http://www.latimes.com/news/opinion/commentary/la-op-bloche11mar11,0,1266240.story?coll=la-news-comment-opinionsThe silence that fueled Walter Reed and Abu Ghraib
The military's culture of fear allows crises to fester before exploding into public view.
By M. Gregg Bloche, M. GREGG BLOCHE is a professor of law at Georgetown University, senior fellow at the Brookings Institution and visiting professor of law at UCLA.
March 11, 2007
WHAT went wrong at Walter Reed Army Medical Center? Congressional hearings and a new commission to study medical care for soldiers and veterans will yield some answers, but in the meantime, a past crisis may provide some clues.
Clinicians correct their mistakes by talking about them, a truth brought home in recent years by multiple studies of medical error in civilian settings. In healthcare, silence is deadly. Military doctors understand this. The culture of armed forces medicine has long encouraged open discussion of clinical and administrative difficulties. Rank has counted for less in such conversations than it typically does in the military. But since 9/11, there's been slippage toward a different ethic — one of denial and evasion. Fear has driven this shift — fear of the consequences of speaking freely.
In 2004 and 2005, I and a colleague, Jonathan Marks, reported that some military doctors covered up detainee abuse — and even helped to plan it — at Abu Ghraib, Guantanamo Bay and secret sites elsewhere.
When these stories and others broke, many in military medicine were shocked and ashamed. They tried to talk about what had gone wrong — and what the rules should be at such places as Abu Ghraib — in the face of pressure to support the Bush administration's few-holds-barred approach to detainees suspected of terrorism. But the Army's top doctor, Lt. Gen. Kevin C. Kiley, and his politically appointed civilian overlord, William Winkenwerder, both of whom now face congressional fire for the squalid treatment of rehabbing soldiers at Walter Reed, made it plain to their troops that they couldn't talk about what went on at Abu Ghraib or Guantanamo.
Shortly after the revelations of prisoner abuse at Abu Ghraib, I was asked by faculty at the military's medical school, the Uniformed Services University of the Health Sciences, to speak at a forum on the ethics of clinical work with detainees. A tentative date in late summer of 2004 was set. I was then told by the event's sponsors that then-Defense Secretary Donald H. Rumsfeld's civilian staff had ordered the session canceled.
Later that year, Maj. Scott Uithol, an Army psychiatrist deployed to Abu Ghraib to help plan interrogations, was to speak at a forensic psychiatry conference on the ethical and other challenges this work posed. The Army Medical Command, headed then as now by Kiley, ordered him not to do so. Kiley ran Walter Reed from 2002 to 2004.
Many other Army doctors gave us similar accounts of being told to keep silent. Several junior officers spoke of threats from above to end their careers and bring criminal charges against anyone who broke with the brass' "don't-ask, don't-tell" approach to mounting evidence of medical complicity in prisoner abuse. A reservist, Maj. David Auch, was scathingly criticized by Pentagon higher-ups when we quoted him in a New York Times article about nightmarish staff and equipment shortages at Abu Ghraib, to the point that a dentist did heart surgery and chest tubes were taken from the dead for reuse.
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