United States Department of Defense United States Department of Defense

News Transcript

Press Operations Bookmark and Share


Media Roundtable with Assistant Secretary Winkenwerder

Presenter: Assistant Secretary of Defense for Health Affairs William Winkenwerder
June 07, 2006 09:00 AM EDT
Moderators: Marianne Coates, Health Affairs Communications Director and Cynthia Smith, Office of the Secretary of Defense, Public Affairs


           MODERATOR:  We have approximately one hour.  We are recording this roundtable, and a transcript of the roundtable will be posted at the DefenseLINK website.  And we would ask that those of you who are on the line to please go around and identify yourself now so we know who has called in.  And then, secondly, as you ask a question, if you would please identify yourself first.  


            Okay, so let me then ask if you would start with the identification of who we have on the line, please.  


            Q     Jim Gerstenzang of The Los Angeles Times.  


            Q     Will Dunham with Reuters.  


            Q     Sandra Basu with U.S.  Medicine.  


            Q     Kevin O'Reilly, American Medical News.  


            Q     Carol Rosenberg, The Miami Herald.  


            Q     Neil Lewis, New York Times.  


            Q     Sara Wood, American Forces Press Service.  


            Q     Leo Shane, Stars and Stripes.  


            Q     Ben Fox, AP.  


            MODERATOR:  Okay, that sounds like we have a good number of people on the line and Dr. Winkenwerder.  Dr. Winkenwerder, for those of you, just to be sure, it's W-I-N-K-E-N-W-E-R-D-E-R -- Winkenwerder -- the assistant secretary of Defense for health affairs.  Dr. Winkenwerder. 


            DR. WINKENWERDER:  Good afternoon, everyone.  Let me just begin by making a few comments.  I'll try to hit on the highlights of this DOD instruction, which is a policy document of the department that addresses medical program support for detainees.  In fact, it's titled, "Medical Program Support for Detainee Operations," and it is dated today. 


            It is a comprehensive, thoughtful policy document reaffirming high ethical principles and humane care and treatment for detainees and persons under the authority and control of the United States armed forces.  In a phrase, it's a very good document. 


            Our efforts on it began some time ago --


            OPERATOR:  Someone has joined the conference. 


            DR. WINKENWERDER:  Could you please identify yourself?


            Q     Hi, I'm Luis Martinez with ABC News. 


            DR. WINKENWERDER:  As you know, Mr.  Martinez, I just made an opening -- this is Dr. Bill Winkenwerder.  I'm the assistant secretary of Defense for health affairs. 


            Q     Doctor, good to see you again. 


            DR. WINKENWERDER:  Yeah, good to see you --


            Q     Good to hear you again. 


            DR. WINKENWERDER:  Yeah.  And we can loop back to you to cover the first thing I said.  But, in a phrase, it's a very good document.  Our efforts began some time ago.  As you know, we issued a series of policy memoranda over the past two or three years addressing various parts and pieces of the issue, and of the whole matter that relates to the role and responsibility of medical personnel.  But let me touch on the high points that this document covers. 


            First, humane treatment has, and always been, remains the standard for detainees' care and treatment.  All health care personnel, regardless of their role, have a duty to comply with the law and to uphold humane treatment of detainees and to report known or suspected violations. 


            Q     Doctor, I'm sorry to interrupt, because I know that Ms.  (Coates ?) said the questions would be later --


            DR. WINKENWERDER:  Yeah?


            Q     But it might be more efficient for all of us -- will we be -- you can describe the document and we'll ask the questions, but the document will be made available to us at the end of this?


            DR. WINKENWERDER:  Yes.  Oh, yes -- right now. 


            Q     Okay, just wanted to be sure.  Very good. 


            DR. WINKENWERDER:  Just issued about 30 minutes ago. 


            Q     Okay, thank you.  Sorry to interrupt. 


            DR. WINKENWERDER:  That's all right. 


            Third, health care personnel, regardless of their role, are not to supervise, direct or conduct interrogations. 


            Fourth, the instruction, the policy document, details and describes our policy and procedure with respect to the appropriate handling of and access to detainee health information and medical records. 


            I think I touched on this, but I'll say it again with respect to the requirement for health care personnel to report possible instances of observed or suspected inhumane treatment of detainees.  That's described. 


            We also speak in this document about establishing a requirement and directing the military services and combatant commanders to ensure that appropriate training for health care personnel is provided before people assume their responsibilities. 


            And then, finally, health care for detainees will be provided with the consent of the detainee with certain exceptions that are identified.  Some of those relate to life-saving emergencies or public health, or to, for example in the matter of hunger striking, to save the life of or prevent serious bodily harm to the detainee. 


            So, with that, let me also add one other point, just to say that it describes the role of the behavioral health consultant.  Behavioral health consultants are professionals who are trained in the area of behavioral sciences.  They are able to make psychological assessments of the character, personality, social interactions and other behavioral characteristics of detainees, and they are able to advise on communications, techniques and skills.  They may not conduct or direct interrogation, or provide any support to interrogations that are not in accord with the law. 


            And one other point, and then I'll stop and open it to questions, but it relates to the matter of behavioral science consultants, and it has been an issue as some who are in the medical realm, in the medical press know, and it relates to the role of physicians serving as behavioral science consultants.  And, on that matter, we say that as a matter of professional personnel management, physicians would not ordinarily be assigned duties as behavioral science consultants.  So the job would typically fall to a psychologist.  But they may be -- we don't completely proscribe the possibility that a person, a psychiatrist, could be assigned; but it would only be with approval of my office when qualified psychologists are not available. 


            So, with that, let me stop and then take your questions. 


            Q     Sir, this is Will Dunham with Reuters.  Do the rules allow for military medical personnel to help shape interrogations of detainees, for example, by using knowledge of a prisoner's condition?


            DR. WINKENWERDER:  No. 


            Q     So medical military personnel would be barred from helping shape the nature of interrogations, not actually conducting it but talking to the interrogators ahead of time and giving them ideas of how to approach a particular detainee?


            DR. WINKENWERDER:  Let me address that.  The quick answer is no, and it is addressed in the back-up document, the enclosure, which goes into greater detail -- it's about a page and a half -- specifically on behavioral science consultants.  And it says, under bullet point E217, "Behavioral science consultants shall not use or facilitate, directly or indirectly, the use of physical or mental health information regarding any detainee in a manner that would result in inhumane treatment, or not be in accordance with applicable law.  And in the first --


            Q     Sir, but --


            DR. WINKENWERDER:  -- one may provide advice concerning interrogations of detainees when the interrogations are fully in accord with the law and properly issued instructions.  They're not to -- they may observe, but they're not to conduct or direct interrogations. 


            Q     Let me just briefly follow up.  You were mentioning the issue of interrogations that were not lawful.  But I'm talking about -- let's look at the hypothetical situation of a perfectly lawful interrogation.  Would military medical personnel be able to help frame how the interrogation takes place?


            DR. WINKENWERDER:  Well, let me go to sort of the broad overview statement about the role.  And they are authorized to make psychological assessments of the character, personality, social interactions and other behavioral characteristics of detainees.  And so that is -- in a quick phrase, that is their role, based on -- and, based on those assessments, advise personnel performing lawful interrogations.  They are able to provide advice based on assessments of character, personality, social interactions or other behavioral characteristics.  That would not include, you know, detainee has condition A, B, C -- may be vulnerable because of that condition and therefore push and probe on that condition. 


            Q     That would not be allowed. 


            OPERATOR:  Someone has joined the conference. 


            DR. WINKENWERDER:  Correct, that would not be allowed. 


            Q     Is that a change from a previous policy?


            DR. WINKENWERDER:  It's just -- no.  It's essentially what we have been doing.  I think, however, there has been a lot in the press that has mischaracterized what we do and have done.  I think it is fair to say, however, that in the early weeks and months without the appropriate detailed guidance that was subsequently put into place, even two or three years ago, that people may not have acted in full accord with these standards and procedures that we're describing today. 


            Q     Does that mean the press reports were not inaccurate then?


            DR. WINKENWERDER:  No, it doesn't mean that. 


            Q     How so?


            DR. WINKENWERDER:  They were inaccurate because they made allegations that -- and I don't have them in front of me -- prefer not to delve into that without the information in front of me, but there were some fairly wild accusations about blatant abuse of medical information and willy-nilly sharing of information and that type of behavior, to my knowledge, never occurred. 


            Q     Can you give an example of an incident two or three years ago when they did act in full accord with these standards and procedures that are being described today?


            DR. WINKENWERDER:  I really -- I cannot. 


            Q     But, Doctor --


            Q     You're acknowledging that this didn't -- sorry, Neil -- you're acknowledging that this did occur two to three years ago?


            DR. WINKENWERDER:  No.  Just did what? You did not define what you're saying occurred. 


            Q     That people did not act in full accord with these standards and procedures that you are describing. 


            DR. WINKENWERDER:  We're going to have to follow up with you to give you an example.  It is not an example of sharing information with interrogators.  It's based on the medical history, the medical information of the detainee. 


            Q     I'm sorry, not? Did you say not based on?


            DR. WINKENWERDER:  Yes. 


            Q     So, to be pointed -- I'm sorry, this is -- to be pointed, some of the press accounts, maybe this is what you have in mind -- perhaps not -- said that behavioral psychologists advised interrogators of vulnerabilities, psychological vulnerabilities of particular detainees to fears and phobias, darkness, loss of -- (inaudible) -- that could be used to exploit -- that could be exploited to aid an interrogation.  That is not accurate, sir?


            DR. WINKENWERDER:  To my knowledge, that did not occur. 


            Q     This is Kevin O'Reilly with American Medical News.  My understanding of what has occurred, and may still be occurring there, is that the behavioral scientists would not be present in the interrogation but either would be viewing on close-circuit television or videotape afterwards the interrogations, and would use -- pick-up things during that and would advise the interrogator, saying, Okay, I picked up this, I picked up that.  Is that occurring? And will this standard change that in terms of just advising how the interrogation would proceed, assuming it's a lawful interrogation?


            DR. WINKENWERDER:  I've said it has always been known from the start that the behavioral science consultant observes interrogations.  How else could they offer advice without being able to observe? However, there is a strong line that is drawn between observing and conducting or directing or monitoring interrogations to determine if -- you know, and I'll use this phrase, someone has gone too far.  That is not the role for a behavioral science consultant.  That is not the role for a medical professional of any type.  That's why we describe the role of medical personnel is not to serve as a medical monitor, if you will, to the interrogation process. 


            Q     Are they able to point to phobias that a detainee might have as an exploitable --


            DR. WINKENWERDER:  No, no, absolutely not. 


            Q     Has that occurred in the past?


            DR. WINKENWERDER:  Not to my knowledge. 


            Q     Certain interrogators have been quoted in the press as saying behavioral scientists have in fact told them these kinds of things, that --


            DR. WINKENWERDER:  Well --


            Q     Is that inaccurate or it's just not to your knowledge? Or where does that lie, sir?


            DR. WINKENWERDER:  We'll have to ask them.  I'm not aware of the quote.  I don't know who you're quoting. 


            Q     I wrote it. 


            DR. WINKENWERDER:  Well, you may have written it, but I don't know who you obtained that from.  I don't know your source, and I haven't spoken --


            Q     That's correct as well. 


            DR. WINKENWERDER:  Pardon?


            Q     That's correct.  You don't.  The person is not named. 


            DR. WINKENWERDER:  So how can I -- I can't comment on that. 


            Q     Sir, Carol Rosenberg with --


            Q     But you have.  You said it didn't -- to you knowledge those things did not occur. 


            DR. WINKENWERDER:  That's correct. 


            Q     Okay. 


            DR. WINKENWERDER:  And people have been asked about the whole range of issues with respect to the role of medical personnel in detainee operations to include interrogations through a study that was conducted by Surgeon General Kevin Kiley, Army surgeon general.  And to my recollection and knowledge, the types of behaviors that someone has suggested about playing upon people's fears and phobias was not surfaced as an issue, or did not point to that as a behavior they observed or saw.  So that's the information that I have to share with you. 


            Q     Doctor, this is Jim Gerstenzang, Los Angeles Times.  Could you just explain how overall the rules are humane, and what changes there are on the rules in terms of force feeding?


            DR. WINKENWERDER:  They're humane because our people are humane, and these words speak to humane behavior.  And if you have observed -- I don't know if you have observed our personnel in action, but I have many, many, many times, and I can tell you they act with humane -- humanely -- and they act with high principles and they're ethical people.  They're doing in many cases very difficult jobs, taking care of injured people on the battlefield.  But they're doing a --


            Q     But how are the rules themselves -- you talk about they're humane because they're humane in terms of the people.  How do the rules themselves --


            DR. WINKENWERDER:  They reaffirm what has been a tradition that goes back decades and decades and decades. 


            Q     And on force feeding, how has it changed?


            DR. WINKENWERDER:  What would you like? I'm sorry, what is your question?


            Q     How has this changed the rules on force feeding, or do they make no changes?


            DR. WINKENWERDER:  We have a policy that is to preserve life.  That policy is an ethical policy.  It's in the best interests of the individual who is a hunger striker, for his life to be preserved, in our judgment. 


            Q     Is that -- does medical science in general agree that it's the caregiver's decision on that, not the patient's?


            DR. WINKENWERDER:  Well, that depends upon the situation.  And the answer is that in -- there are two principles:  the principle of beneficence, or doing right by people; and the principle of autonomy or self-determination.  And in the case of a person who has a terminal disease, typically medical providers will honor the request for treatment to be withdrawn.  In some cases they won't, and we all know about the famous court case of a year or so ago when the debate, the Schiavo case, the debate between the very closest family members.  And our policy reaffirms what our practice has been, which is -- and which is to preserve the life of the person who is under detention.  I might add that it is consistent with the U.S.  law.  It is consistent with the policy of the Bureau of Federal Prisons, title -- and you'll see it in the document -- Title 28, Code of Federal Regulations -- all of these same procedures. 


            Q     Sir, could you -- this is Ben Fox of AP -- could you say what is new in these guidelines that have issued today and why have they been changed?


            DR. WINKENWERDER:  What's principally new is the greater level of detail.  It's a reaffirmation rather than a dramatic change of what we have been doing.  It lays everything out in one document, pulls together what has been a series of policy statements and memoranda.  And it was developed, I might add, with input broadly from all the medical professionals within the military -- and with some consultation and advice from outside the military.  We consulted with the American Medical Association, the American Psychiatric Association, the American Psychological Association.  We have had two separate outside groups of experts visit Guantanamo Bay -- one in October of '05; a second one in April of this year.  And the perspectives and advice that was shared from those individuals has been used in this process in a positive way and has helped us in preparing this policy document. 


            Q     Hello? Doctor, does what you published today in any way change existing policy or practice at Guantanamo Bay?


            DR. WINKENWERDER:  It does not change practice that has been there for the last -- no, it doesn't.  It's a reaffirmation.  It's a clarification.  It's a compilation of everything that we have been doing.  It puts it all in one place.  It sets forth principles that we think are there for many years to come. 


            Q     Doctor -- I'm sorry, were you finished, Carol?


            Q     I had one other follow-up.  Go ahead. 


            Q     Please, please. 


            Q     Back to the notion of who is entitled under right to self-determination to go on a hunger strike, you seem to open up the question on whether there was someone there with a terminal disease, whether they would be allowed to participate in a hunger strike.  Would the policy change if you had a detainee with a terminal disease?


            DR. WINKENWERDER:  The policy is to preserve life.  I don't want to speculate on what the situation might be if a detainee had a terminal disease.  We have not faced that yet, to my knowledge.  But I'll just leave it at that:  we haven't faced that situation. 


            Q     But under medical ethics it would be a different set of --


            DR. WINKENWERDER:  We operate under principles of medical ethics now.  There is no conflict medically, ethically speaking, in our view, between what we are doing and what's laid out in a variety of ethical documents in the medical world. 


            Q     Dr. Winkenwerder?


            DR. WINKENWERDER:  Yes?


            Q     You had said -- this is Neil Lewis, I'm sorry. 


            DR. WINKENWERDER:  Yeah, let me add one other thing to that last -- to that last question about the hypothetical situation of a dying individual.  I would expect that the person, the attending physician, would be involved in the decision with the patient, with the detainee, respecting that person's wish in that circumstance -- or at least evaluating and assessing that person's wishes in that circumstance. 


            Q     And can I follow up on that?


            DR. WINKENWERDER:  And let me make one other comment about the -- you know, I know there's been discussion about the Malta Convention, which is -- the world medical organization that speaks to the issue of hunger strikers.  We view what we are doing as largely consistent with that declaration.  The Malta Declaration notes that when there is a conflict appearing with a hunger striker that the moral obligation urges the doctor to resuscitate that patient, even though it's against the patient's wishes.  That's in the Malta document. 


            It goes on to say, however, that the intervention on the part of the physician should be when the hunger striker has lapsed into coma and is impaired and unable to make a decision.  It's our view that we're basically along the same ethical tenets, same ethical line of thinking; we just don't want to have someone get to death or near death before we seek to save them.  And that only just makes good sense. 


            Q     Doctor?


            DR. WINKENWERDER:  Yes?


            Q     I wanted to ask you about your comments earlier that seem to work on the distinction between a psychologist and a psychiatrist.  You said the job of advising or behavioral scientist would typically be a psychologist --


            DR. WINKENWERDER:  That's correct. 


            Q     -- and a psychiatrist would only be assigned with the approval of your office when qualified psychologists were not available. 


            DR. WINKENWERDER:  That's correct. 


            Q     It is my strong understanding -- and you're free to correct me, of course -- that among psychiatrists there are some who operate precisely as psychologists do, as behavioral scientists, even though there are differences in the two fields.  But some psychiatrists are just as much behavioral scientists as psychologists.  I believe I interrupted you when you were saying that's --


            DR. WINKENWERDER:  Yes. 


            Q     -- similar fashion.  So my question is this making this important distinction about who will be deployed to this duty, is it not as it might seem that the important distinction here is that the psychiatrists operate under a different ethical code than the AMA of "first do no harm," where the American Psychological Association has a more forgiving or flexible code about the kind of things their behavioral scientists can participate in, into consideration here?


            DR. WINKENWERDER:  I don't think that's exactly correct.  But let me offer some perspective on your question, because it's a good question. 


            Psychologists and psychiatrists can do at times similar things, and I think you've made that point.  As we looked at the role of the behavioral science consultant first, it seemed to us that - and in fact it has been the practice for most of the history of Guantanamo Bay that it has been psychologists who have been in that role.  I think there's been a misunderstanding that psychiatrists were then there practicing in this fashion in large numbers, and that's simply not true.  The great majority -- and, by the way, there had not been a large number of either -- typically only a couple at a time during the rotation -- a couple of individuals.  So -- but most have been psychologists.  And typically in the broader field that is a role that's usually carried out by a psychologist, though a psychiatrist may be able to do it.  So our policy doesn't preclude a psychiatrist from performing the task.  It recognizes that it typically would be performed by a psychologist. 


            There is a second issue that did to some extent influence our thinking, and that is as we spoke to the American Psychiatric Association and the American Psychological Association -- the American Psychological Association was -- clearly supports the role of psychologists in interrogations in a way our behavioral science consultants operate.  The American Psychiatric Association, on the other hand, I think had a great deal of debate about that and there were some who were less (comfortable ?) with that.  I don't -- I can't describe for you where they came out exactly on the policy with regards as to psychiatrists participating in interrogations.  But --


            Q     There was less enthusiasm --


            DR. WINKENWERDER:  We try to be sensitive to the respective roles of -- as they are viewed in their professions. 


            Q     And then, Doctor, may I ask you if you earlier, to a series of questions, you said things like the behavioral scientists counseling an interrogator about a detainee's psychological vulnerabilities, phobias, was something that was off the table?


            DR. WINKENWERDER:  That's right. 


            Q     Could you, say, give us any kinds of generic examples of things that are indeed on the table? Because you said what they could do would be to advise on techniques and roles.  I'll get you the quote here, if you'd like:  that the health care consultant could -- let me --


            DR. WINKENWERDER:  With the social characteristics --


            Q     Social interactions. 


            DR. WINKENWERDER:  Yeah, right. 


            Q     But advise on techniques and skills.  So, one of the techniques you have ruled off; that is to say this detainee, the subject of interrogation is vulnerable to A, B or C.  You said that would not be permissible.  What kind of skill or techniques? What kind of -- what's a generic example, or any kind of example, of what the behavioral scientists can indeed advise the interrogator?


            DR. WINKENWERDER:  Well, I'll give a general answer, because it's probably best for me not to go into too great a detail.  I am not a psychologist.  I am not a behavioral science consultant, and we ought to rely on other experts (to give you the most complete answer ?).  However, that said, the thrust is to coach and counsel the interrogator in a way that allows him or her to build a relationship with the detainee, or the person being interrogated, such that there is an exchange of information.  So some people, you know, may be just looking at their personality, their character, the way they interact.  Clues are there as to what makes a person more or less comfortable to talk and to share information.  And that's the kind of thing that they provide. 


            Q     The last thing, if I may, Doctor.  The way you -- the words you use to describe it are strictly in the trust-building positive sense of incentives; in popular formulation, carrots only -- no sticks.  Can they advise on things that --


            DR. WINKENWERDER:  Well, people do lose privileges.  I mean, that's typical practice in a prison environment for behavior that's not in accord with rules and regulations of the prison, for example. 


            Q     I'm sorry, we weren't talking about behavior in accord; we're talking about whether they were forthcoming or not. 


            DR. WINKENWERDER:  I'm talking about behavior that's not in keeping with the rules of the prison, and advice ought to be sought on that matter.  For example, you know, we've had many instances where detainees have physically assaulted health care professionals and assaulted guards.  The recent incident, I think you're aware of, where there was a scheme to lure a guard in to an environment and then assault him or her.  So --


            Q     I'm sorry, I thought we were talking about the interrogation environment here.  I was asking whether -- and you would describe ways that the behavioral scientists could advise the interrogation to develop a rapport to get information.  I was asking in the interrogation environment and the behavioral scientist.  Is there anything on what I term the "stick" side as to ways to press or penalize or deprive anything of that sort in the interrogation environment? Not that --


            DR. WINKENWERDER:  That would not be in accord with approved interrogation techniques.  So that's the rule set that the interrogator has to operate within. 


            Q     Well, there are interrogation techniques that allow pride up, pride down.  I don't see why it couldn't be in accord with proven interrogation techniques. 


            DR. WINKENWERDER:  Right.  I'm going to suggest that if you need more information on this that we will try to find someone who could provide greater detail for you. 


            Q     Thank you. 


            Q     Doctor, could you talk about the rules for using the restraint chair and how they're spelled out and what the process would be and when they decide to use the restraint chair to feed the detainees on hunger strike?


            DR. WINKENWERDER:  This policy document only describes in very general terms the issue of involuntary feeding.  It does not go into the details of the use of a restraint procedure.  That is part of a -- it's an operational decision.  It's an operational set of procedures.  And I -- again, I think we can try to get you more information on that.  But --


            Q     There's a set rule? I mean, what I'm trying to understand here is --


            DR. WINKENWERDER:  I'll say this about -- it's important for everyone to understand about that, the use of any form of restraint.  There's a fundamental purpose -- two fundamental purposes.  One is to protect the individual, the detainee himself or herself.  And we have had situation where detainees have hung themselves, and we don't want them to harm us.  We've also had situations where detainees have attacked and assaulted medical personnel.  So this is in everyone's best interests in these relatively few situations that a restraint be used, and that it be performed in a way that's humane, that's professional, that's not unlike what any of you have worked in a hospital or operated in an emergency room, or what have you -- not at all unlike those same procedures that medical professionals do every day across the United States.  And --


            Q     What's in this document that you're releasing today that spells out when they can use restraints and --


            DR. WINKENWERDER:  Well, it just says this:  that health care personnel shall not participate in any procedure for applying physical restraints to the person of a detainee, unless such a procedure is determined to be necessary for the protection of the physical or mental health, or the safety, of the detainee, or necessary for the protection of other detainees or those treating, guarding or otherwise interacting with them.  And such restraints, if used, shall be applied in a safe and professional manner. 


            I might as well with the last group that we had down in April, several outside medical professionals, and to a person they agreed that the way in which this was -- this procedure was being performed was highly professional, was humane and was consistent with our policy.  And so their main observation was not enough people know the humane, ethical, appropriate way in which we're doing this.  And so we're obviously interested in people understanding that we are doing this in a right way.  There are some simply flat-out false statements that have been made about the manner in which these procedures have taken place. 


            Q     Well, what are some of those false statements? I mean, what --


            OPERATOR:  Someone has joined the conference. 


            DR. WINKENWERDER:  False statements like ramming large-bore tubes down people's throats.  That is an absolute lie -- not true.  Bloodying people up, you know, physically abusing them.  It is absolutely untrue.  These are -- the feeding tubes are what's known in the medical lexicon as 10 or 12 French.  That's about 3 millimeters.  It's smaller than the cartridge inside a ballpoint pen.  I mean, it's smaller than a straw.  It is a tiny flexible tube that's applied with lubrication and anesthetic, and it is not a painful procedure. 


            Q     And the restraints -- (inaudible) -- ?


            DR. WINKENWERDER:  Are also not a painful or inappropriate procedure.  They are -- this is done in a professional way.  It's an approach that's used in U.S.  prison facilities, and it's only used when necessary. 


            Q     Can you say, Doctor, what the current sort of approximate number of detainees are in this situation?


            DR. WINKENWERDER:  I think currently there are four that are being involuntarily fed right now. 


            Q     Thank you. 


            DR. WINKENWERDER:  And it has been around that number -- two to three to four -- for several months now. 


            Q     Several months, you say?


            DR. WINKENWERDER:  Yes, I believe so. 


            Q     Are physicians -- this is Kevin O'Reilly from American Medical News.  Are physicians -- what -- how much are physicians participating in the force-feeding of the remaining two or three or four hunger strikers? You said earlier they wouldn't participate --


            DR. WINKENWERDER:  These are medical procedures they oversee and direct and decide who receives -- who needs to receive, based on their health status, and the degree to which they've had weight loss or body fluid loss, or at risk for infection or other complications, that they require feeding to maintain their health. 


            Q     Why did they start using the restraint chair in January? I mean, the hunger strike had started, this most recent one, in August. 


            DR. WINKENWERDER:  Right.  My sources indicate that it arose out of some assaults that occurred on medical personnel.  And I think the other reason was that some of the detainees were purging, or losing their feedings, and therefore continued to lose weight, despite being fed.  And it was for both of those reasons. 


            Q     So now everybody goes into the restraint chair, right?


            DR. WINKENWERDER:  Pardon?


            Q     So now everybody goes into the restraint chair?


            DR. WINKENWERDER:  No. 


            Q     All involuntarily fed people?


            DR. WINKENWERDER:  No, only people who meet a certain criteria.  People are offered food.  They are urged to be fed, to feed themselves or to take food and liquids.  And most do. 


            Q     No, my question was whether all the involuntarily fed detainees go into the restraint chair -- (inaudible) -- now?


            Q     That is the three or four that you -- two or three or four you --


            DR. WINKENWERDER:  The three or four, yes, those three or four individuals -- that would constitute those that would be fed involuntarily utilizing the restraint chair. 


            Q     And then, sir, when we were down there last time they told us there is a medical ethics board on the base that reviews the decision to do a forced feeding.  Do you know how long that medical ethics board has been reviewing the cases and how many times they've ordered a forced feeding?


            DR. WINKENWERDER:  It is a -- the recommendation for the feeding is a medical recommendation from a physician, and it's a command decision.  They -- the procedure you describe, we'll have to get, if you're interested in more detail we can try to find that for you about any review or group review of that decision process. 


            Q     I guess more generally -- I guess with all these rules it's just -- nothing is really being changed in this policy.  You're just sort of pulling together memos of one sort or another.  I guess what's the significance then of this document? Why did you produce this, issued a new rule?


            DR. WINKENWERDER:  Well, we did it because it's the right thing to do, and we did it because it's a good thing to have all of this guidance in a single place.  It can be referred to again and again, and we expect that it will be, to the extent that people are out in the field and have questions -- you know, new people come and go.  And here it is, and it's a thoughtful, comprehensive document that's based on high medical standards and ethical treatment of people. 


            Q     And where on the website will we see this document?


            DR. WINKENWERDER:  Let's see, do we have a Web address?


            Q     I've been looking for it. 


            DR. WINKENWERDER:  We're trying to find it for you. 


            Q     So let me just clarify one more thing here.  There really is no change, say, in how the psychologists would work with interrogators.  That remains as it's been?


            DR. WINKENWERDER:  Yes. 


            Q     And just to make sure I have the detail correct, the psychiatrists would only really -- the only circumstance under which a psychiatrist would be used has to be approved by your office --


            DR. WINKENWERDER:  That's correct. 


            Q     -- is when there's no qualified psychologist available?


            DR. WINKENWERDER:  That's correct. 


            Q     Okay. 


            DR. WINKENWERDER:  Right. 


            You know, I know that people seem to be pressing on what's new.  The level of detail I think is new.  We issued a memorandum about a year ago, in June of '05.  It covered some of these points.  This document is twice as long.  It goes into considerably greater detail with respect to the role of the behavioral science consultant.  It addresses the matter of hunger striking and involuntarily feeding.  So it does cover those issues.  And then it goes into further detail on other issues. 


            Q     Has there not been this level of detail operationally internally, or is it just this level of detail for the first time publicly available?


            DR. WINKENWERDER:  There has been.  For example, there has been the level of detail out there, and it's essentially what people have been doing for some time.  However, for example, you know, we are in this document making clear about the expectation for training for every person who serves -- and this goes way beyond interrogations or the Guantanamo type of operations, but across the board.  This applies to -- because your questions I think have focused quite a lot on Guantanamo, but this applies to all forces, all situations around the world. 


            So, for example, the area of training.  We initiated a training requirement last summer -- October -- wrote the requirement in the summer months, and then began to implement it in October.  We're glad to share that with you.  I think you should know that, because it is rather extensive.  I mean, there are hours of training that any medical personnel has to go through to serve in a detention facility.  And for any commander, medical commander of a detention facility there's even additional training.  And so, you know, we want our people to have the most explicit, detailed guidance that we can offer them.  Obviously policies can't cover every detail.  That's why you have procedures and manuals and the detail that comes from the folks that are in the field. 



            But let me give you the Web address.  It's www.dtic.mil/whs/directives -- with an S -- D-I-R-E-C-T-I-V-E-S -- /corres/html/ -- this is the longest Web address ever -- 231008.htm.  I hope everybody got that. 


            Q     And that's available through DefenseLINK, though?


            DR. WINKENWERDER:  Yeah, DefenseLINK. 


            MODERATOR:  Yeah, you can Google "DOD directive" -- and then -- Google "DOD directives," all the directives will come up, and you can search 2310, and it will pop right up. 


            Q     Okay, 2310 -- it's 2-3-1-0-0-8, right?


            MODERATOR:  It's 2310.08. 


            Q     Ah, okay, thank you. 


            Q     Thank you. 


            DR. WINKENWERDER:  Okay, thank you. 


            MODERATOR:  Have we any further questions?


            Q     Well, just a leftover question about whether there is some sort of peer review down, as they briefed last time. 


            MODERATOR:  I think to get the answer to that question -- this is Cynthia -- you are going to have to call Robert Durand down there on the ground. 


            Q     You know, they did brief on that, so I'm sort of a little bit surprised that the doctor up there doesn't know about this and thinks that this is (a strike ?) to the commanders.  That's what's puzzling. 


            MODERATOR:  You're just going to have to call Robert, Carol, to get the answer to that question.  I mean, the doctor is not on the ground there overseeing operations. 


            Q     And he's not aware of that.  Doctor?


            MODERATOR:  (Off mike) -- Carol. 


            Q     Okay, thanks, Cynthia. 


            MODERATOR:  Thanks, goodbye. 


            Q     Thank you all very much. 


            Q     Thank you.



Additional Links

Stay Connected