Deputy Warden Travis Scott’s testimony was cut off at the end of the day and will resume Wednesday.
— Jimmy Jenkins
Nov. 1: Who testified on Day 1 of the trial
Kendall Johnson
- Johnson is a witness for the plaintiffs and is incarcerated in the Perryville Women’s Prison.
What did she say?
- Johnson 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 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 uses a wheelchair, is nearly immobile and has trouble speaking. Now Johnson is confined to a special needs medical unit at the prison.
The quote
- “I tried to get help but it was like hitting my head against the wall.”
Cross examination
- Johnson said she is finally receiving medication that has helped her symptoms, but the treatment came too late.
Why it matters
- Johnson’s story and allegations illustrate the continued failures plaintiffs have accused the state of, including delayed care, lack of specialty care referrals and medical neglect.
Robert Joy
- Joy is a witness for the plaintiffs and an independent health care consultant. He previously conducted a staffing analysis of California prisons, and he created a staffing model for health care workers in Arizona prisons.
What did he say?
- Joy testified about the model he created, which calls for many more health care workers in Arizona prisons than are employed by Centurion. “Based on my analysis, the 10 state-run prisons are understaffed.”
- He described using data from the Department of Corrections, Department of Justice and other sources to estimate the actual health care needs of people in Arizona prisons.
- Joy’s model divided Arizona prisoners into cohorts depending on medical need, then extrapolated those numbers out to make an estimate for the entire state prison population.
- He told the court the state prison population has greater mental and physical health needs than in private prisons. He also found the proportion of patients designated seriously mentally ill in Arizona prisons is significantly lower than in other states.
- Joy focused on factors specific to “justice-involved” populations to make estimations.
- He found 18-20% of the prison population is held in isolation, a significantly higher portion than other prison systems. He said he also believes the state is using outdated staffing metrics from nearly a decade ago.
The quote
- “It’s like a big math problem — you need to understand how many patients there are and put them in categories that help you understand the services they need.”
Cross examination
- Attorneys for the state said Joy was not a medical professional, and they took issue with the sources of the data used in his model. They called his work “inflated data” and “junk science.”
Why it matters
- Several court experts have previously testified about how low staffing levels in Arizona prisons were leading to improper and delayed care. Joy’s findings and testimony bolster those claims.
- The findings suggested Arizona is not accurately defining the true number of seriously mentally ill patients in state prisons.
- Joy’s work indicates the current contract likely underestimates the true need for mental and physical health care services.
- Arizona’s use of isolation makes providing health care even more difficult.
— Jimmy Jenkins