[Federal Register Volume 59, Number 117 (Monday, June 20, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-14891]


[[Page Unknown]]

[Federal Register: June 20, 1994]


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Part VII





Department of Justice





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Bureau of Prisons



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28 CFR Part 549




Hunger Strikes, Inmate; Final Rule
DEPARTMENT OF JUSTICE

Bureau of Prisons

28 CFR Part 549

[BOP 1018-F]
RIN 1120-AA18

 
Hunger Strikes, Inmate

AGENCY: Bureau of Prisons, Justice.

ACTION: Final rule.

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SUMMARY: The Bureau, in this final rule, is amending a portion of its 
existing guidelines for the medical and administrative management of 
inmates who engage in hunger strikes. This rule amends the previous 
rule by designating a physician as responsible for determining the 
condition of an inmate, as well as making various other decisions 
concerning the inmate. Other administrative changes have been made to 
assist staff in the proper handling of this medically related issue. 
The rule is in accordance with the Bureau's mission to provide 
essential medical, dental, and mental health services to inmates by 
professional staff, consistent with community standards.

EFFECTIVE DATE: June 20, 1994.

ADDRESSES: Office of General Counsel, Bureau of Prisons, HOLC Room 754, 
320 First Street NW., Washington, DC 20534.

FOR FURTHER INFORMATION CONTACT: Roy Nanovic, Office of General 
Counsel, Bureau of Prisons, phone (202) 514-6655.

SUPPLEMENTARY INFORMATION: The Bureau of Prisons is amending its 
regulations on Inmate Hunger Strikes. A final rule on this subject was 
published in the Federal Register on April 4, 1980 (45 FR 23365).
    Current regulations in 28 CFR 549.62 state that staff shall refer 
to medical staff for evaluation and, when appropriate, for treatment, 
an inmate who is observed to be on a hunger strike. These regulations 
also stipulate that when considered medically appropriate, medical 
staff shall place an inmate engaged in a hunger strike in a hospital. 
Also, when isolation is necessary to measure food and liquid intake/
output, medical staff may place the inmate in a locked hospital or 
other medically appropriate room. Paragraph (a) of this section has 
been amended for editorial clarity and to include a reference to mental 
health staff. Paragraph (b) has been revised to specify that medical 
staff shall place an inmate engaged in a hunger strike in a medically 
appropriate locked room for close monitoring. The reasons for the 
revision to paragraph (b) are both semantic and operational. Some 
Bureau facilities, identified as Medical Referral Centers, are the 
equivalent of hospitals. The remaining Bureau of Prisons facilities 
more typically include health service units; these units are not 
hospitals, although they may be commonly referred to as such. Removing 
the reference to a hospital room therefore is more accurate in 
describing actual practice at typical Bureau facilities. Section 549.63 
(d) separately requires that inmates be transferred to Bureau Medical 
Referral Centers, other institutions considered to be medically 
appropriate, or to community hospitals when medical staff consider it 
medically mandatory. Section 549.62 (b) is intended to provide for the 
initial operational management of a hunger strike where the patient 
faces no immediate or obvious medical risk. The requirement for use of 
a locked room in all cases is deemed necessary for reasons of 
institution security and is intended to ensure the integrity of 
monitoring by medical staff. The revised section does not preclude a 
health services unit room from being used for this purpose; it does, 
however, allow for the use of other rooms. Regardless of the location, 
Bureau medical staff are responsible for determining that the room 
meets the medical needs of the inmate.
    References to specific medical procedures in Sec. 549.63 (a)(6) and 
(7) have been replaced by more general statements (i.e., radiographs 
and laboratory studies as clinically indicated). This has been done to 
allow medical staff flexibility in using available medical technology. 
Paragraph (c) of this section is amended to specify that the physician 
is responsible for making various decisions. This paragraph had 
previously designated medical staff as being responsible. Paragraph (d) 
had stated that when medical staff consider it necessary in order to 
provide appropriate medical treatment, an inmate on a hunger strike 
will be transferred to the Medical Center for Federal Prisoners, to 
another Bureau institution considered medically appropriate, or to a 
community hospital. The amendment to this rule stipulates that when 
medical staff consider it medically mandatory, an inmate on a hunger 
strike will be transferred to a Medical Referral Center. This amendment 
is necessary to reflect the increase in the number of available Bureau 
medical facilities.
    Current regulations in 28 CFR 549.64 state that an inmate may not 
make commissary purchases while under hunger strike management. The 
amendment to this rule states that an inmate may not make commissary 
food purchases while under hunger strike management. This change 
clarifies that an inmate on a hunger strike is prohibited only from 
making food purchases from the commissary.
    Current regulations in 28 CFR 549.65 also state that a medical 
officer determines if the inmate's life or permanent health will be 
threatened if treatment is not initiated immediately or if forced 
medical treatment is necessary. The amended regulations stipulate that 
a physician make these determinations. The amended regulations provide 
an even greater assurance that a medical professional will handle this 
medically related issue and that the inmate will receive proper care 
even though not necessarily in a hospital. Section 549.66 has been 
similarly amended for the same reasons.
    Finally, the heading of 28 CFR 549.60 has been revised for 
editorial reasons.
    Because the amendments are not seen as being more restrictive on 
inmates, but rather deemed necessary for the continued provision of 
quality medical care, the Bureau finds good cause for exempting the 
provisions of the Administrative Procedure Act (5 U.S.C. 553) requiring 
notice of proposed rulemaking, the opportunity for public comment, and 
delay in effective date. Members of the public may submit comments 
concerning this rule by writing to the previously cited address. These 
comments will be considered, but will not receive response in the 
Federal Register.
    The Bureau of Prisons has determined that this rule is not a 
significant regulatory action for the purpose of E.O. 12866, and 
accordingly this rule was not reviewed by the Office of Management and 
Budget. After review of the law and regulations, the Director, Bureau 
of Prisons has certified that this rule, for the purpose of the 
Regulatory Flexibility Act (Pub. L. 96-354), does not have a 
significant impact on a substantial number of small entities.

List of Subjects in 28 CFR Part 549

    Prisoners.
Kathleen M. Hawk,
Director, Bureau of Prisons.

    Accordingly, pursuant to the rulemaking authority vested in the 
Attorney General in 5 U.S.C. 552 (a) and delegated to the Director, 
Bureau of Prisons in 28 CFR 0.96(p), part 549 in subchapter E of 28 
CFR, chapter V is amended as set forth below.

Subchapter E--Hunger Strikes, Inmate

PART 549--MEDICAL SERVICES

    1. The authority citation for 28 CFR part 549 continues to read as 
follows:

    Authority: 5 U.S.C. 301; 18 U.S.C. 3621, 3622, 3624, 4001, 4005, 
4042, 4045, 4081, 4082, (Repealed in part as to offenses committed 
on or after November 1, 1987), 4241-4247, 5006-5024 (Repealed 
October 12, 1984, as to offenses committed after that date), 5039: 
28 U.S.C. 509, 510; 28 CFR 0.95-0.99.

    2. The heading of Sec. 549.60 is revised to read as follows:


Sec. 549.60  Purpose and scope.

    3. Section 549.62 is revised to read as follows:


Sec. 549.62  Initial referral.

    (a) Staff shall refer an inmate who is observed to be on a hunger 
strike to medical or mental health staff for evaluation and, when 
appropriate, for treatment.
    (b) Medical staff ordinarily shall place the inmate in a medically 
appropriate locked room for close monitoring.
    4. In Sec. 549.63, paragraphs (a)(6) and (7), (c), and (d) are 
revised to read as follows:


Sec. 549.63  Initial medical evaluation and management.

    (a) * * *
    (6) Radiographs as clinically indicated;
    (7) Laboratory studies as clinically indicated.
* * * * *
    (c) When valid medical reasons exist, the physician may modify, 
discontinue, or expand any of the medical procedures described in 
paragraphs (a) and (b) of this section.
    (d) When medical staff consider it medically mandatory, an inmate 
on a hunger strike will be transferred to a Medical Referral Center or 
to another Bureau institution considered medically appropriate, or to a 
community hospital.
* * * * *
    5. In Sec. 549.64, paragraph (c) is revised to read as follows:


Sec. 549.64  Food/liquid intake/output.

* * * * *
    (c) Staff shall remove any commissary food items and private food 
supplies of the inmate while the inmate is on a hunger strike. An 
inmate may not make commissary food purchases while under hunger strike 
management.
    6. In Sec. 549.65, paragraphs (a) and (c) are revised to read as 
follows:


Sec. 549.65  Refusal to accept treatment.

    (a) When, as a result of inadequate intake or abnormal output, a 
physician determines that the inmate's life or health will be 
threatened if treatment is not initiated immediately, the physician 
shall give consideration to forced medical treatment of the inmate.
* * * * *
    (c) When, after reasonable efforts, or in an emergency preventing 
such efforts, a medical necessity for immediate treatment of a life or 
health threatening situation exists, the physician may order that 
treatment be administered without the consent of the inmate. Staff 
shall document their treatment efforts in the medical record of the 
inmate.
* * * * *
    7. Section 549.66 is revised to read as follows:


Sec. 549.66  Release from treatment.

    Only the physician may order that an inmate be released from hunger 
strike evaluation and treatment. This order shall be documented in the 
medical record of the inmate.

[FR Doc. 94-14891 Filed 6-17-94; 8:45 am]
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