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Medical Personnel Oversaw Enhanced Interrogations

Monday June 8, 2009
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When suspected terrorist Abu Zubaydah was repeatedly waterboarded, physicians and psychologists were there. When the CIA considered using his fear of insects to make him reveal possible future terrorist attacks, psychologists were there. And when other detainees were shackled by their hands and feet so they could not fall asleep, medical personnel were there.

In fact, medical personnel were integral members of the CIA’s aggressive interrogation program of detainees held at Guantanamo Bay, Iraq, Afghanistan, and at secret locations in other countries. Medical personnel were not impartial monitors safeguarding the health of detainees. Instead they helped to design, implement, oversee, and justify the techniques, according to memos from the U.S. Department of Justice Office of Legal Counsel to the CIA during the Bush Administration. The memos, which gave approval to the CIA to use the so-called “enhanced interrogation techniques,” were released in April by the Obama Administration.

By acting at the behest of the government and not as advocates for the detainees, the medical personnel were operating at odds with accepted medical ethics of their healthcare professions, say some human rights advocates and medical ethicists.

“The medical and psychological personnel worked as a valve that turned up or turned down the intensity of the interrogation,” says Steven Miles, MD, of the Center for Bioethics at the University of Minnesota. Miles has extensively studied and written about the role of U.S. military and other government healthcare personnel in detainee abuse and torture since 9/11.

Nathaniel Raymond, director of the Physicians for Human Rights campaign against torture, agrees: “They were calibrators of harm instead of healers,” he says.

Calibrators of Harm
By advising the interrogators, the medical personnel were going against the central tenet of all health professions “to do no harm,” say some medical ethicists.

“We in the clinical professions should all be aware that our professions have been misused, especially if we are holding to a ‘do no harm’ ethic,” says Jancis Long, PhD, a psychologist and president of the group Psychologists for Social Responsibility. “Some people are blind to the fact that we are complicit if we are part of a system where harm is being done and we don’t speak out.”

The memos specifically cite medical officers, psychological personnel, and medical personnel as part of the interrogation program. But it is not clear if the terms are interchangeable or if they denote nurses and medics as well as physicians and psychologists. When contacted by www.Nurse.com, the CIA declined to comment.

The American Medical Association also declined to comment about the memos when contacted by www.Nurse.com and instead released the following statement: “The AMA has taken the clear stand that the participation of physicians in torture and interrogation is a violation of core ethical values. The AMA will continue to advocate so that no doctor is asked to go against the ethics of the profession through open dialogue with the Obama Administration, government agencies, lawmakers, physicians, and the public.”

The memos make clear that a senior psychologist who was involved in a program to help U.S. military personnel withstand interrogation techniques by enemies who do not abide by the Geneva conventions used that knowledge to help the government use these techniques on U.S. enemies. According to another document, this one released by the U.S. Senate’s Armed Services Committee, the psychologist recommended having other psychologists observe interrogations and “provide advice and assistance to interrogators.”

The American Psychological Association, which has been criticized in the past for helping shape the Bush Administration’s interrogation policy, especially in Guantanamo Bay, posted a lengthy statement on its Web site after the memos were released. “Let’s set the record straight: It is a clear violation of professional ethics for a psychologist to have played a role in the torture of CIA detainees, as described in the recently released Bush Administration memos,” APA president James H. Bray wrote.

The role of the CIA’s Office of Medical Services in the interrogation of detainees is described in detail in a May 10, 2005 memo. The memo states interrogators were trained “to understand and respect the medical judgment of OMS and the important role that OMS personnel play in the program.”

The memo states that medical and psychological personnel were on scene during all interrogations and directly observed any of the techniques in which there was physical contact between the interrogator and the detainee, including such methods as the attention grasp (grabbing a detainee by the collar); walling (slamming a detainee against a flexible wall); facial hold (holding a detainee’s head by hand); or facial slap, insult slap, or abdominal slap. Healthcare personnel also did periodic physical checks during interrogations and kept detailed records about the nature and duration of each technique employed.

How Far is Too Far?
The severity and longevity of physical and psychological pain was the lynchpin determining if or when the techniques reached the Justice Department’s definition of torture. Simply put, the Department of Justice memos define torture as a technique causing prolonged and severe physical or mental pain or suffering. Therefore, the CIA relied on the physicians and psychologists to not just observe the interrogations, but to tell them whether they were torturing a detainee.

The UN Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment defines torture as “any act by which severe pain or suffering, whether physcial or mental, is intentnionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession ...”

The memos show medical personnel had a great deal of control over the interrogations and could stop the procedures. The May 10 memo states: “... on-scene medical personnel can intervene if the detainee has developed a condition making the use of the technique unsafe. More generally, medical personnel watch for signs of physical distress or mental harm so significant as possibly to amount to the ‘severe physical or mental pain or suffering’ that is prohibited by sections 2340-2340A [federal statutes prohibiting torture]. Medical officers must remain cognizant at all times of their obligation to prevent ‘severe physical or mental pain or suffering.’”

But the memos don’t explain how a physician or psychologist could measure just how much physical or psychological pain a detainee could tolerate before reaching the point at which the interrogation would be considered torture.

Of the dozen or so enhanced interrogation techniques used by the CIA, the agency acknowledged that waterboarding and sleep deprivation were the most potentially harmful to detainees. Of all the interrogation techniques, waterboarding has been clearly identified as torture by human rights advocates, medical ethicists, and President Obama.

It is now known that the three detainees who were waterboarded by the CIA experienced the technique dozens of times, with one detainee waterboarded 183 times.

CIA physicians also told interrogators how to use the techniques to cause less harm. For example, they recommended using normal saline solution during waterboarding to prevent hyponatremia in case a detainee ingested large amounts of water. Medical personnel also stood by with resuscitation equipment in case a detainee had a laryngospasm and needed a tracheotomy.

Sleep deprivation was conducted by shackling a detainee’s hands in front of his body so that he had about a 2-to-3 foot diameter of movement, according to the memos. His feet were shackled to a bolt in the floor, with “due care taken to ensure that the shackling does not result in any significant pain for the subject.” All of a detainee’s weight was borne by his legs and feet during standing sleep deprivation, the May 10 memo states.

The memo acknowledges that the standing posture of the detainees could cause edema or swelling of the legs. The memo also states that the CIA’s OMS Guidelines include information about medical monitoring of detainees being subjected to shackling and sleep deprivation. This included specific instructions for medical personnel to require alternative, nonstanding positions or to take other actions, such as ordering the cessation of sleep deprivation in order to relieve or avoid serious edema or other significant medical conditions.

Of interest, diaper rash was another potential side effect for detainees who were being sleep deprived and kept naked, except for an adult diaper. “If the detainee is wearing a diaper, it is checked regularly and changed as necessary ... You have informed us that to date no detainee has experienced any skin problems resulting from use of diapers,” the memo states.

Intake Exams for Overseas Rendition
New detainees were given careful medical and psychological exams by CIA physicians and psychologists, even while being rendered from Afghanistan or Iraq to overseas locations such as Egypt, to undergo interrogation. “New detainees are also subject to a general intake examination, which includes a thorough initial medical assessment ... with a complete, documented history and physical addressing in depth any chronic or previous medical problems,” the memo states.

No interrogations could be carried out unless “medical and psychological assessments indicate that the detainee is fit to undergo the use of the interrogation techniques,” according to the memo.

“When approved, interrogation techniques are generally used in an escalating fashion, with milder techniques used first,” according to the memo. In effect, physical and psychological pain could be racheted up, on the approval of physicians and psychologists.

Instead of calibrating the interrogation techniques, medical personnel witness to harsh interrogations should have been speaking out, Raymond, of Physicians for Human Rights, says. “Instead, there has been a deafening silence from military and intelligence professionals on this issue.”

Janet Boivin, RN, is a senior writer for Gannett Healthcare Group.

To comment, e-mail editorNTL@gannetthg.com.