The death of an inmate who died days after undergoing hernia repair surgery at a state prison in Yuma in June came after a federal judge who oversees Arizona’s historically poor inmate medical care ordered an investigation into the death. According to the autopsy results, he died of unrelated natural causes.

But an autopsy report obtained by Capitol Media Services from the Yuma County Sheriff’s Office through a public records request states that inmate Santos-Silva could have been saved had he received early treatment for the illness that caused his death. No light has been shed on whether or not this was the case. Arizona has been given a sweeping order by a judge to improve inmate health care, with the state hiring enough staff to care for about 25,500 inmates in its nine state prisons. I’m struggling. Another 10,000 people are held in private prisons.

An outside forensic pathologist who reviewed the report for Capitol Media Services said the acute necrotizing esophagitis that caused Silva, 63, to die was detected within hours, giving him any chance of survival. He said he had to be treated.

He said the condition is essentially necrotic and dying tissue in the esophagus and is most often caused by loss of blood supply. An autopsy performed by Dr. Andrea Wiens Oink of the Pinal County Coroner’s Office determined that the cause of death was a combination of hypertensive cardiovascular disease, diabetes, obesity and recent surgery.

An outside pathologist, Dr. Paul Uribe of Texas, said he did not know whether better medical care at the prison would have helped. Silva was serving a life sentence without the possibility of parole for the brutal stabbing of his wife to death in their Mesa home in 1999.

However, Ananth Tripathi, a fellow inmate at the Arizona State Penitentiary Complex in Yuma, wrote a letter to U.S. District Judge Roslyn Silver on July 1, stating that Mr. Silva underwent surgery on June 24, 2024. Afterward, she said she repeatedly asked to see a medical provider. Silver immediately ordered the Arizona Department of Corrections, Rehabilitation and Reentry to ensure an autopsy was performed.

Despite Judge Silver ordering an autopsy to be performed on July 3 and a week later directing prison officials to provide information as it becomes available, the autopsy report, which was completed on September 11, It had not yet been filed in court as of Friday. The Department of Corrections denied the request to record the documents, saying it was not the custodian of the records. However, the department’s policy regarding inmate deaths requires that these records be obtained from the appropriate medical examiner.

The Department of Corrections’ press staff reiterated Friday that it is not responsible for providing coverage to the public or the press. He did not respond to questions about why he did not submit it to the court and said he would not comment on the judge’s order.

Silva was returned to the jail the day after surgery and collapsed after being taken to the jail’s infirmary just after 11 p.m. on June 30, according to a Yuma County Coroner’s Office investigator’s report.

County investigators said Silva arrived at the prison’s medical unit less than 10 minutes after being told by a correctional investigator that he was “having trouble urinating and vomiting and blood was flowing uncontrollably from his body.” He wrote that he had fallen in my house. He was pronounced dead less than 40 minutes after arriving at the prison’s medical ward.

The coroner’s investigator wrote that the surgery actually took place on June 26 and that he returned to the jail the next day. There was no way to immediately determine which date was correct.

The Yuma County Medical Examiner’s Office initially refused to perform an autopsy, according to a Department of Corrections response filed in court in July. After Mr. Silver directed him to obtain a certificate of correction, Yuma County officials agreed and had the Pinal County coroner conduct the death examination. Yuma County, like many other small counties in Arizona, does not conduct its own autopsy.

Dr. Uribe said he has performed more than 2,500 autopsies in the medical field and has never seen the same cause of death.

Mr. Uribe retired from the U.S. Army in 2021 as a lieutenant colonel and chief of the military medical examiner’s office and currently serves as the deputy chief medical examiner for Fort Bend County, Texas. He also performs autopsies on prisoners in Mississippi who die in custody.

He explained clearly what happened to Silva.

“Basically, that part of his esophagus died,” Uribe said. This phenomenon is very similar to when part of the intestine dies due to loss of blood supply.

“The most common cause of virtually dead intestines is ischemia, where blood flow to the intestines is cut off. And he had significant hypertensive cardiovascular disease, narrowing of the arteries due to atherosclerosis. ” he said.

Uribe said the symptoms do not appear to be related to recent hernia surgery.

“I don’t see that connection. I don’t think anything would happen during the surgery that would cause this,” Uribe said Friday.

The questions he can’t answer from the report are when blood flow to the esophagus was lost, “because it takes six hours to repair from there,” or whether he might have been saved if he had been diagnosed earlier. .

Dr. Oink concluded in the autopsy report that Mr. Silva’s death was due to natural causes, based on the circumstances, investigative information, and tests.

Silver is not satisfied with Arizona’s efforts to increase prison staffing. She made it clear in an order she issued last month that the state must comply with an order to fully launch a pilot program to enhance staffing and care at two prisons, including Yuma. said.

“If violations continue, the court may consider imposing monetary sanctions,” Silver wrote.

The same day, he ordered the state Department of Corrections to report by Dec. 10 on its efforts to obtain additional health care funding from the state Legislature and Gov. Katie Hobbs.

According to these reports, Corrections does not yet have sufficient funds to meet the court’s demands and does not know how much money it will need to comply with Mr. Silver’s order. The filing says Hobbs plans to release an executive budget early next month, setting out what he thinks is needed.

Arizona has struggled for more than a decade to improve medical care in its prisons as it battles lawsuits that claim its efforts fall far short of constitutional standards. Silver ruled more than two years ago that the state acted with “deliberate indifference” to the issue and failed to provide health care that met constitutional standards.

She accused then-Prison Warden David Singh of turning a blind eye to years of understaffing by the companies contracted to provide medical care, a problem she said led to unnecessary suffering and deaths.

The state will replace the contractor with NaphCare in October 2022, and the company will continue to add staff while receiving significant raises from the state to pay new doctors, nurses and other health care providers needed to care for inmates. I’ve been working on it.

In January 2023, Governor Katie Hobbs appointed Ryan Thornell, who previously served as Maine’s deputy commissioner of corrections, to replace Singh.

Despite the new leadership, Silver issued a permanent injunction in April 2023 requiring the state to take extensive corrective action to address inadequate medical care for prisoners.

NafCare has struggled to meet the requirements, but a company spokesperson said Friday it has filled nearly all 1,400 provider and other staff positions needed to meet the terms of the permanent injunction. .

But the state is overseeing a pilot project at one Yuma prison facility and another at Perryville prison that house female inmates, aimed at changing the way medical care is provided to inmates. A November 15 report by appointed experts shows that there are still significant gaps in the plan’s implementation. plan. Although progress was being made, there were issues such as a lack of staff and space.

The expert report praised the staff encountered.

“We would like to thank all the frontline staff we encountered during this pilot remote and on-site work for their compassion, dedication, energy, flexibility in the face of uncertainty, and deep dedication to patient care. “I would like to acknowledge this attitude,” the expert wrote. “It’s heartwarming and encouraging, and it’s probably the most valuable ingredient to a successful pilot.”

The lawsuit filed against the state on behalf of the prisoners dates back to 2012.

The state agreed to a settlement signed in 2015. Doug Ducey promised to do a better job in his first year on the job. Still, the problem persisted.

Arizona was fined $1.4 million in 2018 for failing to comply with agreed-upon performance standards, and Silver imposed an additional $1.1 million fine in 2021.

But by 2022, the judge said in a 200-page order that she had had enough.

“Despite years of knowledge from this lawsuit and the Defendants’ oversight of the performance of private health care contractors, the Defendants are in fact attempting to substantively change the health care system and force adequate staffing. No significant effort has been made,” Silver wrote at the time.

“Thus, Defendants act with deliberate indifference to Plaintiff’s serious medical and mental health care needs,” she continued. The judge said Singh’s testimony during the trial “provides convincing evidence that he knew about the failure but refused to accept anything meaningful.” Take steps to correct system deficiencies. ”

Corelene Kendrick, an attorney with the American Civil Liberties Union and a longtime litigator over prisoner health care, said that if Silva had actually sought medical attention and been denied medical attention right up until the moment he collapsed, the death said it was a matter of concern. And died.

Silva stabbed his wife, Alicia Silva, 32, to death on December 4, 1999, while their teenage sons were at their Mesa home.

After killing his wife, Silva stabbed the police in the throat, chest and side while begging the police to shoot him, according to an archived East Valley Tribune article. He spent several years in and out of Arizona state hospitals after being repeatedly found mentally unfit to stand trial. After doctors deemed him competent, a trial began in 2007, and prosecutors sought the death penalty.

A jury convicted him of murder, but declined to impose the death penalty, instead recommending life in prison.