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But the autopsy report, obtained by Capitol Media Services from the Yuma County Sheriff’s Office through a public records request, does not shed any light on whether inmate Santos Silva could have been saved if he would have received earlier treatment for the condition that killed him. ÃÛèÖÖ±²¥ is under a sweeping order from the judge to improve inmate medical care and has struggled to hire enough staff to care for about 25,500 inmates behind bars at the nine state prisons. Another 10,000 are held in private prisons.

An outside forensic pathologist who reviewed the report for Capitol Media Services said the condition that killed the 63-year-old Silva, acute necrotizing esophagitis, would have to have been discovered and treated within hours for him to have a chance of surviving.

He said the condition is essentially dead and dying tissue in the esophagus, most often caused by a loss of blood supply. The autopsy conducted by Dr. Andrea Wiens Oeinck of the Pinal County Medical Examiner’s Office showed it as the cause of death, in a setting of a combination of hypertensive cardiovascular disease, diabetes and obesity and the recent surgery.

The outside pathologist, Dr. Paul Uribe of Texas, said he could not say if better medical care in the prison would have helped. Silva was serving a life sentence with no chance of parole for the brutal 1999 stabbing death of his wife at her Mesa home.

But a fellow inmate at the ÃÛèÖÖ±²¥ State Prison Complex in Yuma, Anant Tripati, wrote to U.S. District Judge Roslyn Silver on July 1 and told her Silva had repeatedly asked to be seen by a healthcare provider after having surgery on June 24, 2024, at Yuma Regional Medical Center but was denied due to “staff shortage.’’

Silver immediately ordered the ÃÛèÖÖ±²¥ Department of Corrections, Rehabilitation and Reentry to ensure an autopsy was done.

Despite Judge Silver’s July 3 order to conduct the autopsy and one a week later directing prison officials to provide it to her once it was available, the autopsy report completed on Sept. 11 had not yet been filed with the court as of Friday.

The corrections department denied a records request for the document, saying it was not the custodian of the records. The department’s policy on inmate deaths, however, requires that those records be obtained from the appropriate medical examiner.

Corrections media relations staff repeated Friday that they were not responsible for providing the report to the public or press. They did not respond to questions about why it had not been provided to the court, saying they had no comment on the judge’s order.

Silva was returned to the prison the day after the surgery and collapsed after being taken to the prison infirmary just after 11 p.m. on June 30, according to a report by an investigator with the Yuma County Medical Examiner’s office.

The county investigator wrote that corrections investigators told him that Silva was “having issues urinating, vomiting and blood coming out of his body uncontrolled’’ when he arrived at the prison medical unit and collapsed less than 10 minutes later. Efforts to resuscitate him failed and he was pronounced dead less than 40 minutes after arriving at the prison medical ward.

The coroner’s investigator wrote that the surgery actually occurred on June 26, and he returned to prison the next day. There was no immediate way to tell which date was correct.

According to a corrections department response filed with the court in July, the medical examiner’s office in Yuma County initially declined to do an autopsy. After Silver’s order directing corrections to obtain one, Yuma County officials agreed and had Pinal County’s medical examiner do the death review. Yuma, like many smaller ÃÛèÖÖ±²¥ counties, does not do its own autopsies.

Uribe said he’s never seen the same cause of death despite performing more than 2,500 autopsies in his medical practice.

Uribe, who retired from the U.S. Army in 2021 as a lieutenant colonel and director of the Office of the Armed Forces Medical Examiner, now is deputy chief medical examiner in Fort Bend County, Texas. He also does autopsies in Mississippi, including for prisoners who die in custody.

He explained what happened to Silva in layman’s terms.

“Basically, that part of his esophagus died,’’ Uribe said, an event very similar to when a part of the bowel dies from loss of its blood supply.

“The most common causes of essentially dead bowel is ischemia, which is cutting off of blood flow to it,’’ he said. “And he did have significant hypertensive cardiovascular disease, narrowing of the arteries by atherosclerosis.’’

Uribe said it does not appear that the condition is related to his recent hernia surgery.

“I don’t see that connection,’’ Uribe said Friday. “And I don’t think there would be anything during the surgery that would trigger this.’’

The question he can’t answer from the report is when the blood flow was lost to the esophagus, “because from there you have six hours to repair it,’’ or whether earlier diagnosis would have helped,

Oeinck concluded in her autopsy report that Silva’s death was from natural causes, based on the circumstances, investigative information and her examination.

Silver has not been pleased with ÃÛèÖÖ±²¥â€™s efforts to boost staffing at its prisons. In orders she issued last month, she noted that she had made it clear that the state must comply with her orders to fully set up a pilot program designed to boost staffing and care at two prisons, including the one in Yuma.

“The Court will consider imposing monetary sanctions if violations continue,’’ Silver wrote.

On the same day, she ordered the state corrections department to report to her by Dec. 10 on its efforts to get additional healthcare funding from the Legislature and Gov. Katie Hobbs.

Those reports show corrections still does not have sufficient money to meet the court requirements — and does not know how much will be needed to comply with Silver’s orders. The filing noted that Hobbs will release her executive budget early next month, clarifying what she thinks is needed.

ÃÛèÖÖ±²¥ has been struggling for more than a decade to improve its prison health care as it worked to deal with a lawsuit alleging its efforts fell far below constitutional standards. Silver ruled more than two years ago that the state had acted with “deliberate indifference’’ to the problems and failed to provide health care that met constitutional standards.

She slammed then-prison director David Shinn for turning a blind eye to longstanding understaffing by the company that contracted to provide health care and said the problems led to unneeded suffering and death.

The state replaced the contractor with NaphCare in October 2022 and the company has been working to add staff while getting big raises from the state to pay the new doctors, nurses and other health-care providers needed to care for prisoners.

In January, 2023, Gov. Katie Hobbs replaced Shinn with Ryan Thornell, who previously was deputy corrections director in Maine.

Despite the new leadership, Silver entered a permanent injunction in April 2023 that required the state to take a wide-ranging number of corrective actions to address poor health care for prisoners.

NaphCare has struggled to meet the requirements, although a company spokeswoman said Friday it now has filled nearly all of the 1,400 positions for providers and other staff required to meet the terms of the permanent injunction.

But a Nov. 15 report by court-appointed experts monitoring a pilot project at the one unit at the Yuma prison and another at the Perryville prison that houses women prisoners designed to change how healthcare was provided to prisoners still shows significant shortfalls in implementing the plan. While progress was being made, problems included a lack of staff and space.

The experts report did praise staff they encountered.

“We want to recognize the compassion, dedication, energy, flexibility in the face of uncertainty, and deep commitment to patient care, of all the front line staff we have encountered during our remote and onsite work on this pilot,’’ the experts wrote. “It is heart-warming, encouraging, and will prove to be the most valuable factor in making the pilot a success.’’

Litigation against the state filed on behalf of inmates goes back to 2012.

The state agreed to a settlement that was signed in 2015, then-Gov. Doug Ducey’s first year in office, promising to do better. Still, problems persisted.

ÃÛèÖÖ±²¥ was fined $1.4 million in 2018 for failing to live up to the performance measures to which it had agreed, with Silver imposing another $1.1 million penalty in 2021.

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

“Despite years of knowledge, driven by this litigation and defendants’ monitoring of private health care contractors’ performance, defendants have in fact made no significant attempts to substantively change the health care system and compel sufficient staffing,’’ Silver wrote at the time.

“Thus, defendants are acting with deliberate indifference to plaintiffs’ serious medical and mental health care needs,’’ she continued. The judge said the testimony from Shinn during the trial “provides compelling evidence of knowledge of the failures but a refusal to take meaningful measures to correct systemic flaws.’’

Corene Kendrick, a lawyer with the American Civil Liberties Union who has been involved for years in the lawsuit over prisoner healthcare, called Silva’s death troubling if indeed he had been asking to be seen by medical staff and had been denied until just before he collapsed and died.

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

According to an archived story by the East Valley Tribune, Silva stabbed himself in the throat, chest and side while begging police officers to shoot him when they confronted him after he killed his wife. He spent the next several years in and out of the ÃÛèÖÖ±²¥ State Hospital after he was repeatedly found mentally incompetent to stand trial. Once doctors determined his competency had been restored, trial started in 2007, with prosecutors seeking the death penalty.

A jury convicted him in the killing but rejected imposing the death penalty, instead recommending a life sentence.