The Arizona Department of Corrections (ADC) is the agency ultimately responsible for providing healthcare to the state's prison population. Even though the Healthcare Services division within the ADC manages the medical clinics in Arizona's prisons, there are a number of sections and divisions that have important roles to play in ensuring inmates receive the care they are legally entitled to recieve. This essay describes the structural organization that ultimately provides healthcare to inmates and how it operates to ensure statutory compliance.
Arizona's Correctional Healthcare System
Arizona Department of Corrections Organizational Structure
The Arizona Department of Corrections (ADC) is ultimately responsible for providing healthcare for the prison inmate population in the state of Arizona (ADC, 2011). This state agency is responsible for maintaining and administering all ADC institutions and programs, including community supervision for adult inmates released to their communities. The ADC is also responsible for developing uniform community supervision services statewide, making recommendations for policy changes and programs to the Arizona legislature and governor, establishing required qualifications for ADC deputy directors and key personnel, and developing programs to encourage inmate rehabilitation.
In order to facilitate the fulfillment of these diverse responsibilities the ADC director is supported by four sections: the Media Relations Office, Legislative Affairs, Legal Services, and Strategic Planning (ADC, 2011). The Media Relations Office handles all internal and external communications, including issuing press releases to the news media and planning public appearances for the director and other ADC officials. Legislative Affairs monitors ongoing issues in the state legislature that could have an impact on ADC operations, liaisons with state representatives, and responds to legislative requests. Legal Services manages responses to inmate lawsuits, reviews proposed settlements, ensures legal directive compliance, conducts inmate and employee depositions, gives advice on disciplinary actions, and oversees the inmate Legal Access Program. Strategic Planning oversees long-term planning strategies, updates relevant publications, produces agency reports, and interfaces with the Auditor General of Arizona.
The ADC director is also supported by the deputy director, whose responsibilities are defined in part by the nature of supporting sections at his/her disposal: Victim Services, Constituent Services/Inmate Family and Friends Liaison, Office of Inspector General, and Emergency Preparedness (ADC, 2011). Victim Services oversees the Restorative Justice program that brings together offenders and crime victims in an effort to encourage offender rehabilitation, and providing support to victims through victim-focused services. Constituent Services provides an avenue for the public to file complaints related to inmate treatment. The Office of Inspector General contains a number of specialized units, including those that conduct background investigations, intelligence gathering, criminal investigations, and audits. The Office of Inspector General also interfaces with Homeland Security and is responsible for ensuring state prisons conform to ADC policy guidelines. The Emergency Preparedness office is responsible for developing plans to ensure the safety of employees and inmates in the event of a technical, natural, or man-made disruption or disaster, and conducting annual exercises to ensure prison staff is properly trained to respond to such emergencies.
Also reporting directly to the ADC director are four division directors responsible for the following functions: Administrative Services, Offender Operations, Support Services, and Health Services (ADC, 2011). These divisions are more intimately involved with overseeing the day-to-day operations of Arizona prisons. Administrative Services is responsible for monitoring the financial performance and compliance of ADC prisons, prison construction and maintenance, information technology infrastructure, procurement, and budget planning. Offender Operations administers the 562 million dollar annual budget for all prisons statewide, ensuring the inmate population is secure at all times, oversees community supervision, oversees prisons operated by private contractors, and organizes the parole boards. Support Services is responsible for the hiring of all ADC employees, providing spiritual support for inmates, and offering employment opportunities to inmates while incarcerated. Health Services is responsible for providing healthcare to the Arizona prison population, which includes medical, mental health, dental, and pharmacy services.
ADC Healthcare Services
Prisoner access to basic healthcare needs is mandated by the Eight Amendment's prohibition against cruel and unusual treatment (American Civil Liberties Union, 2009). To avoid legal liability, the ADC must therefore ensure that correctional staff does not ignore a substantial risk of harm to the prisoner because of a medical condition. For example, an inmate passing out would be sufficient cause to get the inmate examined by a nurse or physician. Failure to do so puts the prison system at risk for an Eight Amendment claim. In addition, Arizona Title 31, section 201.01, subsection D. requires the director of ADC to provide healthcare for the entire state prison population.
In order to comply with both federal and state law, medical facilities must therefore be provided at prisons and state-run correctional facilities. This task would require the combined efforts of several sections within the ADC, primarily Administrative Services, Offender Operations, Support Services, and Health Services. Budgeting for, building, and maintaining the medical clinics would be the responsibility of Administrative Services and Offender Operations. Support services would perform background checks on medical staff seeking to fill positions within the ADC, and Health Services would be responsible for the day-to-day operations of the prison medical clinics.
In order to ensure that the quality of healthcare provided to inmates is above reproach the ADC has sought and received accreditation from an independent accrediting agency, the National Commission on Correctional Health Care (NCCHC) (ADC, 2011, Medical Services). The NCCHC healthcare standards are intended to help prison healthcare clinics meet international and national standards of basic human rights. Unfortunately, the widespread patient safety revolution currently underway in most western countries, including the United States, has failed to penetrate the walls of prison healthcare clinics (Stern, Greifinger, and Mellow, 2010). This may change in the future, since the Procurement Services Unit of ADC Administrative Services is currently seeking proposals from private healthcare providers who are accredited by the Joint Commission. The Joint Commission is the primary independent accrediting agency for civilian hospitals in the U.S. And therefore helps determine the quality of care nationally (2011). If a healthcare provider is contracted by the ADC to provide medical care for inmates and is also accredited by the Joint Commission, then this would eliminate separate sets of healthcare standards for prison inmate and civilian populations.
The ADC therefore ensures state prison inmates have access to healthcare that meets minimum basic human right standards, by building medical clinics, providing the necessary funding, performing background checks and screenings before hiring medical staff, training prison staff about their legal responsibility to recognize and report possible inmate medical conditions, and meeting or exceeding the statutory requirements for providing healthcare to inmates. The quality of the healthcare provided can also be determined by ADC policy, if they choose to exceed the minimum human rights requirements by seeking accreditation through the Joint Commission.
The ADC in Action
FOX News in Phoenix, Arizona reported on December 6, 2011 that ADC has initiated an investigation into claims that state prison inmates were being denied access to healthcare for weeks and months (KSAZ FOX 10, 2011). A legal coalition called the Prison Law Office has pointed out that the rate of suicide in Arizona prisons is over twice the national average and suggests this may be a symptom of inmates not receiving adequate medical and mental health services. Correctional officials claim there is no evidence of a systemic problem, but the ADC notes that their efforts to privatize healthcare services has made it harder to find medical personnel willing to take positions that may disappear in the near future. In addition, budget restrictions have forced them to cut payments to outside medical services contractors and this may have had restricted inmate access to healthcare services.
The ADC has agreed to investigate these complaints. The complaints filed by inmates and their families would have likely been handled by Constituent Services. The decision to conduct an investigation was probably made by the director, who probably then gave oversight responsibility for the investigation to Legal Services. Legal services would then depose the prisoners who filed complaints and assess whether any instances of denial of care violated statutory and Constitutional requirements to provide healthcare to prisoners. The deputy director may be tasked to have the Office of Inspector General conduct its own investigation. If federal or state law was violated then Legal Services may recommend offering settlements to prisoners and their families to avoid costly lawsuits. All four services divisions may be tasked to address shortcomings. Administrative Services may be asked to go through the budget plan to see if funding levels for healthcare services can be increased. Offender Operations may be asked to identify shortcomings in their procedures that allowed denial of healthcare incidents to occur, and then make recommendations for preventing future occurrences. Support Services may be tasked with beefing up its recruiting efforts to find qualified medical personnel to staff prison medical clinics, and Healthcare Services will likely be required to review its procedures for any shortcomings in its procedures that led to denial of…