Arizona prison nurse says Centurion directed her to falsify report, evading $100,000 fine
On the eve of a landmark trial that will determine the way Arizona provides health care to incarcerated people, a prison nurse alleged the state's contractor, Centurion of Arizona, directed her to file a false report during her employment, in order to evade a $100,000 federal court sanction.
A Centurion spokesperson said Wednesday the company takes allegations seriously, and "will take appropriate action where staff conduct is considered to have violated our company code of ethics, our contractual obligations to the state, or the law."
Pat Borden, a registered nurse for 30 years, said she witnessed countless examples of poor health care and denial of care in Arizona prisons, and continued instances of administrative impropriety. She eventually resigned from her position in 2021 because of her concerns.
In 2019, she worked as a nurse for Centurion of Arizona at the ASPC-Phoenix complex, predominantly in the Alhambra Unit, which serves as the intake facility for the Arizona prison system.
Looking back, Borden said she felt like she generally held to her principles amidst a very corrupt and poorly run operation. However, there was one time when she felt obligated to betray her morals at the direction of her boss, the director of nursing for the complex.
She said she was brought into her boss's office after "an inmate returned from offsite and no one had properly done a return-from-off-site visit report.” The purpose of such a report is to make sure any new doctor's orders for a patient would be implemented by the health care staff upon their return to the prison.
“Basically to make sure they were stable enough to come back to the prison,” she said.
In this particular instance in 2020, Borden said a return-from-offsite report had not been completed for a prisoner who had returned the previous evening.
“The director of nursing wanted me to document it as a late entry, like I actually saw the guy for that purpose,” she said. “But I did not see him for that purpose.”
Nevertheless, Borden agreed to do it.
“The director said, ‘Thanks – you’re going to save Centurion $100,000' – I’ll never forget that.”
Borden said she didn’t understand the severity of what she was agreeing to at the time, until she was thanked for saving money.
“I realized I must have done something wrong,” she said.
Borden went into the computer system and created a new return-from-offsite report. And she fraudulently composed it as a late entry. She said when she got home that night, it hit her.
“I had lied on a medical document.”
Something she had never done before in her career.
'I’ve always fought for the underdog'
Born and raised in Brooklyn, New York, Pat Borden speaks with an unmistakable inflection, projected by a sense of strength and determination that she credits to her Italian upbringing.
“I was taught to be a very honest and direct person,” she said, “and I’ve always fought for the underdog.”
Throughout her career as a registered nurse, she has used her voice to advocate for her patients. Borden worked in New York, New Jersey and Arizona, performing general health care, and specialized fields like oncology, dialysis and stem cell collection.
Borden is in good standing with the Arizona Board of Nursing. She says she has never had a disciplinary action taken against her in her entire career. To her knowledge, she has never been named in a lawsuit regarding her delivery of care.
“I like health care,” she said, “it’s my passion. I went into nursing when there wasn’t a lot of money in it because I care about people.”
Borden retired from nursing in 2016, only to take it up again in 2019 in order to help her son raise money for a business venture. She looked through job postings online, and one stood out. “I saw that they were looking for a nurse to work in a prison,” she said. Borden had worked in prisons in New York and remembered how grateful the incarcerated people were for her treatment. “Plus it paid well, and the hours were good.”
She had a good interview with Centurion of Arizona and started working for them at the ASPC-Phoenix complex, in the Alhambra Unit.
"The orientation was geared toward giving the inmates good care," she said, "and so I felt comfortable that it would be OK.”
Prisoners denied specialty care
Borden says things were good at first, but then a series of leadership changes resulted in what she viewed as a troubling pattern of denial of patient care and poor administrative decisions.
“Each new boss brought in new policies and procedures they would seem to come up with on on the fly,” she said. “Nothing was documented.”
She noticed a trend of denying specialty care referrals to prisoners. Hundreds of prisoners are processed through the Alhambra intake center every week, and Borden says many of them weren’t getting the care they needed.
When an incarcerated patient needs services beyond the capabilities of the prison health care center, they are supposed to be sent out to a facility that can perform the treatment.
However, Borden said Centurion was reluctant to allow such referrals because it would cost the company more. She said she and her fellow nurses were pressured by administrators to tell their patients to request specialty care referrals after leaving Alhambra, at the next prison that would become their permanent housing.
While most prisoners only spend a brief amount of time at the intake unit, Borden says many would be there for weeks without proper care.
She said nurses would write instructions for treatment to be sought “At Next Yard,” “At Next Complex,” or “At Next Facility.”
“That basically meant that they don’t want to deal with it here at intake,” she said. “They were kicking the can down the road.”
Emails from Centurion administrators show the company was concerned with this practice being documented in writing, because it violated the terms of court-ordered compliance measures in a settlement agreement.
“It has been identified that there has been an increase in the use of ‘at next complex’ or ‘at next facility’ as the timeframe for an action to occur when the patient should follow-up on a concern” wrote a Centurion administrator to the entire Phoenix prison staff. “This time frame is not admissible for multiple compliance measures.”
But instead of encouraging quicker treatment in the email, the Healthcare Delivery Facilitator provided guidance on how to word the language differently.
“Instead of ‘appointment scheduled for next complex,’ consider - ‘appointment scheduled to occur in 2-3 weeks’ or ‘appointment scheduled to occur within 30 days.”
But Borden said many patients needed immediate treatment.
“We had somebody who came in with a really bad infection,” she said. “We knew it was infected, but instead of sending him out for surgery, they made him wait. He needed surgery. It was painful to watch this guy not get taken care of ━ to not be sent out.”
'Call The Providah'
In defiance of the pressure from Centurion, Borden continued to advocate for her patients to receive specialty care. Outside transfers required the approval of the prison doctor, known as the “Provider.” So Borden became known among her colleagues for an often repeated saying, which they memorialized by hanging a sign in the office.
“It said ‘Call the provider’” she recalled, but she says it was spelled in a way to ridicule her thick, Brooklyn accent: “P-r-o-v-i-d-a-h.”
She felt like she was being mocked for being the only one who cared.
Undeterred, Borden said she would not be silenced. “It made me feel more determined to get the attention my patients deserved,” she said.
Court orders performance measures, fines
Filling out return-from-offsite reports is another of the performance measures monitored in the Arizona prison health care settlement known as Parsons v Ryan. The settlement, composed of more than 100 health care benchmarks, was agreed to in 2015, to resolve long standing conditions that attorneys for the plaintiff class say are unconstitutional.
The Department of Corrections, however, has failed to live up to the agreements it made in the settlement. Federal Judges have twice fined the state more than $1 million for failing to comply. And most recently, Judge Roslyn Silver, who now oversees the case, rescinded the settlement agreement, setting the case for a trial that will begin on November 1.
One of the benchmarks the state must submit to a federal judge every month, Performance Measure 44, asks “Are inmates that are returning from an inpatient hospital stay or ER transport with discharge recommendations from the hospital having the hospital’s treatment recommendations reviewed and acted upon by a Medical Provider within 24 hours?”
In a January 2020 order, Judge Silver threatened the state with additional fines if they continued to fail to meet the benchmarks. “If Defendants are found in contempt, the Court will impose a fine of $100,000 per Performance Measure per location to coerce compliance with this Order,” Silver wrote.
As the state's contractor, Centurion must repay the state for fines assessed by the courts. Borden said she believed her boss was referencing these potential fines when she thanked her for saving the company $100,000.
Borden speaks to administrator, says nothing changed
Things got so bad in 2021 that Borden went to an administrator with her concerns.
“I told the director of nursing in 2021 that I was noticing the inmates were getting poor care,” she said. “They had recently hired a new provider, who was providing substandard care.”
Borden said provider was bringing down the overall quality of treatment. “He was saying no to everything.”
She alleged another superior, a nurse practitioner, wasn’t properly conducting prisoner intakes.
“She would order half the medication that an inmate would need,” Borden said. “She believed that all the inmates were lying, and she wouldn’t give them proper care.”
Despite her conversation with the nursing director, Borden said nothing changed. She resigned from Centurion in September. In her resignation letter, Borden wrote: “I had hoped I would have had the opportunity to improve patient care, but I can no longer continue to work under the constraints imposed on me, including understaffing and a standard of care which is considerably below average.
“I can no longer risk my license as I watch failed quality measurements and the harm it is causing to my patients.”
In response to Borden’s allegations, a Centurion spokesperson said the company “does not comment on personnel matters but we take any allegations of improper staff conduct very seriously.
"We thoroughly investigate any complaints and will take appropriate action where staff conduct is considered to have violated our company code of ethics, our contractual obligations to the state, or the law.”
'Something needs to be done'
After she left Centurion, Borden said she wanted the public to know about what she had witnessed in the prisons.
"There are people there in prison with no voices and I needed to be their voice,” she said. “The prisoners should get the same care that all of us want for ourselves and our families.”
The issue is personal for Borden, whose son is incarcerated. The family maintains his innocence, and the experience has emboldened Borden to become an even more outspoken advocate.
“Something needs to be done,” Borden said. “If you don’t speak up, you’re just as guilty as the person doing wrong.”
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