Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a)
Incarcerated person who are participating in an individual or mass organized
hunger strike shall be provided health care (including assessment, monitoring,
and treatment) regardless of the reason for their strike.
(b) The Warden or designee and Chief
Executive Officer (health care) or designee shall determine when a mass
organized hunger strike exists.
(c)
Response to hunger strikes.
(1) Health care
staff shall not prescribe meal replacements, including milk, juice, or
nutritional supplements to patients participating in a hunger strike unless
medically necessary.
(2) Designated
licensed health care staff shall observe all participants daily and determine
any need for immediate medical attention.
(3) When custody staff identifies an
incarcerated person as a participant in a hunger strike, staff shall adhere to
the following timelines:
(A) Within 24 hours,
health care staff shall notify each participant in a mass hunger strike that
they are eligible for sick call evaluations during the hunger strike.
(B) Within 72 hours, mental health staff
shall conduct a mental health evaluation for patients in the Mental Health
Services Delivery System (MHSDS) or Developmental Disability Program (DDP).
After the initial 72-hour evaluation, patients in the MHSDS or DDP shall have a
mental health evaluation scheduled at least every 14 calendar days.
(C) Within seven calendar days, the
participant shall be scheduled for a face-to-face triage assessment by a
Registered Nurse who shall provide education on the adverse effects and risks
of fasting and the refeeding syndrome.
(D) After 14 calendar days, and at least
weekly thereafter, health care staff shall schedule identified participant(s)
(even if not in a high-risk group) for a Primary Care Provider visit which will
include a Body Mass Index determination.
(E) After 21 calendar days, participant(s)
shall be provided with written information about advance directives including,
but not limited to, the following forms; CDCR 7421, Advance Directive for
Health Care, and CDCR 7465, Physician Orders for Life-Sustaining Treatment
(POLST).
(d) A
hunger strike participant may not refuse placement or housing for medical
needs.
(e) Informed refusal.
(1) The participant shall receive information
about their medical condition, the proposed course of treatment (including
nutrition support), and their prospects for recovery. If the participant
refuses recommended medical care, the participant shall be asked to sign a CDCR
7225, Refusal of Examination and/or Treatment, and complete a POLST to
delineate the care they will accept.
(2) Health care staff shall grant
participants autonomy in health care decisions.
(A) If the participant refuses to indicate
their wishes regarding medical management including questions of refeeding and
resuscitation if required, then all necessary interventions including
artificial nutrition to protect life and limb shall be carried out.
(B) If the participant is deemed unable to
give informed consent, the Department shall obtain a court order to treat the
participant.
(3) Health
care staff shall not participate in forced feeding of patients.
Note: Authority cited: Section
5058, Penal
Code. Reference: Section
5054, Penal
Code; Sections
3200-
3212, Probate
Code; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern
District of California.
Note: Authority cited: Section
5058, Penal
Code. Reference: Section
5054, Penal
Code; Sections
3200-
3212, Probate
Code; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern
District of California.
