When Mary Faith Casey was wheeled into a Pima County courtroom in August 2022, the judge could see something was terribly wrong. Casey had lost 50 pounds in four months behind bars. Alarmed, the judge ordered her transferred immediately to a hospital. Within weeks, she was in hospice. She died soon after.
This May, a federal judge ruled her case was “reasonably comparable” to a jail death — underscoring what critics say is a chronic failure of medical care at the Pima County jail.
Casey’s story is part of a broader reckoning. The county’s for-profit health care provider, NaphCare, has repeatedly failed to meet its contractual standards. Now, as its $65 million agreement comes up for renewal this month, county leaders are weighing whether to take jail health care in-house.
The day after the judge ruled her case was comparable to a jail death, Pima County Attorney Laura Conover disputed part of that characterization in a court filing. Conover wrote that Casey was released to Banner Hospital, where she received treatment for a month before being placed on hospice care.
A spokesperson for the Pima County Attorney’s Office, Shawndrea Thomas, told Arizona Luminaria on Aug. 14 they could not comment on pending litigation. “We will provide a statement as soon as it is legally appropriate to do so,” Thomas said.
The county hired for-profit company NaphCare in 2021 to manage a $63 million contract. That decision came after the county replaced the previous health care provider, Centurion, when officials canceled the agreement following a breach of contract.
Nationally, at the state level, and previously in Pima County, NaphCare has been beset with controversies and lawsuits.
Arizona Luminaria began reporting on deaths in the jail in the fall of 2022, shortly after Mary died. Since 2017, the number of publicly known jail deaths in the county is at least 60. If you count Mary’s death, the number would be 61.
Pima County Supervisor Matt Heinz, of District 2, who is also a medical doctor, said the board needs to discuss the contract with NaphCare, and he hopes to do that at a meeting in September. “I believe it is incumbent on us to seriously consider making this change,” Heinz told Arizona Luminaria, “and to do so in a way to make it safe for everyone, and make it financially feasible.”
He said the current setup is not working, “or not working as well as it should be working.” At the same time, Heinz said the NaphCare contract is up too soon to be able to switch over to in-county care this year. He suggested renewing the contract for just one or two years.
A spokesperson for NaphCare shared a statement with Arizona Luminaria that the company was proud of the collaboration with Pima County. “While we plan to continue partnering with county and [jail] leadership to provide patient-centered care, we are also prepared to support the county should they decide to operate the health program internally.”
“At NaphCare, quality patient care is our top priority,” the statement continued. “As long as we are providing care in Pima County, we will aim to ensure that every patient we treat receives exemplary healthcare to support a healthy return to the community.”
A pattern of underperformance
While the inner workings of jails are often opaque, county audits and oversight reports offer a window into medical care inside the jail. According to the county’s own monitoring, NaphCare has a troubled performance record.
A review of 15 monthly county audits from April 2024 through June 2025 shows repeated failures to meet contractual standards for medical care in the jail. The contractual inadequacies follow the same pattern Arizona Luminaria reported on in 2023.
In response to questions about the ongoing failure to meet performance standards, Paula Perrera, director of Pima County’s Department of Detainee and Crisis Systems, responded via email on Aug. 15 that the audit results showing unmet standards “don’t always mean care is lacking, they often reflect documentation gaps or minor process issues.”
A review of those performance indicators shows NaphCare consistently failed to meet its contractual obligations to:
- Conduct immediate mental health evaluations for people at high risk of self-harm. NaphCare was found in violation of seven out of eight checks over 15 months.
- Deliver verified medications within 24 hours. Out of seven audits, the company failed six times.
- Develop treatment plans for people with mental illness. Out of eight audits, the company didn’t meet requirements seven times.
- Properly manage patients undergoing withdrawal — failing in all seven audits that measured compliance.
Perrera said some of these issues were due to staffing shortages, which she says are being corrected, as well as Pima County holding NaphCare to higher standards.
“Pima consistently meets national standards and has earned several prestigious awards, partly because we hold our contracted provider to higher expectations,” Perrera said. In 2023, the National Commission on Correctional Health Care named the jail facility of the year “for its commitment to solving opioid crisis-related challenges.” That same year, at least eight people died while in custody in the jail
“Our performance indicators are intentionally designed to flag even small inefficiencies so we can drive excellence and continuous improvement in correctional health care,” Perrera said.
On the issue of patients being properly managed as they undergo withdrawal, for example, Perrera said, “Our performance indicator requires very strict adherence to said protocol, even one missed round can result in a failed score.” She also said that patients held in intake for long periods can affect their performance scores.
“NaphCare and Pima County’s investment in opioid treatment has resulted in a reduction in deaths and hospitalizations,” Stephanie Coleman, the NaphCare spokesperson added.
“Currently, we are treating more than 500 patients per day through the [medication assisted treatment] program and over the last year, we have reduced send out to the [emergency departments]/hospitals for overdose by 40%,” Coleman said. “All our efforts in Pima County are aimed at maximizing the safety and well-being of each patient to prepare them for a healthy return to the community.”
The improvements do not mean people are getting necessary treatment, however.
In June 2024, for example, six high risk patients did not receive an immediate mental health evaluation. The next month, in July 2024, at least nine people did not receive a face-to-face consultation within 24 hours of a sick call request describing a new clinical symptom. The same month, at least six patients experiencing withdrawal symptoms were not properly managed.
The examples continue:
- In Oct. 2024, six out of 16 mental health patients needing treatment plans did not receive them.
- In Dec. 2024, two out of six patients on suicide watch did not receive daily evaluations.
- In Jan. 2025, four of 14 patients receiving treatment for opioid addiction did not have their treatment continued
- In April 2025, 11 out of 15 patients in the mental health unit did not receive their 10 hours per week of structured activity. The same month, NaphCare officials failed to record vitals for patients in restraint chairs, do rounds for patients held in segregation, and conduct evaluations within 14 days for mental health patients.
Those and other failures occurred despite the high cost of providing health care in the jail and despite increasing national scrutiny of NaphCare’s performance.
Before Pima County contracted with the company, a 2020 Reuters investigation found that jails where NaphCare provided healthcare had the highest death rates in the nation among major providers over a three-year period. The reporting also found a higher rate of deaths in jails using a major health care contractor over jails where it was provided by a local government.
The company has faced lawsuits and contract disputes across the country. Earlier this year in Spokane County, Washington, NaphCare abruptly pulled out of a contract to provide care in the county’s jail. NaphCare has been particularly troubled in Washington: they were ordered to pay $27 million in a 2022 lawsuit about a death in a jail, and this year were ordered to pay $25 million to a man whose leg turned gangrenous while in jail and needed to be amputated.
Pima County Sheriff Chris Nanos told Arizona Luminaria via email on Aug. 14, “Naphcare falls under the Pima County Health Department…please seek them out for any concerns you may have.”
Staffing
In the 30 months Arizona Luminaria has reviewed NaphCare’s staffing level at the Pima County jail, not once has it been fully staffed.
From April 2024 through June 2025, Pima County deducted, on average, about $117,000 dollars from NaphCare’s monthly fee. At the same time, each month it deducted thousands more for its failures to meet contractual performance standards.
That is a drop from a previous 15-month average, from Feb. 2022 through April 2023, when the county deducted more than $210,000 from NaphCare’s monthly fee.
“Many County departments are not fully staffed at any given time,” Perrera told Arizona Luminaria.
In 2022, Mary Casey was detained in the jail from April 30 to Aug. 18. Reviewing both performance audits and staffing numbers in that period shows the following:
- No psychologist for the mental health populations from March 1, 2022 through end of September, 2022
- No chief psychiatrist from the end of April 2022 through mid August 2022
- Shortages of mental health professionals at various levels throughout the spring and summer of 2022, including staffing nobody in the mental health units from mid-May through the end of July 2022
Linda Everett, division manager for the county’s Detainee and Crisis Systems department, said the period in question, including when Casey was in the jail, was during the emergency contract period. “Naphcare was left with the staff Centurion had and had to do their own recruiting for open positions. In the meantime, they used their Corporate Leadership to cover and still do when needed.”
A list of grievances obtained by Arizona Luminaria via public records requests specifies dozens of complaints of lack of sufficient medical care. One grievance, from March 23, 2023, is about someone putting in a sick call request for chest tightness and shoulder pain — potential symptoms of a heart attack. The grievance continues: “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.”
Laura, currently living in a homeless encampment at 100 Acres, has been in and out of jail for years. She says she was in jail while pregnant with her youngest daughter, in 2019, and realized then the dangerous deficiencies in medical care.
Laura didn’t want to share her last name for fear of reprisals and because she shared what she called an embarrassing story. A social worker who has known Laura for years confirmed that she has long been in and out of the jail.
Her most recent stint in jail was this summer, and she said the situation hasn’t much improved. “It’s hard enough to be in jail, it’s hard to survive. You don’t get any treatment and you get depressed,” she said. Laura said she put in one kite — a commonly used term for a sick call request — that was never responded to.
“Everything is so slow,” Laura said, describing her most recent time in the jail. “They’re fucked up to you,” she said of the guards. “When you ask for a tampon, they don’t give them to you.” She said she had to make a homemade tampon.
Heinz told Arizona Luminaria understaffing cannot be taken lightly. “Every year I’ve been a supervisor, staffing has been an issue” in the jail. He said going back even before his time on the board, staffing was never properly managed. “What’s not safe for inmates is not having proper staffing. It’s our duty to make sure people have proper health care in the jail system.”
While acknowledging that it would be expensive to take on health care and offer the necessary incentives to make sure there is enough staffing, “As a government entity, we’re not looking to make sure we have a profit margin.”
County weighs ending private healthcare contract
The ongoing problems have pushed the county to consider whether to end its relationship with NaphCare.
In April, County Administrator Jan Lesher directed Deputy County Administrator Steve Holmes and Paula Perrera “to develop a timeline outlining the steps required to consider and accomplish such a transition.”
Lesher’s directive called for an assessment of the jail’s medical needs, estimated costs, insurance requirements, and a timeline for phasing out the private contract.
In a response, included in the same memo, Perrera cautioned: “shifting our correctional health staffing model is anticipated to take a minimum of two years to plan and implement in order to maintain levels of care and accreditation status.”
She provided a step-by-step outline for how the transition could occur but warned that “the complexity of this project also brings uncertainty, and it is likely that unforeseen issues will need to be considered as this project moves forward.”
“Provision of correctional healthcare services is complex, multifaceted, and requires expertise to minimize the occurrence of adverse events and costly litigation,” Perrera wrote.
She added that healthcare in the Pima County jail is “‘head of class’ as evidenced by our multiple awards.”
Bringing health care in-house would not automatically solve the systemic challenges. Jails everywhere struggle to provide adequate care for people often arriving with untreated chronic conditions, substance use disorders, and acute mental health crises. But county officials argue that direct oversight of staff and care protocols could improve accountability and outcomes.
Providing medical care is a constitutional mandate. The Supreme Court ruled in 1976 that failing to provide adequate care can violate the Eighth Amendment’s prohibition on cruel and unusual punishment.
For Casey’s family, the constitutional principle is little comfort for what they lost.
The legal fight over Casey’s final months is ongoing. So is the county’s reckoning with the system that failed her.
Carlin Casey, Mary’s son, told Arizona Luminaria in a statement, “We hope that our lawsuit and increased public awareness helps to shine a light on the inexcusable conditions in the Pima County Jail. My family and I are haunted by what happened to my mother, and hope other families are spared this nightmare.”
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