Chapter 5 – Adult Custody and Security Operations

To establish a framework/guideline for staff to understand and ensure uniform handling of incarcerated persons participating in an individual or mass hunger strike and to ensure prompt resolution of hunger strike(s) while attending to the health and safety of the incarcerated person.

The purpose of this policy is to delineate the roles and responsibilities of all staff during an individual or mass organized incarcerated person hunger strike.

The Warden and Chief Executive Officer (CEO) have overall responsibility for the implementation of this procedure.

The following shall define language usage in this Article:

• Hunger Strike
  A method of non-violent resistance or pressure in which an incarcerated person refuses to consume food with the objective to achieve a goal.

• Hunger Strike Participant
  An incarcerated person who has refused to consume any food, including canteen, for nine consecutive meals, either individually or as part of a mass hunger strike, with the objective of achieving a goal. The department will not recognize a hunger strike participant until they have refused their ninth consecutive meal.

• Initiation of Hunger Strike
  Initiation of Hunger Strike is the day the incarcerated person has refused their ninth consecutive meal.

• Mass Hunger Strike
  Three or more hunger strike participants united with a common goal or set of demands disrupting institution operations and may require statewide or institutional mobilization.

The Warden or designee shall inform the Associate Director (AD) of their respective mission, and the CEO or designee shall inform the Regional Health Care Executive (RHCE), no later than 24 hours or the first business day after all hunger strikes.

If the incarcerated person is not consuming water or liquids, the Facility (or Unit) Captain or Associate Warden (AWAssociate Warden) shall be immediately notified. The Facility (or Unit) Captain or AWAssociate Warden will notify the Warden and CEO.

Office of Inspector General (OIGOffice of the Inspector General) and Headquarter (HQ) Administrator of the Day (AODAdministrative Officer of the Day) shall be notified according to their matrix for all hunger strikes.

Day one after initiation of a hunger strike:

• When a staff member becomes aware of an incarcerated person who has refused nine consecutive meals, the staff member shall notify the respective Facility (or Unit) Sergeant or Lieutenant where the incarcerated person is housed, prior to being relieved from duty.

• The Facility (or Unit) Sergeant or Lieutenant shall immediately notify the respective Facility (or Unit) Captain and AWAssociate Warden.

• That same day, the Facility (or Unit) Sergeant or Lieutenant shall interview the hunger strike participant, shall make every effort to resolve the hunger strike, and shall document initial hunger strike information on CDCRCalifornia Department of Corrections and Rehabilitation Form 128-HS, Initial Hunger Strike Chrono.

• Refer the incarcerated person for a Mental Health Assessment to be completed within 72 hours of referral.

• The CDCRCalifornia Department of Corrections and Rehabilitation Form 128-HS, shall be routed to the Facility (or Unit) Captain, or AWAssociate Warden, Warden, incarcerated person’s Facility (or Unit) Clinic Registered Nurse (RNRegistered Nurse), CEO, Chief Medical Executive (CME), Chief Nurse Executive, Chief of Mental Health (CMH), Chief Psychiatrist, Records, Public Information Officer (PIOPublic Information Officer) and if after hours or on weekends or holidays, the Triage Treatment Area nursing staff. A copy shall also be filed in the Electronic Health Records Systems (EHRS), Electronic Records Management System (ERMSElectronic Records Management System).

• The Watch Commander shall document the hunger strike participant(s) on the Daily Activity Report and notify the appropriate institutional executive staff and PIOPublic Information Officer via email.

• The CME or designee shall ensure that the incarcerated person’s primary care team is informed of the hunger strike.

  • The RNRegistered Nurse shall complete a hunger strike assessment.

  • The hunger strike participant shall be discussed daily in the daily huddles (examples are the following but not limited to: inpatient, outpatient, or Restricted Housing Unit [RHU] Huddles) and appropriate clinical action shall be taken in accordance with the Health Care Department Operations Manual (HCDOM) subsection 4.1.1.(d)(1)(A)2.a. This information shall be communicated to the executive team. subsection 4.1.1.(d)(1)(A)2.a. This information shall be communicated to the executive team.

• Custody shall remove food items from the housing of those who are participating in a hunger strike. The food shall be appropriately inventoried, documented on a CDCRCalifornia Department of Corrections and Rehabilitation Form 1083, Inmate Property Inventory, or within the departmental approved record keeping system, and securely stored. All items shall be returned to the incarcerated person upon resolution of their hunger strike. Should an incarcerated person refuse to have their food removed from their cell they would not be considered a hunger strike participant.

• Staff shall continue to offer every incarcerated person participating in the hunger strike the regular provision of state-issued food at every regularly scheduled meal serving time, except as otherwise prescribed by a physician.

• If at any time a transfer is clinically necessary, it shall be coordinated by the Health Care Placement Oversight Program (HCPOP) and shall include communication between the sending and receiving institutions’ Warden, CEO, CME, CMH and Chief Psychiatrist.

• Staff shall ensure that hunger strike incarcerated persons have access to water at all times and are offered state-issued food daily as scheduled.

• Information concerning hunger strike incarcerated persons shall be communicated during the institution’s executive meeting until the incarcerated person(s) have ended their hunger strike.

• Both the Warden or designee and CEO or designee shall participate or receive updates in this communication with the goals of both rapidly resolving the matter and ensuring that the incarcerated person is receiving care consistent with the Health Care Department Operations Manual (HCDOM).

• For incarcerated persons who are housed in RHU, document the refusal of each meal on their Automated Restricted Housing Record.

Five business days after initiation of hunger strike:

• Five business days after the incarcerated person has been identified as a hunger strike participant, and every five business days thereafter, the Facility (or Unit) Captain and the Supervising Registered Nurse II (SRNSupervising Registered Nurse II) shall interview the incarcerated person(s) in an attempt to resolve the hunger strike issues and document on a CDC Form 128-B. A copy of the CDC Form 128-B shall be sent to the incarcerated person’s Facility/Yard/Unit clinic RNRegistered Nurse or Health Care Staff designee. A copy of the CDC Form 128-B shall be filed in the EHRS, within the departmental approved record keeping system, including digital or physical incarcerated person record storage, and in the Warden’s office, and emailed to the Facility (or Unit) AWAssociate Warden, Warden, and the CEO.

Ten calendar days after initiation of hunger strike:

• The Warden or designee shall email a copy of each CDC Form 128-B generated by the Facility (or Unit) Captain and SRNSupervising Registered Nurse II to their respective mission AD and RHCE or designee every Wednesday until the hunger strike is completed.

Fourteen calendar days after initiation of hunger strike:

• The institution CME or designee shall request a Care Team Enhanced Conference (CTEC) to take place no later than calendar day 21 of the hunger strike.

Fifteen calendar days after initiation of hunger strike and beyond:

• Daily rounds, observation, and documentation by licensed healthcare staff.

• Weekly primary care provider evaluation or more frequently as clinically indicated.

No later than 21 calendar days after the initiation of hunger strike:

• The CTEC shall occur no later than 21 days of the hunger strike and is to assist with the resolution and clinical management of the hunger strike. The CTEC shall meet weekly, or as clinically necessary until the hunger strike has ended.

  • Attendees shall include: the incarcerated person’s medical and mental health primary care team, institution clinical leadership, headquarters medical and mental health consultants, the CEO or designee, the Warden or designee, and legal representation from the Office of Legal Affairs (OLAOffice of Legal Affairs) and California Correctional Health Care Services OLAOffice of Legal Affairs.

  • The CTEC will consider all factors concerning the hunger strike including:

    • The stated and any likely underlying reason(s) for the hunger strike and efforts taken to resolve the stated or potential causes for the hunger strike by custody or licensed health care staff.

    • The current medical and mental health status of the incarcerated person, including weight, BMI, vital signs, activity level and the results of nursing, and medical and mental health assessments during the hunger strike.

    • The incarcerated person’s medical decision-making capacity.

      • Past or pending actions to seek orders pursuant to Penal Code (PCPenal Code) sections 2602 or 2604.

    • Whether the incarcerated person has engaged in past hunger strikes and the dates, duration, and any known reason(s) for past hunger strikes.

    • Any mental health factors that have an impact on incarcerated person’s decision.

    • The appropriateness of the incarcerated person’s current housing.

• If a court order is to be pursued:

  • During the CTEC, a decision will be made regarding which clinical and custody staff will serve as declarants.

  • Warden, CEO, RHCE, respective mission AD, and HCPOP shall determine whether the incarcerated person should be transferred to a CDCRCalifornia Department of Corrections and Rehabilitation institution in the county in which the order will be sought.

  • If the incarcerated person is to be transferred, this shall be carefully coordinated with the receiving institution’s Warden, CEO, CME, CMH, and Chief Psychiatrist.

End of a hunger strike:

• Once an incarcerated person has resumed eating, the staff member who observed the incarcerated person eat shall immediately notify their supervisor and the Facility (or Unit) Sergeant or Lieutenant, and the clinic RNRegistered Nurse or Health Care Staff designee.

• The staff member who observes the incarcerated person eat shall document the conclusion of the hunger strike, observation of what was consumed, what actions were taken to end the hunger  strike,  and  current  weight  (if  available),  on  a  CDC  Form 128-B.

• A copy of the CDC Form 128-B shall be sent to the Facility (or Unit) Captain, AWAssociate Warden, Warden, CEO, and the incarcerated person’s Facility (or Unit) clinic RNRegistered Nurse or Health Care Staff designee.

• A copy of the CDC Form 128-B shall be filed in the EHRS and within the departmental approved record keeping system, including digital or physical incarcerated person record storage.

• Refeeding shall be conducted according to the CCHCS Hunger Strike, Fasting, and Refeeding Care Guide.
  

If three or more incarcerated persons voice a common goal or set of demands, this shall represent a mass hunger strike.

During a mass hunger strike, the institution shall follow the procedure detailed in DOMDepartment Operations Manual section 51100.6.

The institution’s Warden or designee shall notify the respective mission AD, or HQ AODAdministrative Officer of the Day during non-business hours, and OIGOffice of the Inspector General of all mass hunger strikes.

All visits for identified/documented leaders of a mass hunger strike will be suspended during their involvement in the hunger strike. Only incarcerated persons with active legal cases will be allowed attorney visits. If an incarcerated person is participating in a hunger strike during an attorney visit, they shall be monitored to determine if they consumed food. If an incarcerated person consumes food during the attorney visit, the information shall be documented on a CDC Form 128-B, and the hunger strike shall be considered over. A copy of the CDC Form 128-B shall be sent to the incarcerated person’s Facility/Yard/Unit clinic RNRegistered Nurse or Health Care Staff designee, and a copy shall be filed in the EHRS, within the departmental approved record keeping system, including digital or physical incarcerated person record storage, in the Warden’s office, and disseminated via email.

If the mass hunger strike disrupts institution operations, the institution Warden or designee shall determine if it is necessary to implement modified programing as defined in the California Code of Regulations (CCRCalifornia Code of Regulations), Title 15, section 3000, the institution emergency operations plan as detailed in CCRCalifornia Code of Regulations, Title 15, section 3301, and/or activate the Incident Command Posts (ICP).

For mass hunger strikes an Incident Report shall be created in the SOMSStrategic Offender Management for all participants, and a CDCRCalifornia Department of Corrections and Rehabilitation Form 128-HS shall be created for each participant.

If a mass hunger strike is anticipated, the Office of Correctional Safety may activate the Department Operations Center (DOC) at the minimum activation as a precautionary measure. Potentially impacted institutions shall be on standby to activate their ICP should a mass hunger strike occur.

In the event of a mass hunger strike, the DOC shall change from a minimum activation to a full activation as required. Affected institutions may activate their ICP.

The Deputy Director, Facilities Operations, or designee shall ensure that the content of this Article is accurate and current.