Saturday, August 16, 2008

Viva California

Both houses of the Californian legislature have passed a resolution that requests

all relevant California agencies to notify California-licensed health professionals (doctors, psychologists, and others) about their obligations under international law relating to torture,

those health professionals to be notified that if they participate in
torture they may be subject to prosecution,

the Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals from participating in prisoner and detainee interrogations.

This comes in the wake of uncontrovertible evidence unearthed by US medical doctor Steve Miles, a bioethicist at the University of Minnesota, that health care professionals were involved in torturing prisoners in Guantanamo Bay. Here's a brief excerpt from an article Miles wrote in a bioethics journal, describing the torture of one detainee in Guantanamo Bay (based on heavily censored US army records):

The Interrogation of Prisoner 063

Two government documents detail medical and psychological participation with the interrogation of Prisoner 063, Mohammed al-Qahtani, at Guantanamo Bay between November 23, 2002 and January 11, 2003 (Zagorin and Duffy 2005). The first is an 83-page interrogation log (ORCON 2003). The second is an Army investigation of complaints of mistreatment of prisoners at Guantanamo Bay, including Prisoner 063 (United States Army 2005, 13–21). The third and fourth are notes taken in relation to that Army investigation (CTD Fly Team 2006; GITMO Investigation 2004). The second set of these notes extensively describes medical collaboration with one or more interrogations but the record is so heavily redacted that it is not possible to determine which, if any, of this material described the interrogation of Prisoner 063 (GITMO Investigation 2004).

According to the Army investigation, the log covers a period in the middle of al-Qahtani’s interrogation that began in the summer of 2002 and continued into 2003. For eleven days, beginning November 23, al-Qahtani was interrogated for twenty hours each day by interrogators working in shifts. He was kept awake with music, yelling, loud white noise or brief opportunities to stand. He then was subjected to eighty hours of nearly continuous interrogation until what was intended to be a 24-hour “recuperation.” This recuperation was entirely occupied by a hospitalization for hypothermia that had resulted from deliberately abusive use of an air conditioner. Army investigators reported that al-Qahtani’s body temperature had been cooled to 95 to 97 degrees Fahrenheit (35 to 36.1 degrees Celsius) and that his heart rate had slowed to thirty-five beats per minute. While hospitalized, his electrolytes were corrected and an ultrasound did not find venous thrombosis as a cause for the swelling of his leg. The prisoner slept through most of the 42-hour hospitalization after which he was hooded, shackled, put on a litter and taken by ambulance to an interrogation room for twelve more days of interrogation, punctuated by a few brief naps. He was then allowed to sleep for four hours before being interrogated for ten more days, except for naps of up to an hour. He was allowed 12 hours of sleep on January 1, but for the next eleven days, the exhausted and increasingly non-communicative prisoner was only allowed naps of one to four hours as he was interrogated. The log ends with a discharge for another “sleep period.”

Medical Treatment during Interrogation

Clinicians regularly visited the interrogation cell to assess and treat the prisoner. Medics and a female “medical representative” checked vital signs several times per day; they assessed for dehydration and suggested enemas for constipation or intravenous fluids for dehydration. The prisoner’s hands and feet became swollen as he was restrained in a chair. These extremities were inspected and wrapped by medics and a physician. One entry describes a physician checking “for abrasions from sitting in the metal chair for long periods of time. The doctor said everything was good.” Guards, medics and a physician offered palliative medications such as aspirin to treat his swollen feet.

Intravenous fluids were regular administered over the prisoner’s objection. For example, on November 24, the prisoner refused water. A Captain-interrogator advised him that the medic “can administer IV [sic: the log’s contraction for intravenous fluids of an unspecified volume is used throughout this article] fluids once the Captain and the Doctor on duty are notified and agree to it.” Nine hours later, after taking vital signs, medical personnel administered “two bags” of intravenous fluids. Later that day, a physician evaluated al-Qahtani in the interrogation room and told him that he could not refuse medications or intravenous fluids, and that he would not be allowed to die.

The next day, interrogators told the prisoner that he would not be allowed to pray if he would not drink water. Neither a medic nor a physician could insert a standard intravenous catheter, so a physician inserted a “temporary shunt” to allow an intravenous infusion. The restrained prisoner asked to go the bathroom and was given a urinal instead. Thirty minutes later, he was given “three and one-half bags of IV [sic]” and he urinated twice in his pants. The next day, the physician came to the interrogation room and checked the restrained prisoner’s swollen extremities and the shunt. The shunt was removed and a soldier told al-Qahtani that he could pray on the floor where he had urinated.

From December 12 to 14, al-Qahtani’s weight went from 119 to 130 pounds (54 to 59 kilograms) after being given six IVs. On December 14, al-Qahtani’s pulse was 42 beats per minute. A physician was consulted by phone and said that “operations” could continue since there had been no significant change. Al-Qahtani received three more IVs on the December 15 and complained of costophrenic pain. A physician came to the interrogation cell, examined him, made a presumptive diagnosis of kidney stones and instructed the prisoner to take fluids. The next day blood was drawn in the cell.

Of course, treatment such as this is prohibited by the Geneva Convention which requires that prisoners be treated at all times humanely, not be tortured, and so on and so forth. While one can argue whether ot not the described actions of health care personnel constituted torture (they did not, to my mind), they did at a minimum enable the continuation of torture by means of keeping prisoners sufficiently fit to be able to be tortured again. They also enabled torture by way of declaring the prisoner fit enough to be tortured again.

Is it not remarkable that the American Medical Association has not come out with a strong statement condemning the participation of US medical doctors in the torturing of prisoners of war in Guantanamo Bay? Perhaps this is due to the fact that the AMA is always a little bit slow. It took the organisation only more than a hundred years to apologise for institutionalised racism that it practised for many years.Local AMA chapter had rules discriminating against black doctors as recent as the late 1960s. To be fair, it is not only the AMA that is dragging its feet on the issue, the American Psychological Association also can't decide where it stands on the issue. Very much unlike the American Psychiatric Association (ie medical professionals) which regulated against the participation of US psychiatrists in such activities in 2006. Since then the US military has replaced psychiatrists with psychologists to assist them in developing sound torture techniques. The US military is one of the the largest employers of psychologists in that country.

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