A federal judge is expected to decide this month whether treatment of inmates in Maricopa County Sheriff Joe Arpaio's jails passes constitutional muster, settling a 30-year-old class action lawsuit.
U.S. District Court Judge Neil Wake heard nearly four weeks of testimony from inmates, jail employees, correctional health officials and experts, including psychiatrists who looked at the same medical records and reached different conclusions.
At issue is whether those who have not been convicted of a crime - who make up about two-thirds of the jail population - are being denied adequate food, health care and housing in violation of constitutional provisions that protect them from punishment.
Inmates described rotten food, feces-strewn intake cells and health crises that are belittled or ignored. Physicians testified that, among other things, health care workers fail to identify and treat mentally ill inmates, allowing their conditions to worsen and endangering their safety.
One man received mental health services only after his psychotic behavior was brought to the attention of detention staff by a psychiatrist hired as an expert in the case. That day, more than two weeks after he'd been booked, he was placed in a cell with two other inmates. The next day, the inmate was beaten so badly that he required emergency treatment at a hospital.
"Maricopa County jails and Correctional Health Services failed this extremely sick and vulnerable inmate at every turn," ACLU attorney Margaret Winter said in her closing statement. "(His) case is no aberration."
Attorneys representing Arpaio and Correctional Health Services, a separate agency responsible for inmates' medical, mental and dental care, argue that anecdotal cases of moldy bread or beaten inmates do not constitute the systemic failures needed to prove federal rights violations.
Beyond that, they maintain that jail conditions are constitutional and that pretrial inmates are examined for health problems, fed a balanced diet, given access to outdoor exercise and recreation and afforded adequate medical, mental and dental care.
The county, represented by Phoenix attorneys Dennis Wilenchik and Michele Iafrate, wants to end provisions of a consent decree that resulted from the original 1977 lawsuit, arguing in part that a federal prison reform act requires the decades-long case to be closed.
Court oversight cannot continue, the lawyers argue, unless Wake finds "current and ongoing" violations of conditions addressed in the original agreement.
"This is not a proper forum to seek sweeping reforms in the jail system. That ship has sailed," Wilenchik wrote in court papers last week following closing statements. "This is not a proceeding to determine a 'wish list' of care not required" under the agreement or the Constitution.
Wake can dismiss the agreement or keep all or part of it in place.
"I think the judge in this case may find contention with one or two issues," said Jack MacIntyre, an attorney and chief deputy for the sheriff's office. "But for the vast, vast majority, the judge is going to find that we've been exceeding the constitutional requirements for years and years."
Winter, of the ACLU's national prison project, said she is hopeful that Wake will find that conditions in the jails are still lacking.
"He was exceedingly attentive to the evidence and asked very probing questions," she said. "I believe that the facts and the law are on our side."
It's the county's job to prove that pretrial inmates are housed and cared for in accordance with their federal rights and rebut claims that they are at "substantial risk of serious harm to their health or safety" and that jail and health officials have acted "with conscious disregard for that risk."
A key defense is that Correctional Health Services is accredited by the National Commission on Correctional Health Care, a voluntary program that, for a fee, accredits more than 500 jails and prisons nationwide.
But accreditation does not equal constitutional care, Winter said, and previous court rulings support that. The accreditation process scrutinizes the systems and procedures that are in place, but not the quality of care.
A psychiatrist who testified on behalf of correctional health - and who also surveys jails and prisons for the accreditation agency - said Maricopa County jails have appropriate systems to identify and treat mentally ill inmates.
But Dr. Kathyrn Burns said she could not testify to the quality of care the jails provide.
In any case, experts for the inmates argued that both mental and medical care fall short of the accreditation standards.
The jail's clinics, licensed by the state Department of Health Services until 2003, were placed on probation by the accreditation agency in 2006 because of failure to assess inmates for medical problems and keep track of the mentally ill behind bars. Those areas are still out of compliance, two experts testified.
MacIntyre said jails cannot be held to the same standards as other institutions, particularly one the size of Maricopa County, among the top 10 jail systems in the country with a daily population of nearly 10,000 inmates.
"Do things happen in the jail? You bet they do," he said. "Do people die in the jail? You bet they do. But people die on the streets, too."
"For the most part, (inmates) are in medical, dental crisis from the instant they're booked."
Wilenchik called the consent decree the "epitome of judicial micromanagement," precisely the type of lengthy litigation and oversight that the federal prison reform act sought to avoid.
But Winter said that the federal law does not give jails license to violate constitutional rights.
"Congress did not have the authority to sweep away the Eighth Amendment, and it didn't pretend to do that," she said.
"It's true that there are enormous problems in county jails. But they have an obligation to make it right," she said. "My hope is that, with some encouragement from the federal court, they can do better."