Judge hands Ohio’s former prisons chief sweeping control over Arizona prison healthcare

A federal judge on Friday appointed
Ohio’s former prisons chief to run Arizona’s prison healthcare system,
giving her the sole power to determine what the state needs to do to
stop violating the constitutional rights of inmates with substandard
medical care — and she set the stage for nullifying two state laws that
experts have said make it impossible to do that.

Although the Arizona Department of
Corrections, Rehabilitation and Reentry and the plaintiffs in a
class-action lawsuit agreed weeks ago to appointing Annette
Chambers-Smith as the receiver, it didn’t become official until Judge
Roslyon Silver issued an order formally naming her to the role.

In her Friday order, Silver also laid
out the sweeping powers that Chambers-Smith, who directed the Ohio
Department of Rehabilitation and Correction from February 2019 to March
2026, will have. Chambers-Smith will take over all of the prison
healthcare duties and authorities outlined in Arizona law. Silver laid
out a number of specific things that will be fully under
Chambers-Smith’s control:

• Personnel
  — She can hire, fire, suspend, supervise, promote, transfer, discipline
  and set compensation for ADCRR employees and contract staff doing
  healthcare work. She can also create, abolish or transfer positions.
• Contracts
  — She can negotiate, enforce, terminate or renegotiate all ADCRR health
  care vendor contracts. She must give ADCRR Director Ryan Thornell and
  the Arizona Department of Administration 30 days’ notice before amending
  or approving a contract that could affect indemnification or insurance.
• Budget
  — She can formulate and establish the annual ADCRR healthcare budget
  and she is granted all of the financing authority over prison health
  care normally granted to the director of the agency.
• Policy
  — She can write ADCRR policies, department orders and protocols, and
  she can adopt rules that will last after her term ends.
• Property — She can acquire, dispose of, modernize, repair and lease property and equipment. ADCRR must assist in those efforts.
• Access
  — She has unrestricted access to all ADCRR facilities with or without
  notice, plus access to outside governmental records, including AHCCCS,
  the state’s Medicaid program.

Court-ordered receivers of prison
healthcare systems are rare, a point that Silver made in February when
she determined that the 14-year-long court battle would not result in
improved healthcare for inmates as long as the state of Arizona remained
in control of the decisions.

“Ordering the implementation of a
receivership is extraordinary, and the court has exercised caution and
critical reflection in making the decision,” Silver wrote at the time.
“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.”

In her order appointing
Chambers-Smith, Silver remained exasperated with ADCRR, writing that,
over the course of the “multi-year, interminable litigation,” she and
prior judges have “identified entrenched systemic failures in
Defendants’ administration of health care” that remain much the same now
as they were when the lawsuit was first filed in 2012.

Silver also made a point to direct
Chambers-Smith to name individuals and agencies who obstruct her work in
complying with the terms of an agreement that ADCRR and the plaintiffs
reached in 2023. The judge wrote in February that the state failed to
comply with 131 of the 154 “quality indicators” in that agreement.

And those who stand in the way will be punished, she said.

“Any person or entity interfering
with the responsibilities and authority of the Receiver or who otherwise
attempts to thwart the performance of the receiver, pursuant to the receiver’s plan and orders of the court, will be subject to a finding of
contempt,” Silver wrote.

Chambers-Smith was directed to follow
state law, regulations and contracts as best she can — but she’s not
entirely bound by them. Silver wrote in her order that, if compliance
would interfere with constitutional care, the receiver may ask the court
to waive those laws.

Silver signaled that there are two
specific laws, which the court’s expert identified as “persistent
barriers” to constitutional care, that may face judicial nullification.
One is a 2009 law that requires the privatization of prison healthcare —
prior to that, it was managed directly by the Corrections Department —
and the other is a cap on pay for specialists in the prison healthcare
system.

The judge also indicated that she may
override the Arizona Legislature’s budget decisions: Chambers-Smith was
given authority to decide ADCRR’s healthcare budget, and if she finds
the amount available in the fiscal year’s budget to be inadequate, she
is to notify the Legislature and Gov. Katie Hobbs’ office. If those
parties can’t satisfy the receiver, Silver wrote that she may “order the
waiver of Arizona state laws, regulations, and contracts that interfere
with the requirements and desired outcome of the receivership.”

Requests for comment to spokespeople
for the Arizona House of Representatives and Senate were not immediately
returned. Hobbs’ office declined to comment. ADCRR’s press office did
not respond.

Silver’s appointment of
Chambers-Smith won’t go into effect immediately, as ADCRR is already
appealing her ruling putting the healthcare system into receivership,
and the agency has said it will ask an appellate court to delay the
receiver’s appointment until that appeal is heard.

The appointment takes effect 21 days
after 9th U.S. Circuit Court of Appeals rules on that yet-to-be-filed
request for a stay of Silver’s order.

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 order declaring the health care system
“pervasively and systemically unconstitutional.” The next year, a
permanent injunction was issued with 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.

“The court’s patience has run out.
Too many individuals are needlessly suffering while defendants have
deployed many delay tactics,” Silver wrote in the February order placing
the healthcare system into receivership. “The court has exercised
restraint for much of this litigation, to the point that anymore
tolerance of unconstitutional healthcare becomes judicial indulgence.”