Doctor: Guantánamo erred by lubing forced-feeding tubes with olive oil

A Navy doctor holds a feeding tube used to deliver a can of Ensure up the nose and down the back of the throat and into the stomach of a prison camp hunger striker on June 26, 2013 at the U.S. Navy base at Guantánamo Bay, Cuba. The military reviewed this photo as a condition of release.
A Navy doctor holds a feeding tube used to deliver a can of Ensure up the nose and down the back of the throat and into the stomach of a prison camp hunger striker on June 26, 2013 at the U.S. Navy base at Guantánamo Bay, Cuba. The military reviewed this photo as a condition of release. GETTY IMAGES

Navy medical staff put Guantánamo prisoners’ health at risk by using “for cultural preference” olive oil to lubricate feeding tubes, a doctor testified at federal court hearing on prison force-feeding practice Tuesday.

Dr. Steven Miles, a professor of medicine at the University of Minnesota who specializes in bioethics, testified in court that it’s unacceptable, risky medical practice to use lubricant that is not water-based for inserting a feeding tube into a patient. He said the detention center should survey detainees whose tubes were lubricated with olive oil for signs of a form of non-infectious pneumonia that could mislead a physician to diagnose cancer or tuberculosis.

The testimony took aim at a long popular talking point by Navy medical staff grappling with re-nourishing hunger strikers shackled by all four limbs to a restraint chair: Malnourished protesters could choose a familiar flavor — olive oil — over lidocaine to lubricate their nasogastric feeding tubes.

During a visit by Miami Herald journalists in March, a senior medical officer explained that olive oil was offered “for cultural preference.”

The officer, a Navy commander whose name has not been disclosed, said in a sworn statement read to the court Tuesday that he had an olive-oil-lubed feeding tube put inside him when he first got to the detention center — and was satisfied that his staff handled renourishing those engaged in “non-religious fasting” in the “kindest, safest and most humane ways possible.”

Justice Department lawyer Andrew Warden told the judge in court that the detention center discontinued the practice in June. He showed a 2014 chart of the tube insertions — up to twice daily — into on-again, off-again hunger striker Abu Wa’el Dhiab, and noted that he got his last olive oil lube June 25.

The olive oil issue arose in the second day of Dhiab’s challenge of Guantánamo hunger strike management policy. Doctors called by Dhiab’s lawyers accuse the military of being bound by prison procedures that do not permit individualized medical care — and effectively punish hunger strikers by using a tackle-and-shackle technique and immobilizing them in a restraint chair for tube feedings.

Patrick Davis, a trial attorney at the Justice Department’s Civil Division Federal Programs Branch, countered by reading aloud from a series of detention center documents that showed, while the admiral who runs the prison signs off on each detainee’s entry into the forced-feeding program, a senior medical officer was responsible for making the recommendation.

Prison policy says that while falling below 85 percent of ideal body weight may be one criteria for a forced-feeing, other overall health issues are also taken into consideration. Restraints are used as a matter of safety, not punishment, they say.

Miles said the issue of long-term impact of the use of olive oil was as much a concern for released Guantánamo detainees who are sent “out into the world with no ability to access their records” — and might be misdiagnosed as having tuberculosis or a mass in their lungs.

Using lubricants that are not water soluble, he said after court, risked a chronic inflammatory disease, lipid pneumonia, that has been linked to olive oil use in India. He said documents he studied on Guantánamo forced-feeding practice did not explain the origins of the idea. “It may have been some cute general saying, ‘Since they have olive oil in their diet, let’s use that.’ ”

U.S. District Court Judge Gladys Kessler, who is considering the Syrian’s challenge of prison practice, chimed in that olive oil was “in use for many years at Guantánamo,” and questioned whether this was a certain departure from accepted medical standards of care.

“This should never have happened,” the doctor replied. “One doesn’t have to make very many salads to know that olive oil is not water soluble.”

At Guantánamo, Navy Capt. Tom Gresback said prison medical staff stopped using the olive oil in favor of “water-based lubricants” after some lawyers challenged the practice. “This change was implemented to eliminate risk, albeit minimal, for olive oil to get into the bronchial tree and lungs, thereby possibly causing illness.”

He did not answer a question on whether the detainees had been surveyed for sickness caused by the use of olive oil. “There is no medical evidence which would indicate that any residual amount of a non-water based lubricant remains in the detainees’ lungs in the unlikely event any ever entered the bronchial tree,” he said.

The prison spokesman had no estimate of how many detainees were fed using the olive oil. At the height of the hunger strike last year, 46 detainees were designated for tube feeding on a single day.

The hearing was to continue Wednesday morning in open court with Justice Department lawyers, who declined to bring witnesses, reading aloud from documents prepared for the judge. Then, according to Kessler, it would close for a while to handled classified or protected information, that attorneys described as screening of videos of Dhiab‘s being restrained and force-fed at the prison.

Kessler has ordered release of the recordings, which one attorney said numbered 32, once U.S. officials redact prison staff faces and voices. She set no deadline for the public to get to see them.

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Related material:

Study a chart of the rise and fall and rise again of the Guantánamo hunger strike here.

Guantánamo judge: USS Cole accused not entitled to MRI

A Guantánamo war court judge has denied a defense lawyer’s request to have doctors conduct an MRI scan of the accused USS Cole bomber's brain.

A Pentagon-paid, civilian death-penalty defender, Rick Kammen, argued for the MRI at the war court in August, saying former CIA captive Abd al Rahim al Nashiri, 49, might have “organic brain damage.” Kammen said he had an obligation to investigate for potential mitigation evidence as part of preparation for the capital tribunal.

In his three-page ruling, now posted on the Office of Military Commissions website, Air Force Col. Vance Spath, the judge, did not address the fact that there is no magnetic resonance imaging device at Guantánamo. The U.S. Navy base prison ordered and purchased one, but then military commanders reassigned it to treat troops and their families in Georgia.

Instead Spath ruled against the request for two reasons:

▪ He wasn’t persuaded that military medical staff provide “inadequate” healthcare or showed “deliberate indifference” to the medical needs of Nashiri, the Saudi accused of orchestrating al-Qaida’s suicide attack on the USS Cole warship off Yemen on Oct. 12, 2000. Seventeen American sailors were killed, and dozens more were wounded.

▪ Defense lawyers didn't first make the request for the MRI scan to the senior Pentagon official in charge of the war court. The Pentagon recently announced the appointment of a former Marine general as Convening Authority for Military Commissions, a role designated as the first hurdle for defense attorneys seeking resources.

Kammen said Tuesday that defense attorneys already had a request pending at the Office of the Convening Authority.