This story is supported by a grant from the Fund for Investigative Journalism.

“It’s in my heart to take care of people, to take care of everything,” Leticia Romero says. She’s sitting on a walker on her mother’s front porch on the south side of Tucson. She’s drowsy from the Suboxone she recently took to allay her opioid addiction. 

Leticia wants to steer others clear of making some of the mistakes she’s made. More pointedly, she wants to help keep people out of the Pima County jail, where she says she felt like she was tortured, where she thought she was going to die.

Taking care of people isn’t just Leticia’s attitude, it was also her job. 

She worked as a caretaker in various nursing and rehabilitation homes around Tucson. But she struggled with her mental health, sometimes running out of her medication. 

Then, last year, “I met the blues,” she says, referring to the increasingly prevalent small blue pills — fentanyl — that are tied to a deadly crisis throughout the country. 

Going sometimes weeks without being able to refill her prescriptions, she began self-medicating with leftover meds she could scrape together, as well as by smoking flame-sizzled blue pills off of wrinkled strips of aluminum foil.

The fentanyl high not only numbs her pains, it “humbles me,” she says. It started becoming hard for her to keep a job.

Leticia speaks with a reporter at her home in Tucson, Ariz. on April 17, 2023. Credit: Michael McKisson

Leticia’s struggles culminated in February of 2023. She was high, had been fighting with her fiance, and was in tears as she walked with him near her mother’s home. A law enforcement cruiser drove by. An officer saw that she was distressed. She says they stopped to question the couple. 

The interaction ended with Leticia in jail — the Pima County Adult Detention Center —  on complaints that included domestic violence. She says she had previously put her fiance in a headlock, and he had bruises on his neck. 

Leticia told the officer they’d been fighting and she gave her fiance the bruises.

The next two days  —  locked up in Pima County jail — were hell, she says. 

At least one guard belted her flat on her back against a restraint bed — a hard plastic contraption on the floor — where she says she was denied the use of a toilet and left to defecate and urinate on herself. Guards mocked her and laughed, she says. 

Leticia says she was not given the critical medical attention — Suboxone medication — she needed and repeatedly requested to alleviate opioid addiction and withdrawal symptoms.

She shared pictures with Arizona Luminaria that she took upon her release to document how her body deteriorated in jail: open wounds with partially scabbed over rashes covering her buttocks and groin.

“They wouldn’t give me toilet paper unless I started hitting myself” to get their attention, she says.

“I needed to be in a hospital so I just tried to start knocking myself out, hitting myself,” she says. 

After they released her from the restraint bed Leticia says she was moved to a frigid room, given nothing to sit on or cover herself with but an anti-suicide smock. The thick, bulky garment is sleeveless, fastens with straps, and is hard to tear and fashion into a noose to hang oneself by.

“I was on a concrete floor, getting tortured for what?” she says.

Though she says the guards were dismissive and general jail conditions dangerous, Leticia points her finger at healthcare, saying that medical staff visited her a couple times and still never provided her Suboxone for withdrawals, which can be deadly.

“They should be able to treat you decent,” she says.

Suboxone is a brand name drug used to treat opioid withdrawals and has become a common term used to refer to various opioid-addiction treatments. While both inmate and employee sources specifically refer to Suboxone, the broader medical neglect complaint is that many people detained in the jail are routinely not getting any form of opioid-addiction medication, Suboxone, Subutex or otherwise. 

Medical care in Pima County jail is managed by NaphCare, a for-profit company headquartered in Alabama. NaphCare also manages healthcare in Pima County’s Juvenile Detention Center. The contract between NaphCare and the county, signed in 2021, is through Sept. 30, 2025 with a maximum fee of $62.9 million dollars.

NaphCare’s first full year of offering services was the jail’s deadliest year in recent history — with most of the deaths related to overdoses or suicide. 

In 2021, the year Sheriff Chris Nanos took office for the second time, 10 people died in the jail. That’s more than three times the national rate as of 2019, the last year for which national statistics from the Bureau of Justice Statistics are available. 

The overwhelming majority of jails in the United States don’t have any deaths in a given year, or, at most, one or two. With an average annual death rate of nearly 10 a year, critics say there is something seriously wrong at the Pima County jail. 

In 2022, at least 12 people died in the jail.

Inmates and former employees suggest that medical neglect and chronic understaffing are putting lives at risk. The county’s own monthly audits have found that NaphCare has consistently failed to provide adequate and timely care to the people detained in the jail. 

In seven out of seven months that the Behavioral Health Department assessed whether or not “patients undergoing withdrawal are appropriately managed,” NaphCare failed to meet the performance indicator, according to audits conducted by the county and provided in an email to Arizona Luminaria by Behavioral Health Department officials.

In an April 14 emailed response to a detailed list of questions and requests for responses to claims about inadequate medical care in the jail, NaphCare said their “mission is to improve and save lives.”

“We aim to ensure that every patient we treat within the Pima County Detention Center receives community standard of care to support a healthy return to their community.”

The claims of substandard medical care in Pima County jail come on the heels of a damning 2022 federal judge’s court order about the state’s years-long failure to care for inmates in Arizona’s Department of Corrections prisons. Judge Roslyn Silver’s order, cited the state correction agency’s “deliberate indifference to the substantial risk of serious harm posed by the lack of adequate medical and mental health care affecting all prisoners.”

Last summer, the department of corrections hired NaphCare to manage health care in state prisons. 

Silver’s permanent injunction issued on April 7 relied on medical care experts to outline new safety requirements to “remedy the egregious constitutional violations” of inmates’ rights. 

Those remedies include appointed monitors to document care, extensive hiring of medical staff, a qualitative review of the work of all physicians and regular documentation of “all aspects of care to allow for monitoring of these requirements.”

The ruling further stated that the department of corrections “may not delegate such monitoring to the contractor (e.g., NaphCare) providing health care services to prisoners, if there is one.”

Criminal justice experts say NaphCare is part of the Arizona criminal justice system that has failed to uphold legal, civil and human rights meant to protect people who are in the care of correctional officials. Silver’s sweeping, detailed remedies could be a roadmap for accountability and transparency aimed at improving healthcare in prisons and jails.

Access to care frequently depends on the correctional officers, or guards, who work for the sheriff’s department. Those guards frequently block access to medical care, according to Leticia and other recent and current inmates Arizona Luminaria spoke with.

Overall conditions in the jail — including how guards treat and interact with inmates, daily living conditions, how crowded the jail is, and how often inmates are allowed to shower, exercise and leave their cells — all influence the health of inmates. 

“Trying to provide adequate medical care in a correctional facility is extremely problematic for a number of reasons,” said Jared Keenan, legal director of American Civil Liberties Union, ACLU, of Arizona. “First, you have private companies that generally are going to try to cut costs as much as possible.”

“Using jail prison as the first and only solution to many of society’s problems is precisely what we’ve been doing for decades related to drug addiction. And it does not solve the problem,” Keenan added.

Leticia is one of a dozen people recently or currently detained in Pima County jail who spoke with Arizona Luminaria, sharing accounts of what they feel are serious medical neglect and substandard care.

“I have been diagnosed with hep. C, I was taking mavyret which is the cure on the streets. By law medical was supposed to continue my care and failed to do that. In turn what I get is a death sentence. I have tried to deal with medical and I keep getting a road block and threats. My care (health) has nothing to do with security yet security wants to make threats for me trying to get care?” Grievance submitted 3/30/23. Read full text here.

A list of 111 medical grievances from March 2023 filed by people incarcerated in the jail document the dangers in detail — severe medical conditions that are overlooked or dismissed by correctional officers and medical staff. Arizona Luminaria obtained the grievances through a public records request. 

The documents include details and a narrative about the complaint. Some of them include responses from staff, or are classified as closed. The status of the grievances that Arizona Luminaria reviewed are current as of March 31.

“I haven’t been seen for throwing up blood which has been occurring for about a week,” one inmate wrote on March 8. 

“Officer didn’t care nurse said she will see where I’m at in line. Need medical attention ASAP… I’m peeing blood… I need medical now!!!!!” another inmate wrote on March 5. 

“I’m not being seen by mental health. I’m SMI [serious mental illness] I’m NOT RECEIVING my COURT ORDERED treatment and I’m not receiving my medication for my mental health!!!!” a third inmate wrote on March 28.

Read more

Leticia says that at more than one point while in the Pima County jail, she feared the mistreatment and medical neglect she endured was going to kill her. 

“I didn’t kill anybody, I just have a mental illness,” she says. 

She shares a warning for anyone about to enter Pima County jail: “You and your family are not safe in there. I wouldn’t even let my sick dog go in there.”

Arizona Luminaria spoke with four former NaphCare employees and three former or current Pima County Sheriff’s Department correctional officers — all of whom echo the consistent claims of inadequate healthcare.

Taken together with public records and lawsuits, the information and accounts paint a picture of medical neglect and serious harm that people face when they are detained in Pima County jail. 

“Any type of delay and diagnosis, delay in triaging and escalation of care will often, unfortunately, lead to poor health outcomes,” said Dr. Elena Jimenez-Gutierrez, a medical expert and member of Physicians for Human Rights with experience attending to patients in and out of carceral settings. 

And such delays, “might mean complications, depending on the disease, to different organs, amputation, loss of some dexterity, loss of some vision or or hearing. It could also mean death and very serious illnesses,” she says

Grievances filed by people detained in the Pima County jail received by Arizona Luminaria via a public records request. The grievances detail problems people in the jail have had receiving medical care and other issues. Credit: Michael McKisson

NaphCare’s troubled history — and troubled present

NaphCare took over health care services in the jail in Oct. of 2021, after the previous vendor, Centurion Detention Health Services, was found to have committed “a material breach of their contract,” according to an August 2021 memo from Director of Pima County Behavioral Health, Paula Perrera.

Currently, in at least three cases, NaphCare is being sued by families of people who have died in the jail. They are the families of Jacob Miranda, Sylvestre Inzunza, and Pedro Xavier Martinez-Palacios.

In the case of Martinez-Palacios, who died at 24 years old on Jan. 14, 2022, an amended complaint filed in February of 2023 states that NaphCare was “negligent in their care” of him during his time in the jail, “failing to provide medical care within the standard of care.” 

In an amended complaint filed in February of 2023 on behalf of the estate of Miranda, who died in the jail at 22 years old on Oct. 11, 2021, attorneys for the plaintiff state that the failures of both NaphCare and Centurion, the previous medical provider for the jail, to properly administer care are “representative of a pattern of abuse and neglect of incapacitated and vulnerable adults as evidenced by previous incidents, lack of appropriate staffing, and ongoing patterns of abuse and/or neglect of vulnerable adults.”

Pima County isn’t the only place where NaphCare has faced serious criticisms and lawsuits. 

In Washington state in 2022, NaphCare was hit with a $27 million dollar verdict for its role in the death of someone in the Spokane County Jail. Similar troubles go back as far as 2003, when an Alabama state audit charged NaphCare with supplying “dangerous and extremely poor quality health care” in a state prison. 

Prison Legal News, a media outlet which has been covering prisons and jails since 1990, has written and published dozens of articles about complaints, lawsuits, settlements and damning audits of the controversy-plagued medical provider.

“I’ve put in several mental health request and still haven’t been seen. I’m SMI [Serious Mental Illness] and need my Meds. I’m SMI and have been on medication through Codac for years. Since 2013 I have been a SMI determination. I’ve been on a regiment through Codac that was court ordered by the Federal court for me to take. I’ve been in here since 01/23/2023 and I still have not been seen by the provider or started my medication regiment that works for me. I’m now exhausting my administrative remittance. Next will be law suits.” Grievance submitted 3/2/23. Read full text here.

Two of the principal concerns in Pima County jail are slow or absent responses to medical requests and delays or denial in the delivery of needed medications. Lack of staffing, lack of professionalism, and a culture of dehumanizing apathy are also frequent complaints, according to a dozen current and former inmates who spoke with Arizona Luminaria.

Taken as a whole, families and criminal justice experts argue that the conditions in the jail have led to 14 deaths in the last 15 months, and at least 52 deaths in the jail since 2017, according to a Dec. 27 memo regarding jail deaths from County Administrator Jan Lesher to the board of supervisors. Lesher’s memo counts 49 in-custody deaths, as well as two compassionate release in-hospital deaths and one death pending certification. 

Since the memo, at least two more people have died in the jail.

“We have a responsibility, from a health care perspective or from a public safety perspective, to the residents of Pima County and to those who are incarcerated and to those who incarcerate the incarcerated, and we have to do that job,” Pima County Supervisor Matt Heinz said in an interview with Arizona Luminaria discussing the problems plaguing the jail. 

“If it makes more sense to have the behavioral health and or the health care brought in house to the county, I’m open to looking at that,” he said, referring to not relying on a private, for-profit contractor, such as NaphCare, and letting the county manage their own healthcare in the jail.

Heinz called the state of Pima County jail, and the high death rate, “unconscionable, unacceptable.”

“It should not be a death sentence to be in our jail,” Heinz said.

It is the legal responsibility of the sheriff’s department, as mandated by the U.S. Supreme Court, to provide health services to people detained in the jail.

The Pima County Sheriff’s Department did not respond to a detailed request for comment on widespread allegations about abuse and neglect at the jail, including about substandard medical and mental health care.

In an October 2022 interview with Arizona Luminaria regarding deaths and unsafe conditions in the jail, Nanos said his department investigates every death and he’s working to prevent future deaths. 

“One death is bad enough,” Nanos said. “It should never be accepted. It’s horrific. It is.”

In a Dec. 5 memo to the Pima County Board of Supervisors, Nanos addressed critical issues at the jail, including an “increased risk of suicide attempts, inmate violence, and in increase in drug use.”

“This crisis has no embellishments,” he wrote. “As some of you have seen firsthand, it is real, it is urgent, it worsens and remains untenable.”

Pima County Board of Supervisors Chair Adelita Grijalva responded on April 14 via email to questions about problems with health care in the jail.

“We deeply regret the loss of lives in the Pima County Detention Center, where detainees have yet to go to trial or are serving brief sentences for relatively minor offenses,” Grijalva wrote. “They do not deserve to die.”

Grijalva said the sheriff is responsible for operating the jail, while the board’s role is limited and includes facilitating and funding the health care delivered in the facility.

“The Board reviews the medical vendor contract terms to ensure it addresses the provision of quality and timely care that meets or exceeds the community standard of care and provides transparency and accountability,” she wrote.

She said the Behavioral Health Department, which administers the medical service contract and audits contractors providing medical care, such as NaphCare, designates financial penalties for failing to meet requirements of the contract. 

The department scrutinizes the vendor’s performance and “requests corrective action when indicated,” she wrote. “Our Behavioral Health Department investigates every detainee complaint and requires the vendor to address any negative findings.”

Grijalva said the board takes “the responsibility for the care and well-being of our community members detained in our facility very seriously.”

She cited privacy considerations for declining to discuss current and former inmates’ statements about medical neglect.

Officials with the Behavioral Health Department responded to questions about the county’s audits of NaphCare’s performance, however, did not respond to questions about the medical neglect claims of former and current inmates, as well as former NaphCare employees. 

“I had small egzima patches on my left and right thigh and my left arm. They burn and itch and getting worse each week and are open wounds, been dealing with this for over 2 months and need help please.” Grievance submitted 3/14/23. Read full text here.

The county’s response

One approach the county is considering to mitigate harms is building an entirely new jail, which could cost as much as $380 million.

The idea is currently being studied by a Pima County Blue Ribbon Commission launched by the Board of Supervisors in February.

Another approach the sheriff’s department and the county have been exploring includes expanding diversion programs — sending people suffering mental health problems or drug abuse issues not to the jail, but to different programs, such as STEPs or a crisis response center. 

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And yet, according to a January 2023 “snapshot of the jail population,” noted in a March 1 memo from Lesher, the county administrator, to the board of supervisors “out of a total census of 1837 detainees 35% or 645 people had a substance use disorder diagnosis or were otherwise flagged as requiring substance use intervention. Of those 645 people with substance use issues 278 or 43% were also receiving medication for a mental health condition.”

The memo goes on to note that, “the total number of detainees who may be experiencing symptoms of mental illness is unknowable as many detainees may have never been diagnosed with a mental illness or are adept at masking their symptoms. Detention, in and of itself, is a traumatic experience.”

Lesher added that, “When you combine detention with criminal prosecution, the loss of meaningful contact with family, friends and employment; it is not beyond the realm of possibility or even expectation that detainees who did not enter detention with a mental illness will become unstable, despondent and ill during their detention stay.”

Recognizing the importance of getting mental health providers and healthcare workers in the jail, Nanos also recently said: “I question the motive. Are we doing this because we want to put services in there for people who are there or are we doing it because we have nowhere in the community to put these people except in our jail?”

Nanos made the comments to officials at the Pima County Blue Ribbon Commission’s first meeting on March 17.

“We’re making a mistake,” Nanos said, referring to the county’s detention of people with mental health issues. “That [care] should be handled by healthcare professionals,” he said.

The accounts of former NaphCare employees and current and former inmates call into question the training of health care professionals inside the jail. 

Lack of orientation and organization

Two of the four former NaphCare employees said in interviews with Arizona Luminaria that they received “no training” when they were first hired. 

Arizona Luminaria is not identifying the four former employees, all of whom requested anonymity because they were not authorized to speak with the media and feared retribution for speaking about the conditions they experienced and witnessed in the jail.

The identities and work experience of the former NaphCare employees were reviewed through former work identification cards and pay stubs. 

For clarity and to protect their identities, Arizona Luminaria is referring to the whistleblowers who worked for NaphCare in the jail as Former Employee 1, Former Employee 2, and Former Employee 3. The fourth former NaphCare employee shared similar accounts of the widespread lack of medical care, but is not quoted in this article. 

The four employees, with a total of about five years of experience in the jail, had responsibilities that included treating and assessing patients in the infirmary; booking; working in the detox unit; and distributing medications. They had regular interactions with both inmates and guards.

Former Employee 2 said that they were not given any guidelines about how to act or stay safe in the jail.

Former Employee 1 recounted one instance in which they were left alone in a hallway with a number of inmates — against basic safety protocols for jails. They said their experience of being hired and beginning to work for NaphCare felt like “being sucked into an airplane engine.”

All four former NaphCare employees attributed the lack of training to the chronic staffing shortages and general disorganization in the medical units of the jail. The pharmacy was particularly chaotic, they said, leading to misplaced medications and delays in delivery to inmates.

In the April 14 emailed statement, NaphCare said they provide “orientation and training to all staff.” The statement continued: “We use multiple modes of training, including on-demand courses in our online learning platform, interactive videos and peer-to-peer skills training. All new hires are also assigned a peer for orientation at the detention center. Additionally, staff have ongoing opportunities for continuing education.”

Delayed or denied medication is a consistent problem, according to the former NaphCare employees and both former and current inmates. 

Jason spent weeks that spanned from February into March of 2023 detained in the Pima County jail. Fearing retaliation for speaking out, he requested to be referred to only by his first name. 

Jason worked as an U.S. Air Force boom operator on KC-135 planes in Iraq. But, like some veterans, he says he struggled after re-entering civilian life in the mid-2000s. He’s been in and out of the Veterans Affairs hospital in Tucson for drug addiction. 

His mother, Melanie, explains that Jason was using drugs to self-medicate. 

“He buries stuff so deep. On the outside he’s so fun to be around, he’s so happy, but there is something very troubled deep in there,” she says. Melanie requested use of her first name only because she feared her son could face retaliation or harm.

“I’m staying alive,” Jason would tell his mother, as he struggled with his post-traumatic stress disorder. She was worried he might take his own life. Melanie says that when her son was arrested for breaking and entering in Tucson, he told her the arrest needed to happen. Jason says he was over his head with drugs.

He had recently been prescribed three medications from the Tucson VA Medical Center: an antidepressant, a migraine medication and, most importantly, Buprenorphine, which is used to treat opioid addictions. Arizona Luminaria reviewed his prescriptions. 

Melanie was hopeful that jail would be the wakeup call her son needed.

Despite giving the medical staff at the jail a list of his medications, he never received them. Melanie, who was in frequent touch with her son while he was in the jail, says Jason put in multiple requests, as well as multiple grievances, but never received his required medications.  

Jason says staff told him he was ineligible to get his VA-prescribed medications. “I would think that would be part of rehabilitation,” his mother said.  

On April 18, NaphCare responded in an email regarding questions about its policies for VA-prescribed medications 

“We contact the VA to request a release of information upon notification that a patient has medications prescribed by the VA. Once the release is provided by the VA, we administer the medications, typically within 24 hours.”

The military veteran made it through the worst of his withdrawal, and was transferred from the jail to a state prison in late March.  

Jason isn’t the only inmate not receiving medications meant to help with opioid withdrawals. Former Employee 1 said the NaphCare standard is to supply opioid addiction medication for a maximum of three days, if it’s given at all.

“I haven’t received methadone since I’ve been here. [Redacted by AZ Luminaria] just laughed and shut the door and locked away. I was taking methadone on the outs and I haven’t received any since I’ve been here.
Staff response: you were seen by the MAT Nurse and you do not meet the criteria for MAT services at this time” Grievance submitted 3/6/23. Read full text here.

Several former and current inmates told Arizona Luminaria they weren’t given any opioid medication to manage withdrawals.

NaphCare says it administers opioid withdrawal medication to patients in withdrawal and for patients enrolled in the Medication Assisted Treatment program, which is referred to as MAT. 

“For patients enrolled in the MAT program, we maintain community-verified doses of buprenorphine while they are in custody indefinitely until release or until transfer to prison or another jurisdiction. There is no “cap” on how long these patients receive the medication,” according to an April 18 statement from NaphCare.

Jimenez-Gutierrez, the medical expert with experience caring for people who are incarcerated, said federal drug authorities allow physicians to provide Suboxone (a widely used opioid withdrawal medication) for up to 72 hours to “enable detainees to receive the medications without interruption while the detention establishes a longer-term plan for the remainder of detention.”

However, she said, the goal of the short-term rule is to allow health care providers flexibility to address emergencies when a patient is experiencing acute withdrawal.”

The rule is not meant to withhold medical care and life-saving medications.

“During the 3-day period, the provider is expected to arrange for the patient’s referral for treatment in a maintenance or detoxification program,” she said.

NaphCare should be held accountable for proving they are providing constitutionally-mandated health care, she said.

“Are these patients being referred for treatment within those 3 days if they are acutely withdrawing from opiates? Are those with terminal cancer and/or other very painful conditions being allowed to extend their opiate or Suboxone courses?” Jimenez-Gutierrez said.

In the April 18 statement, NaphCare wrote, “For opioid withdrawal, most correctional facilities use comfort medications and blood pressure management as the primary treatments. NaphCare goes a step further. We have incorporated an advanced protocol to administer a taper of buprenorphine (Subutex) for patients experiencing withdrawal. We start a taper of buprenorphine as soon as the patient starts to enter mild withdrawal at the earliest point that it is safe to start the medication. The medication is based on a score that assesses symptoms and is typically provided for a period of 5 to 7 days to reduce the symptoms and risks associated with opioid withdrawal.”

“One person who was serving a weekend sentence called the jail before turning themselves in to explain that they needed medication and wanted to make sure they would have access to it,” Former Employee 2 said. “They were told that they could bring it with them and would be able to receive the meds. And yet, during their few days in jail, they received none of their medication.”

Former Employee 2 said such neglect, sometimes leading to medically perilous situations, is typical. The other former NaphCare employees said they witnessed similar widespread incidents of inmates unable to obtain their medications.

Other basics, such as access to toilet paper, are a consistent problem, according to multiple current and former inmates and former guards.

According to the April 14 statement from NaphCare, “Medications that a person may be taking are verified through community providers and retail pharmacies. Patients are typically administered medications within 24 hours of booking.” 

NaphCare said, in response to allegations that there have been interruptions or delays in inmates’ access to medications, “At no point were patients without medications.”

“I’m feeling like crap. tight chest, sharp shoulder pains. I have been on heart medication since I was 9 years old. I have had 2 heart attacks in the last 5 years, 5 in my life. Medical cut off my god dang heart medication with out seeing me to ask obvious questions or even take a blood pressure reading? I have sent at least 5 requests saying my medication is screwed up AGAIN and have got no answer, no call to medical, no nothing. I need my heart medication before I have another heart attack that would be 100% preventable had they listened to anyone of my requests and got me my medications.” Grievance submitted 3/23/23. Read full text here.

Kites ignored

A “kite” is a common carceral slang term for an official medical request. In Pima County jail, kites can be filed in two different ways, according to the former NaphCare employees, former guards and former inmates: either via an electronic tablet, which longer-term detainees are sometimes given, or by a small paper slip, on which inmates explain why they need medical services.

After an inmate submits a kite for healthcare, “a face to face encounter is conducted by qualified healthcare professional within 24 hours of receipt by health staff,” according to NaphCare’s contract. 

According to the April 14 statement from NaphCare, “All patients have access daily to directly request medical care. Registered Nurses (RNs) review the requests twice a day and triage for follow-up by the appropriate provider. Emergent requests are addressed immediately.”

“The care here at the jail is very good medical care,” said Linda Everett in an AZPM article. Everett is the county’s program manager for correctional health, which is managed by the county’s Behavioral Health Department. “Actually they have access to medical care 24 hours a day, seven days a week,” she said. 

According to accounts from inmates and NaphCare employees, as well as the list of grievances, however, that’s far from the reality.

“I have been hear about a year and every kite or request I have put through to medical, dental, and mental health do not get answered on our side. I have been told by the hygienist she responds to ALL kites yet I have never received any on my end of the tablet system! I never know if any of my medical/dental/mental health requests are received, responded to or even erased! This is crazy like sending a message into a black hole!” Grievance submitted 3/11/23. Read full text here.

”Sometimes you would get five or 10 kites a day from the same person. And once they got to the point where we were from 300 to 1,800 deep in the queue. Well, some of them are as much as a month old,” Former Employee 3 said.

They remembered that the longest response time to a kite that they saw was 39 days.

They don’t have the staffing to go through them,” they continued. “You start getting so many duplicates, important ones fall through the cracks just because there’s hundreds to go through.”

They said that many of the kites are for minor issues — stubbed toes, or razor burn or requests for acne cream. “But then you’ll have kites that say, I’m suicidal, I’m going to kill myself,” they said. “And it’s 20 days old.”

Former Employee 3 recalled instances of wounds that went untreated for such a long period of time that people had to be hospitalized.

All four former NaphCare employees recalled inmates who were forced to take drastic measures to be seen for medical care, whether faking seizures, getting into fights, trying to assault staff — anything to get noticed. 

Leticia poses for a photo at her home in Tucson, Ariz. on April 17, 2023. Credit: Michael McKisson

“And you’ll hear them say, I put in kite after kite,” Former Employee 3 said. “You’ll see it’s been for weeks sometimes they’ve been requesting to be seen and it’s just been kind of swept by the wayside.” 

Leticia, the woman jailed after fighting with her fiancé, says she started hurting herself in her attempts to get medical attention. 

“I was screaming to them: ‘My pain is a 9!’ I was screaming, ‘Sergeant, sergeant, sergeant!’” she says. 

That’s when she began banging her head again. “And then someone would open the door and tell me to stop. That I had to wait another two hours,” she says.

Steven Fox is currently detained in the Pima jail. He wrote a letter addressed to Democrat Gov. Katie Hobbs detailing what he calls human-rights abuses and pleading for help before more people die. Fox shared a similar letter with Arizona Luminaria.

“I’ve watched inmates tell officers their suicidal and that officer laughs and closes the door in the inmates face, then later that same inmate has tried or took their own life by attempting suicide,” Fox writes “I didn’t know the outcome because they cover our windows with magnets so we can’t see them cutting the body from where this was done ie bunkbed.” 

Last fall, Fox was bitten by a spider inside the jail. He says he told a guard that his foot was burning. The guard responded, “Let it fucking burn,” Fox writes.

After he formally submitted a medical request, with pus still leaking out of his wound, it was at least three weeks before he was seen, Fox said in an interview from the jail with Arizona Luminaria. In the meantime, he says he procured some antibiotic cream from another inmate, adding that for five days he was refused access to a shower to clean his wound. 

He called the treatment “cruel and unusual punishment.” 

“Even a delay of 24 to 48 hours with a bacterial infection can lead to complications,” said Jimenez-Gutierrez, from Physicians for Human Rights. “He could have had permanent damage to that extremity and he could have also had a systemic, generalized body response to the infection, which in medicine we call sepsis, which could have been fatal.” 

She added that such treatment “constitutes a violation of standard of care. And he should have been seen in a prompt manner, within 24 hours.”

In another instance, this January, a table that was being cleaned fell and landed on Fox’s foot, causing severe pain and the quick bruising and swelling of his foot. Though the pain was terrible, and parts of his foot were blackened by a bruise, he said he wasn’t seen for over six hours. 

“My heel was totally black,” he said. 

A nurse gave him Tylenol and he said he waited three weeks to receive an X-ray. After three weeks, medical staff told him he would no longer be receiving Tylenol. To this day, he has pain in his foot and, 10 weeks later, he says has never been given the results of his X-ray.

Details of a letter from Steven Fox, who is currently detained in the jail, similar to one he wrote to Arizona Gov. Katie Hobbs detailing what he calls the human-rights abuses and pleading for help. Credit: Michael McKisson

Steven has not been convicted, and is still awaiting trial. In April, Fox called again from the jail, saying that a guard was retaliating against him for speaking with Arizona Luminaria. 

The guard, Fox says, accused him of using other inmates’ tablets to make calls to people outside the jail, which Fox refutes. He says the guard then sent a note via the jail’s tablet communication system to all of the other inmates in his pod, threatening to take away all of their tablets if they let Fox use them again. Fox said that following the guard’s admonishment that he’s received threats from the other inmates.

“Told her I had fallen climbing upon my bunk, told me medical was too busy. I have a hip replacement and I need to be taken. I need medical attention, asap. To be taken to the hospital.” Grievance submitted 3/4/23. Read full text here.

Tyler Settles, also currently detained, spoke with Arizona Luminaria in April by phone from inside the Pima jail. He says he started feeling a tightness in his chest in late January. Worried that he might be having a heart attack, he didn’t think he had time to file a formal kite, so he started banging on the door of his cell to get a guard’s attention. 

When a guard finally came, Tyler says that he was told to cut out the racket. 

He says he made clear to the guard that he was having chest pains, but the guard, again, only told him to stop banging on the door.

A few minutes later, as his chest pain continued and he continued to bang on the door, the same guard opened the small hatch in the door to his cell and released a cloud of pepper spray into Tyler’s face. 

To date, he says he has not been seen by medical staff. His chest pains finally calmed later that day, but still occasionally resurface. Besides his initial attempt to ask for help from the guard, he says he hasn’t submitted a kite for his chest pains.

Jimenez-Gutierrez also commented on Tyler’s account, saying that pepper-spraying someone with chest pain “could have compromised his health even further. And it could have increased his anxiety level. And so if you were having a heart attack, that would increase your blood pressure and might make your condition worse.”

She said that such response was “definitely a failure of their triaging and escalation of care.”

Tyler said that while in jail he was put on suicide watch, which meant he was moved to solitary confinement. Tyler said he was never suicidal. At a Blue Ribbon Commission meeting on April 13, jail officials discussed the problem of inmates on suicide watch being segregated and detained alone into single cells.

Former Employee 3 summed up the reality of healthcare in the Pima jail: “People aren’t being seen really at all.” 

Leticia speaks with a reporter at her home in Tucson, Ariz. on April 17, 2023. Credit: Michael McKisson

Leticia’s return to jail

In March, about a month after Leticia was released from jail, she relapsed.

She started smoking the blue fentanyl pills again. She started fighting with her fiance again. 

“I was in a bad place,” she says, but emphasizes that she wasn’t trying to hurt anyone, and just needed help. 

Help is not what she got. 

Leticia says her fiance also was back to using, and she was scared he would hurt himself. 

As they both fell into a mental health and substance abuse crisis, she says they tried calling the Crisis Response Center. The crisis center is a 24/7 walk-in psychiatric center that addresses patients with mental health issues or who are struggling with substance abuse. 

Leticia tried to get someone from the center to help, but she says that no one was able to come to them. Scared, not knowing what else to do, she says she called 911, and the Tucson Police Department responded. 

Leticia says she told officers that she had threatened her fiance, and she was again taken to the jail. 

Again she says she was restrained, humiliated, and not given the medical attention, including for opioid addiction, she needed.

“It’s just chaos and hatefulness in there,” she says. And those who suffer the brunt of it,” she says, are “people who are disabled and us Mexicans. Our people are being treated like that in there.”

She describes her period of withdrawal in prison, during which she was not given medication, as “eternal hell.” 

“I needed Suboxone,” she says. “I had pain that was inside me that was too much. I just wanted to pull my hair out. ” 

At the March 17 Blue Ribbon Commission meeting to study building a new jail, Nanos said: “Putting somebody in jail who is perfectly sane is traumatic.” 

Now, imagine the depth of that trauma, he said, for someone in the throes of opioid withdrawal or a mental health crisis.

“For the past 3–4 weeks I’ve been struggling with my anxiety and depression I’ve been trying to cope and handle it the best I can most of the day 9/10 I’m falling more and more into a depressed state followed by uncontrollable anxiety at times I start to lose faith and doubt my self I feel things are getting worser everyday.” Grievance submitted 3/23/23. Read full text here.

“For years we have needed better medical care in jails and prisons. For years we have thrown people with substance use disorders in jails and prisons as some kind of solution that sort of doesn’t work,” said Keenan, the ACLU legal director. 

He added, “Judges, elected officials and our court systems have been very reluctant to really aggressively try to solve it. And it costs lives every day. It costs lives of folks who should not be dead or whose health should not be as damaged as it is because they’re not receiving the sort of care that they should be.”

“Officials use the word policy a lot. Policy, policy, policy. But where does that leave us?” Leticia asks. “You go in there [the jail] and you feel like you don’t count. Like you’re not a person.”

A former guard at the jail spoke to Arizona Luminaria about Yunan Tutu, a 26-year-old with mental health issues who had been in and out of jail. 

After being arrested on a burglary charge in June of 2022, Tutu was deemed incompetent to stand for trial. For six months, he waited in the jail after the court ruled that jail officials’ care for Tutu so he could be restored to competency and stand trial.

When a doctor checked on Tutu two weeks after Christmas, he was reportedly refusing food. By January 10, he was dead.

Shortly after his death, Tutu’s little sister started a GoFundMe account to pay her brother’s funeral expenses. 

The family raised $885.

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John Washington

John Washington is an investigative journalist based in Tucson with a focus on immigration and borders, as well as criminal justice and literature. His first book, "The Dispossessed: A Story of Asylum...