W.03 Voluntary refusal of food and/or fluids (hunger strike)

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The management of a prisoner voluntarily refusing food and/or fluid must be consistent with maintaining the prisoner's health and security. Prisoners who refuse food and/or fluids are to be managed as close as possible as if they were not refusing food and/or fluids, in line with any risk and health assessments that will be completed.

Consideration

Any person carrying out duties in accordance with this process must understand the reason(s) behind their actions.

If you do not understand the actions recommended by this guidance, it is your responsibility to seek clarification on the actions required.

W.03.01 Definition of voluntary refusal of food and/or fluids (Hunger strike)

A hunger strike is defined as the voluntary refusal of food and/or liquids by a prisoner for more than 24 hours in a way that would damage their health if continued.

  1. Prisoners who fast as part of a legitimate cultural or religious observance are not considered to be voluntarily refusing food. They can however be notified to corrections health staff when staff have concerns regarding their wellbeing. Interventions will be offered and provided by health staff only if the prisoner consents.
  2. Prisoners who refuse to eat a normal diet but are taking a food substitute (e.g. Complan) are not considered to be voluntarily refusing food but will be notified to health staff. Health care will be offered based on clinical assessment and provided only if the prisoner consents.
  3. Prisoners who do not meet the criteria because of an eating disorder or any other similar mental illness will be assessed by health staff and referred for care to forensic mental health services.

W.03.02 Initial actions when a prisoner is refusing food and/or fluids (hunger strike)

Watch Point

As soon as staff become aware a person is refusing food and/or fluids, health staff are to be notified.

This enables health to assess whether there are any underlying immediate health risks regarding the prisoner, which staff need to be aware of.

W.03.02.01 PCO interview and activities

  1. The prisoner is to be interviewed (using W.03.02.Form.01 Hunger Strike – Staff Interview) within four hours by the unit Principal Corrections Officer (PCO) or assigned staff member. At the interview staff will:
    1. talk with the prisoner to determine what would need to change for them to begin eating and or drinking again
    2. address what would need to change (if disclosed) or put steps in place to resolve
    3. ensure the prisoner receives any support they need to resolve any grievance or what would need to change; through the appropriate channels
    4. try to determine if the prisoner intends to continue to refuse food for longer than 72 hours (three days)
    5. ask the prisoner to confirm in writing why they are voluntarily refusing food. If the prisoner refuses to do this then the stated reason is to be recorded in an IOMS Offender file note (word for word) under the file note title of Health
    6. complete a M.05.02.Form.01 Review risk assessment with the prisoner
    7. discuss with the prisoner their needs regarding pro social, cultural, spiritual, family, whānau support and what may need to occur to evaluate and facilitate contact with them
    8. if a prisoner is intermittently fasting due to a legitimate cultural and/or religious observance, ask when the religious observation will end
    9. summarise the interview outcomes and actions in a detailed IOMS Offender file note under the file note title of Health.
      Watch Point

      The person’s response to questions about what would need to change for them to stop the hunger strike should not be summarised.

      Questions asked and responses provided must be recorded (word for word) on the interview template (in the event these are required for legal proceedings).

      • If interview discussions result in the disclosure of personal health information custodial staff are to discuss with health staff as this component of the conversation or interaction must only be recorded in the patient’s electronic health record.

W.03.02.02 Notifications and Incident Reporting - Commencement

  1. If the prisoner confirms they wish to continue their hunger strike after their interview, custodial staff will:
    1. confirm to the Health Centre Manager (HCM) and health staff the prisoner is refusing food and/or fluids
    2. advise the prison director as soon as possible, especially if there is media interest in the person and/or a health risk or any other risk associated to the hunger strike
    3. log an incident report in IOMS. Staff must categorise the incident under Prisoner Safety / Welfare – Hunger strike
    4. notify the incident line 0800 555 500 according to the incident reporting category. Refer to IR.06.Sch.01 Schedule of incident categories
    5. commence working with health staff to develop the W.03.02.Form.02 Hunger strike management care plan as detailed under prisoner welfare, placement and care management section
    6. evaluate identified pro social, cultural, spiritual, family, whānau support and how the prisoner might have contact with them.

Notifications and Incident Reporting – Conclusion

  1. The hunger strike shall be deemed over when the prisoner advises staff verbally or in writing that they are or wish to commence eating again. On confirmation the hunger strike is over staff are to:
    1. advise health staff and seek advice for safely recommencing food and/or fluids
    2. update the incident line 0800 555 500
    3. update the IOMS incident report within 2 hours.

Contact and media queries

  1. During a hunger strike, a prisoner’s contact person may be notified:
    1. only if the disclosure is authorised by the prisoner, or
    2. the prisoner has reached the stage where they are seriously ill or being transferred to a hospital (unless the prisoner says not to tell their contact person).
      Consideration

      It is good practice for staff to verify contact person details with the prisoner to ensure they are up to date and correct in IOMS.

      It is also good practice to confirm that the contact person in IOMS is the desired contact in the circumstance.

      If a contact person is to be called, make sure health are consulted regarding information that can be provided without breaching the person’s privacy in regards to health information.

  2. All media inquiries are to be referred to Corporate Affairs via the Communications Service Desk. Staff must not speak to the media about Corrections matters under any circumstances.
    Communications Service Desk
    Extension 68365
    Phone 04 460 4365
    Mobile 021 761 828 (urgent after hours)
    Email Comms.ServiceDesk@CORRECTIONS.GOVT.NZ

W.03.03 Prisoner welfare, placement and care management

collaboration

Any person who voluntarily refuses food and/or fluids will be managed and cared for jointly between custodial staff and health staff.

All staff are responsible for working together to ensure the person is treated humanely and with respect.

Watch Point

People undertaking a hunger strike should not be transferred to a different site unless the transfer is clinically required to support their ongoing care and wellbeing.

  1. Prisoners will have review risk assessments and health assessments completed as needed to ensure their health and wellbeing.
  2. Staff will continue to actively engage with the prisoner to address what would need to change for the prisoner to cease the hunger strike.
  3. Prisoner placement will be determined jointly between custodial and health staff and will be made according to the needs and welfare of the prisoner.
    (See W.03.03.Res.01 Hunger strike - Prisoner Placement Guidance for guidance on placement of the prisoner.)
    Watch Point

    Health staff will provide guidance and support in the care of the prisoner and provide updates to the regional operations director health and the prison director for cases where the hunger strike exceeds 72 hours, or if the person has high / complex clinical health risks.

    Health staff will also ensure a person refusing food and or fluid is:

    • assessed by a Registered Nurse within 36 hours
    • assessed by a Medical Officer / Registered Nurse Practitioner within 72 hours.
  4. After initial interview, if the prisoner confirms they are continuing to refuse food and or fluids custodial staff will complete a W.03.02.Form.02 Hunger strike management care plan in consultation with Health staff outlining:
    1. prisoner placement according to the needs and welfare of the prisoner
    2. routine / structured day (detailing association level / how entitlements will be met)
    3. the frequency of welfare monitoring checks / at risk observations
    4. what food should be offered and for how long and what records need to be kept
    5. any pro social, cultural, spiritual, family, whānau support the prisoner has and how contact with them will occur
    6. the indications / situations for custodial staff to contact health staff during the day and after hours if a prisoners health deteriorates.
  5. Custodial staff will complete a daily summary of prisoner care and engagement as part of the hunger strike management care plan. This summary will be recorded in IOMS as an Offender file note under the file note title of Health.
  6. If a prisoner is assessed as ‘At Risk of Self Harm’ or health staff recommend appropriate ‘Segregation’ on medical grounds at any stage during a hunger strike, the hunger strike management care plan will be reviewed, updated and utilised as the hunger strike management care plan required under those policies.
    collaboration

    Within five days of the prisoner first refusing food and/or fluids, the HCM is responsible for organising a multi-disciplinary team (MDT) meeting.

    MDT meetings will occur regularly throughout the hunger strike and can include health staff, custodial staff, the person’s case manager, any other appropriate people and the person on hunger strike (if they consent).

    Consideration

    The following policies and resources work in conjunction where needed when caring for a prisoner refusing food and or fluids:

    • POM S.06.04 Prisoner welfare monitoring check
    • POM M.05 Prisoners at risk of self harm
    • POM M.05.01.Res.03 ISU Supported Decision Framework
    • POM M.07 Segregation of prisoners
    • W.02.Res.01 Dry Cell Placement Summary
    • Corrections Health Services Policy for voluntary refusal of food and / or fluids

W.03.03.01 Recommencing of food and fluids

  1. If the prisoner refusing food and/or fluids advises (verbally or in writing) that they plan to start eating and/or drinking again, custodial staff must:
    1. seek confirmation from the prisoner in writing that they plan to commence eating and or drinking again.
    2. advise health staff.
      Watch Point

      There can be significant health risks to the person if restarting food and fluids is not managed appropriately.

      Health staff will assess the person and provide guidance on how the person is to be safely transitioned back to resuming a normal diet after a prolonged period of fasting.

      Food and or fluids are not to be offered to the person without health staff advice.

W.03.03.02 Responsibilities for deteriorating prisoner health

Watch Point

Any prisoner on a hunger strike will be transferred to hospital if the care they need becomes outside the scope of staff.

Health staff will be responsible for consulting with hospital specialists to discuss transfer to hospital and ensure the person’s competence to make an informed decision regarding their health care is reviewed by a suitably trained Medical Officer.