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Walter Jordan tried to tell the world he was dying in prison in Arizona when he mailed a handwritten message, titled 鈥淣otice of Impending Death,鈥� to the federal court in Phoenix. Nine days later, he was dead. According to Dr. Todd Wilcox, a physician who reviewed Jordan鈥檚 case, the 67-year-old might have survived if he had received competent treatment by the Arizona Department of Corrections (ADOC) and its private, for-profit health care contractor, Corizon Health.

Jordan died of an invasive squamous cell skin cancer that ate through his skull and invaded his brain. Dr. Wilcox identified multiple deficiencies in Jordan鈥檚 care, concluding that his death was 鈥渦nfortunate and horrific鈥� and that he had suffered 鈥渆xcruciating needless pain鈥� in the final months of his life.

Jordan himself testified to his own impending death in his letter. 鈥淎DOC and Corizon delayed treating my cancer,鈥� he wrote. 鈥淣ow because of there [sic] delay, I may be luckey [sic] to be alive for 30 days.鈥�

Jordan died in prison, but his words have reached us, and they are a call to action against poor prison conditions that lead to pain and death for prisoners who have a right to proper care from the institutions charged with their custody.

This is not a new problem.

In 2012, the ACLU, the Prison Law Office, and others sued ADOC, alleging that it failed to provide minimally adequate medical and mental health care to the 34,000 prisoners in its custody. In 2014, the parties reached a settlement with ADOC agreeing to comply with 103 performance measures designed to ensure that prisoners receive decent health care.

Three years later, ADOC remains chronically out of compliance with some of the most critical measures. These measures include ensuring that prisoners are transferred with their medications, making sure that prisoners needing to see an oncologist or other specialist are scheduled in a timely manner, and ensuring that patients who are sick enough to be housed in a prison infirmary are regularly seen by a physician.

You don鈥檛 have to look far for the likely causes of Arizona鈥檚 continuing inability to provide basic health care to prisoners. An outside hospital recently threatened to stop treating ADOC patients, citing $1.2 million in unpaid bills. Within the prison system, understaffing is a chronic issue. Fewer than 60 percent of physician positions are filled. One prison has had no mental health staff since May 2016.

Last month, Dr. Jan Watson, a physician who had worked in ADOC, about her experiences there. She described being the only physician for more than 5,000 patients and having 鈥渋nmates dropping left and right.鈥� Watson described frequently running out of medications and having her requests for specialist referrals denied 鈥� 鈥淚t was just 鈥榥o, no, no,鈥� all the time,鈥� she said. Her request for a neurology consult for a patient who had multiple seizures was turned down. Her supervisor told her 鈥渋t costs too much money.鈥�

But the cost of ADOC鈥檚 continuing noncompliance shouldn鈥檛 be measured in dollar amounts: It should be measured in human lives.

In an earlier report to the court, Dr. Wilcox found that nearly 40 percent of the prisoners whose deaths he reviewed had received grossly deficient care. Examples included a 44-year-old woman who bled to death after being given medication that was known to harm patients with her condition and a 59-year-old cancer patient whose massively infected wounds were swarmed by flies in the days before he died.

Adding to this startling information, Dr. Pablo Stewart, a psychiatrist, found ADOC mental health care to be likewise deficient, identifying a number of prisoner suicides that could have been prevented with adequate care. After a 25-year-old woman hanged herself, an revealed that prison staff had falsified records to show that they had conducted required security checks on her unit, when in fact they had been eating and socializing in a control room. In the spring of 2017 there were four suicides in less than three weeks, an astonishing rate of self-harm.

ADOC officials may soon face the consequences of their ongoing failure to honor the agreement they signed. In October 2017, U.S. Magistrate Judge David Duncan, citing ADOC鈥檚 鈥減ervasive and intractable failures to comply,鈥� ordered top prison officials to show why they should not be held in contempt and fined $1,000 for each prisoner who does not receive the health care services to which he or she is entitled under the settlement. A contempt hearing will be held in late February.

Fixing Arizona鈥檚 broken prison health care system won鈥檛 be quick or easy, but a prison sentence shouldn鈥檛 become a death sentence for prisoners with treatable conditions.