Monday, March 27, 2006

Biscuits, anyone?

By William Fisher

"Press Office", chirped the Defense Department voice on the phone.

"Yes, good morning. My name is Bill Fisher. I write for Truthout. I have a couple of questions about the Biscuit program. Would you be able to help me?"

"What are Biscuits?" said a confused voice.

"They are military shorthand for Behavioral Science Consultation Teams", said I.

"Let me connect you with the person who knows about that program," said the helpful voice.


Then came an answering machine. "This is Jane Doe (I am not using her real name because I might get her in trouble). Please leave your name and phone number and the nature of your question, and I'll call you back", said the disembodied voicemail message.

I did, adding that I wanted to file a story today. Then I waited. And waited. And waited some more.

Altogether I called three times, each time being referred either to a different person (who was away from his/her desk), or to another automated voice mailbox, where I left the same message.

The questions I never got to ask anyone at DOD were:

"I'd like to know whether BISCUIT units are working at Abu Ghraib and Bagram and other U.S.-controlled detention centers as well as at Guantanamo", and "Some folks who are in the medical and other health-provider fields have been critical of the BISCUITS at Guantanamo Bay, saying they have been using doctors and nurses and psychologists to help the interrogators get information out of the detainees, and advising about how best to keep people alive who are on hunger strike there."

Now, if my name happened to be Bob Woodward or Jane Mayer or Sy Hirsch or Walter Pincus or Jim Risen, I suppose I could have called a "high level official close to the Bush Administration", who might speak "on condition of anonymity".

But I wanted to discover whether a plain vanilla working stiff journalist - and taxpayer -- could actually get some information on a sensitive subject from a famously secretive government.

I guess I got my answer. The silence was deafening.

Now, just in case you've been living on Pluto for the past year or so, BISCUITS -- Behavioral Science Consultation Teams - consist of military psychiatrists, psychologists, behavioral scientists, and other healthcare professionals. Their role, it has been charged by former Guantanamo interrogators, is to advise them on ways of increasing psychological duress on detainees, sometimes using their medical records to find ways of exploiting their fears and phobias, to make them more cooperative and willing to provide information.

In one example, published in the New York Times, "interrogators were told that a detainee's medical files showed he had a severe phobia of the dark and suggested ways in which that could be manipulated to induce him to cooperate."

The DOD has said that there is very limited access to prisoners' medical records. But many members of the healthcare community remain skeptical.

An article in the New England Journal of Medicine said interviews with doctors who helped devise and supervise the interrogation regimen at Guantánamo showed that the BISCUIT program was explicitly designed to increase fear and distress among detainees as a means to obtaining intelligence.

And between July 2003 and March 2004, a doctor was allegedly "pressured by OGA personnel into filling out death certificates on Iraqi detainees" though the doctor was not given the opportunity to examine the bodies. The causes of death given for two detainees were later found to be inaccurate. The term "OGA" (Other Government Agencies) is generally used to refer to the CIA.

After April 2003, when Defense Secretary Donald H. Rumsfeld tightened
rules on detainee treatment, one interrogator said detainees' medical records had to be obtained through BISCUIT team doctors, but that the doctors always obliged. The former interrogator said the BISCUIT team doctors usually observed interrogations from behind a one-way mirror, but sometimes were also in the room with the detainee and interrogator.

The biscuit teams were also central, the former interrogators told the New York Times, in devising strategies like "Operation Sandman," in which a detainee's sleep patterns were systematically interrupted several times a night.

Then there is the issue of the "autonomy" of a doctor's patients. That refers to a patient's fundamental right to decide which medical interventions he will permit. That well-established canon of medical ethics requires that a detainee who is on a hunger strike has the "autonomy" to remain on a hunger strike if that's what he wants. If one is a healthcare provider, the patient is a patient whether or not he's a prisoner. Which means that medical personnel are barred from forcing a prisoner to stay alive, or advising others about how to reach that objective.

So, to return to my unanswered questions to the DOD: Have the BISCUITs changed at all as a result of criticism from civilian medical and other healthcare authorities? And are they being used elsewhere?

As to the "elsewhere" question, what we know is that Maj. Gen. Geoffrey Miller, the former commander at Guantanamo, recommended the use of BSCT teams at Abu Ghraib when he was sent there to "GITMO-ize" it in August and September of 2003. According to the testimony of those who were at Abu Ghraib, psychologists were indeed involved in the interrogations and abuses of detainees.

Gen. Miller recently invoked his right against self-incrimination in a case of two soldiers accused of using dogs to intimidate detainees at Abu Ghraib. This invocation was the first sign by Miller that he might have information that would implicate him in the abuses in Iraq. Numerous reports indicate that Miller instituted the use of dogs to intimidate prisoners at Abu Ghraib after first using the technique at Guantanamo Bay. A military investigation recommended that Gen. Miller, who is soon to retire, be reprimanded, but a higher-ranking officer denied the request.

And a senior human rights attorney told me on condition of anonymity, "I would suspect since the BSCTs continue to be used as part of the intelligence apparatus at Gitmo" and because have been judged favorably by the military establishment "they are likely in place at the very least at strategic interrogation facilities in Iraq and in Afghanistan."

As to changes in the way the BISCUITs operate, the DOD finally issued revised guidelines last June, after various healthcare professional organizations and prominent medical authorities ignited a firestorm of criticism. Both the American
Psychological Association and the American Psychiatric Association have
made clear that it is unethical for members of their profession -- whether in the military or not -- to participate interrogations or to provide information to interrogators about ways to "break" a detainee.

Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, acknowledged that the new guidelines came about as the result of a review of procedures begun after allegations of medical personnel assisting in abusing prisoners surfaced. "What got the ball rolling was an awareness from all the information coming out of Abu Ghraib and the various allegations," he said.

Some of the most passionate of these allegations have come from Brigadier General Stephen N. Xenakis, M.D., who retired from the U.S. Army in 1998, after serving in many high-level positions, including Commanding General of the Southeast Regional Army Medical Command. He has reportedly played a major role in driving the DOD to re-examine its medical practices.

Last month he said: "Medical officers enjoy special privileges and status and are expected to abide by and stand up for their professional principles at all times and in all situations. This operation - the War on Terror - is no different... It is important to remember that the burden of leadership is to ensure that high moral and ethical practices are maintained in even the most demanding situations."

But, speaking about prisoner deaths while in U.S. custody, Gen. Xenakis charged, "To date, we have no indication that either the Army Medical Department or the Office of the Assistant Secretary of Defense for Health Affairs has conducted a thorough investigation of the medical care provided to detainees and the circumstances surrounding the known deaths."

The new guidelines, said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, consolidates "principles and procedures for U.S. military medical personnel when working with detainees under control of U.S. armed forces."

The guidelines specify that military medical personnel must observe medical ethics, make medically appropriate decisions, and report inhumane treatment. Military healthcare professionals must "be guided by professional judgment and standards similar to those that would be applied to members of the U.S. armed forces, including duty to protect the physical and mental health of the detainee" and "will not participate in any activity that is not consistent with applicable law."

But in a briefing for reporters, Winkenwerder declined to say whether the guidelines would prohibit some of the activities described by former interrogators and others. He said the medical personnel "were not driving the interrogations" but were there as "consultants".

Winkenwerder added that "only a very, very small number of reports of observation of possible abuse" have been recorded. Pentagon officials have previously said that the practices at Guantánamo did not violate ethics guidelines.

The Pentagon invited representatives of a number of health-related professional associations, including the American Medical Association, to pay a one-day visit to Guantanamo Bay. But they were not allowed to interview any detainees.

One of those attending, Prof. Nancy Sherman, who teaches philosophy at Georgetown University and has written extensively about ethics in the military, said that the DOD had worked hard to present a positive, upbeat image of what occurred at Guantánamo. "I think what was being sought was some sort of confirmation that their practices were ethically sound" and that some of the news accounts were wrong, she said.

Professor Sherman added that the distinction between using psychiatrists and psychologists as consultants rather than as providers of medical care was a tenuous one that invited ethical problems.

Winkenwerder said the new procedures separate individuals who are providing care from health professionals who work in other capacities in detention operations. Medical personnel who are in a provider-patient relationship with detainees -- those who actually provide treatment -- "shall not and will not undertake detainee-related activities for purposes other than to provide health care," he said.

"Such healthcare personnel shall not actively solicit information from detainees for purposes other than healthcare purposes," he explained.

But medical professionals in other roles in detention operations should not provide actual care for detainees, the new guidelines say. Such individuals might include behavioral-science specialists, such as FBI profilers; forensic psychiatrists, who are often appointed by a court to evaluate the mental competency or sanity of an individual; prison psychologists, who evaluate the potential danger of somebody to society; or public-health experts, who evaluate potential for disease outbreaks.

Which still leaves us with nagging questions: Aren't forensic psychiatrists physicians? Aren't they, as well as behavioral science specialists and prison psychologists, governed by the ethical rules of their professions?

Medical doctors take an oath to "do no harm". While psychologists and behavioral science specialists may not have to take such an oath, they are nonetheless committed to doing good, not harm.

And what part of "do no harm" don't they understand? It doesn't require an oath to act ethically. And there is nothing ethical about advising interrogators about how to "break" detainees.