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Prison Medicine and the California Hunger Strike

The Federal court decision on August 19 giving the state permission to force-feed hunger strikers deemed “at risk of near-term death or great bodily injury” is a shameful one. It violates long-established international law. The World Medical Association confirms force-feeding as an inhuman and degrading treatment that qualifies as torture by the European Court of Human Rights. Today’s order allows prisoners who previously executed “do not resuscitate” directives to be excluded, unless they were signed for the purpose of taking part in the hunger strike. It also allows officials to ignore such a directive if they determine “it was the result of coercion.”

The fact that such a sweeping order came at the request not only of corrections officials but of the court-appointed receiver’s office which oversees health care in the prisons is profoundly disturbing to those of us in the health professions who believe that our patients, including patients who are prisoners, have the right to reject unwanted medical treatment and their autonomy should be respected.

This hunger strike is historic; it will be remembered for years to come as a moment when prisoners united across deep racial divisions to assert, with their bodies on the line, what it means to be human fighting against an inhuman system. It is a moment when the prison medical department could have shown that it has been rehabilitated. It could have demonstrated its independence from the custodial culture that has overwhelmed it for so many years.  Prison medical staff had the opportunity to play a protective role for their patients who are risking their health and possibly their lives by for an end to long-term solitary confinement.  It’s a loss for everyone that they have allied themselves so shamefully with an intransigent prison administration that continues to deny the humanity of those in its custody.

The legal and advocacy team and family members of prisoners engaged in the strike have heard numerous reports of medical neglect during the last six weeks of the strike. Prisoners report that medications have been abruptly stopped with little regard for consequences, and with inadequate monitoring of the condition for which the medication was being taken.  Medications for diabetes were stopped, but no testing of blood sugar followed.  Likewise medications for high blood pressure discontinued without follow up monitoring.  Strong pain drugs have been blocked causing withdrawal symptoms rather than tapered down slowly.  Some prisoners told advocates that they had not had been weighed or their vital signs taken as mandated in the CDCR protocols, and that nurses just briskly walked the tiers saying “drink plenty of water”, rather than stopping and inquiring about each person’s condition. One hunger striker, Billy Sell, died in his cell, and those near to his cell described that his requests for medical help went unanswered.

Eight years ago the CDCR’s entire medical operation was put under Federal Court Receivership.  The Court finding of fact stated that “…it is an uncontested fact that, on average, an inmate in one of California’s prisons needlessly dies every six to seven days due to constitutional deficiencies in CDCR’s medical delivery system.  This statistic, awful as it is, barely provides a window into the waste of human life occurring behind California’s prison walls due to the gross failures of the medical delivery system.” (Plata v. Davis)

While public outrage and pressure has pushed facilities upgrades and more qualified staff have been hired, CDCR medical has not adequately altered its way of functioning. Investigative reporters recently documented the fact that between 2006 and 2010, the CDCR sterilized 250 women prisoners without their informed consent, all while under the Federal Receivership. This month the courts intervened again to order the transfer of prisoners susceptible to Valley Fever from two Central Valley prisons where more than 1,800 prisoners became ill and at least 62 died from the airborne fungus between 2008-2012.

The medical department still falls on its knees to custody and its patients suffer for that lack of independence. Yes, it takes great courage to stand against the sway of cruel custody, and I admire those who have done so despite harassment and personal sacrifice.  I’m sure there are those brave souls engaged at this time, perhaps just not enough and with not enough support from the Department or the public.

The Department of Corrections asserts that the force feeding order was requested because “the health and safety of inmates is our top priority.” After 43 days of a hunger strike, the best way to demonstrate concern for the health and safety of prisoners is to participate in good-faith discussions to reach a reasonable agreement before any more lives are lost, or any prisoners subjected to the pain and humiliation of force-feeding.

Corey Weinstein, MD is the past Chair of the International Human Rights Committee of the American Public Health Association and held Certification as a Correctional Provider from the National Commission on Correctional Health Care before retiring as a Correctional Medical Consultant.

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