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Special Defense Department Briefing

Presenters: Principal Deputy Assistant Secretary of Defense for Health Affairs, Steve Jones and Army Surgeon General and Commander U.S. Army Medical Command, Lt. Gen. Kevin C. Kiley
July 07, 2005
Special Defense Department Briefing

            STAFF:  Well, good afternoon, and thank you all for being here this afternoon and for your interest in this topic. 

 

            Before we get started, I just wanted to mention that Secretary Rumsfeld this afternoon -- in fact, just a few minutes ago -- went over to the British embassy to personally express his condolences in the attacks that took place in Great Britain today.  For those of you who may not have seen his statement, we did put out a statement a little while ago.  If you don't have it, we can certainly get it for you.  

 

            Today we are here and joined by Dr. Steve Jones, who is the principal undersecretary of Defense for Health Affairs.  He is Dr. Winkenwerder's principal deputy, who unfortunately could not join us today.  And he is joined by Lieutenant General Kevin Kiley, who is the United States Army's surgeon general. 

 

            They're here today to talk to you about the assessment that they have conducted with respect to detainee medical operations.  Mr. Jones will start us off today, followed by a review of the assessment by General Kiley, and then we'll take a few questions and wrap this up. 

 

            MR. JONES:  Good afternoon.  And I have only been here since November, so I haven't had a chance to meet many of you.  But hopefully I will as time goes on.  And I would like to also, second, express, Bryan, that Dr. Winkenwerder has a personal interest in this issue, and he wished he could have been here with you today, but unfortunately unavoidably couldn't.  So I'm pleased and honored to be here in his stead. 

 

            This afternoon we want to add to the factual knowledge in the public domain concerning activities of military health care professionals with detainees held in this global war on terrorism. The Defense Department has directed and sponsored numerous evaluations, investigations and assessments to identify details of detention at facilities and prisons in Afghanistan, Iraq, Guantanamo Bay, Cuba.  And as you know, we learned from those reports that some inappropriate behavior took place, but that those instances did not represent the overwhelming majority of our military personnel engaged in detainee operations. 

 

            With each report that offered new information, this department took actions to correct policy and practices, as well as to hold accountable those who acted inappropriately.  Inappropriate behavior, unlawful activities, inhumane treatment are not tolerated. 

 

            However, recognizing that instances have occurred it is necessary in order to improve and take actions essential to prevent future reoccurrences.  This process of identification, accountability, policy and practice reinforcement, and improvement is ongoing.  Our approach in pursuing this improvement is both objective and ethical. 

 

            In all matters affecting the physical and mental health of the detainees, our military health care personnel have a duty to perform, encourage and support actions to uphold the humane treatment of detainees.  In treating these individuals, medics are guided by professional judgment and standards similar to those that they would apply to the treatment of U.S. Armed Forces personnel.  This includes a duty to protect both physical and mental health.  Our military medical personnel provide outstanding medical care for detainees who suffer disease or injury. 

 

            From the health care perspective, we have reinforced our policies, practices and medical support to detainee operations.  Over a year ago, we positioned a combat support hospital in proximity to Abu Ghraib to better support the health care needs of detainees. 

 

            We revised our policy regarding the notification and conduct of forensic examinations and autopsies of detainees, ensuring that both investigative agencies and the Armed Forces Medical Examiner receive notice of detainee deaths for further evaluation. 

 

            We reemphasized our policies regarding detainee records management and confidentiality.  The Army updated and reissued their Handbook of Emergency War Surgery to address medical management of prisoners and detainees.  Last month the department issued a memorandum reaffirming policies regarding the protection and treatment of detainees in U.S. custody.   

 

            Today you will learn details of a comprehensive assessment conducted by the Army Medical Department to gain even more factual information about detainee medical operations.  I wish to commend General Kiley for commissioning this assessment, as well as those team members who conducted the numerous interviews and compiled the resulting information.   

 

            The men and women of our military healthcare system with whom I come in contact with daily are of the highest professional caliber.  I firmly believe they're acting appropriately in their duties to treat all detainees humanely.  

 

            With that, let me introduce to you surgeon general of the Army, Lieutenant General Kevin Kiley. 

 

            General? 

 

            GEN. KILEY:  Thank you, Steve. 

 

            Good afternoon, everyone. 

 

            We did learn a lot from our military medical personnel who have been and are currently deployed in support of detainee operations in Afghanistan, Cuba and Iraq.  And Dr. Jones is correct in his characterization of our military healthcare professionals.  They are taking the correct actions and honorably performing their duties to this country.  This five-month assessment confirms that. 

 

            As the Army surgeon general, I directed Major General Martinez Lopez to conduct his comprehensive assessment of detainee medical operations in Cuba, Iraq and Afghanistan.  General Martinez Lopez and his team of six began their assessment in November of 2004 and completed their efforts in April of 2005.   

 

            This was an assessment of policies, procedures and doctrine, not an investigation.  The team's mission focus was on obtaining information in four specific areas:  detainee medical policies and procedures, detainee medical records management, incidence and reporting of detainee abuse, training of medical personnel in these areas.     

 

            The team reviewed all previous detainee assessment and investigative reports.  Team members visited five countries and 22 states gathering assessment information from healthcare professionals in over 180 military medical units.  They interviewed more than 1,000 medical personnel and surveyed 178 Officer Basic students, enlisted medics and trainers at deploying installations.  These interviews were largely with active duty or Reserve component medical personnel, however, some Air Force and Navy medical personnel were interviewed.   

 

            The assessment findings include the following:  the majority of medical personnel interviewed did not observe any abuse, and with few exceptions, those medical personnel who did observe suspected abuse reported it.  The assessment team referred unreported, suspected cases of abuse to CID or to the chain of command.  We found no evidence of systemic problems in detainee medical care.  We also found that although initial policies for detainee medical support were inadequate, medical care received by detainees was good.  Initial training was limited, and generation of detainee medical records was inconsistent.   

 

            As the theater matured, these policies and training programs were developed, published and fielded.  Military medical training now includes detainee medical operations and is incorporated into our medical officer and enlisted training and medical precommand courses.   

 

            And so in summary, the assessment results demonstrate that the nation can be proud of our military medical professionals.  We have a dedicated team of them working every day to provide quality health care for each patient they treat, whether a U.S. service member, coalition troop or detainee.  The assessment clearly demonstrates that military medical professionals reported suspected abuse in the overwhelming majority of cases.  Allegations of possible abuse were routinely forwarded to the CID or to the chain of command, or corrections were made on the spot.  Detailed medical care is now standardized across OIF, OEF and Guantanamo Bay. 

 

            Thank you all very much.  And I'll take your questions now. 

 

            Charlie? 

 

            Q     General, do you -- you say that there's no evidence of systemic abuse or collusion by the military in any abuse, but you promised to give us specific examples of problems that you've had. Could you give them to us?  Cases in which there was collusion or abuse.    

 

            GEN. KILEY:  I'm not aware in the assessment's report of any cases of collusion between medical personnel and any potential episodes of abuse. 

 

            There were some cases where medical personnel were observed, in their care for detainees, that was not in concert with our standards for health care; specifically, the possibility of dropping a stretcher a little too roughly, or withholding pain medication until the very last second, as examples of the level of perceived abuse.  On-the-spot corrections were made to those within the medical facilities and the chain of command. 

 

            Q     The Lancet, the British medical journal, reported last year that there were instances -- well, where medical personnel intentionally did not report abuse, and in one case, apparently revived a prisoner who had been beaten, so that he could be beaten again.  You had no -- you found no -- 

 

            GEN. KILEY:  We found no evidence in that assessment of any of those episodes.  And our assessment team looked at all of the news reports and medical reports that had been published as part of our directive, and attempted to reconcile those efforts.  And I'm not aware of any -- I'm not aware of any reports of medical personnel reviving people for further abuse. 

 

            Yes, ma'am? 

 

            Q     Could you tell us how many allegations or how many cases you had referred to the CID? 

 

            GEN. KILEY:  The number of individuals interviewed, who answered a question -- did you observe anything that you were concerned may have been abuse -- was 32 out of over 1,000 interviews.  And of those 32, approximately 24 -- 26, excuse me -- were reported to either the CID or the chain-of-command. 

 

            Q     By that person or by your -- 

 

            GEN. KILEY:  By that person in those cases, because the interview process was a questionnaire.  The first question asked, "Did you see anything that concerned you that may have been abuse?"  The second question that followed that was, "What did you do?  Did you report that?"  And 26 of the 32 said they did. 

 

            Q     And what about the remaining six? 

 

            GEN. KILEY:  The remaining in general were individuals who didn't report it to the CID because they made on-the-spot corrections.   

 

            Q     Any punishment for the cases? 

 

            GEN. KILEY:  I don't know the answer to that.  I don't have, you know, what kind of punishment was done other than verbal counseling, direction not to do that kind of thing again. 

 

            Q     Do you have a sense of what the results were from those 26 cases that were reported up the chain of command? 

 

            GEN. KILEY:  No.  The CID has got our whole report, the CID Command.  They are reviewing those cases again.  They're in the process of validating, where they can with their own information sources, cases that they see may have also been reported to them.  I don't have any more specific numbers as to exactly what happened in every single one of those cases. 

 

            Q     General, did your report look at the issue of whether or not military doctors and psychologists or psychiatrists aided interrogators, preparing them for interrogations to get more information, the so-called BSCT  [Behavioral Science Consultation Team] teams? 

 

            GEN. KILEY:  We interviewed 11 psychologists and psychiatrists who were serving in roles of what we now are teaming the BSCT teams. And the sense of their interviews was that they clearly understood that they were not healthcare providers, that they were consultants to the interrogators.  And every single one of them, to one extent or another, voiced a sense of responsibility to ensure the welfare of detainees during the interrogation process. 

 

            Q     Did you find any evidence to support or deny the allegations in the New England Journal that caregivers, not BSCT team members, but caregivers were sharing that type of either physical or psychological information in order to give interrogators a hint as to how they might get more out of people? 

 

            GEN. KILEY:  We did not find any indication of that in our assessment.  The interrogators and the BSCT team members have a firewall -- if we can use that term -- between them and medical records.  And in our assessments with the BSCT team members, we found no evidence that we were -- that there was a passing of clinical information that would be used in a detrimental way to torture. 

 

            Q     And did you find any evidence one way or the other on whether healthcare personnel, whether on BSCT teams or caregivers or others were involved in supporting any sort of aggressive or abusive interrogation techniques, which is also alleged?   

 

            GEN. KILEY:  There was nothing in the assessment statements that would lead me to think that.  I did not see that in the statements. 

 

            Q     General, what prompted this assessment?  Was it -- 

 

            GEN. KILEY:  Several things.  One was our concern that there was a growing sense that medical personnel may or may not have been involved in detainee abuse and torture.  We reviewed other published reports and found very little reference to medical operations or medical issues.  And we felt -- I felt, frankly, obligated to demonstrate what I intuitively knew, which was that our doctors and our nurses and our medics were doing the right thing, taking care of detainees as well as they could under the circumstances where they would find themselves, and felt like a team that was empowered to an assessment vice an investigation, but at least give us a sense of whether we have been doing the right thing or not -- and that is our conclusion. 

 

            Q     Would you explain the ethical and legal firewall between the BSCT teams and the medical records?  Why does that exist? 

 

            GEN. KILEY:  Well, we have a DoD policy on that now that does address the privacy in health care records for detainees. Additionally, I think the feeling was, just to be sure that there was no perception that BSCT members were either also health care providers to the detainees, which would put -- it would put a BSCT member into a real bind if they were a health care provider to a detainee and at the same time consulting with interrogators.  So one was one of perception, and then just administratively to keep things clean. 

 

            Q     Did BSCT members ever have access to the medical records prior to that policy being put into -- 

 

            GEN. KILEY:  As I understand it, early on in operations in Guantanamo -- and I can't tell you for how long -- the original members had access to the medical records. 

 

           

            Q     General, the six who didn't report their views -- were these happening in Afghanistan, Cuba or Iraq? 

 

            GEN. KILEY:  I'm sorry.  Could you -- 

 

            Q     The six who didn't report their views -- where did it happen?  In Iraq?  Afghanistan?    

 

            GEN. KILEY:  I believe it happened in medical units in Iraq, which was again -- was -- the answer to the question was, we didn't report it, because we didn't feel we needed to report it.  We could do an on-the-spot correction and fix the problem. 

 

            Q     But General, excuse me, are you saying, just to clarify what you said before, that there was no evidence, in your assessment, that any of these physicians and doctors, psychologists and psychiatrists, BSCT team members aided interrogators in any way in their -- in refining coercive interrogations by giving them information and advice on how to increase the stress levels -- 

 

            GEN. KILEY:  I didn't say that.  I didn't say that.  We did not get into a level of detail in the assessment about the specific advice and recommendations that BSCT members gave to interrogators, specifically did you do these things or not do those things.  What we asked them was what did they perceive their roles and missions to be, and in general terms they answered with advice and assistance to the interrogators, and then a secondary mission to ensure the well-being of the detainees. 

 

            Q     But you didn't get the details in that first part, whatever that advice was. 

 

            GEN. KILEY:  That's correct.  To my knowledge as I stand here, no. 

 

            Q     You mentioned sort of incidents that involve medical personnel, like dropping a stretcher from too great a height or withholding pain medication.  Is there a number -- 

 

            GEN. KILEY:  Delaying, if I could correct.   

 

            Q     Delaying. 

 

            GEN. KILEY:  There was a delaying, versus a holding. 

 

            Q     Okay. 

 

            GEN. KILEY:  Right up to the fourth hour of an every-four-hour medication. 

 

            Q     How many occurrences of that did you find? 

 

            GEN. KILEY:  Well, of that nature, quantifying that, in a range from something simple like that to some healthcare provider who is hit or struck by a detainee and slaps back or hits back, I don't have a specific number.  It was a certain percentage.  I mean, the whole group, the whole 1,000 only had 32 positive incidents.  And so I couldn't give you an estimate.  I haven't tallied it up that way.  It can't be more than 10 or 12 in that group. 

 

            Q    Okay.  So the 32 you're talking about, sir, -- you said that was observing abuse -- 

 

            GEN. KILEY:  Right.   

 

            Q     -- and this is where this is actual medical personnel who may have -- could have committed an act of abuse -- 

 

            GEN. KILEY:  No, no, that's not 32 cases of medical personnel observing medical personnel.    

 

            Q     Okay, right. 

 

            GEN. KILEY:  That's 32 cases of medical personnel saying I saw something that I thought may have been abusive.  And it included detainees who came in abused.  It included detainees being held on tarmacs out in the sun.  It included observation of senior leaders hollering at detainees.  So it was a whole host -- this was not 32 cases of medical personnel observing medical personnel.  I don't want you to get that impression. 

 

            Q     A subset of that is -- 

 

            GEN. KILEY:  A small subset of that were a couple of cases inside of our facilities. 

 

            Q     But these are among the 32, which you tell us is a possible slapping back. 

 

            GEN. KILEY:  Oh, slapping -- 

 

            Q     But these are among the 32, not in addition. 

 

            GEN. KILEY:  Yes, sir.  Yes sir. 

 

            Q     One of the points New England Journal of Medicine brought up is the role that the BSCT teams played, and I think that there is a sense, at least from them, that there's something creepy about a physician or a doctor using their medical knowledge that they gained in med school and then took a Hippocratic oath to increase stress or to do anything other than heal.  Can you talk about that as a -- as a physician? 

 

            GEN. KILEY:  I know that's an issue.  My sense is that interrogations that are safe, legal and ethical within the confines of our operations, that medical advice and recommendations that are also safe, legal and ethical are probably appropriate.  I would suggest there are those who probably don't agree with that. 

 

            I know the American Psychological Association has recently issued a policy statement recognizing the requirement for psychologists to have an ethical view of their duties.  But it doesn't prohibit them from assisting in interrogations.  And in terms of the ethics of a physician assisting in interrogation, I -- you know, I'm not sure I have an answer to that specifically.  In a safe, ethical and legal environment, my sense is that that's appropriate. 

 

            Q     General, do you feel like you have the full picture of this issue, considering that your assessment only interviewed and surveyed your own medical personnel?  Or did you also speak to detainees, their representatives, Red Cross or other independent groups?   

 

            GEN. KILEY:  I do think it's an accurate assessment for a couple of reasons.  One, the thousand personnel that we interviewed were focused interviews, in the sense that we looked to medical units that were clearly identified as being part of detainee health care operations.  So we went to the hospitals associated with Abu Ghraib and other locations, validated that those facilities were, in fact, taking care of detainees.  So we were asking the right people. Doesn't do any good to ask medics in a maneuver combat unit that aren't seeing detainees what they know about detainee health care.  So we went right to the source. 

 

            We did not talk to detainees.  One of the other subgroups of questions and answers was in our patients were did the detainees' claim that they were abused, and there were those that did.  And almost to a person, those allegations or claims by detainees were reported to the chain of command or CID.  So, indirectly, we took feedback from detainees, or individuals we interviewed had taken feedback from detainees. 

 

            Q     Did you speak to the Red Cross or no? 

 

            GEN. KILEY:  We did not.  We did not talk to any of those other organizations. 

 

            STAFF:  We have time for about one more. 

 

            Q     General, you mentioned you interviewed a thousand people for this.  Do you have any estimate how many doctors there were or have been in the field and have worked with detainees in that capacity? 

 

            GEN. KILEY:  I don't have an answer for the number of doctors. We interviewed a hundred and -- about 192 physicians and about 211 nurses, six dentists, physicians assistants, and then about 400-plus enlisted personnel across the range.   

 

            The broad number we have used, across all theaters of operation since the global war operations began, is about 20,000.  But those 20,000 medical personnel were not all involved in detainee operations. Unfortunately, I do not have a number to tell you of the thousand we saw was that a third, half or three-quarters of the total number of medical personnel; I just don't have that number.  But we know we focused on medical groups, medical units, and non-medical units that were involved in detainee operations and detainee care. 

 

            STAFF:  Let's make yours the last one. 

 

            Q     Yeah, just to put this in context, somebody just turning on the TV now watching this, they say another Abu Ghraib report, or another Abu Ghraib investigation.   

 

            Where do you fit in terms of the Taguba report, the Fay report, the Schlesinger report -- all the things that have been done in the last year; just kind of summarize where you fit. 

 

            GEN. KILEY:  I would say to you that my initial blush when I saw the responses of the assessment actually reinforced what we saw when we looked at Taguba and the Fay-Jones-Kearns report, which is that there was a paucity of issues associated with medical personnel in those other reports, and our own assessment says the same thing.  We just   did not see -- you know, even if you were to believe the canary-in- the-cave theory, that there's somebody out there that saw it all and if we just got to him, he would tell us everything, we just did not find that.  I mean, the soldiers, when they thought they saw something, they reported it, and they told us in our interviews that they reported it.  And frankly, they were grateful somebody came and asked them. 

 

            So, from a medical perspective, I have a sense that this kind of brings some closure to some of the issues that have been out in the press about, you know, this great silence in the medical community -- we haven't heard anything from the medical community about this.  And we've been working on this for a long time and very aggressively attempting to ferret this thing out and I think we've got an answer that says our doctors and nurses and medics, you know, did the right thing. 

 

            STAFF:  Thank you very much. 

 

            GEN. KILEY:  Thank you.

 

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