WASHINGTON (AP) — From the early stages of the CIA's coercive interrogations of terror detainees, the agency's health professionals were intimately involved.
Front-line medics and psychologists monitored and advised on abusive tactics, even as they sometimes complained about the ethical dilemmas gnawing at them, according to this week's Senate intelligence committee report. Senior CIA medical officials helped the agency and the White House under President George W. Bush.
The report describes rare moments when CIA health professionals openly balked and objected. But for four years, until Bush shuttered the CIA prison program in 2006, medical teams at each "black site" observed almost every step of procedures that President Barack Obama now calls torture.
They oversaw water dousing to ensure detainees suffered but did not drown. They inserted feeding tubes and improvised enemas. They took notes when detainees were body-slammed and forced to stand for hours — intervening only to ensure that the brutal measures were not crippling enough to prevent the next round of interrogations.
Medical ethicists, already familiar with debate on the issue, say that both the Senate report and a CIA response fail to comprehensively tackle questions of medical morality and offer reforms.
"The Senate report is quite an indictment, but it leaves the American people, whatever their political views, uncertain about how medical ethics should be upheld," said Dr. Arthur Caplan, head of medical ethics at New York University's Langone Medical Center. "The behavior we're reading about is flat-out unethical for any health professional."
The Senate committee's report, a summary of a much larger 6,700-page document that remains classified, includes an entire section about how two former Air Force psychologists devised the harsh techniques under a CIA contract and played conflicting roles as interrogators and health professionals. Committee chairwoman Sen. Dianne Feinstein, D-Calif., says in a forward that the larger report "is far more extensive."
The summary paints a highly critical portrait through case studies of the interrogations of al-Qaida suspects, showing how doctors and technicians tended to each detainee and what they privately told colleagues and superiors in emails and memos.
The CIA's official rebuttal says the agency "took seriously its responsibility to provide for the welfare of CIA's detainee population, including being able to address emergency and long-term medical and psychological needs." In a Thursday news conference, CIA Director John Brennan did not specifically cite medical personnel but acknowledged that agency "officers inadequately developed and monitored" the detention program's "initial activities." But he added that most CIA officials worked "in accordance with the legal and policy guidance they were provided."
"So it begins," an unnamed medical officer emailed in August 2002 to leaders at CIA's Office of Medical Services in Virginia after interrogators for the first time used a water dousing technique on a terror detainee. The captured al-Qaida suspect was strapped to a board in a Thailand prison while water poured over his face. The medic's email was carefully clinical. "Longest time with the cloth over his face so far has been 17 seconds. This is sure to increase shortly. NO useful information so far."
The prisoner, Abu Zubaydah, vomited and in a later session, blacked out, with swallowed water bubbling from his mouth. A day later, another CIA officer emailed to a colleague about the disturbed reaction of one of the medics.
"Want to caution that this is almost certainly not a place he's ever been before in his medical career. ... It is visually and psychologically very uncomfortable." It is unclear from the Senate report whether both emails referenced the same medical officer.
The internal clash between medical personnel's interrogation duties and their oath to "first do no harm" is repeated throughout the Senate report. It says that the CIA's Office of Medical Services played a clear role advising CIA and Bush administration lawyers on which techniques could be used and how far interrogators could go before inducing lasting pain or the threat of death.
As early as March 2003, the report says, "OMS completed draft guidelines on the use of CIA's enhanced interrogation techniques, specifically, addressing the waterboard interrogation technique." And in 2005, as Bush administration lawyers reviewed the tactics, the CIA reported that "it is the OMS's view that ... the program in place has effectively avoided severe physical pain and suffering, and should continue to do so."
In a 2004 CIA inspector general's report on interrogation and detention, the CIA's chief of medical services said the OMS "was neither consulted nor involved in the initial analysis of the risk and benefits" of coercive techniques.
In March 2003, a medical officer in the CIA's Poland prison watched accused 9/11 attacks mastermind Khalid Sheikh Mohammed thrash through two waterboarding sessions. The medic objected when interrogators prepared Mohammed for a third round, saying it would violate draft guidelines sent from OMS the previous day. He was quickly overruled and watched as the detainee went under again.
The same day, the medical officer cabled to another official that "things are slowly evolving from OMS being viewed as the institutional conscience and the limiting factor to the ones who are dedicated to maximizing the benefit in a safe manner and keeping everyone's butt out of trouble."
Medical ethicists say the blurry lines between CIA service and ethical guidelines constitute a core problem.
"These doctors were co-opted when they knew better," said Dr. Stephen Xenakis, a retired brigadier general with the U.S. Army's medical corps. Xenakis co-authored a 2010 critique in the Journal of the American Medical Association that accused the CIA's medical service of institutional failure "to uphold medical ethical values."
One former CIA psychologist, Kirk Hubbard, wrote in the Analyses of Social Issues and Public Policy in 2007 that he opposed torture but insisted that psychologists should be able to "assist in developing effective, lawful ways to obtain actionable intelligence in fighting terrorism. If the information can be obtained non-coercively, so much the better."
Several medical ethicists said they were dismayed that the Senate report included no reform proposals that would preclude health professionals from assisting in abusive interrogations. Caplan urged the creation of national commissions, and Xenakis said, "There has to be a clear firewall at CIA and other agencies and an independent chain where they can object and where their objections are heard at the highest level."