Judge orders autopsy of Arizona inmate who died after surgery

A federal judge who issued a sweeping ruling last year requiring Arizona to vastly improve unconstitutionally bad prisoner health care has taken the unusual — and possibly unprecedented — step of ordering the corrections department to ensure an autopsy was completed on an inmate.

Inmate Santos Silva died June 30. The order from U.S. District Judge Roslyn Silver came just days after a prisoner at the Yuma prison where Silva had been incarcerated filed a document in the health-care 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 ordered last year in the health-care case.

That injunction requiring immediate state action came after more than a decade of inadequate health care 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, he repeatedly asked to be seen by a medical provider. Tripati wrote that his requests were denied by the private company contracted by the state to provide health care 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.”

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

She said she’s 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 health-care 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 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 provides health-care services in local jails and state prisons in a variety of states.

A spokesperson did not address questions about the allegations raised in Tripati’s court filing, but said in a statement that the Birmingham, Alabama, company’s mission is to “improve and save lives.’’

“When a tragic loss of life occurs, we conduct a thorough review to identify any potential areas for improvement,’’ the spokesperson said in a statement provided to Capitol Media Services. “NaphCare is working with ADCRR and the court’s appointed physician monitors to review this case.

The corrections department said it was working on a response.

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Arizona has been struggling for more than a decade to improve its prison health care 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 health care 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 health care 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 health-care providers needed to care for about 35,000 prisoners in state-run and contract prisons.

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

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

But NaphCare has struggled to meet the requirements. In an 18-page document filed in court 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 health care.

And the corrections department’s own June 2024 progress report showed NaphCare had 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 brutally stabbed he 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 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 that 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 had enough.

“Despite years of knowledge, driven by this litigation and defendants’ monitoring of private health care 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. 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.’’