Federal judge orders autopsy in Arizona prison death

PHOENIX — A federal judge who issued a sweeping permanent injunction last year requiring Arizona to vastly improve unconstitutionally bad prisoner healthcare has taken the unusual — and possibly unprecedented step — of ordering the corrections department to ensure an autopsy is completed on an inmate who died on June 30.

The order from U.S. District Judge Rosyln Silver came just days after a prisoner at the Yuma prison where inmate Santos Silva had been incarcerated filed a document in the healthcare case that said Silva died because of poor care following hernia surgery.

Silver’s order to the Arizona Department of Corrections, Rehabilitation and Reentry said Silva’s death “may relate to ADCRR’s compliance with the permanent injunction” the judge had entered in the healthcare case.

That injunction requiring immediate state action came after more than a decade of inadequate healthcare provided to tens of thousands of prisoners in the state’s care.

Inmate Anant Tripati wrote that after Silva, 63, had hernia surgery on June 24 surgery, he repeatedly requested to be seen by a medical provider. Tripati wrote that his requests were denied by the company contracted by the state to provide healthcare to prisoners, NaphCare, “due to staff shortage.’’

“As a result, he died June 30, 2024 due to bleeding,’’ Tripati wrote. “Had NaphCare sufficient providers, he may still be alive,’’ referring to the private company paid by the state to provide health care.

Corene Kendrick, a lawyer with the American Civil Liberties Union who has been involved for years in the lengthy lawsuit over prisoner healthcare, called the allegations raised by Tripanto “very alarming.’’

And she said shes never seen Silver or the previous judge on the case respond to communications from a prisoner like she did in this case.

“Unfortunately, it’s not the first time that incarcerated people have contacted the court … either reporting that they themselves were in urgent need of medical care and about to die or reporting alarming things that happened with other prisoners who did die,’’ Kendrick said. “But to my knowledge and memory, this is the first time that the judge has responded by directing the department to make sure than an autopsy be done by the county medical examiner.’’

Kendrick has been working on the healthcare lawsuit since before it was filed in 2012.

The corrections department responded to Silver’s order by immediately contacting the Yuma County Attorney and the county medical examiner and requesting that they do an autopsy, according to a filing from corrections department lawyers. They implied that the medical examiner had initially decided that an autopsy was not required but changed that decision once Silver’s order was known.

The autopsy was completed on July 5 by the Pinal County Medical Examiner, according to a Wednesday filing by the state’s lawyers. The results are expected in six to eight weeks.

The filing noted that Pinal County conducts all autopsies for Yuma County. A spokeswoman for Yuma County said any additional information on Silva’s case would have to be released by the corrections department.

NaphCare did not immediately provide a response to a request for comment on the allegations contained in Tripati’s court filings.

The corrections department said it was working on a response.

Arizona has been struggling for more than a decade to improve its prison healthcare as it worked to deal with a lawsuit alleging its efforts fell far below constitutional standards.

Silver ruled two years ago that the state had acted with “deliberate indifference” to the problems and failed to provide healthcare that met constitutional standards.

She slammed then-prison director David Shinn for turning a blind eye to longstanding understaffing by the company that contracted to provide healthcare and said the problems led to unneeded suffering and death.

The state replaced the contractor with NaphCare in October 2022 and the company has been working to add staff while getting big raises from the state to pay the new doctors, nurses and other healthcare providers needed to care for about 35,000 prisoners in state-run and contract prisons.

Gov. Katie Hobbs also replaced Shinn with Ryan Thornell, who previously had been deputy corrections director in Maine.

That did not assuage Silver, who entered a permanent injunction in April 2023 that required the state to take many wide-ranging corrective actions to address poor healthcare for prisoners.

But NaphCare has struggled to meet the requirements. In an 18-page document filed in court just a day before Silva died, the court monitor listed item after item where the state was “not yet compliant’’ with the detailed orders Silver issued on access to mental and physical healthcare.

And the corrections department’s own June 2024 progress report showed that NaphCare had not filled only about 400 of the 1,400 provider positions required to meet the terms of the permanent injunction.

Silva was serving a sentence of life with no chance of parole for first-degree murder. He stabbed his wife, Alicia Silva, 32, to death while their teenage sons were in a Mesa home on Dec. 4, 1999.

According to an archived story by the East Valley Tribune, Silva stabbed himself in the throat, chest and side while begging police officers to shoot him when they confronted him after he killed his wife.

Silva spent the next several years in and out of the Arizona State Hospital after he was repeatedly found mentally incompetent to stand trial. Once doctors determined his competency had been restored, trial started in 2007, with prosecutors seeking the death penalty.

A jury convicted him in the killing and agreed with prosecutors that the crime was committed but rejected imposing the death penalty, instead recommending a life sentence.

The lawsuit was filed in 2012 on behalf of inmates. The state agreed to a settlement which was signed in 2015, then-Gov. Doug Ducey’s first year in office, promising to do better.

And the state was fined $1.4 million in 2018 for failing to live up to the performance measures to which it had agreed, with Silver imposing another $1.1 million penalty in 2021.

But by 2022 the judge, in a 200-page order, said she had enough.

“Despite years of knowledge, driven by this litigation and defendants’ monitoring of private healthcare contractors’ performance, defendants have in fact made no significant attempts to substantively change the health care system and compel sufficient staffing,’’ Silver wrote at the time.

“Thus, defendants are acting with deliberate indifference to plaintiffs’ serious medical and mental health care needs,’’ she continued. And the judge said the testimony from Shinn during the trial “provides compelling evidence of knowledge of the failures but a refusal to take meaningful measures to correct systemic flaws.’’

She even accused Shinn of being more interested in protecting himself than protecting inmates. Silver cited his decision to send a letter about staffing level to Centurion, the company that previously had the contract to provide health care for prisoners, but then concluding he didn’t need to follow up.

“The only possible conclusion to draw is that Shinn had little interest in changing the underlying reality,’’ the judge said. “Rather, his letter appears to have been nothing more than a half-hearted effort to generate a piece of paper he could cite to avoid contempt.’’