Paul Krugman calls attention to this figure showing Medicare costs vs. private insurance:
Seeing this figure, wouldn’t everyone think that replacing Medicare with private insurance was just the thing for cost saving?
June 13th, 2011
A bill in New York would ban health professionals involvement in torture. It is a sad comment that such a bill is needed. The state medical association is opposed. In contrast, the state psychological association supports it. We are pushing a similar bill in Massachusetts, as are psychologists in other states. Here is an article from the AMA newsletter:
Medical board could discipline physicians for torture under N.Y. bill
The unique proposal would give the state board the authority to punish doctors and others who take part in, or conceal evidence of, tortureBy Kevin O’Reilly
A New York bill that is the first of its kind in the nation would make participation in torture or interrogation of prisoners grounds for board discipline of physicians and other health professionals.
Dozens of medical students and other health professionals in training lobbied in favor of the legislation in late May, meeting with nearly 40 New York state legislators, said Allen Keller, MD. He helped organize the lobbying trip and directs the Bellevue Hospital Center/New York University Program for Survivors of Torture in New York City.
The bill, which was introduced in March by Democratic Assemblyman Richard N. Gottfried and has 39 co-sponsors, would give the state medical board and other health professional licensing boards the explicit authority to suspend or revoke practice rights based on evidence presented in accordance with the state’s usual due-process procedures (assembly.state.ny.us/leg/?default_fld=%0D%0At&bn=A05891&term=&Summary=Y).
Under the bill, physicians and other health professionals would be barred from directly participating in torture, treating patients with the intent of determining when torture could continue, concealing medical evidence of torture or taking part in individual interrogations. Health professionals could generally advise interrogators on rapport building or other nonabusive techniques.
The bill is needed to give medical licensing boards clear authority to discipline doctors and others for participating in torture, supporters say. In 2007, a complaint was brought against one psychologist alleged to have participated in abusive interrogations at Guantanamo Bay, but the New York state body that licenses psychologists said it did not have jurisdiction to investigate the matter.
“We want to clarify that this is, indeed, grounds for discipline and also to achieve a preventive effect,” said Dr. Keller, associate professor of medicine at NYU School of Medicine. “It’s easier for individuals to torture than we’d like to think, because of hierarchies and environments that allow it. We believe this legislation would help physicians who are put in an untenable position to say, ‘I can’t do this; I’d lose my license.’ ”
A state matter?
The American Medical Association and the Medical Society of the State of New York have policy opposing physician participation in torture or direct participation in interrogations. But the MSSNY said the matter is best handled at the federal level, noting that torture is already criminal under federal law. In a June 2 letter to the New York State Assembly, MSSNY Senior Vice President and Chief Legislative Counsel Gerard Conway noted other concerns.
“The bill provides no practical recourse for physicians who are intimidated by military superiors into withholding reports of torture,” Conway wrote. “There are inherent challenges and barriers to evidentiary discovery for accusations of torture in the military and prisons. Physicians may be poorly positioned to defend themselves since, ostensibly, many of these incidents would occur overseas. Physicians would have to overcome claims of national security and national defense and would have to operate in domains in which civil authority will be limited.”
In response, Dr. Keller said that, with regard to accessing classified documentary evidence, physicians would be on a level playing field with anyone bringing a complaint. If the evidence were classified, then neither the medical board nor the physician would have it to use in a proceeding. On the other hand, if national-security documents were brought into evidence, then both the physician and the board would have equal access to them.
And, he said, it is appropriate for state medical boards to act because they are the bodies charged with regulating physician practice.
“Health professionals — whether they practice in their state or in the Army or wherever — they do so because they have a license that is issued not by the federal government or the Army but by a state,” Dr. Keller said.
The New York legislative session is scheduled to end June 20. Advocates are pushing to have similar legislation proposed in other states.
June 10th, 2011
The Campaign for Peace and Democracy recent statement calling for end to US support for the Bahrain dictatorship is now in the New York Review of Books.
June 10th, 2011
e The New York Times has an interesting article on how physicians’ attitudes, interests, and politics are changing as the profession moves towards becoming more female and more likely to be (high paid) workers rather than self-employed business people. As they report, doctors are now less concerned about tort reform and insurance reimbursement and more concerned about healthcare access and public health. This change could presage an important change in healthcare politics in the country, as physicians come to identify with other workers, not other business people.
As Physicians’ Jobs Change, So Do Their Politics
By Gardiner Harris
AUGUSTA, Me. — With Republicans in complete control of Maine’s state government for the first time since 1962, State Senator Lois A. Snowe-Mello offered a bill in February to limit doctors’ liability that she was sure the powerful doctors’ lobby would cheer. Instead, it asked her to shelve the measure.
“It was like a slap in the face,” said Ms. Snowe-Mello, who describes herself as a conservative Republican. “The doctors in this state are increasingly going left.”
Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against “socialized medicine” on doctors’ behalf.
But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.
There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.
That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
“It was a comfortable fit 30 years ago representing physicians and being an active Republican,” said Gordon H. Smith, executive vice president of the Maine Medical Association. “The fit is considerably less comfortable today.”
Mr. Smith, 59, should know. The child of a prominent Republican family, he canvassed for Barry Goldwater in 1964, led the state’s Youth for Nixon and College Republicans chapters, served on the Republican National Committee and proudly called himself a Reagan Republican — one reason he got the job in 1979 representing the state’s doctors’ group.
But doctors in Maine have abandoned the ownership of practices en masse, and their politics and points of view have shifted dramatically. The Maine doctors’ group once opposed health insurance mandates because they increase costs to employers, but it now supports them, despite Republican opposition, because they help patients.
Three years ago, Mr. Smith found himself leading an effort to preserve a beverage tax — a position anathema to his old allies at the Maine State Chamber of Commerce and the Republican Party but supported by doctors because it paid for a health program. The doctors lost by a wide margin, and the tax was overturned.
Mr. Smith still goes to the State Capitol wearing gray suits, black wingtips and a gold name badge, but he increasingly finds himself among allies far more casually dressed, including the liberal Maine People’s Alliance and labor groups. And while he still greets old Republican friends — he is a lobbyist, after all — he spends much of his time strategizing with Democrats.
Representative Sharon Anglin Treat, a powerful Democrat who was first elected in 1990, said that she and Mr. Smith were once bitter foes. “But Gordon’s become like a consumer activist,” she said with a big smile. “I’ve seen him more times in the last few years than I can count.”
Dr. Nancy Cummings, a 51-year-old orthopedic surgeon in Farmington, is the kind of doctor who has changed Mr. Smith’s life. She trained at Harvard, but after her first son was born she began rethinking 18-hour workdays. “My husband used to drive my son to the hospital so that I could nurse him,” she said. “I decided that I really wanted to be a good surgeon, but also wanted to raise healthy, well-adjusted kids I would actually see.”
So she went to work for a hospital, sees health care as a universal right and believes profit-making businesses should have no role in either insuring people or providing their care. She said she was involved with the Maine Medical Association, for the most part, to increase patients’ access to care.
Dr. Lee Thibodeau, 59, a neurosurgeon from Portland, still calls himself a conservative but says he has changed, too. He used to pay nearly $85,000 a year for malpractice insurance and was among the most politically active doctors in the state on the issue of liability. Then, in 2006, he sold his practice, took a job with a local health care system, stopped paying the insurance premiums and ended his advocacy on the issue.
“It’s not my priority anymore,” Dr. Thibodeau said. “I think Gordon and I are now fighting for all of the same things, and that’s to optimize the patient experience.”
Many of Mr. Smith’s counterparts in other states told similar stories of change.
“When I came here, it was an old boys’ club of conservative Republicans,” said Joanne K. Bryson, the executive director of the Oregon Medical Association since 2004.
Now her group now lobbies for public health issues that it long ignored, like insurance coverage for people with disabilities.
Even in Texas, where three-quarters of doctors said last year that they opposed the new health law, doctors who did not have their own practices were twice as likely as those who owned a practice to support the overhaul, as were female doctors.
Dr. Cecil B. Wilson, the president of the A.M.A., said that changes in doctors’ practice-ownership status do not necessarily lead to changes in their politics. And some leaders of state medical associations predicted that the changes would be fleeting.
Dr. Kevin S. Flanigan, a former president of the Maine Medical Association, described himself as “very conservative” and said he was fighting to bring the group “back to where I think it belongs.” Dr. Flanigan was recently forced to close his own practice, and he now works for a company with hundreds of urgent-care centers. He said that in his experience, conservatives prefer owning their own businesses.
“People who are conservative by nature are not going to go into the profession,” he said, “because medicine is not about running your own shop anymore.”
May 30th, 2011
The Campaign for Peace and Democracy has released the following press release announcing a statement opposing US support for the Bahrain government, currently brutally suppressing its own population with the aid of foreign troops. The statement was signed by Psychologists for Social Responsibility, which is acknowledged in the press release, along with 1,200 individuals, including hundreds of Bahrainis who signed at great personal risk.
If you would like to sign or donate to help publicize the statement, please do so now at the CPD website.
***********
FOR IMMEDIATE RELEASE
May 24, 2011
Contact: Joanne Landy cpd@igc.org
HUNDREDS OF BAHRAINIS JOIN
U.S. CAMPAIGN AGAINST U.S. SUPPORT
FOR THE GOVERNMENT OF BAHRAIN
NEW YORK, N.Y., May 24 2011 – In a response that surprised U.S. organizers of a campaign calling on the United States government to repudiate its partnership with the Al Khalifa regime in Bahrain, hundreds of people from Bahrain joined in signing the Campaign for Peace and Democracy’s launching statement “End U.S. Support for Bahrain’s Repressive Government.”
“The statement was originally circulated for signatures in the United States, but we have been deeply moved by the fact that hundreds of Bahrainis have added their names,” said Joanne Landy, CPD Co-Director. “Given the violent government crackdown in Bahrain, the very act of signing is incredibly courageous. Bahraini signers have implored us to pressure the Obama administration to decisively repudiate its support of their brutal and authoritarian government.”
On May 16, the New York-based Campaign for Peace and Democracy (CPD) began circulating its statement, which has thus far gathered more than 1200 signatures including those of Ed Asner, Medea Benjamin, Noam Chomsky, Martin Duberman, Daniel Ellsberg, Mike Farrell, Chris Hedges, Adam Hochschild, Jan Kavan, Kathy Kelly, Dave Marsh, Frances Fox Piven, Katha Pollitt, Alix Kates Shulman and Cornel West. The statement is below and on the CPD website. Signatures are still being accepted. The statement will be sent to President Obama, Secretary of State Clinton, and key members of Congress, as well as to domestic and international media.
In the United States, Psychologists for Social Responsibility (PsySR) gave organizational endorsement to the statement. Stephen Soldz, PsySR president, stated, “We cannot be silent. Many of our members are health providers. The government of Bahrain has arrested nearly 50 doctors and other health providers, many of whom have been tortured. Their ‘crime’ is refusing to let injured protesters die and informing the world press about the abuses they witnessed.” [See the report by Physicians for Human Rights.]
In the face of mounting complaints against Washington for muting its criticisms of repression in Bahrain, President Obama did say in his May 19 speech on the Middle East, “…we have insisted both publicly and privately that mass arrests and brute force are at odds with the universal rights of Bahrain’s citizens. The only way forward is for the government and oppositi on to engage in a dialogue, and you can’t have a real dialogue when parts of the peaceful opposition are in jail.” However, in the same speech Obama referred to Bahrain as a “friend” and “partner” of the U.S., thus signaling that the massive human rights violations in that country would not stand in the way of continuing U.S. support for the regime or the continuing presence of the U.S. Fifth Fleet, a naval force supporting an interventionist foreign policy.
In words reminiscent of the Administration’s disgracefully neutral stand on the uprisings in Tunisia and Egypt up until the last moment, when the Ben Ali and Mubarak regimes were clearly no longer sustainable, President Obama has called on both the government and the opposition in Bahrain to “engage in dialogue.” What is needed now, however, is not episodic toothless reprimands to Bahrain’s government or pressure on the opposition to engage in dialogue with the regime, but a clear U.S. break with the Al Khalifa government. This would involve:
- An unambiguous statement from Washington that because of the atrocious government repression, Bahrain is not a “partner” or “friend” of the U.S.
- An immediate end to all U.S. aid to Bahrain
- Vigorous condemnation of Saudi Arabia and the United Arab Emirates for sending in forces at the request of Bahrain’s government to back up the repression
CPD has launched this campaign in order to build pressure on Washington to stop propping up the Al Khalifa government. The brave people of Bahrain deserve no less.
THE TEXT OF THE CPD STATEMENT FOLLOWS:
End U.S. Support for Bahrain’s Repressive Government
May 16, 2011
(Add your name, donate or share at http://www.cpdweb.org/stmts/1019/stmt.shtml )
On Feb. 13, 2011, inspired by the forced resignation of Egyptian President Hosni Mubarak, peaceful democratic protests erupted in Bahrain. Protests grew and, in response, King Hamad bin Isa Al Khalifa invited other Gulf states to send security forces into the country to assist in violently suppressing the demonstrators. The March 15 invasion by Saudi Arabia and the United Arab Emirates brought an intensification of torture, secret trials, demolition of Shia mosques, and repression against human rights activists, journalists, labor, lawyers, medical professionals, students, political figures, and others. On March 18 the regime destroyed the Pearl Monume nt that had served as the protest center.
Like many other autocracies in the region Bahrain has been a key U.S. partner. It has provided a home to the U.S. Navy’s Fifth Fleet, responsible for naval forces in the Persian Gulf, Red Sea, Arabian Sea, and the coast of East Africa as far south as Kenya. This is why Washington’s response to the vicious repression in Bahrain has been so muted and pro-forma, in contrast to forceful denunciations of repression in countries outside the U.S. orbit, such as Iran and Libya.
Richard Sollom from Physicians for Human Rights says health care workers in Bahrain have been targeted on a scale he has never encountered. Government forces have invaded hospitals; doctors have been dragged out of the operating room, abducted and detained for giving care to wounded protestors. The government says it will try 47 medical workers it accuses, incredibly, of causing the deaths of protesters by inflicting additional wounds on them.
Hundreds of workers, including union leaders, have been fired for striking for democratic change. Security forces closed down the General Bahraini Federation of Trade Unions headquarters. The Bahrain Center for Human Rights writes, “Bahrain is currently considered a dangerous zone for the freedom of press and journalists.” On April 3 the government suspended the country’s only independent newspaper, Al Wasat. On May 2 it arrested two politicians belonging to the opposition Al Wefaq party.
Bahrain’s population is 60 percent or more Shia, with the government dominat ed by a Sunni minority. There is systematic discrimination against the Shiite majority in political representation, employment, wages, housing, and other benefits. The government has tried to split the opposition along Shia-Sunni lines, but uprising leaders insist their struggle for democratic rights is non-sectarian.
Zainab Alkhawaja wrote to President Obama after her father, Abdulhadi Alkhawaja, former head of the Bahrain Center for Human Rights, was beaten unconscious in front of his family and arrested by masked men: “if anything happens to my father, my husband, my uncle, my brother-in-law, or to me, I hold you just as responsible as the Al Khalifa regime. Your support for this monarchy makes your government a partner in crime. I still have hope that you will realize that freedom and human rights mean as much to a Bahraini person as it does to an American, Syrian or a Libyan and that regional and political considerations should not be prioritized over liberty and human rights.”
Amnesty International, Human Rights Watch, Physicians for Human Rights, the International Crisis Group and many others have exhaustively documented the brutal terror of Bahrain’s government. No further evidence is needed. As long as the repression continues, the promise to lift the state of emergency is only an empty public relations gesture. The United States should end all aid to Bahrain, condemn the invasion by Saudi Arabia and the United Arab Emirates, and sharply denounceBahrain’s horrific suppression of democratic rights.
As the Arab Spring has swept through North Africa and the Middle East, the role of the United States has been truly shameful.Washington’s rhetoric cannot conceal a deep fear of democracy. Its first instinct was to stand behind its old friends. Only when it became obvious that Ben Ali’s and Mubarak’s days were numbered were they abandoned. As for Saudi Arabia, this ultra-reactionary monarchy, with its appalling treatment of women and religious minorities,is almost never criticized by U.S. officials.
There are those who, while deploring repression in Bahrain, justify continuing U.S. support for that country’s brutal tyranny as “realism”; in a dangerous world, they argue, our security depends on having a Middle Eastern state willing to host the Fifth Fleet. This argument is profoundly mistaken. Interventionist naval forces are part of a foreign policy that, by siding with despots and pitting the United States against the Arab people’s longing for responsible government and a better way of life, guarantees endless terrorism and bloodshed and an even more dangerous world for everyone. For good reason, democratic movements around the world today do not trust the United States, which they see as motivated by imperial interest. That is why the U.S. desperately needs a new foreign policy, one that welcomes democratic forces — not hypocritically, in order to manipulate them and blunt their impact, but to stand in solidarity with their struggles to win political power for the people and achieve social and economic justice.
* * * * * * *
THE CAMPAIGN FOR PEACE AND DEMOCRACY advocates a new, progressive and non-militaristic U.S. foreign policy — one that encourages democratization, justice and social change. The Campaign sees movements for peace, social justice and democratic rights, taken together, as the embryo of an alternative to great power politics and to the domination of society by privileged elites. Founded in 1982, the Campaign opposed the Cold War by promoting “detente from below.” It engaged Western peace activists in the defense of the rights of democratic dissidents in the Soviet Union and Eastern Europe, and enlisted East-bloc human rights activists against anti-democratic U.S. policies in countries like Nicaragua and Chile.
Recent CPD campaigns include: support for the democratic revolutions in Egypt, Tunisia and Libya; New York Review of Books letter to Iranian officials in defense of human rights leader Shirin Ebadi and a statement “End the War Threats and Sanctions Program Against Iran, Support the Struggle for Democracy Inside Iran.” Additional CPD statements have been Opposition to the U.S. Wars in Afghanistan and Pakistan, and on Gaza, “No More Blank Check for Israel!”
Campaign for Peace and Democracy, Co-Directors Joanne Landy and Thomas Harrison, 2790 Broadway, #12, NY, NY 10025. Email: cpd@igc.org Web: www.cpdweb.org
May 24th, 2011
As one of very few health professionals who has viewed Guantanamo detainee health files as a consultant to defense and habeas attorneys, I was not at all surprised by the findings of a new paper in PLOS Medicine by Vincent Iacopino and Stephen N. Xenakis: Neglect of Medical Evidence of Torture in Guantánamo Bay: A Case Series. Iacopino and Xenakis report on their examination of the medical records and reports by independent medical and psychological consultants on nine Guantanamo prisoners. They find that, despite strong evidence that the prisoners were subjected to torture, the health professionals examining and treating them made no attempt to determine if the prisoners had been abused and failed in their ethical (and military) duty to document and report torture and ill treatment.
The findings of this study demonstrate that allegations by these nine detainees of torture were corroborated by forensic evaluations by non-governmental medical experts and that DoD medical and mental health providers at GTMO failed to document physical and/or psychological evidence of intentional harm.
In each case we reviewed, detainees alleged forms of abuse that are highly consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time [12]. In one case, unclassified interrogation plans and interrogation summaries provided precise corroboration of the methods of torture and ill treatment that the detainee alleged.
….
The medical evaluations in this case series revealed evidence of severe physical and severe and prolonged psychological pain as stipulated in the Bybee definition of torture. But, according to the Bybee definition of torture, even if the requisite pain thresholds had been exceeded, the infliction of such pain had to be the interrogator’s “precise objective” to constitute torture.
….
The medical doctors and mental health personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to “personality disorders” and “routine stressors of confinement.” Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment.
The documentation of torture and ill treatment in medicolegal evaluations conducted by non-governmental medical experts indicates that each of the detainees continues to experience severe, long-term and debilitating psychological symptoms that are likely to persist for many years, and possibly a lifetime.
The Defense Department has issued a response to Iacopino and Xenakis which, in its failure to even mention their main charges can be taken as an official confirmation that Guantanamo health professionals do no investigate or document the terrible abuses suffered by many prisoners there:
DoD personnel working in detention facilities operate under a high level of scrutiny and consistently provide the most humane and safe care and custody of individuals under their control. The Joint Medical Group is committed to providing unconditional appropriate comprehensive medical care to all detainees regardless of their disciplinary status, cooperation, or participation in a hunger strike. The healthcare provided to the detainees being held at Guantanamo Bay rivals that provided in any community in the United States. Detainees receive timely, compassionate, quality healthcare and have regular access to primary care and specialist physicians. The care provided to detainees is comparable to that afforded our active duty service members. All medical procedures performed are justified and meet accepted standards of care. A detainee is provided medical care and treatment based solely on his need for such care and the level and type of treatment is dependent on the accepted medical standard of care for the condition being treated. Diagnosis of such conditions and medical care and treatment for them are not affected in any way by a detainee’s cooperation, or lack thereof, during an interrogation session. Similarly, medical care is not provided or withheld based on a detainee’s compliance or noncompliance with detention camp rules or on his refusal to end a hunger strike. Medical decisions and treatment are not withheld as a form of punishment. Additionally, the medical staff has no involvement in discipline decisions made by detention personnel.
This DoD reesponse also neatly elides the Iacopino and Xenakis claims in another way in that it is written in the present tense and thus only applies to current practices. Yet Iacopino and Xenakis, by their methodology of examining medical records, are talking about past practices. The DoD “response” makes no claims whatsoever recording the appropriateness of past practices. It thus seems likely that some of those practices were indefensible, even by Defense Department spokespeople not usually noted for their truthfulness.
The Iacopino and Xenakis findings are entirely consistent with my experience reading medical files on one Guantanamo prisoner on whom I consulted. Despite claims that he had been subjected to abuse, and mental health symptoms consistent with abuse, there was no indication in the hundreds of pages I read that any health professional had made any attempt to find out if he had been abused or to document possible abuse. Rather, the mental heath staff seemed only interested in whether the prisoner might make a suicide attempt. Beyond that, his obvious anguish appeared to be of no interest to the psychologists and other mental health staff.
Further, the Guantanamo medical unit and the Obama Justice Department fought tooth and nail to prevent any independent examination of these records, much less of the prisoner himself. The prisoner’s attorneys requested, and the habeas judge ordered, that the records be made available for examination by an independent psychologist, me, to determine if there was a possibility that mental health issues might interfere with the prisoner’s ability to cooperate with his attorneys. The Guantanamo medical staff filed a declaration denying any need for independent evaluation. And the Justice Department appealed every step. First they opposed any access to records as too burdensome. Then they appealed access to more than the past few month’s records. They appeared to objected to any scrutiny on principle, which in itself in a sign of inadequate transparency at Guantanamo and is the exact opposite of what should occur in an institution run by a democratic government. We cannot take the word of officials at an institution absent meaningful independent scrutiny that abuses and ethical lapses were, or are, absent.
The Iacopino and Xenakis paper contributes to existing evidence, including the questionable use of anti-malarial drugs, that Guantanamo healthcare was often problematic and deserves independent scrutiny. While the Bush and Obama administrations have made every effort to keep those records secret, health professionals should challenge that secrecy. We should demand that Guantanamo medical records be opened, with prisoner consent, to independent inspection. Further, all detainees desiring it should be able to receive independent medical evaluations.
Additionally, independent of the issues of possible abuse, the complete medical records of released prisoners should be made available to those prisoners and/or their current health providers. To suppress medical records for years of a person’s life is unethical as it interferes with released individuals’ ability to obtain required care in the present and the future. Health professionals from all disciplines should make clear that denial of access to their records by released prisoners is in simply unacceptable.
May 1st, 2011
A story I missed from last month demonstrating the lengths to which the government went to keep Guantanamo prisoners out of the US:
WikiLeaks cable casts doubt on Guantanamo medical care
By Carol Rosenberg | McClatchy Newspapers
WASHINGTON — The Bush administration was so intent on keeping Guantanamo detainees off U.S. soil and away from U.S. courts that it secretly tried to negotiate deals with Latin American countries to provide “life-saving” medical procedures rather than fly ill terrorist suspects to the U.S. for treatment, a recently released State Department cable shows.
The U.S. offered to transport, guard and pay for medical procedures for any captive the Pentagon couldn’t treat at the U.S. Navy base in southeast Cuba, according to the cable, which was made public by the WikiLeaks website. One by one, Costa Rica, the Dominican Republic, Panama and Mexico declined.
The secret effort is spelled out in a Sept. 17, 2007, cable from then assistant secretary of state Thomas Shannon to the U.S. embassies in those four countries. Shannon is now the U.S. ambassador in Brazil.
At the time, the Defense Department was holding about 330 captives at Guantanamo, not quite twice the number that are there today. They included alleged 9/11 mastermind Khalid Sheik Mohammed and two other men whom the CIA waterboarded at its secret prison sites.
The cable, which was posted on the WikiLeaks website March 14, draws back the curtain on contingency planning at Guantanamo, but also contradicts something the prison camp’s hospital staff has been telling visitors for years — that the U.S. can dispatch any specialist necessary to make sure the captives in Cuba get first-class treatment.
“Detainees receive state-of-the-art medical care at Guantanamo for routine, and many non-routine, medical problems. There are, however, limits to the care that DOD can provide at Guantanamo,” Shannon said in the cable, referring to the Department of Defense.
The cable didn’t give examples of those limits. But it sought partner countries to commit to a “standby arrangement” to provide “life-saving procedures” on a “humanitarian basis.”
It’s unclear what prompted the effort. The cable said then Deputy Secretary of State John Negroponte had approved making the request at the behest of then Deputy Defense Secretary Gordon England, who at the time oversaw Guantanamo operations.
Negroponte said Wednesday that he had “no recollection” of the request but that it would have been unrealistic to expect the Latin American nations to agree to it, “because anything to do with Guantanamo was always so politically controversial for any of these countries.” England didn’t respond to a request for comment.
Earlier that year, a captive had managed to commit suicide, according to the military, inside a maximum-security lockup. Two medical emergencies also tested Guantanamo’s medical services in 2006: Two captives overdosed on other prisoners’ drugs they’d secretly hoarded, and then three men were found hanged in their common cellblock before dawn one Saturday.
In 2007, lawyers for Guantanamo’s eldest detainee, former U.S. resident Saifullah Paracha, who Pentagon officials said was a key al Qaida insider, also challenged the military’s plans to conduct a heart catheterization procedure at the base.
Paracha, now 63 and still suffering from a chronic heart condition, wanted to be taken to the U.S. or his native Pakistan for the catheterization. He refused to undergo the procedure at the base, even after the Pentagon airlifted a surgical suite and special equipment to the base to undertake the procedure.
The U.S. Supreme Court refused to consider Paracha’s request that he be brought to a U.S. hospital rather than have the experts brought to him.
“Where do they treat soldiers with heart problems?” said Zachary Katznelson, who at the time was part of Paracha’s pro-bono legal team. “They get them out of Guantanamo as soon as possible. They take them to a real cardiac care unit. It’s already risky enough.”
The WikiLeaks cable “clearly indicates that everything we were telling the courts, everything that Saifullah was telling us, was true,” Katznelson said. “Guantanamo did not have the facilities to adequately treat Saifullah on the island.”
The cable also makes clear that the driving force behind seeking the arrangements was the fear that detainees would use a medical emergency to exercise their legal rights.
The cable said that emergency medical treatment on American soil presented “serious risks” to the U.S. government, or USG.
“Admitting particular detainees might lead litigants to argue that U.S. courts should order the USG to admit other, more dangerous, detainees,” the cable said. “These concerns are unique to the United States and are not something that third countries face.”
A State Department official said the U.S. was never able to arrange for emergency medical treatment elsewhere. But a Pentagon spokeswoman argued such a deal wasn’t really necessary.
U.S. captives in Cuba “receive the highest quality medical care, the same caliber as that received by our own service members,” Army Lt. Col. Tanya Bradsher said.
“Medical emergencies are handled on a case-by-case basis to identify the most effective means of providing appropriate medical treatment to the detainee at Guantanamo,” she said. “This may include bringing in outside medical capabilities should the need arise.”
Those outside specialists have included cardiologists and a spinal surgeon. Colonoscopies are done more or less routinely.
Today, there’s an added complication: Congress forbids the Defense Department to use taxpayer money to transport Guantanamo captives to the U.S.
(Rosenberg reports for the Miami Herald.)
April 27th, 2011
Paul Krugman recently raised the question of where the capitalist term “consumer” started being used for medical patients and discussed the pernicious effects this usage has on healthcare:
Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.
What has gone wrong with us?
On his blog today he answers the origins question:
Rashi Fein directs me to a paper he published in 1982, which begins
A new language is infecting the culture of American medicine. It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.
Prophetic words.
Alas, I can’t find a publicly available copy of the Fein paper.
April 24th, 2011
Hans Rosling has found a new way to show his data on the growth of human health and wealth, with its optimistic story of human progress, in this video from the BBC:
January 8th, 2011
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