A judge on Friday found Arizona's prisons chief to be in civil contempt of court and fined the state $1.4 million for failing to adequately improve health care for inmates.
The decision involving Corrections Director Charles Ryan stems from the state's acknowledged failure to follow through on some improvements that it promised in 2014 when it settled a lawsuit over care.
The lawsuit said some prisoners complained their cancer went undetected or they were told to pray to be cured after begging for treatment.
It also claims the failure of the medical staff at one prison to diagnose the metastasized cancer of an inmate resulted in his stomach swelling to the size of a pregnant woman at full term.
The state denied the claims that it was providing shoddy care.
"The inescapable conclusion is that defendants are missing the mark after four years of trying to get it right," Duncan wrote. "Their repeated failed attempts, and too-late efforts, to take their obligation seriously demonstrate a half-hearted commitment that must be braced."
Over the past year, Duncan has repeatedly expressed frustration over what he said was the state's "abject failure" to adequately overhaul prison health care and has questioned the accuracy of the state's reports about how it is faring in making the changes.
The magistrate also called Ryan to court last summer to grill him over whether he tried to undermine a court order that prohibited retaliation against prisoners who participated in the lawsuit. However, the contempt ruling and fines weren't imposed over the retaliation allegations.
The state has followed through on some promises it made to improve inmate care. But the areas in which Duncan required improvements included ensuring newly prescribed medications be provided to inmates within two days and making medical providers tell inmates about the results of pathology reports and other diagnostic studies within five days of receiving such records.
The state has acknowledged more than 1,400 instances in December, January and February during which it failed to make the improvements it promised.
The Department of Corrections expressed disappointment in the ruling and plans to appeal it.
"The Arizona Department of Corrections strongly disagrees with his ruling and is confident that the 9th Circuit Court of Appeals will reverse it because it is contrary to both the evidence and the law," the agency said in a statement.
The office of Gov. Doug Ducey, who is Ryan's boss, says the contempt ruling was unjustified.
"We stand by Director Ryan and will continue to challenge any judge who attempts to set agency policy from the bench," Ducey spokesman Daniel Scarpinato said in a statement.
In testimony in late March, Ryan blamed Corizon Health Inc., the health care provider for Arizona's prisons for the past five years, for the failure to make all of the improvements. The company isn't a target of the lawsuit.
Duncan said the state's reluctance to comply with the settlement was motivated by a fear of losing its prison health care contractor. "If a private contractor is pushed to the door because it cannot meet the state's obligations, then so be it," Duncan wrote.
Corizon chief executive Steve Rector said in a statement that the judge fails to recognize the improvements that have been made to inmate care in Arizona.
"This legal battle unfortunately also underlines why incarceration policy is best made under the direction of Arizona's elected policy leaders, the governor and state Legislature and not in courtrooms," Rector said.
The lawsuit was settled in 2014 without the state acknowledging any wrongdoing.
Ryan previously said the state's contractor for prison health care would have to pay any fines. Attorneys for the prisoners say having the contractor pay the fines would undermine the purpose of the financial penalty, which is to force the state to improve inmate care.
Ryan has proven to be a contentious figure in his nine years as Arizona's prisons director.
He was criticized in the 2009 heat-related death of an inmate who was left for nearly four hours in an unshaded outdoor holding cell during triple-digit heat. No criminal charges were filed in the death, though more than a dozen corrections employees were fired, suspended or otherwise disciplined.
About five years later, prison officials were accused of botching the execution of Joseph Wood, who was given 15 doses of a two-drug combination over nearly two hours.
Ryan also came under criticism in 2014 by a prison teacher who was raped by an inmate at a prison in Florence after being left alone with a sex offender. The teacher said Ryan allowed lax training, staffing shortages and poor security at the prison.
The state paid $3 million to settle the case.
Ryan is the second Arizona law enforcement leader within the past two years to be found in civil contempt.
Another judge found then-Maricopa County Sheriff Joe Arpaio to be in civil contempt in May 2016 for disobeying a court order to stop his immigration patrols.
Arpaio was later convicted of criminal contempt but was eventually pardoned by President Donald Trump.