D.21.01 Voluntary Refusal Of Food (National Procedure)

Procedure Standards

The management of any prisoner voluntarily refusing food shall be consistent with maintaining the health and security of that prisoner and shall be managed in a way that respects the cultural and religious beliefs of those affected.

Procedure

1. Immediately it comes to the attention of staff that any prisoner is limiting their food and liquid intake, the health centre staff shall be advised and the prisoner shall be interviewed by the PCO and asked to identify the reasons for their action.
2. Should the prisoner deemed to be voluntarily refusing food (as defined above) the PCO shall, where possible, investigate the prisoner’s reasons and attempt to resolve any issues of concern.
3. The PCO shall notify National Office Operations according to the criteria stated for Hunger Strikes in the PPM E.08 Incident Reporting in Prisons and PECCS.
4. The prisoner’s At-risk status shall be reassessed and an At Risk Management Plan shall be actioned.
5. An At Risk file shall be established according to requirements.
6. A suitable registered health professional on receiving confirmation that a prisoner is voluntarily refusing food shall undertake an assessment of the prisoner.
7. The prisoner’s weight, daily fluid balance, blood pressure, temperature / pulse, urine ketones / fructomasine level, general appearance and behaviour, and any other information necessary to monitor the prisoner’s health shall be measured and recorded in the prisoner's health file.
8. Following the assessment the suitable registered health professional shall immediately advise the Medical Officer.
9. Within 24 hours after a prisoner is deemed to be voluntarily refusing food the prisoner shall be examined, with their consent, by the Medical Officer to establish the prisoner’s physiological database.
10. The tests (see 6 above) are to be repeated daily should the prisoner continue voluntarily refusing food for more than 72 hours. The findings are to be recorded in the prisoner’s health file and the Medical Officer advised of any abnormalities.
11. All necessary health care acceptable to the prisoner shall be provided, including:
    • Fresh drinking water being available to the prisoner at all times.
    • Where practicable the prisoner’s fluid intake shall be observed and recorded.
    • All meals are offered to the prisoner and each meal is left in the prisoner's cell for a reasonable period of time depending upon the circumstances, such as weather and cell hygiene.
    • The content of each meal and the prisoner’s response is recorded.
12. Should the prisoner refuse any form of medical intervention they shall be interviewed daily by a suitable registered health professional and all refusals shall be logged.
13. During the period the prisoner is voluntarily refusing food;
    • Care should be taken to ensure that all media contact complies with the Department’s Visiting and Media policies.
    • The Regional Manager shall maintain close contact with the National Office Communications Unit.
    • Security checks on prisoners voluntarily refusing food shall be maintained in the normal manner unless the Prison Manager gives a direction that the checks are to cease.
14. The voluntary refusal of food shall be deemed to be over when the prisoner advises staff in writing that they are recommencing eating and their voluntary refusal of food is over.
15. On confirmation that the voluntary refusal of food is over;
    • The Medical Officer shall examine the prisoner and recommend any further medical treatment.
    • National Office Operations shall be advised as required by PPM E.08 Incident Reporting in Prisons and
    • The IOMS Incident Report shall be up dated within 2 hours.
16. Prisoners who are taking a food substitute (e.g. Complan) are not considered to be voluntarily refusing food, but their health status should be monitored by the Health Centre staff.

Key Roles and Responsibilities

Regional Manager

• Maintains contact with the Head Office Communications Unit.

Prison Manager

• Notifies the Regional Manager.
• Takes any appropriate local action to resolve issue(s) of concern raised by the prisoner.

PCO

1. On advice that a prisoner is limiting food and liquid intake:
   • Interviews the prisoner to identify the reasons for the prisoner’s action and wherever possible investigates the reasons given to seek a way to resolve the issue of concern.
   • Informs health centre staff.
2. On confirmation of voluntary refusing food status:
   • Notifies the Prison Manager.
   • Notifies the Unit Manager.
   • Notifies Heath Centre staff.
   • Notifies National Office Operations according to the criteria stated for Hunger Strikes in PPM E.08 Incident Reporting in Prisons and PECCS.
   • Updates IOMS reports as required.
   • Notifies next of kin (with the consent of the prisoner).
   • Ensures that necessities (e.g. water, meals) are provided and are available at all times.
   • Ensures At Risk reassessment procedure implemented (PPM B.14).

Medical Officer

• Examines the prisoner no later that 24 hours following commencement of the prisoner voluntarily refusing food.
• Supervises the prisoner’s health and ensures health care acceptable to the prisoner is provided.
• Establishes the prisoner’s physiological database.
• Recommends medical interventions as required.
• Examines the prisoner on confirmation that the voluntarily refusal of food is over.
• Recommends medical treatment as required.

Suitable Registered Health Professional

• On advice that the prisoner is limiting food and liquid intake interviews the prisoner and notes details in the prisoner’s medical file.
• On confirmation that the prisoner is voluntarily refusing food (as defined above) conducts initial health assessment and notes details in the prisoner’s health file.
• Notifies the Medical Officer.
• Daily measures and records in the prisoner’s health file the prisoner’s weight, daily fluid balance, blood pressure, temperature/pulse, urine ketones/fructomasine level, general appearance and behaviour, and other information necessary to monitor the prisoner’s health.
• Monitors the prisoner’s health and reports to Medical Officer and the PCO any changes in health status.

Corrections Officers

• Informs the PCO immediately when it appears that a prisoner is limiting their food and liquid intake.
• Monitors and records details of any prisoner who refuses food or liquid.
• On receiving notification from a prisoner that they are voluntary refusing food shall immediately advise the PCO.
• When a prisoner is confirmed as voluntarily refusing food shall monitor and record the content of each meal placed in the cell and the prisoner’s response and as far as practicable record fluid intake.
• Maintain normal security checks unless instructed by the Prison Manager to discontinue such checks.

Communication Unit

• Assists Regional Manager with all media management activities.

Prisoner

• Advise staff that they are voluntarily refusing food and reasons for taking the action.
• Confirm voluntary refusing food status in writing.
• Advise staff when voluntary refusal of food over and ready to recommence eating.
• Confirm end of voluntary refusal of food in writing.