Reports Criticize Medics for Overlooking Abuses


The New York Times

August 27, 2004

The failures of Army medical staff members to prevent and report torture, as detailed in reports about abuses at Abu Ghraib prison this week, shows the need for more investigation and better training, medical ethicists and the Army itself said yesterday.

Punishment was recommended for two medics in a report released on Wednesday by Maj. Gen. George R. Fay and Lt. Gen. Anthony R. Jones. The report also described acts by unknown doctors and medics, who presumably would be punished if they were ever identified.

Under international law, said Dr. Vincent Iacopino, research director for Physicians for Human Rights, the failures by members of the military to report torture "are war crimes, so anyone responsible should be held accountable."

Although all soldiers have a duty to report war crimes, many physicians feel that doctors, nurses and medics have a higher obligation to do so, and they are bothered by the dual loyalties created by war: a doctor may feel torn between loyalty to comrades and the duty to treat and protect patients, even those from the enemy side.

The Fay report accused a medic of failing to report abuse even after guards ignored his instructions to stop it, described a doctor's indifference to proper care of prisoners and implied that medical personnel knew of the cover-up of a death.

But the 171 pages of the report that were released contain only a fraction of what investigators know, said Dr. Steven Miles, a bioethicist from the University of Minnesota's medical school who has been collating accounts from human rights groups, testimony at military trials and news media interviews with witnesses.

He described himself as "just grossed out" by the evidence.

For example, the Fay report describes a doctor who refused to remove a prisoner's catheter, despite a request from a guard to do so.

The guard, Sgt. Theresa Adams, found the prisoner in a cell where he had been placed on his return from the prison hospital. He was naked and bleeding, with a catheter hanging from him with no bag attached.

The prisoner, a Syrian jihadist, had shot a guard with a gun smuggled into the prison and was tortured after he recovered - chained to a bed by a dislocated shoulder and beaten on his wounded leg.

The doctor, a colonel whose name Sergeant Adams apparently could not remember, refused, saying the catheter had been put in at the hospital and could be removed there the next day.

According to the report, Sergeant Adams asked whether he had ever heard of the Geneva Convention, and was told: "Fine, sergeant. Do what you have to do, but I am going back to bed."

Dr. Iacopino said a doctor might correctly have hesitated to remove a wound drain inserted by a surgeon, "but there ought to have been a better response."

"It seems to have been a form of negligence," he said.

Dr. Miles said an open catheter was an infection risk and should have been removed or attached to a bag.

"He should have sent the guy back to the hospital or dealt with it himself," he said. "To simply ignore it is unacceptable."

The report also described an incident on the night of Nov. 4, 2003, when a suspect in an attack on a Red Cross building was brought in.

The prisoner, who had been hit in the head with a rifle butt during his arrest by Navy Seals and Central Intelligence Agency officers, died, apparently as a result of the blow, within an hour. Unidentified American medical personnel gathered with C.I.A. and military intelligence officers around the body on the floor of a shower room.

The body was zipped into a body bag with ice, but the next day it was carried out on a litter, as if the prisoner were only sick. Other reports have said a medic put an intravenous line into the corpse's arm to add to the illusion.

The Fay report said that this had been an effort to fool Iraqi prisoners and guards, and that the body had been correctly autopsied and the death attributed to the head blow. But "any time you start messing with the time and scene of a death, you're doing something unethical," Dr. Miles argued.

Doctors seem to have colluded in covering up other deaths of detainees in Iraq, he said. A well-known case was described in The Denver Post in May, in which an Iraqi general suffocated after his interrogators pushed him upside down in a sleeping bag and sat on his chest. An on-site surgeon, whose report was initially posted on a Pentagon Web site, said the general had died of natural causes.One of the medics described in the Fay report was called to treat a prisoner who had been punched so hard that he could not breathe. While there, the medic saw detainees stacked naked in a pile - a now well-known photograph. He failed to report the incidents.

Army regulations, the Geneva Convention and the federal War Crimes Act require all military personnel, not just medics, to report evidence of abuse or torture.

"Some people think that's politically correct nonsense, but it's not," said an Army spokeswoman. "From privates to generals, we're trained up on the Geneva Convention. Medics aren't special - all soldiers are morally accountable for their actions."

If an immediate superior did not act, she said, the medic should have reported the abuse up the chain of command, or to the Army inspector general's office or, failing that, to an officer of another unit.