In 2012, the Arizona Legislature made a major change in how health care was delivered in our state prisons. In a party-line vote, lawmakers decided to privatize prison health services. Governor Brewer signed the law in 2012.
Arizona Privatizes Health Care in State Prison System | Prison Legal News
What followed? The AZ Department of Corrections fired the state-employed doctors, nurses, and health staff, contracting the work out to private companies.
Then-ADOC Director Chuck Ryan was tasked with dismantling a decades-old, state-run system and replacing it with a contract model. Instead of directly providing care, the ADOC would write requests for proposals (RFPs), select vendors, and manage contracts.
That transition — from running health care to managing contracts — didn’t go well.
Over the next several years, complaints increased. Inmates and their families experienced and documented delayed treatment, missed medications, and preventable suffering. Lawsuits followed. The most significant case, now Jensen v. Thornell, has been in federal court for more than a decade. As the case drug on over the years the court repeatedly found serious deficiencies in care.
Now, after years of frustration and missed benchmarks, U.S. District Judge Roslyn Silver appointed a court-controlled receiver to take over prison health operations. It reflects the court’s opinion that the state has been unable to fix the system on its own. Governor Hobbs believes good progress has been made on her watch. I don’t know whether that’s true or not but clearly Judge Silver doesn’t believe so.
Arizona state prisons lose control of health care after federal ruling
So what happened? Why did the privatization experiment fail?
A root cause points to the transition itself. Running a health system with your own staff and managing a vendor contract are two different skills. When Arizona privatized prison health care in 2012, it didn’t just switch providers. It changed the whole operating model.
The Department of Corrections had decades of experience delivering care directly. But contract oversight needs a different culture, staffing model, data systems, and ability.
Good contract management requires objective performance monitoring, clear accountability, and the ability and wherewithal to enforce penalties when vendors don’t meet demands in the scope of work. It also requires a solid contract that allows the state to actually provide the accountability needed including compliance and enforcement provisions.
In short… contract development and management are different from running a program yourself.
By nearly all accounts, that shift from service provision to contract management was poorly executed, especially during the Ducey administration. Whether privatization was a flawed idea from the start or whether it failed because the transition to contract management was mishandled is a legitimate debate.
The outcome isn’t.
For 14 years, incarcerated people have lived in a system under court supervision due to what the court believes is substandard care.
As Arizona moves forward under federal oversight, we owe it to taxpayers and to those in custody to learn from our policy mistakes.
We learned those lessons were learned the hard way.
