PHOENIX (AP) — A federal judge who previously concluded Arizona was providing inadequate medical and mental health care to prisoners said she will give the state three months to ensure it has enough health care professionals to meet constitutional standards.

In a filing late Monday, Judge Roslyn Silver outlined the changes she plans to impose on the Arizona Department of Corrections, Rehabilitation and Reentry to remedy its constitutional violations of prisoners’ rights.

She previously concluded there weren’t enough health employees to care for the roughly 25,000 incarcerated people housed in state-run prisons and that corrections officials had made no significant attempts to fix the understaffing problem.

The case went to trial in late 2021 after Silver threw out a 6-year-old settlement over prison health care, saying the state showed little interest in making many of the improvements it promised under the deal. She had concluded that $2.5 million in contempt of court fines against the state didn’t motivate authorities to comply with the settlement, either.

“Given this history, the court cannot impose an injunction that is even minutely ambiguous because defendants (state officials) have proven they will exploit any ambiguity to the maximum extent possible,” Silver wrote on Monday.

The judge laid out the draft terms of what will be the court-ordered overhaul of prison health care, giving lawyers a chance to comment on the changes. But she cautioned that attorneys shouldn’t expect significant changes to her upcoming order.

The number of health professionals needed at state prisons wasn’t specified by the judge, but she set ratios for the number of professionals needed to treat a given number of prisoners.

Silver said she plans to appoint four officials who will monitor the corrections department’s compliance with the court-ordered changes. When the settlement was in effect, lawyers representing prisoners said the state did a poor job of such monitoring and inflated its compliance numbers.

American Civil Liberties Union attorney David Fathi, who represents prisoners in the class-action lawsuit, expressed hope that Gov. Katie Hobbs would appoint a corrections director who will treat the health care of incarcerated people seriously.

Corrections Director David Shinn, who was appointed by then-Gov. Doug Ducey in October 2019 and announced his resignation in late December, was criticized previously by Silver for testifying that prisoners often have greater access to health service than people who aren’t locked up. Silver had said the claim was “completely detached from reality.”

“You can’t turn around the Titanic on a dime,” Fathi said. “There has been a broken system for a long time. It will not be fixed overnight.”

The corrections department, which in the past had denied it provided inadequate care, didn’t respond to a request for comment Tuesday.

In a blistering verdict last summer, Silver said the state’s inaction showed it is acting with “deliberate indifference” to the risks of inadequate care and said the state has adopted a health care system for prisoners that has led to preventable deaths. The judge had said prisoners weren’t getting timely access to emergency treatment, medications, treatment for chronic diseases and specialty care.

Lawyers representing prisoners had previously asked Silver to set up a receivership where the court would take over health care operations in state prisons and appoint an official to run those services there.

Though she has shied away from a receivership, Silver said she would revive that possibility if the state acts in bad faith or fails to comply with the court-ordered changes.

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