This paper examines the structural organization of the Arizona Department of Corrections (ADC) and how its various divisions collaborate to deliver constitutionally and statutorily mandated healthcare to the state's prison population. The paper traces the ADC's organizational hierarchy — from the director's supporting offices through the four major division directors — with particular attention to the Health Services division. It discusses accreditation standards, the role of independent medical licensing boards, and a 2011 news case in which inmates were allegedly denied care. The paper concludes by evaluating how reliance on external accrediting and licensing bodies protects both inmate health and the ADC's institutional credibility.
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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, a number of sections and divisions play important roles in ensuring inmates receive the care they are legally entitled to receive. This essay describes the structural organization that ultimately provides healthcare to inmates and how it operates to ensure statutory compliance.
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, liaises 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 the supporting sections at his or her disposal: Victim Services, Constituent Services/Inmate Family and Friends Liaison, the Office of Inspector General, and Emergency Preparedness (ADC, 2011). Victim Services oversees the Restorative Justice program, which brings together offenders and crime victims in an effort to encourage offender rehabilitation, and provides 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. It 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 for 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 annual budget for all prisons statewide, ensures 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 hiring 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.
Prisoner access to basic healthcare is mandated by the Eighth Amendment's prohibition against cruel and unusual punishment (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 a prisoner because of a medical condition. For example, an inmate losing consciousness would be sufficient cause to have that inmate examined by a nurse or physician. Failure to do so puts the prison system at risk for an Eighth Amendment claim. In addition, Arizona Title 31, Section 201.01, Subsection D requires the director of the ADC to provide healthcare for the entire state prison population.
In order to comply with both federal and state law, medical facilities must be provided at prisons and state-run correctional facilities. This task requires 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, & 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 United States and therefore helps determine the quality of care nationally (2011). If a healthcare provider contracted by the ADC is also accredited by the Joint Commission, this would eliminate the existence of separate sets of healthcare standards for prison inmate and civilian populations.
"2011 investigation into inmates denied healthcare"
"Independent licensing boards and standards of care"
The ADC ensures state prison inmates have access to healthcare that meets minimum basic human rights 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 elevated by ADC policy choices, such as seeking accreditation through the Joint Commission, which would bring prison healthcare in line with the standards applied in civilian hospitals across the country.
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