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SUBJECT: Medical Program Support for Detainee Operations Translation: SUBJECT: Exploitation of Military and DoD Contract Health Care Professionals Executive Summary Translation: "Military health care professionals are instructed to shut the f*** up and do as you are told. Non-medical commanders can (and probably will) order you to violate your personal principles of medical/nursing/PA/BSC ethics. You may even be ordered to commit crimes against humanity. You are instructed to remember that you are a military officer (or NCO, or soldier/sailor/airman/marine) first, and everything else second. Remember Rule Number One: if someone is labeled an 'enemy combatant', anything goes; Rule Number Two: refer to rule number One; Rule Number Three: if you object to the above rules, you risk being labeled an illegal combatant Enemy of the State yourself. After all, if you are not with us, you are with the terrorists. Never forget: in detention, as in space, no one can hear you scream." Translation of Specific Sections of the Policy Follows: 4.1.2. Health care personnel charged with the medical care of detainees have a duty to protect detainees’ physical and mental health and provide appropriate treatment for disease. To the extent practicable, treatment of detainees should be guided by professional judgments and standards similar to those applied to personnel of the U.S. Armed Forces. Translation: "'Health care personnel' (HCP) not charged with the medical care of detainees will do whatever the Commander tells them to do, even if this means harming or contributing to harm of the patient, er, enemy combatant. Note that we are explicitly devaluing physicians by lumping them together with other HCPs, including Airman Snuffy who once watched an entire episode of 'House' on television. Note that the phrase 'to the extent practicable' is synonymous with the term 'never'." 4.1.3. Health care personnel shall not be involved in any professional provider-patient treatment relationship with detainees the purpose of which is not solely to evaluate, protect, or improve their physical and mental health. Translation: "We are setting up a two track system for physicians and other medical professionals: Docs specifically assigned to a 'professional provider-patient treatment relationship' (PPPTR) role will be allowed to act as humane physicians, in accordance with the Hippocratic Oath and international law; physicians and other 'LIPs' (Licensed Independent Providers) assigned to break down the will of 'illegal combatants' will do whatever Command asks of them; basic biomedical ethical principles will not apply. See section 4.3: Health care personnel engaged in non-treatment activities, such as forensic psychology, behavioral science consultation, forensic pathology, or similar disciplines, shall not engage in any professional provider-patient treatment relationship with detainees... "So, Mondays/Wed/Fri, Doc Jones is assigned to a PPPTR role; she is issued a stethoscope. On Tues/Thurs, Doc Smith, on the other hand, is assigned to an NTA role (Non-Treatment Activity); he is issued a cattle prod." 4.1.4. Health care personnel, whether or not in a professional provider-patient treatment relationship, shall not apply their knowledge and skills in a manner that is not in accordance with applicable law or the standards set forth in Reference (c). Translation: "Note: there is no Reference (C) in the instruction (check the text: http://www.dtic.mil/whs/directives/corres/rtf/231008x.rtf). There never was. If you wish to extrapolate the content of Reference (C), an executive summary of same would be: 'Shut up and do what you're told, Major, or suffer the consequences.'" 4.4. Medical Information. Health care personnel shall safeguard patient confidences and privacy within the constraints of the law. Under U.S. and international law and applicable medical practice standards, there is no absolute confidentiality of medical information for any person. Translation: "We are setting up a pseudo-legal cover for our blatant misuse of patient medical information by incorrect extrapolation of specific cases to the general misuse of medical information as we see fit. This is known as the 'slippery slope' fallacy. IF it is true that physicians are required to report child abuse or drug use to law enforcement or command authorities, then it MUST be true that Achmed's childhood trauma from a severe dog bite can be communicated to the OGA guy in the black outfit sans nametag, who can (and will) transmit this information to Doc Smith, who is assigned to NTA prisoner interrogation duties today. Quod Erat Demonstrandum." "For an explanation of OGA, go here: http://www.post-gazette. com/pg/03236/214533.stm" 4.4 (continued) However, whenever patient-specific medical information concerning detainees is disclosed for purposes other than treatment, health care personnel shall record the details of such disclosure, including the specific information disclosed, the person to whom it was disclosed, the purpose of the disclosure, and the name of the medical unit commander (or other designated senior medical activity officer) approving the disclosure. Translation: "If the person to whom it is disclosed is an OGA spook, however, the use of pseudonyms will be required, as in 'I told Agent Orange to set dogs on Achmed to break his will.'" Similar to legal standards applicable to U.S. citizens, permissible purposes include preventing harm to any person, maintaining public health and order in detention facilities, and any lawful law enforcement, intelligence, or national security-related activity. Translation: "'Any lawful law enforcement, intelligence, or national security related activity' means do anything the F*** we say, or risk being labeled an enemy combatant yourself, LtCol (Dr.) Jones. After all, name me something, anything we do in military service which cannot be construed as a 'National Security-Related Activity'. Can't think of anything, can you, punk? Neither can we, so shut your pie hole and follow orders." 4.4.1 When the medical unit commander (or other designated senior medical activity officer) suspects the medical information to be disclosed may be misused, or if there is a disagreement between such medical activity officer and a senior officer requesting disclosure, the medical activity officer shall seek a senior command determination on the propriety of the disclosure or actions to ensure the use of the information will be consistent with applicable standards. Translation: "The medical unit commander is explicitly *not* given authority to implement ethical patient care standards and to enforce observation of the Hippocratic Oath and basic humanity. The non-physician, non-medically-trained commanding bureaucrat has the authority to overrule physicians under her command. Biomedical ethics takes a back seat to military rank and political position on the org chart...always. Although this is tantamount to allowing a physician to order a pilot to take off in an airplane suffering from a known, fatal mechanical problem, this is policy, so deal." 4.4.2. Consistent with applicable command procedures, International Committee of the Red Cross physicians shall be given access to review medical records of detainees during visits to detention facilities. "'Applicable command procedures' includes the right to ignore international laws, treaties and conventions. After all, if our Commander in Chief can issue policy letters that explicitly and unconstitutionally overturn laws passed by the Congress of the United States of America via 'signing statements' (see http://www.nybooks.com/articles/19092), how much easier is it for a military commander to promulgate a 'Command Procedure' that states that OPSEC (Operational Security) would be threatened by granting ICRC representatives access to our detainees? Note that this policy slyly limits ICRC access to medical records only during 'visits to detention facilities'. Wasn't it smart of us to exclude our dozens of 'Black Sites' housing ghosted beneficiaries of 'extraordinary rendition', the mere existence of which we deem to be a National Security matter, and thus completely off limits to namby-pamby, beret-wearing, clove cigarette-smoking, snail-eating ferners, including especially frog-speaking, U.N. resolution-waving, ICRC medical scum?" 4.5. Reportable Incident Requirements. Any health care personnel who in the course of a treatment relationship or in any other way observes or suspects a possible violation of applicable standards, including those prescribed in References (b), (c), and (e), for the protection of detainees shall report those circumstances to the chain of command. Translation: "...who will ignore the whining of lower-ranking medical pukes with extreme prejudice, while simultaneously using every lever of UCMJ power at their disposal to neutralize the threat posed by intelligent subordinates with backbones. After all, there are only two good types of military subordinates: stupid ones who don't talk back, and smart ones who suck up. Smart ones who talk back are by far the absolute worst, especially when they are embarrassingly 100% correct in their medical and/or ethical judgments." Health care personnel who believe such a report has not been acted upon properly should also report the circumstances to the medical program leadership, including the Command Surgeon or Military Department specialty consultant. Translation: "...who will cover-up the whining of their lower-ranking puke subordinate whiners, in order to protect their own asses and careers. Besides, in 2006, only incompetent clinicians stay in the military to attain O-6 or above rank. After years of flying desks and sucking up to superiors to make rank, what kind of moron Command Surgeon or specialty consultant would risk his/her retirement pension by making waves about touchy-feely stuff like compunctions about abusing prisoners? That would require integrity and honor-- two qualities beaten out of military officers in order to attain O-6 rank." Officials in the medical program leadership may inform the Joint Staff Surgeon or Surgeon General concerned, who then may seek senior command review of the circumstances presented. Translation: "...if they have a suicidal need to destroy their own careers, subject themselves to adverse performance reviews and Letters of Reprimand, while not affecting the actual care of detainees one iota." Other reporting mechanisms, such as the Inspector General, criminal investigation organizations, or Judge Advocates, also may be used. Translation: "...because, since 2001, we have seen how effective these mechanisms have been in covering up war crimes and violations of international laws at Abu Ghraib, Guantanamo, Bagram Air Base, and various classified 'rendition' sites across Eastern Europe. The IG system is especially helpful in whitewashing wrongdoing by the chain of command. All that is required is a legal finding that the crimes against humanity were committed unilaterally by 18 year olds who had been asking 'do you want fries with that' until the day before their Reserve units were activated, rather than as a direct result of inhumane torture policies promulgated by General officers, such as this one: LtGen Ricardo S. Sanchez's 14 Sep 2003 Interrogation Rules of Engagement. The IG office can truthfully avow that there is 'no evidence' that black-clad OGA spooks misused the above flawed policy to coach kids from Cresaptown, Maryland on the 'command-approved' modalities for breaking down the wills of suspected terrorist detainees who 'may' have been involved in killing their own buddies. Best of all, not one of these legal mechanisms involves humans who know anything about the ethical standards of medical care of patients by physicians and other health care professionals, which is the entire point: the Flag Rank Chain of Command is considered paramount and sacrosanct, while mealy-mouthed complaints by company grade and field grade physicians are consigned to the unique military circular file reserved for all dissenting opinions by inferiors. Res ipsa loquitur." 4.5.1. Health care personnel involved in clinical practice activities shall make a written record of all reports of suspected or alleged violations in a reportable incident log maintained by the medical unit commander or other designated senior medical activity officer. Translation: "...so that said incident log can be ignored and/or held against the medical officer as evidence of her disloyalty to the infallible will of the President, who was chosen by God and His Son, Jesus Christ, Himself to remake the Middle East in America's image, in Jesus' Holy Name, Amen." 4.6. Training. The Secretaries of the Military Departments and, as appropriate, Combatant Commanders shall ensure health care personnel involved in the treatment of detainees or other detainee matters receive appropriate training on applicable policies and procedures regarding the care and treatment of detainees. This training shall include at least the following elements: Translation: "1) Basic cattle prod insertion techniques: Above the waist 2) Advanced cattle prod insertion techniques: Below the waist 3) How to use anesthesia drugs to Poison the Pizzas of Enemy Combatants to subdue them 4) Basic use of seduction by cute psychiatrists (of either gender): Up to R 5) Advanced use of seduction by cute psychiatrists (of either gender): NC17 and beyond 6) Koran desecration 101: Elemental Alterations (fire, water, earth, etc.) 7) Koran desecration 201: Bodily Functions 8) Fingernail anatomy refresher course for bamboo sliver insertion purposes 9) Recent advances in waterboarding: Is air mandatory or optional for human survival? 10) Clinical Electricity: Neurophysiologic responses to genital application of alternating current vs. direct current, and their connection to Broca's cortical area mediating speech production" 4.7. Consent for Medical Treatment or Intervention. In general, health care will be provided with the consent of the detainee. Translation: "In specific cases, consent is entirely optional." 4.7.1. In the case of a hunger strike, attempted suicide, or other attempted serious self-harm, medical treatment or intervention may be directed without the consent of the detainee... Translation: "So stuff that NG tube down Achmed's nose now, Major, because your commanding officer orders you to do so...Don't believe me, son? Read this and weep:" Such action...must be approved by the commanding officer of the detention facility or other designated senior officer responsible for detainee operations. Translation: "...because that non-medical Commander outranks the most senior physician on base/post, so his/her will is Law, regardless of any limpwristed biomedical/ethical objections you harbor in your terrorist-loving heart." 4.7.2. Involuntary treatment or intervention under subparagraph 4.7.1. in a detention facility must be preceded by a thorough medical and mental health evaluation of the detainee and counseling concerning the risks of refusing consent. Such treatment or intervention shall be carried out in a medically appropriate manner, under standards similar to those applied to personnel of the U.S. Armed Forces. Translation: "Detention Center X-ray, Andrews AFB, November 11, 2008: SSgt Johnson, we are about to stuff an NG tube down your nose involuntarily because you have gone on a hunger strike to protest your detention as an enemy combatant as a result of your seditious anti-Empress Jenna postings to various internet blog sites from June 2007 through October 2008. You have been medically evaluated by a legally-sanctioned housekeeper physician's assistant assistant's assistant, and mentally evaluated by your Commanding Officer, who has given you the Command-designated pseudo-DSM-V diagnosis of 'Nuts'. Therefore, in accordance with policy, you are hereby given the following legal order: suck it down." 4.9. Health Care Personnel Management. As a matter of personnel management policy, except as provided in this paragraph, health care personnel’s support of detainee operations is limited only to providing health care services in a professional provider-patient treatment relationship in approved clinical settings, conducting disease prevention and other approved public health activities, advising proper command authorities regarding the health status of detainees, and providing direct support for these activities. Medical personnel shall not be used to supervise, conduct, or direct interrogations. Health care personnel assigned as, or providing direct support to, BSCs, consistent with Enclosure 2, or AFME personnel, are the only authorized exceptions to this paragraph. The Assistant Secretary of Defense for Health Affairs (ASD(HA)), or designee, must approve any other exceptions to this paragraph. Translation: "Doctor Jones, ASD (HA) Winkenwerder says you have to go to Cell Block 17 to help interrogate Achmed, so refer to the executive summary of Department of Defense INSTRUCTION NUMBER 2310.08E June 6, 2006: 'shut the f*** up and do as you are told'." Face it: Military Medicine is Dead, Jim. R. Carlton Jones, M.D. ex-LtCol, USAF, MC ex-Medical Director of Anesthesia, Travis AFB, CA ex-Assistant Chief Anesthesiologist, Andrews AFB, MD Harvard '85, USU '90, WHMC residency 1994 Diplomate, American Board of Anesthesiology, 1995 webmaster_AT_medicalcorpse_DOT_com http://www.medicalcorpse.com Nemo Me Impune Lacessit Above Copyright (C) 2006 R. Carlton Jones, M.D. All republishing rights reserved. E-mail webmaster_AT_medicalcorpse.com for permission to republish whole or in part.
