By Peter Slevin and Joe Stephens
Washington Post Staff Writers
Thursday, June 10, 2004
Military interrogators at the U.S. detention facility at Guantanamo Bay, Cuba, have been given access to the medical records of individual prisoners, a breach of patient confidentiality that ethicists describe as a violation of international medical standards designed to protect captives from inhumane treatment.
The files, which contain individual medical histories and other personal information about prisoners, have been made available to interrogators despite continued objections from the International Committee of the Red Cross, according to interviews and documents obtained by The Washington Post. After discovering the practice in mid-2003, the Red Cross refused to send medical monitoring teams to the facility for more than six months, sources said.
There is no universally established international law governing medical confidentiality. But ethics experts said international medical standards bar sharing such information with interrogators to ensure it is not used to pressure prisoners to talk by withholding medicine or by using personal information to torment a detainee.
"I don't think any American medical worker, doctor, nurse should go along with this," said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania. "The role of health care workers in any facility should be solely looking after the health of patients; anybody who is not involved in that should not have access to medical records."
How military interrogators used the information is unknown. But a previously undisclosed Defense Department memo dated Oct. 9 cites Red Cross complaints that the medical files "are being used by interrogators to gain information in developing an interrogation plan." Maj. Gen. Geoffrey Miller, the commander of the facility at the time, denied the allegations, according to the memo.
Military officers have reported a continuous search for defensible ways to pressure Guantanamo's 600 prisoners to reveal details about terrorist operations and organizations. Early last year, the Defense Department formally authorized interrogators to use "stress and duress" techniques designed to disorient detainees and weaken resistance. With proper permission, the guidelines allow some prisoners to be subjected to techniques designed to "invoke feelings of futility."
A Defense Department spokesman declined to comment on the use of medical files that are generated by medical personnel at Guantanamo Bay or other detention facilities around the world. A Pentagon official, who refused to be named, said public discussion about the files could violate a Defense Department policy of not commenting on interrogation techniques.
But specialists in international humanitarian law said that by making the files available to nonmedical personnel, U.S. authorities crossed a line that separates the medical needs of prisoners from the government's interest in interrogating them.
"That is a violation of ethical standards that are quite old and accepted," said Leonard S. Rubenstein, executive director of Physicians for Human Rights, a Boston-based advocacy organization. "I don't think you would find any medical person who would say this is okay."
Steven H. Miles, a professor of bioethics at the University of Minnesota, said that using the information in interrogations of detainees would be a "clear-cut violation" of the Geneva Conventions.
"This is an enormously serious breach," said Miles, past president of the American Association of Bioethics. "You just can't do that."
Miles said use of information in the prisoners' medical records also would violate the ethics code of the World Medical Association, which prohibits doctors from providing information that could aid "cruel, inhuman or degrading treatment" or "diminish the ability of the victim to resist such treatment."
A separate code developed by the International Council of Prison Medical Services requires that medical personnel who work in prisons "respect the confidentiality of any information obtained in the course of our professional relationship with incarcerated patients."
The previously unreported use of the medical records comes as Congress is questioning the Bush administration's treatment of foreign prisoners in Iraq, Afghanistan and Cuba. Criminal investigations are underway into unexplained deaths of detainees in Iraq and Afghanistan, and into practices condemned by human rights groups. The harassment and sexual humiliation of prisoners inside Iraq's Abu Ghraib prison was described last fall in a Red Cross report as "tantamount to torture."
Extraordinary secrecy surrounds the Guantanamo Bay detention center, which primarily houses prisoners captured in Afghanistan. Except for the six captives facing military tribunals, detainees -- some of whom have been there two years or more -- are not allowed to meet with lawyers or relatives. Red Cross monitors are the only outsiders many are permitted to see.
Red Cross officials would not comment on the issue of medical records. But last October, the head of the organization's Washington office, Christophe Girod, made a rare public complaint that the Guantanamo Bay facility was "an investigation center, not a detention center." Girod said he was frustrated by the indefinite confinement of prisoners at the facility.
Brig. Gen. Rick Baccus, who commanded the Guantanamo Bay facility from March 2002 to October 2002, said that after new detainees were processed and given a medical review, their records were routinely shared with military intelligence personnel. Military doctors and medics were available to advise interrogators about the new detainees' health, Baccus said, in an effort to determine whether the prisoners were strong enough to withstand questioning.
Baccus said he knew of no prohibition on interrogators reviewing the files over time, but he added that he was unsure how often that occurred or how the information might have been used. He said no one, including the Red Cross, raised concerns about use of the records during his time at the facility. If he had determined the practice violated rules or international codes, Baccus said, "I would have stopped the process."
Baccus was succeeded by Miller, who worked to improve intelligence gathering. U.S. authorities considered Miller's work such a success that in late August they dispatched him to Iraq with orders to improve interrogation efforts at Abu Ghraib.
An account pieced together from confidential documents and sources familiar with the matter shows that a Red Cross team discovered the sharing of the medical records in a visit to the Guantanamo Bay medical facility in mid-2003, during Miller's tenure there.
The Red Cross team's task, repeated at prisons throughout the world, was to assess how the complex's medical facility functioned. The medical team studied equipment and treatment options, speaking with detainees and U.S. military medical staff. Other Red Cross experts monitored other aspects of prison life.
The team's mission was not to treat detainees, but to ensure that they received adequate care. If a prisoner had persistent headaches, was he able to see a doctor? If he suffered from psychological problems -- 21 captives have tried to kill themselves at Guantanamo Bay -- was he receiving treatment?
U.S. military doctors told Red Cross medics that interrogators had access to prisoners' medical records, according to two people knowledgeable about the issue who demanded anonymity because details of the interrogations and Red Cross monitoring are kept secret. As one source said, the doctors "were very honest about that" and "some people expressed concern."
Daryl Matthews, a civilian psychiatrist who visited Guantanamo Bay in May 2003 at the invitation of the Pentagon as part of a medical review team, described the prisoners' records generated by military physicians as similar to those kept by civilian physicians. Matthews said they contain names, nationalities, and histories of physical and psychological problems, as well as notes about current complaints and prescriptions.
Matthews said an individual's records would routinely list psychologists' comments about conditions such as phobias, as well as family details, including the names and ages of a spouse or children.
Such information, he said, would give interrogators "tremendous power" over prisoners. Matthews said he was disturbed that his team, which issued a generally favorable report on the base's medical facility, was not told patient records were shared with interrogators.
Asked what use nonmedical personnel could make of the files, he replied: "Nothing good."
The practice made some military medical workers at Guantanamo Bay uncomfortable. "Not everyone was unified on this," said one person aware of the situation. "It creates a tension. You have people with many different opinions."
The Red Cross team considered the breach of patient confidentiality a grave problem and protested. "Doctors in the ICRC did not want to play this game," said the source. When U.S. authorities made clear that the policy would continue, the Red Cross responded with a decision that no medical team would return to Guantanamo Bay.
The Oct. 9 Defense Department memo recounts a meeting between Red Cross monitors and military officials. It quotes Vincent Cassard, a Red Cross team leader, as saying that "there is a link between the [military] interrogation team and the medical team. This is a breach of confidentiality between a physician and a patient. Only medical personnel are supposed to have access to these files."
The memo says Miller, the commander, disputed the claim and asked the Red Cross to recheck its facts. In response, Cassard complained that Miller "was not taking the discussion seriously."
After the dispute, the Red Cross continued to monitor other activities at the prison. But with the issue still unresolved, the organization has only recently agreed to send a medical specialist to the detention facility. The medical visit is the first since last summer, and officials intend to keep confidential any prisoner information they learn to prevent further personal details from being recorded in military files.
Red Cross officials, bound by confidentiality rules that call for findings to be delivered only to host governments, would not discuss when or where they lodged complaints about the issue of medical records. When the Red Cross has discovered problems at Guantanamo Bay in the past, it has reported them to the prison commander and, if necessary, to a Pentagon committee that oversees detainee policy.
Staff writer Scott Higham contributed to this report.