California prison officials are grappling with starvation-related ailments among hunger-striking prisoners who have refused to eat for nearly six weeks to protest the state's solitary confinement policies.
As the hunger strike enters its 40th day on Friday, dozens of inmates have been sent to hospitals or prison infirmaries, and officials are bracing for more illness among the 118 prisoners who have not eaten since the strike began.
They are also expecting to have to deal with serious medical conditions plaguing those whose systems are weakened after fasting for weeks and who are now seeking to begin eating again.
The hunger strike is the latest difficulty to plague the state's prison system, which is under orders by a federal court to reduce crowding by the end of the year, possibly by releasing up to 10,000 inmates early.
Medical care in the prisons was taken away from the state as part of the same case, and placed under the control of a court-appointed receiver. Another court appointee is in charge of the system's mental health programs.
Among the complaints sending inmates to hospital are dehydration, cramping, vomiting, diarrhea, dizziness and lightheadedness, said Liz Gransee, a spokeswoman for the federal receiver overseeing care in the state's prisons.
"It can have long-term effects on your internal organs as your body is pretty much eating itself from the inside out," Gransee said, describing the effects of the hunger strike.
Prisoners launched the current hunger strike - the latest in a string of actions in recent years - in prisons statewide on July 8 to demand an end to a policy of housing inmates believed to be associated with gangs in near-isolation for years on end.
This strike, however, has already gone on twice as long as a similar action in 2011 and has attracted more prisoners - 30,000 at its peak - although numbers have since dramatically dwindled.
By the 40th day of refusing food, inmates would likely be suffering from a raft of medical and psychological issues, some of which might not be reversible, said Dr. Marc Hellerstein, who studies nutrition at the University of California, Berkeley.
"Everything shrinks and the body tends to starving and just about nothing else," he said. "They will have less judgment, they will have less interest, they will become socially withdrawn and isolated. They just want to curl up in a corner."
State Undersecretary for Corrections Martin Hoshino said California was working closely with the federal receiver overseeing prison care to handle medical issues as they arose.
"In my memory I can't think of a time when we were not in more lockstep with the receiver's medical teams and clinicians," he said, adding that inmate health was a top priority.
Hoshino confirmed that medical issues arising from the strike were a key concern right now, and that officials were bracing for more as prisoners continue to refuse food.
The latest hunger strike is aimed at conditions at four Secure Housing Units that house more than 4,500 inmates in near isolation, some for committing crimes while incarcerated and others because they are believed to be gang members.
The units, where many prisoners are kept in cells for 23 hours per day and allowed an hour of solitary exercise in an enclosed yard, have drawn attention from human rights activists, who say prisoners are harmed by lack of social interaction.
As the strike has lengthened, the federal receiver, J. Clark Kelso has stepped up monitoring and begun trying to encourage participants to eat, said Gransee.
The receiver's office did not release the total number of inmates who began eating again after falling ill, but strike participation is dropping: On Monday, 292 inmates were on strike, 144 continuously since the action began; by Thursday, 226 were striking, 118 continuously, officials said.
One inmate who had been involved in the hunger strike has died. William Sell stopped striking on July 21 and hanged himself the next day, but a corrections spokeswoman said the suicide was not related to fasting.
Along with the possible side-effects of prolonged fasting comes another danger when inmates begin to eat again. To avoid shocking the system, small meals are served to those who want to resume eating, and some are sent to hospitals, Gransee said.
The receiver is also encouraging hunger strikers to drink beverages that replace lost electrolytes and nutritional supplements such as Ensure, although inmates who take supplements are not counted as striking.
Dolores Canales, whose son John Martinez is serving 25 years to life for murder, said he lost weight and became weak, but was hopeful that media attention will lead to changes.
"He believes the system is terribly wrong, not just for the prisoners but for society in general," Canales said.