"Some of the women had what clearly looked like scabies and the others had an undifferentiated rash. Most women reported long delays in receiving any treatment, despite submitting multiple Health Needs Requests, and also reported that the treatment they had been provided of skin cream and antibiotics was not resolving the condition," continues the letter, a copy of which was obtained by New Times.
What's more, women who had nearly identical-looking symptoms received "extremely different diagnoses," if they were seen by medical professionals at all.
"It's disturbing, because these women — whatever they're having, they've had it for a long time," says Corene Kendrick, staff attorney for Prison Law Office and author of the letter.
Women began reporting the itchy and painful skin condition as early as November 2015, Kendrick says, and many were given hand lotion and told they had dry skin. Others were given antibiotics but said the painful condition returned once the medication ran out.
Kendrick's letter stems from Parsons v. Ryan, a 2012 class-action lawsuit against the Arizona Department of Corrections in which the PLO was a co-plaintiff. As part of the settlement in that case, PLO staff members regularly tour prisons to document any untreated health problems. Kendrick says she first encountered the "scabies-like" outbreak on a recent visit to Perryville.
"We told them, 'We're here to talk about health care,' and the women kept saying, ' Look at my arm, look at my leg, look at this weird rash.' The rash and infestation were all they wanted to talk about."
So far, the outbreak seems to be contained to the San Carlos Unit of the Perryville prison, a minimum-security facility with 1,250 beds, but it isn't hard to imagine a scenario in which it spreads.
After touring the prison, Kendrick looked through some of the inmates' medical files. She says she was shocked by what she saw.
"There was a whole range of diagnoses. It didn't seem like there was any coherent attempt to get to the bottom of it. It seemed very hit or miss when it came to the diagnoses that were given out," she tells New Times.
The letter states that women were diagnosed with scabies, MRSA, staph, folliculitis, pseudomonas, bacterial infection, shingles, psoriasis, contact dermatitis, allergies, and dry skin.
"We wanted to raise it as a systemic issue, because if it is a communicable-disease outbreak, you need to address it and prevent it from being spread further," Kendrick explains.
"She has lesions under her armpits that are almost the size of a Ping-pong ball," says a doctor whose wife is incarcerated at Perryville.
According to the Centers for Disease Control and Prevention, scabies is caused by the human itch mite (Sarcoptes scabiei var. hominis), a microscopic creature that burrows into the upper layer of the skin, where it lives and lays its eggs. If an infestation is untreated, the mite will continue to lay eggs and spread the rash. Scabies is contagious, typically spread by direct, prolonged, skin-to-skin contact.
"It's pathetic what's going on out there — the health care out there is horrible and practically nonexistent," says a local doctor who contacted Kendrick because his wife is among the women who has had the rash for months.
The doctor asked that New Times not publish his name for fear his wife would face retaliation at the prison. He says his wife has told him that many women have open lesions all over their bodies, while others are scratching themselves at night until they bleed.
"The physician's assistant that's taking care of my wife now keeps saying, 'Oh, you have dry skin,' or, 'Oh, you have folliculitis,'" he says. "That guy's full of shit. She has lesions under her armpits that are almost the size of a ping-pong ball."
In her letter, Kendrick notes that women voiced concern about poor sanitary conditions in the San Carlos Unit, in particular the fact that "cleaning supplies for the dormitories, especially the bathrooms, were in short supply or watered down."
Under these circumstances, she says, "If it's something communicable, they're never going to get rid of it."
In addition to the AG's office, copies of the letter were sent to a private law firm that represents the ADC and to the Maricopa County Department of Health. Kendrick says she has so far only heard back from the private law firm, which notified her that they would forward the letter to Corizon Health, the Tennessee-based, for-profit health-care provider for Arizona state prisons.
Neither the ADC nor Corizon responded to New Times' requests for comment.
As New Times staff writer Elizabeth Stuart documented in a recent cover story, "Lack of Adequate Health Care is a Death Sentence for Arizona Inmates," Arizona's prison health-care system is one of the worst in the nation. The settlement in the 2014 lawsuit was supposed to increase transparency and accountability, but Stuart found that owing to a lack of cooperation on the part of the defendants, health-care remains abysmal.
"The state has made so little progress on the goals outlined in the settlement agreement, which include, among other things, increasing the number of medical professionals serving prisoners and decreasing the wait time to see a doctor, that the ACLU in April demanded that a federal judge force the ADC to step up," Stuart wrote.
The defendants have yet to respond to the motion.
**Editor's Note 6/8/16: Arizona Department of Health Services spokeswoman Holly Ward provided the following comment about the possible scabies outbreak at Perryville:
"We were notified in February 2016 of a cluster of rash illness at Perryville prison. We are aware that there was a complaint at the end of May 2016 about ongoing scabies in Perryville, but our attempts to follow up with the complainant were not returned."
Added Ward: "We worked with the Arizona Department of Corrections and the Perryville medical staff to respond in February. A dermatologist evaluated approximately 50 inmates, resulting in multiple diagnoses including acne, staph/folliculitis, and other non-infectious dermatological conditions. Twelve inmates were identified to have resolved or resolving scabies. Prison staff provided education and cleaning products to inmates, and ensured adequate laundry facilities."
Read Corene Kendrick's letter regarding conditions at the Perryville women's prison in Goodyear: