Department of Corrections and Rehabilitation - Operations Manual

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Chapter 5 – Adult Custody and Security Operations

Article 10 – Hunger Strike

Effective December 11, 2024

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51100.6 Individual Hunger Strike Procedure

  • 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.