Cecilia Edwards’ path to the witness stand was fraught with peril.

A clinical coordinator working for Corizon Health at an Arizona prison in Yuma, Edwards testified Friday in federal court about a lack of patient care during an evidentiary hearing in the Parsons vs. Ryan prison health care settlement.

Magistrate Judge David Duncan is evaluating the integrity of the state-run monitoring system that’s supposed to be keeping an eye on Corizon’s compliance with established health care performance benchmarks. The Arizona Department of Corrections (ADC) pays Corizon Health to handle all physical and mental health needs for the men and women in the 10, state-run prisons.

Edwards gave several hours of detailed testimony that cast doubts upon the health care monitoring system, but at first she could barely speak.

“Are you concerned that if you testify today, you may face adverse actions?” asked Prison Law Office (PLO) attorney Corene Kendrick, representing the inmates in the Parsons case.

“Yes,” Edwards replied through tears, visibly shaking.

Timeline Of Intimidation

Edwards described a timeline of intimidation that she says unfolded in the weeks and days before her appearance in court. “I was scared, and defensive and nervous about testifying,” she said.

Attorneys for the plaintiff class in the settlement subpoenaed Edwards in early May. According to Edwards, she was subsequently contacted by attorneys from Corizon to speak about the subpoena.

Edwards said she called a “compliance line” for Corizon and ADC employees and told people of her concerns about the quality of patient care at the Yuma prison.

A week after she called to complain, Edwards said drug detecting dogs were brought to the medical clinic where she worked, something she had only seen once before in her time at ADC.

Three days before she was to testify, Edwards said she was alerted by a co-worker that people at ADC had been asking questions about her. She said the conversation lead to her to believe that she was under some sort of investigation by ADC, for potentially being “compromised by the inmates.”

At this point, Edwards told the court she called PLO attorney Corene Kendrick and left a voice message asking for help.

Kendrick transcribed the voicemail and submitted it to the court, which prompted Judge Duncan to call an emergency telephonic hearing on May 30. After the hearing, Corizon provided a separate attorney, who Edwards said she was comfortable working with.

Edwards said all of the previous events caused her to leave a “6-inch stack” of documents at her home in Yuma that she said back up her concerns about patient care.

When Judge Duncan asked Edwards why she had decided to not bring him the documents the day of her testimony, Edwards replied, “It’s been a tough week,” and broke down in tears.

Duncan devoted a lengthy aside to comforting Edwards, but reminded her she would have to tell the truth about what she knew. Duncan also arranged with Edwards’ attorney to have the stack of documents mailed to his chambers.

Concerns About Patient Care

Edwards echoed many of the concerns raised by Angela Fischer, a former Corizon mental health counselor who testified on Thursday.

Edwards told the court she has worked with Corizon at Yuma for a total of 20 months as a scheduler, certified nurse assistant and pharmacy assistant.

In her current role as a clinical coordinator, Edwards has a unique perspective on the prison health care system. She told the court her job is to act as a go-between for medical providers seeking specialty treatment for patients and the outside experts that provide the treatment.

“I get the patients seen by a specialist,” Edwards said.

If someone at the Yuma prison has a badly broken wrist, the doctor on site requests a referral for the patient to an orthopedic surgeon. It is Edwards’ job to relay that request to a Utilization Management team at Corizon Health headquarters, who can approve the referral, request more information, or suggest an alternate treatment in response.

Edwards said she supplies all the information and documentation in support of the referral, and if it is approved, coordinates with a scheduler and the specialty provider to get the patient the prescribed treatment.

But as Dr. Jan Watson previously testified the back and forth of the referral process often breaks down.

Cancelling Referrals To Avoid Fines

Many of the state prisons in rural areas struggle to find specialty care providers, and Edwards testified Yuma is no exception. She told the court many specialty care providers have told her they don’t work with ADC patients because Corizon Health is slow to pay its bills.

The Parsons vs. Ryan settlement outlines specific time frames in which referrals for specialty care must be met.

Edwards testified that when a patient’s case was at risk of missing the time frame, which could potentially lead to monetary fines, Corizon management instructed her to cancel the referrals.

She was then told to continue to look for specialty care providers, and reschedule the referrals when was found them. Such a practice would allow the compliance clock to be reset. In the eyes of the state monitor, it could appear that the referral was requested and completed in a timely manner.

Edwards said this practice led to a delay in care for many patients, and in some cases may have put their lives at risk.

Edwards said at one point she was directed to cancel and reschedule 200 optometry requests.

“Three months ago we were told that we needed to start entering them as ‘outside consults’ instead of the way we were doing it, which was ‘appointments,” she said.

Edwards told the court “appointments have a time frame of 14 days to be seen by the provider — the consults have a longer time frame.”

Judge Duncan then asked “Do you see how that might be a problem with respect to the performance measure that calls for a specific time frame?”

“Yes,” Edwards replied, saying she had raised the issue with her administrator.

She told the judge she had been requested to cancel other specialty consults because no providers were available.

“So somebody at Corizon could think the thing to do is to cancel referrals because then we don’t have that time frame,” Judge Duncan posited. “So that they can start the clock again not be exposed to these fines.”

“It’s my understanding that the fines have been a part of the discussion,” Edwards responded.

Defending the state, attorney Tim Bojanowski asked Edwards if there was ever a time she could recall when a patient whose referral was cancelled did not get their appointment rescheduled.

“Yes,” Edwards replied, “when the patient passed away.”

After hearing Edwards' testimony, plaintiff attorney David Fathi said there was little doubt in his mind that Corizon is cancelling and rescheduling specialty health care appointments to avoid fines from the Judge.

“Changes are made in the way health care is provided, not to maximize healthy outcomes, but to beat the monitors — to avoid non compliance scores on the monthly monitoring reports,” he said.

Understaffed Clinic Leads To Denial Of Care

One way people in prison can seek treatment for medical conditions is by going to the clinic at their facility during designated times called “nurses’ line.” Ironically, Edwards testified on many days, there were no nurses to be found.

Edwards said it was her understanding that the nurses’ line was supposed to be open seven days a week from 7 a.m. to 7 p.m. However she said the actual operating hours are more like 7 a.m. to 10 a.m. and “sometimes not at all.”

When pressed, Edwards estimated there was, on average, no nurse staffing the line three to four days a week.

“How long has this been going on?” Duncan asked.

“As long as I can remember,” Edwards replied. She said she had called the Corizon compliance line to specifically report that inmates were being turned away at the clinic because it was understaffed.

Impending Financial Sanction

At the end of the hearing Judge Duncan reiterated the fact that he can’t order the state to hire more people to work in the prison health care system.

“That’s frustrating to me,” Duncan said, “because that’s the obvious solution. It’s a solution that has a price tag attached to it — a price tag that is apparently too high for the state of Arizona to pay.”

Instead, Duncan said he will move to the "next best solution."

“And that is to impose a financial sanction that will perhaps be a price that the state will find is too high to pay, and they’ll choose, as they’re free to do, to hire more people to be able to perform the services that they need to perform.”

Duncan could also install an independent monitor if he concludes the state-run program can’t be trusted.

A Duty To Tell The Truth

“I believe that other people feel this way,” Edwards said at the end of her testimony. “Other people know things and they do not want to come forward.” She said fear of retaliation keeps them quiet.

PLO attorney Corene Kendrick asked Edwards if she feared for her own safety and the safety of her family.

“Yes,” Edwards said. “But my duty was to find out what was going on and why there was so much pressure put on us to meet these deadlines with scheduling.”

Edwards said she had been struggling with what she was going to tell the court. “It’s been extremely hard, but I haven’t found that ‘I don’t care button’ yet,” she said.

“I think I’m a fully established human being with my morals and values,” Edwards said. “I realized I had to come, I had to tell the truth, and whatever happens - happens.”