DoD Issues Guidance for Medical Personnel Dealing with Detainees

Military Medicine, Summer 2005

In June, DoD officials issued new guidelines for military medical personnel dealing with detainees. The new rules deal with patient care, interrogations and medical-record confidentiality, among other issues, the Defense Department's top doctor said today.

Dr. William Winkenwerder Jr., assistant secretary ofdefense for health affairs, outlined the new guidance in a media roundtable in his Pentagon office. He said the memo, which he issued to the military services and other DoD agencies June 3, consolidates "principles and procedures for U.S military medical personnel when working with detainees under control of U.S. armed forces."

In general, the new guidance specifies that military medical personnel must be guided by medical ethics, make medically appropriate decisions and report inhumane treatment.

Specifically, Winkenwerder explained, the new policy states 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."

The new policy also provides for the creation and distribution of medical records, which must be complete and accurate, but do not carry any guarantee of "absolute confidentiality," he said.

Winkenwerder said U.S. and international law and accepted standards of medical care carry no guarantee of complete confidentiality. Even in the civilian medical establishment there are circumstances in which patient confidentiality could legally and ethically be breached, and the policy concerning detainees' records follows a similar standard.

Circumstances in which medical-record confidentiality could be breached include "to prevent harm to any person, to maintain public health and order in detention facilities, and any lawful law enforcement-, intelligence-, or national security-related activity," Winkenwerder said.

However, even under these circumstances, there are specific procedures medical professionals must follow and document. The disclosure must be approved by the local medical unit commander, and commanders must keep detailed records on specific information disclosed, the person to whom it was disclosed, the purpose of disclosure, and the name of the commander who approved the disclosure.

The new procedures also separate individuals who are providing care from healthcare 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," Winkenwerder said.

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

Conversely, medical professionals in other roles in detention operations should not provide actual care for detainees. Such individuals might include behavioralscience 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.

"It's separating these roles to make very clear that there's not to be mixing of the roles," Winkenwerder said.

He said 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.

DoD officials surveyed medical personnel who have served in detainee operations in Iraq, Afghanistan and Guantanamo Bay, Cuba, and solicited input from the military services and the Joint Staff.

LTG Kevin Kiley, the Army's surgeon general, has undertaken a separate review of allegations that military medical personnel took part in abuses and assisted in interrogations. Winkenwerder didn't discuss the ongoing review except to say that "only a very, very small number of reports of observation of possible abuse" have been recorded.

The doctor explained that the new rules don't change current guidelines for medical personnel, just provide more specificity.

"What we are issuing ... goes beyond existing standards and it represents, in our view, a real improvement to the existing guidance," he said.

Throughout the military, standards of care for detainees is required to be the same as that of care provided military personnel. At Guantanamo Bay, detainees receive care at a state-of-the-art detention hospital dedicated to their treatment.

In Iraq and Afghanistan, detainee care is not separate from that provided troops and civilians. In Iraq, for instance, detainees receive medical care at the combat support hospitals in Balad and Baghdad or at the medical facility at Abu Ghraib.