In an order issued Tuesday, Judge David Duncan said he was considering holding the defendants in civil contempt in the Parsons v. Ryan prison health care settlement.

Duncan said “pervasive and intractable failures” had led to the ruling.

When the state settled a lawsuit over poor health care conditions with inmates in Arizona prisons, it agreed to meet a set of guidelines or stipulations. There are rules on how quickly inmates should be given their diagnosis and how often they should be seen by mental health care providers.

Attorneys for the inmates have alleged that the state and its private contractor, Corizon, have been consistently and substantially in non-compliance with many of those stipulations.

They say state records show that medical information isn’t being entered quickly enough, follow-up appointments aren’t happening, access to specialty physicians is limited and inmates’ access to medications is interrupted.

But Corene Kendrick from the prison law office says the state needs to focus on comprehensive reform.

“A lot of times with addressing areas where they’ve been non-compliant, they rob Peter to pay Paul,” Kendrick said of the state’s allocation of resources. “They don’t have enough doctors at one institution so they say, ‘Well, we’re gonna bring some over from the other institution.”

Kendrick says the whole system needs to be overhauled.

Duncan is presiding over the settlement. In his order, he gave the state until January 2018 to come into full compliance with 11 stipulations in the settlement or else face a $1,000 fine for every instance of non-compliance.

Duncan noted that the defendants had been out of compliance for months and said “the court is now putting defendants on notice.”

The plaintiffs have asked that any potential fines be used to hire outside experts to advise the court on how to improve the delivery of medical and mental health care in the prisons.

In testimony earlier this year, ADC Assistant Director Richard Pratt testified that since Corizon took over the prison health care contract in 2013, they’ve been fined $3 million for staffing offsets.

Duncan speculated at the time that Corizon was making a conscious financial decision to keep staffing rates low and instead pay the fines.

In Tuesday’s order, Duncan echoed that concern, saying “the power of economic carrots and sticks is clearly understood by the defendants.”

Kendrick says she hopes the fines will bring attention to the desperate conditions in Arizona prisons.

“Money talks,” Kendrick said. “And this judge has been very patient for three years since we reached the settlement and has given the state multiple attempts to come into compliance. At this point, this is apparently what it will take to wake up the state.”

As of August, the state prison population was more than 37,000. The state pays Corizon $12 a day per prisoner for health care services, meaning the contract could be worth more than $160 million a year.

"The Arizona Department of Corrections remains firmly committed to holding its current contracted health care provider, Corizon, accountable for its contractual responsibility to provide inmates the constitutionally-mandated health care to which they are entitled. Moreover, ADC already has taken significant and concrete actions to encourage Corizon to meet the specific performance measures under the Parsons Stipulation," said ADS spokesman Andrew Wilder.

Corizon’s contract ends in 2018. The state is currently accepting bids for the next five-year contract.

EDITOR'S NOTE: The story has been updated to correct what the state pays Corizon for health care services.

Parsons Contempt Order