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.”