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DoD Health Affairs Secretary visits Guantanamo

US Southern Command Website
By Army Spec. Shanita Simmons
August 13, 2005

GUANTANAMO BAY, Cuba – The Assistant Secretary of Defense for Health Affairs visited U.S. Naval Station Guantanamo Aug. 8 to ensure that detainees here are receiving the highest level of care.

Dr. S. Ward Casscells met with Joint Task Force military personnel to discuss whether current policies affecting detainee care and treatment are being properly implemented. He also toured the Joint Task Force detainee and base hospitals where he was briefed on the latest procedures and equipment used to treat detainees.

“As a practicing doctor, I wanted to ensure that the detainees were getting good care. I was pleased to see the state of the art equipment being used, and the caregivers gave good answers to my questions,” said Casscells. “I came here today in an oversight role to determine whether the policies that were drafted are actually being carried out.”

Casscells met confidentially with individual Troopers of all ranks and inquired whether they believed they had the support of their leadership and the equipment necessary to properly perform their duties. Casscells expressed confidence that the individuals he spoke with were truthful in their responses, especially when he asked whether they had knowledge of or witnessed any mistreatment of a detainee. “Moreover,” Casscells stated, “as the personnel at the camp had no names on their uniforms, and I spoke with them in private, I am confident I got the truth.”

He mentioned that a recent article published in the Journal of American Medical Association that challenged the ethics of enteral feeding by Joint Medical Group personnel prompted him to visit Guantanamo Bay and witness the procedure himself.

“I got to witness two of the tube feedings done by the nurse. In those instances I witnessed, there was no fighting or resistance,” said Casscells. “Tube feeding is a complicated issue because the detainees are not American citizens, they are not prisoners of war, nor are they criminals in the usual sense. They have this controversial status, which makes the circumstances difficult.”

After meeting with physicians and other medical personnel, Casscells concluded that the care detainees received met the guiding principles set out in the Geneva Conventions, and exceeds those standards in several respects. For example, there are seven doctors, 12 nurses, and 83 Corpsmen caring for 355 detainees. They can call in specialists within 12 hours. Sick call is daily. They can make appointments. If they object to a female doctor, they are offered a male doctor.

Preventive medicine (for example, colonoscopy, vaccinations, eye exams, stress tests) is routine, as is dental care (two cleanings per year), and psychological care.

In addition to reviewing the ethics of medical procedures, Casscells wanted to ensure that detainees were treated humanely during interrogations. He met with the director of interrogations to discuss allegations of physical abuse against detainees that have been publicized in recent newspaper articles.

“The interrogation process was explained to me as being non-physical and non-confrontational. The interrogators reported they have gotten information [from detainees] that is saving lives,” said Casscells. “A lot of them have been implicated by independent observers for having participated in terrorist activities. We can not take that lightly, so we just cannot cut them all loose. Our number one mission is to make sure that our troops’ lives are saved. So if they can provide information that keeps our troops alive then that is very good.”

In the future, Casscells said he would like to meet with Islamic physicians and religious leaders to discuss various medical
ethics issues. He also hopes to get input from these individuals on controversial issues such as enteral feeding. “Medical ethics is important, and not simple. We routinely seek a broad spectrum of viewpoints. But I have not seen anything that suggests the feeding policy is wrong. No U.S. law or religion approves of suicide. Since some of the strikers are said to have told the doctors they are ordered by detainee leaders to go on hunger strike, the doctors have to feed them when there is a risk of death, since they feel they cannot take at face value the refusal of food from someone who is coerced, or someone who may be depressed.”

“I should also add that it was reassuring to hear Admiral Buzby say his goals are to deliver humane care, to take care of his troopers too, and to be transparent. The mission statement, ‘holding the right people, in the right place, for the right reasons, and doing it the right way,’ is taken seriously. That’s leadership.”

Casscells assumed his current position in April 2007. He is responsible for the overall leadership of the military health system, and he serves as the principal advisor to the Secretary of Defense in regards to health care policies and programs.

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