Former Chief Of Psychiatry: Arizona Prisons 'Cruel, Dated, Insensitive And Inhumane'
Dr. Leonel Urdaneta has worked in correctional mental health care since the 1970s. After holding positions in Kansas and New Mexico, the board certified psychiatrist recently served as the chief of psychiatry in Arizona for Corizon Health from 2017 to 2019. Corizon was the former contractor for the state’s prison health care services.
In October 2019, Urdaneta contacted the attorneys representing inmates in Parsons v. Shinn, a class action lawsuit over unconstitutional health care in state prisons.
In an email, Urdaneta wrote: “My reason for reaching out to you is my interests in bringing to light the dysfunctions I was witness to during my two years as head of the Psychiatric Service for the contract, dysfunctions that were part to AZ Correctional Department and of Corizon itself. Those dysfunctions caused tremendous harm to patients, including suicides and severe self-injurious damage.”
After a federal judge denied the state’s attempt to block him, Urdaneta testified in a deposition in Phoenix on Dec. 10, 2019, witnessed by attorneys involved in the Parsons lawsuit.
'Cruel, Dated, Insensitive And Inhumane'
Dr. Urdaneta said he quit his job with Corizon in Arizona in May 2019.
“I did not want to continue really working within a system that I think was failing in many ways,” he said. “I found the Arizona system very onerous, difficult to work with, misguided and jaded.”
“I used to say, ‘Hey, I was in New Mexico, I was in Kansas. I never felt this same degree of callousness of concern in any of those other places,’” Urdaneta said. “And even though, you know, they were not exemplary, certainly, they had greater dedication of treating patients and doing the best for them. I think the Arizona Department of Corrections that I knew then was cruel, dated, insensitive and inhumane.”
During his tenure in Arizona, Urdaneta supervised psychiatrists as well as mental health and nurse practitioners. He also provided direct patient care, partly because of staffing shortages. He said he mostly treated patients at the Phoenix prison, but also saw patients at Florence, Perryville and Eyman.
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“Overall, there was an obsessiveness with quantity only within the department within the psychiatric mental health field, obsessiveness with reaching some benchmarks with the indicators that the system had been working with,” Urdaneta said. “Those indicators were, for the most part, quantitative. There was very little concern with the quality of it all.”
Udaneta said he had a general message for staff and colleagues: “These are human beings. These are patients. They cannot be treated simply on a conveyor belt as just goods. They are human beings that need to be understood. This is not what mental health and psychiatry are all about. So this created some conflicts.”
Urdaneta said the bureaucratic institutions of Corizon Health and the Arizona Department of Corrections did not share his vision.
“The pursuit, no matter what, continued to be, ‘Let's reach those benchmark numbers so we don't fail the quantity,’ but in the meanwhile, quality was being sacrificed all around, in my opinion,” he said. “I call it an unholy alliance in which the care of patients was being sacrificed in the pursuit of policies and procedures that had mostly to do with the obtaining of benchmark numbers."
Urdaneta said there were blurred lines within the hierarchy of the Corizon structure which caused complications and power struggles.
He said conflicts between psychology and psychiatry had an effect on patient care.
“It became a beach ball sort of thing. Let's see where we send them now,” Urdaneta said. “Let's see where we can send them to Tucson or Lewis and so on, without consideration whatsoever for the condition of the patient, without consideration for the clinical progress or lack of it of the patient.”
Urdaneta said patients would be inappropriately discharged from the Phoenix facility based on non medical factors like bed space at another prison and this resulted in actual harm to patients.
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Lack Of Facilities For Seriously Mentally Ill Patients
Urdaneta said the facilities within the Department of Corrections are inadequate to deal with the many severely mentally ill patients they are treating.
“Patients, for instance, at times had to be put in areas where they had very limited space and all behind bars,” Urdaneta said. “They could barely lay there to sleep, let alone to do any other activities.”
He was also concerned about inappropriate usage of isolated confinement.
“I had a patient who had developed psychotic symptoms, many of them coming from isolation” Urdaneta said. “I remember one particularly that developed, for instance, voices because there was no one for this amount of time that he could talk to. He was totally isolated."
Urdaneta called the effect of isolations "very, very damaging to the human mind even when they are just for a short amount of time rather than being provided some sort of human contact.”
The Sickest Patients Become Casualties
Urdaneta described one patient in the deposition who was repeatedly committing acts of self harm.
“I read the history, I say, ‘This patient has such-and-such diagnosis,’ even though I have not seen it. ‘This patient needs to be seen or else he continue to injure himself at the inpatient level of care.’ That went nowhere.”
Urdaneta said the patient was accused by other mental health staff of “manipulation.”
“What is it in this guy that is there to manipulate when he goes repeatedly to the emergency room and he injures himself?” Urdaneta wondered.
Urdaneta said the patient complained of having to see different therapists each day.
“There was no therapeutic alliance, which is basic,” he said. “I mean, that's primordial for the care of human beings, OK. There was nothing there, OK. So these patients were left only to the management of officers that took care of them, looked at them for hours, and then they were moved to maybe a higher status being seen every other day.”
Urdaneta said under the conditions he witnessed, “the sickest patients become casualties.” He said the Department of Corrections has a unit assigned for patients who self-injure themselves.
“That’s unheard of. You can’t do that.”
“There were many cases like that over and over again. And the patients then end up in the emergency room over and over and over,” Urdaneta said of inmates who had committed acts of self harm. “Sometimes the same patient eight, nine, 10 times within a very short period of time.”
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Understaffed And Poorly Trained
Urdaneta said staffing was usually a factor in the poor mental health care provided in the prisons. “I know, for a fact, that the numbers were low,” he said. Urdaneta said he would complain about using different counselors each day to see suicidal patients instead of the same mental health provider.
“And they would say, we don't have more. You know, that's all we got.”
Urdaneta said he had concerns about the quality of the mental health staff.
He described many of them has having a “lack of knowledge, lack of empathy, lack of experience in a population that is difficult to treat.”
Urdaneta said the mental health staff didn’t have the necessary training to provide treatment.
"I would be told sometimes, ‘Well, the patient is receiving CBT’ (cognitive behavioral therapy) or some other sort of manual therapy and so on,” Urdaneta said. “But then you ask, ‘OK, what is the training with this particular counselor in this particular area?’ Well, I don't think she had been trained in this. So how can you provide that if you haven't been trained, if you don't have enough knowledge with that which you are saying you are practicing?”
Urdaneta said a person in charge of mental health at the Tucson facility who acted like “an officer in disguise.”
“What I mean by that,” he said, “people who treat human beings, again, as if they were just felons. They are more concerned about satisfying the administrative part of the correctional department rather than satisfying the treatment and caring of patients as you're supposed to be.”
Urdaneta said a lack of correctional officer staff prevented patients from getting treatment on time.
“There were many cases reported to me from the psychiatric practitioners that they had been unable to see the patient because of the lack of escort or similar sort of issue, and those were fairly common,” he said.
Urdaneta cited one instance where a patient with Tourette's syndrome was disciplined by correctional officers.
“So it is typical of Tourette's sometimes to make remarks that come out with ticks and mannerisms of their own that were then misunderstood and for which then they suffered the consequences of administrative repercussions,” he said.
Urdaneta said he believed the patient lost access to visits for a period of time.
Urdaneta said he was concerned that there was not enough talk therapy available for patients, saying there were innumerable instances where it was needed but not received.
“There were not enough therapists, counselors, well prepared to do therapy," he said. "The main concern was, again, the quantity in terms of, did we reach the benchmarks.”
Urdaneta testified that patients were only receiving brief encounters with mental health staff.
“So I come in here, listen for five minutes, throw medications, and that’s it,” he said. “I got the feeling that these encounters were a conveyor belt, depersonalizing the patient altogether.”
He said he was surprised by the “the total ignorance about human nature and the handling of patients like cattle.”
Urdaneta said qualified mental health staff exist within the Department of Corrections but they are few and far between.
“There were a few counselors, let me tell you, that were darn good. Here and there, and they had the care of patients and so on in mind,” Urdaneta said. “But, again, talking to some of those, they tell me, ‘I'm overwhelmed.’ They also decried the fact that the system as a whole was not supporting what they wanted to do with these human beings.”
Urdaneta said the intake process at the department concerned him because many patients were not seen by a psychiatric practitioner within a reasonable amount of time.
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The Cards Are Stacked Against The Patient
“I had particular problems in that aspect with the many patients who came from jails with a combination of medications, or medications that did not make any sense, or medications that maybe made sense but, therefore, needed to be followed up much sooner than what the department wanted or required,” he said. “I think it was too lax. I think it was 42 days to see any patient, you know, that came in.”
Urdaneta said he believed a psychologist, working for the Department of Corrections, was involved in interfering with his requests to change policies he found problematic.
“We had, at the Department of Corrections, somebody who is a psychologist who doesn't understand that part of psychiatry," he said. "We did not have somebody that we could go to who was a psychiatrist at the central office to discuss these matters. So policies were policies even if they were blighted.”
He said patients waiting for 42 days to be seen at intake to the prison was “totally clinically inappropriate. You know, if the patient seems to be all right, yeah, maximum, maybe two weeks.”
Urdaneta said he had concerns about the psychotropic medication review board, the process by which a patient can be involuntarily medicated. He said the person who was supposed to be representing the patient during the process was never present.
“Never saw it,” he said. “At least in those that I presided, never saw it. So the interest all around was in having the patient then committed for treatment one way or the other.”
Urdaneta said the patient would be asked to leave the room when the decision was being made about their medication, which he thought was a violation of their civil rights.
“So the cards were stacked against the patient all around,” he said.
Urdaneta said he had a problem with the way psychological counseling and psychiatry are separated in the Arizona prison health care system.
“I think it's an artificial separation,” Urdaneta said. “I said we had to change. There is no mental health here and psychiatry here. You know, everything comes together.”
High Ranking Whistleblower
Urdaneta said he raised many of his concerns within Corizon but had no access to make complaints with anyone at Arizona Department of Corrections.
While several former Corizon employees have come forward with similar concerns, ACLU attorney David Fathi says Urdaneta is, so far, the highest ranking health care official to blow the whistle in Arizona.
“When your chief psychiatrist says that your system is cruel, insensitive, and inhumane, you’ve got a serious problem,” Fathi said. “Dr. Urdaneta confirmed the problems that we’ve long known about or suspected. The chronic staffing shortages. The drive-by mental health encounters. The dismissive and dehumanizing attitudes toward patients with mental illness.”
Fathi says if the settlement goes to trial as plaintiffs in the Parsons lawsuit have asked, they hope to call Dr. Urdaneta as a witness or if he is not available, submit the deposition as evidence.
Fathi called Urdaneta’s testimony “a very valuable look into the system from an unimpeachable source who has no incentive to shade the facts one way or the other.”
“The energy with which the state fought to silence him is a testimony to how important they viewed his testimony as being,” Fathi said.
KJZZ contacted Dr. Urdaneta but he did not provide a comment for this story.
Corizon Health and the Arizona Department of Corrections declined to comment.