Testimony of Hunger Strike Standard Operating Procedure, March 5, 2013

On May 13, 2013 Al Jazeera English published a document entitled Standard Operating Procedure: Medical Management of Detainees on Hunger Strike. It is a revision of the 2005 document that can be found here. In this revised document we read that

When evaluating and treating a detainee on hunger strike, JMG [= Joint Medical Group] will make reasonable efforts to obtain voluntary consent for medical treatment. When consent cannot be obtained, medical procedures that are indicated to preserve health and life shall be implemented without consent from the detainee [p. 2]

Decisions to force-feed a detainee must be approved by the camp commander and notified up the chain of command all the way to the Department of Defense:

If the JTF-GTMO Commander makes the decision to authorize involuntary feeding of a detainee, he/she will immediately inform the Commander, United States Southern Command (USSOUTHCOM) of his/her decision. In turn, the Commander USSOUTHCOM, will notify appropriate Joint Staff and Department of Defense offices of the necessity of initiating involuntary feeding of a detainee [p. 2]

Also, "[i]n event of a mass hunger strike, isolating hunger striking patients from each other is vital to prevent them from achieving solidarity" [p. 14]

Forced feedings are carried out through the insertion of nasogastric tubes:

Place a 10 French or 12 French feeding tube into the patient's stomach per standard medical practice. Viscous lidocaine should be offered for the nostril and the throat. The tube should be well lubricated prior to insertion. A linguist shall be present to assist with instructions [p. 15]

The forced feeding may require restraints and the order for them must be signed by the medical provider

Medical restraints (e.g. chair restraint system) should be used for the safety of the detainee, medical staff and guard force […] Medical provider signs medical restraint order to enterally feed the detainee the prescribed diet [p. 18]

Vomiting is not allowed:

Upon completion of the nutrient infusion […] the detainee is removed from the restraint chair and placed in a "dry cell". The guard force will observe the detainee for 45-60 minutes for any indications of vomitings or attempts to induce vomiting. If the detainee vomits or attempts to induce vomiting in the "dry cell" his participation in the dry cell protocol will be revoked and he will remain in the restraint chair for the entire observation time period [p. 18]

As to the dry cell, it may be "the detainee's original cell with the water source turned off temporarily for the observation period [p. 19]

Although the feeding can be "completed comfortably over 20 to 30 minutes" and the observation period lasts for 45-60 minutes (see above), the detainee may remain in a restraint chair for up to two hours:

The total time the detainee is in the chair restraint system (to include the feeding process and the post-feeding observation) should not exceed 2 hours [p. 18].

Feeding tubes may be reused if a detainee so requests [p. 25]. Moreover,

If the detainee must use the toilet during enteral feeding, and line-of-sight cannot be maintained, the EFT must be removed and re-started to finish the EF [= enteral feeding] [p. 26].

It is appropriate for the nurse to direct guards to wash the hands of detainees who present for EF with feces on their hands [p. 26]

Manual restraint may be applied in addition to that of the chair:

To reduce head an jaw motion during insertion of the EF tube if required: While the detainee is seated and appropriately restrained in the feeding chair, one guard will position themselves behind the detainee and hold the detainee's head in the midline position [p. 28]

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