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Arizona Prisoners Required to Pay Medical Expenses for Overdoses

by Douglas Ankney

On March 15, 2019, the Arizona Department of Corrections (ADOC) implemented a change to its disciplinary procedures for prisoners. Policy No. 803 now mandates that prisoners requiring hospital treatment for substance abuse must repay the cost of “all medical related expenses,” including ambulance transport, as well as the “cost of staff overtime.”

ADOC spokesperson Bill Lamoreaux said that while the department “understands that the struggle with addiction is not an easy one,” it believes that “obtaining contraband illegal drugs while incarcerated requires a series of deliberate and extremely poor choices.”

Even prior to this policy change, the ADOC charged prisoners a $4 copay for healthcare visits and took 10 percent of deposits into prisoners’ trust accounts to cover medical treatment costs. ADOC prisoners who test positive for illegal drugs must also pay for the urinalysis test. Prison officials insist the policy is designed simply to hold prisoners accountable for their actions.

ADOC prisoners with jobs typically earn 10 to 80 cents an hour. About seven percent of the state’s prison population – around 3,000 prisoners – receive drug treatment, though 78 percent have “significant substance abuse histories,” according to a March 2019 ADOC report. Methadone is only provided to pregnant prisoners who are addicted to opioids, per accepted medical protocols.

Rebecca Fealk, program coordinator for the American Friends Service Committee in Arizona, said prisoners have told her group, “Oh yeah, my treatment was a worksheet that asked me about negative outcomes from using.”

Karen Hellman, division director of Inmate Programs & Reentry for the ADOC, admitted to the state House Judiciary Committee in March 2019, “I could not today treat everyone in the system who needed treatment immediately. The need of the inmates is greater than our capacity to deliver.”

Dr. Josiah Rich, director of The Center for Prisoner Health and Human Rights at Rhode Island’s Miriam Hospital, said that Opioid Use Disorder (OUD) is a disease and the new policy betrays “an ignorance about what the disease is and how to treat it.”

“People don’t decide, ‘Hey, I think I’ll overdose today,’” Rich said. “They don’t decide, ‘Oh, I better not overdose today because I might have to pay money from my account to pay for the treatment I’m going to need.’ People overdose because there’s a discrepancy between how much tolerance they have and the amount and purity of the drug and the potency of the drug that they consume.”

Dr. Kimberly Sue, medical director of the Harm Reduction Coalition and a physician at New York City’s Rikers Island jail complex, agreed that the ADOC’s policy “runs counter to the reality of addiction.”

“An opioid overdose inside a prison indicates medical mismanagement of a treatable disorder,” she said, adding that “for the people currently incarcerated, we should be providing medications if at all possible in the case of [OUD].”

Treating addiction as the poor choice of people who just need a stronger sense of morality is really “just reflexively punitive and entirely counterproductive,” noted David Fathi, director of the ACLU’s National Prison Project.

“From a public health perspective, this is the worst policy imaginable,” he added. “The solution is treatment, not punishment.”

The ADOC is struggling to meet the terms of a class-action settlement reached in 2015 over its healthcare services. For its failure to do so, U.S. Magistrate Judge David Duncan levied a $1.4 million fine in June 2019. [See: PLN, April 2019, p.56; May 2018, p.28].

In December 2019, U.S. District Court Judge Roslyn Silver named an outside evaluator to report on the ADOC’s medical services. Fathi said the new policy “certainly is consistent with some of the resistance that we have seen in the case to providing even basic and life-saving healthcare,” and “This obviously does affect the ability of our clients in [the class-action suit] to get necessary healthcare.” 



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