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Testimony of unreported deaths and medical treatment without consent

Minutes, Meeting of the Armed Forces Epidemiological Board
Island Club, North Island Naval Air Station, San Diego, California
February 19, 2002

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CAPT. YUND: […] I'm, again, Captain Jeff Yund from the Bureau of Medicine and Surgery. I work for Admiral Hart and a number of other admirals.

Two main topics. I'm going to tell you a little bit about Guantanamo Bay, what's going on down there. Then--there's a little bit of preventive medicine in the Guantanamo Bay segment. Then the preventive health assessment, which is pretty much purely preventive medicine.

After September 11th, Navy Medicine was involved in many places in New York, of course, also at the Pentagon.

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Staff from Bethesda were very involved in all of the Anthrax response in D.C. and Capitol Hill.

Eventually it became clear that Guantanamo Bay was going to be receiving detainees. I want to tell you a little bit about what's happening at Guantanamo Bay.

There's a small naval hospital there serving a population of about 3,000 people. The CO, Captain Shimkus, is now the Joint Task Force 160 surgeon. As of January 31st, his population had popped up, increased by about 60%. This additional 60% was a somewhat different population from the other 3,000 that he had in his population and has necessitated some changes in business.

One of the first things the CO did was start up a six-bed detainee advanced care unit in the hospital. This had the staff that you see there. Interestingly, all of the detainees travel with two MPs in addition to their shackles. The next change to business was an echelon one for sick call and some emergency medical care at Camp X-ray, very close to--right where the detainees are being housed.

Also very early on, a preventive medicine team from EPMU2, including a preventive medicine doc and EHO and IHO and microbiologist and also four technicians showed up to help deal with a number of anticipated preventive medicine issues in dealing with detainee health.

A couple of other things, a joint aid station was

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for health care to be provided to the joint task force personnel. This was kept pretty strictly separate from the aid station, if you will, at Camp X-ray.

Also, a SPRINT team, special psychological rapid intervention team, was brought down to--primarily to assist the staff at the hospital and also the JTF--deal with the issues--significant issues that were anticipated that might be--might surround dealing with such a different patient population from what they were used to.


Fleet Hospital 20 was rapidly organized as a subunit of the full fleet hospital and brought down--the size of a full fleet hospital is up to 500 beds, but in this case it was pared down a little bit to 20 to 36 ICU and other acute care beds, capability for two surgical suites. The staff you see here--and agreat CQ-rity. (Laughter.)

CAPT. YUND: I'm going to have to talk to my secretary about that.

A lot of security issues that the hospital and also the fleet hospital are having to deal with.

One of the very early decisions that was made was that the quality and level of detainee care was going to be equal to the care that U.S. troops receive there or anywhere. One proviso is that it will all be done at Guantanamo Bay. So this level of care that we normally provide is considerably more
 
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difficult when the patient is in shackles and there are two MPs around--and they're very close around. They're not off at the periphery.

In addition, there was going to be a need for long-term rehabilitative care, which is not usually in the mission of a fleet hospital, but in this situation, it was an added mission.

The number of infectious disease and preventive medicine issues--I'll just mention malaria. A number of the detainees arrived with malaria parasites in their blood. There are two issues. Certainly you want to treat the malaria that the individual detainee has, but another issue is that malaria has been absent from this part of Cuba for--or maybe from all of Cuba for quite some time. So another big issue is doing what's necessary to prevent malaria from becoming endemic in this area again.

A number of medical legal issues surrounding care with--of the detainees. Informed consent is absolutely practiced. There are translators. Informed consent is probably more strictly applied in this situation than for our own folks. There are some times when there are procedures that are required to save a life that, even if informed consent is not obtained,
the procedure is carried out.

There is a great deal of medical photography going on in order to document the before and the during and the after.
 
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Mortuary affairs is an important but hopefully small aspect of the activities of the hospital. A number of the detainees have died of the wounds that they arrived with. So there's attention being paid to doing the things with the body that would be appropriate for their culture.

These are just a few of the Navy boots on the ground down there.

Now, we're going to move on to the preventive health assessment. I just wanted to give you a brief glimpse of Guantanamo Bay. If there--I suppose there might be some questions about that. If anybody has any questions about Guantanamo Bay, I might be able to answer them.

Sir?

DR. CAMPBELL: Doug Campbell. What kind of surveillance did you do for the health issues that detainees had when they arrived there?

CAPT. YUND: Well, one thing that's ongoing in the detainee camp is disease and non-battle injury surveillance, the same type of disease and non-battle injury surveillance that our troops have applied to them on a deployment. In addition, every detainee received a complete history and physical examination when they arrived.

So there was--we learned quite a bit--our people down there are learning quite a bit about their health and about what sort of conditions they have when they arrive.
 
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DR. OSTROFF: One quick question. I know that TB has been a particular concern from the very beginning. Is there any suggestion that any of them have had active tuberculosis?

CAPT. YUND: I have heard that up until a couple days ago there had been no active cases of tuberculosis.

DR. CATTANI: Jacqui Cattani. This may be a bit of a detailed question, but you mentioned malaria and the prevention of reintroduction of malaria into Cuba. Can you tell me what you're actually doing, or is that a level of detail too sort of far down?

CAPT. YUND: No, I don't think that's too far down. If we had somebody--the main thing that you want to do is--

DR. OSTROFF: If I can ask you to talk into the microphone.

CAPT. YUND: Oh, sorry.

DR. OSTROFF: Otherwise we can't record.

CAPT. YUND: The main concern is while you're treating someone who's parasitemic is to guarantee that vector mosquitoes can't get to that person. So, in order to do that, there are--I mean, you can use insect repellants, both permethrin and Deet. Other ways to go about that are adulticiding and larviciding for mosquitoes in the area to cut down the number of mosquitos.

DR. CATTANI: I guess the point was are you
 
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treating them with primaquine as a gamenocidalcidal (ph) agent? That would be more effective in most cases than just trying to do vector control or limitation.

CAPT. YUND: Right. Yes, ma'am, I think they are receiving primaquine.

DR. BERG: Bill Berg. Jeff, what is being--can you give us a bit more detail on the diagnosing and ruling out tuberculosis? I was the JTF surgeon there when the Cuban refugees were there. There were two challenges. One, we had to get a technician in Gentmo (ph) who knew how to do AFB smears and then, because there were no AFB culture capabilities there, they had to be sent up to the Naval Hospital Portsmouth. What is in place to address that, that a diagnosis is not missed in an area that normally does not have much to do with TB?

CAPT. YUND: What I'm going to tell you is a guess, but there's a microbiologist there with the EPMU team. So that brings additional capability as far as smears. I doubt that they're doing cultures on site there, but that may be--they may be doing that. So I don't really have a definitive answer for you.

DR. OSTROFF: Other questions? (No audible response.)

CAPT. YUND: Okay, we'll move on to the next series of slides.

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CSHRA Note

Captain Yund has said that the statements he made above regarding unreported deaths were not made from personal or direct knowledge, but that this "is not the type of statement that I would make without having learned it from a source I considered reliable."

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