California prisons can force-feed inmates on hunger strike, rules Federal Judge

If dozens of hunger-striking California state prison inmates are so close to death that they must be force-fed, the method will likely be less invasive than what was used on terror suspects at Guantanamo Bay, the prison system's top medical services official said Tuesday.

U.S. military officials came under heavy criticism from human rights advocates when they snaked feeding tubes through the noses and into the stomachs of terror suspects who refused to eat.

California prison officials won a court order Monday saying they could force-feed dozens of inmates who have been on a hunger strike for six weeks over solitary confinement conditions.

Dr. Steven Tharratt, director of medical services for the federal official who oversees medical care for California's prisons, said if the state employs force-feeding, it's most likely to be done by pumping nutrient-enriched fluids into the bloodstreams of unconscious inmates.

"It's not really a forced re-feeding at that point," Tharratt said. "It doesn't evoke images of Guantanamo Bay or anything like that. It's actually a totally different setting."

State prison officials have struggled to deal with a hunger strike that started last month and, at its height, involved thousands of inmates. There are 45 inmates who have refused anything more than water, vitamins and electrolytes since July 8 to protest the yearslong isolation of gang leaders.

Starvation weakens the immune system, leaving people more vulnerable to infections, said Dr. David Heber, director of the UCLA Center for Human Nutrition. Hearts pump more slowly and depression can set in. The most common causes of death include irregular heartbeat or heart attack.

Many of the hard-core strikers are likely to reach crisis stage in the next two weeks as they reach 60 to 70 days without significant nutrition, Tharratt said. They already are risking irreversible kidney damage, he said, and eventually they won't be able to make decisions about their own care.

"They become basically listless, inactive, their speech starts to slow, they eventually become confused and eventually come to a stage where they're not able to give consent one way or another," he said.

It is at that stage that Monday's order by U.S. District Judge Thelton Henderson of San Francisco could come into play. He has given state officials permission to disregard inmates' do-not-resuscitate directives if the officials believe the inmates acted under duress, for instance under threats by gang leaders who organized the hunger strike on behalf of inmates held indefinitely in California's Security Housing Units.

About 3,600 inmates are housed in the units because of crimes they committed in prison or they have been validated as leaders of prison gangs. The four organizers of the hunger strike all are serving life sentences for murder, have committed a string of assaults while incarcerated and lead rival prison gangs.

The California Department of Corrections and Rehabilitation "has tried to make this an issue of not giving in to gangs," said state Assemblyman Tom Ammiano, D-San Francisco.

While violent gang leaders are promoting the strike, that doesn't excuse the department's response, Ammiano said in a statement: "Like Guantanamo, abuse is not justified by who it is practiced on. Second, CDCR has failed to show that its measures have achieved anything for public safety. It's contradictory to claim that the SHU stifles the gangs and then to claim that the gangs are running the hunger strike from the SHU."

Jules Lobel, president of the Center for Constitutional Rights, represents hunger strikers in Guantanamo Bay and in California. He also is suing in federal court over conditions in the California isolation units. He dismissed prison officials' argument that inmates are being coerced by gang leaders into refusing food.

Prisoners are held indefinitely both in the SHUs and at Guantanamo Bay based on administrative decisions without a formal trial, Lobel said. While California officials have begun reviews leading to the transfer of many SHU inmates back into the general population, he said that is not enough.

Lobel said the forced-feeding order violates international law, and that state officials would be better off negotiating with gang leaders over concessions like more frequent visits and telephone calls that could prompt inmates to end their strike.

Many inmates have cycled on and off the hunger strike, taking food and then resuming their fast, Tharratt said. As of Tuesday, 94 inmates in six prisons had refused at least nine consecutive prison meals, including the 45 who have not taken nutrition in more than six weeks.

No inmate is currently near death at any of the prisons, he said.

The striking inmates have been moved near each other in each prison so they are easier for medical officials to monitor. Each is seen at least once a day, and often more frequently, by medical staff. Each has been prescribed a liquid nutritional supplement, though they are free to refuse it as they are all medical care, Tharratt said.

Monitoring the hunger strikers and caring for the dozens who have voluntarily agreed to accept intravenous fluids or solid food is complicating efforts to care for the medical needs of other inmates, he said. The prisons have moved some inmates out of their infirmaries to make room for hunger strikers, while some strikers have periodically been sent to outside hospitals before they are returned to their cells.

(Published by Huffington Post - August 20, 2013)