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Dr.
William Winkenwerder Jr. Assistant Secretary of Defense
for Health Affairs
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By
Kathleen T. Rhem
American Forces Press Service
WASHINGTON -- Department of
Defense officials recently issued new guidelines for military
medics dealing with detainees.
The new rules deal with patient care, interrogations and
medical-record confidentiality, among other issues, the
department’s top doctor said June 17.
Dr. William Winkenwerder Jr., assistant secretary of defense
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 medics
must be guided by medical ethics, make medically appropriate
decisions and report inhumane treatment.
Specifically, Winkenwerder said the new policy states
military health-care 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 that 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 medics 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 health-care professionals who work in other
capacities in detention operations. Medics 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 health-care personnel shall not actively solicit
information from detainees for purposes other than health-care
purposes," he said.
Conversely, medics in other roles in detention operations
should not provide actual care for detainees. 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.
"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 surfaced
of medics assisting in abusing prisoners.
"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 medics who have served in detainee
operations in Iraq, Afghanistan and Guantanamo Bay, Cuba,
and solicited input from the military services and the
Joint Staff.
Army Lt. Gen. (Dr.) Kevin Kiley, the Army's surgeon general,
has undertaken a separate review of allegations that military
medics took part in abuses and assisted in interrogations.
Winkenwerder did not 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 said the new rules do not change current guidelines
for medics. They simply 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
are required to be the same as that of care provided to
service members. 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 separated
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.
Winkenwerder said that he returned earlier this week from
a visit to Iraq where he visited medical-care facilities.
"I witnessed our people taking care of detainees
in one hallway, and in the next hallway were Iraqi civilians,
and the next hallway were U.S. Soldiers," he said.
In Iraq and Afghanistan, detainees do not just receive
the same standard of care as U.S. troops do, but actually
the same care, from the same providers in the same facilities.
While he was in Iraq, Winkenwerder said he spent time
with military health-care providers, including some involved
in caring for detainees there.
"They offered their views that they must care for these
individuals as they would care for U.S. service members,
and what I observed is that they're doing just that,"
Winkenwerder said. "Their professionalism, if you could
only see it, would make all Americans proud."
