WP: Senate report: Uncooperative terrorism suspects faced rectal rehydration, feeding

http://www.washingtonpost.com/national/health-science/senate-report-uncooperative-terrorism-suspects-faced-rectal-rehydration-feeding/2014/12/09/fcffb1ec-7fb8-11e4-8882-03cf08410beb_story.html

Senate report: Uncooperative terrorism suspects faced rectal rehydration, feeding

By Brady Dennis

December 9, 2014

Among the more jarring passages in the Senate Intelligence Committee's report on CIA interrogations of terrorism suspects are descriptions of agency employees subjecting uncooperative detainees to "rectal rehydration" and "rectal feeding."

The report [1] said that at least five detainees underwent the procedures without documented medical necessity and that others were threatened with them. While the CIA defended its approach, the techniques are all but absent from modern medicine.

"For all practical purposes, it's never used," Thomas Burke, a Harvard Medical School professor and emergency physician at Massachusetts General Hospital, said in an interview. "No one in the United States is hydrating anybody through their rectum. Nobody is feeding anybody through their rectum. . . . That's not a normal practice."

He added that he had polled more than a half dozen colleagues with decades of clinical experience and that none had ever employed it.

Rectal hydration was used on wounded soldiers in World War I. In 1881, President James A. Garfield's doctors tried to feed him rectally as he lay dying from an assassin's bullet. He received egg yolks, milk, whiskey, beef bouillon and drops of opium in this manner, although he continued to waste away, according to a biographer.

More recently it has been used only in dire circumstances, such as in the treatment of a 21-year-old man who was discovered by trekkers to be suffering from shock in the mountains of Nepal, according to a 2005 paper.

But Tuesday's report detailed a new twist on an antiquated procedure.

Abd al-Rahim al-Nashiri, a Saudi citizen who allegedly masterminded the bombing of the USS Cole, launched a hunger strike that resulted in the CIA force-feeding him rectally, the report stated. Khalid Sheik Mohammed, the architect of the 9/11 attacks, also was subjected to rectal rehydration [2] with no documented medical need, the report said. An interrogation official later said the measure demonstrated his "total control over the detainee."

Another detainee who apparently underwent the procedure was Majid Khan, a Pakistani citizen and former suburban Baltimore resident, who pleaded guilty in 2012 to five war crimes, including murder, attempted murder and spying. He was held by the CIA overseas for three years before being transferred to the military facility at Guantanamo Bay. The report said Khan was subjected to "involuntary rectal feeding and rectal rehydration," which included two bottles of Ensure. Later that day, his "lunch tray," consisting of hummus, pasta with sauce, nuts and raisins, was pureed and "rectally infused."

CIA medical officers discussed rectal rehydration as a form of behavior control, according to the report, with one officer writing, "[w]hile IV infusion is safe and effective, we were impressed with the ancillary effectiveness of rectal infusion on ending the water refusal in a similar case."

The same officer, the report said, wrote: "[r]egarding the rectal tube, if you place it and open up the IV tubing, the flow will self regulate, sloshing up the large intestines." Referencing the experience of the medical officer who had subjected Mohammed to rectal rehydration, the officer wrote: "[W]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag -- let gravity do the work."

In a June 2013 response, the CIA insisted that agency medical personnel on scene during interrogations monitored detainees' hydration and food intake to ensure that they "were physically fit and also to ensure they did not harm themselves."

There has been a history of detainees going on hunger strikes. Earlier this year, a federal judge ruled that the military could force-feed [3] a Syrian detainee to prevent him from dying, though she urged authorities to consider alternative methods.

The CIA said that personnel who administered rectal rehydration did not do so as an interrogation technique or to degrade a detainee, but rather because it was "a well acknowledged medical technique to address pressing health issues." The agency dismissed the suggestion that the practice was used to assert "total control" over detainees, saying that "a single flippant, inappropriate comment by one CIA officer concerning the technique, quoted in the study, is not evidence to the contrary."

The agency also argued that the practice was "deemed safer" than using IV needles with noncompliant detainees, and more efficient than forcing a feeding tube through a detainee's nose, down his throat and into his stomach. The CIA said that Khan had removed his own feeding tube, "which posed the risk of injury and other complications."

But Burke, the Harvard medical professor, said that explanation falls short. Every day in the United States, health workers encounter uncooperative, belligerent or mentally disturbed patients who need hydration or sustenance. "And [in] none of them do we put a tube in their bottom," he said.

Burke said the idea of hydration is plausible, because the colon can absorb water. But the notion of feeding a person rectally has little physiological basis. "It doesn't make any sense," he said.

"What we can say is that because nobody [in the medical field] would do it, it has to lead to the question of what were they really doing?" he said. "We deserve a better explanation."

[1] http://www.washingtonpost.com/wp-srv/special/national/cia-interrogation-report/document/

[2] http://www.washingtonpost.com/wp-srv/special/national/cia-interrogation-report/key-findings/

[3] http://www.washingtonpost.com/local/crime/2014/11/07/82adf186-66ce-11e4-836c-83bc4f26eb67_story.html