It is important to note that the OLC memos were drafted in a way that suggests there was no dissenting opinion about the use of harsh interrogation techniques, yet yesterday we heard Ali Soufan, the FBI interrogator who was the first on the scene to interrogate accused terrorist Abu Zubaydah, testify that the lead CIA forensic psychologist assigned to the Zubaydah interrogation left the CIA facility in protest when the SERE contractors began to use harsh techniques.

Throughout this time, my fellow FBI agent and I, along with a top CIA interrogator who was working with us, protested, but we were overruled. I should also note that another colleague, an operational psychologist for the CIA, had left the location because he objected to what was being done.

This was followed by withdrawal of all FBI agents from the interrogations because of concerns about employing torture.

Yet the 2002 Bybee memo on techniques does not report any dissent from CIA psychologists, but does rely heavily upon "psychological evaluations". These are almost certainly the evaluations of contractors.

Indeed, after spending a lot of time reading the memos and documents related to the "Enhanced Interrogation Techniques" used by the CIA on "High-Value Detainees", it is becoming increasingly clear that in designing the CIA interrogation program, there was a deliberate effort made to circumvent the CIA Office of Medical Services (OMS)- the division that oversees the doctors, psychologists and nurses employed by the CIA. Instead, the Torture architects consulted contractors, many of whom who were psychologists who had experience working as former SERE instructors. The recently released memos bear out these details. The 2005 OLC Memo from Stephen Bradbury, "2005 Bradbury Memo" (PDF), which was written to replace the 2002 memos in approving waterboarding, cites the still-secret CIA Inspector General's report. Excerpts from this report criticized the CIA for not involving the Office of Medical Services (OMS, the CIA doctors and other health professionals) in the development or application of the enhanced interrogation techniques:

We note that this involvement of medical personnel in designing safeguards for, and in monitoring implementation of, the procedures is a significant difference from earlier uses of the techniques catalogued in the Inspector General's Report. See IG Report at 21 n26 ("OMS was neither consulted nor involved in the analysis of the risk and benefits of [enhanced interrogation techniques], nor provided with the OTS report cited in the OLC opinion [the Interrogation Memorandum]."). Since that time, based on comments from OMS, additional constraints have been imposed on the use of the techniques.

This decision to exclude CIA doctors from the torture was likely by design. Doctors are generally aware of their oath not to do harm (and the sordid history of physicians being involved in torture), and it is likely that at least some of those informed of the program would have resisted. But it was certainly a bad decision, as there is evidence that the early waterboarding of Zubaydah and accused Cole bombing mastermind al-Nashiri went awry:

A heavily censored footnote on page 15 of the "2005 Bradbury Memo" (PDF) discusses what appears to be a near-death episode excerpted from the still-secret CIA Inspector General report:

In our limited experience, extensive use of the waterboard can introduce new risks. Most seriously, for reasons of physical fatigue or psychological resignation, the subject may simply give up, allowing excessive filling of the airways and loss of consciousness. An unresponsive subject should be righted immediately and the interrogator should deliver a sub-xyphoid thrust to expel the water. If this fails to restore normal breathing, aggressive medical intervention is required. Any subject who has reached this degree of compromise is not [censored hereafter].

Zubaydah and KSM are the only detainees known to undergo "extensive waterboarding" by the CIA, and KSM was waterboarded differently than Zubaydah (KSM had medical personnel in the room, see below). Indeed, Zubaydah is the only detainee who reported losing control of his bowel or bladder function or his consciousness during his interrogation. From the recently-leaked International Committee of the Red Cross report on "High Value" Detainees ("ICRC Report (PDF)"), Zubaydah described his interrogation including waterboarding:

On this occassion my head was in a more backward, downwards position and the water was poured on for a longer time. I struggled without success to breathe. I thought I was going to die. I lost control of my urine. Since then I still lose control of my urine when under stress.

<snip>

I collapsed and lost consciousness on several occasions. Eventually the torture was stopped by a doctor.

Thus it appears the IG report footnote is referring to a waterboarding "ADVERSE EVENT" of Zubaydah that required resuscitative medical intervention. Furthermore Al-Nashiri was only waterboarded 2 times, which I and others have speculated may have been due to a bad outcome also requiring resuscitative medical intervention.



Involvement of Medical Personnel in waterboarding after January 2003

Guidelines established by the CIA on January 28, 2003 (probably in response to bad medical outcomes with waterboarding of AZ or al-Nashiri) established new rules for interrogation. A memo signed by George Tenet, Guidelines on Confinement Conditions for CIA Detainees (Jan. 28,2003) ("Confinement Guidelines"), is cited in the "2005 Bradbury Memo" (PDF), but has not yet been released, even in redacted form.

What this says with regard to medical personnel in general and CIA medical doctors specifically is yet unknown. However, clues to the contents of this memo come from its citation:

Medical and as appropriate, psychological personnel shall be physically present at, or reasonably available to, each Detention Facility. Medical personnel shall assess the physical condition of each detainee at intervals appropriate to the circumstances and shall keep appropriate records.

Thus by January 28, 2003 it is apparent that the CIA recognized a need for involvement of "medical personnel" in caring for detainees, but whether this required physicians, nurses, physician assistants or corpsmen is unknown. Importantly this was almost certainly contractor medical support, as the first involvement of the CIA OMS was not documented until December 2004, long after the waterboarding had ceased.



Involvement of Medical Personnel in Waterboarding KSM

Khalid Sheik Mohammed was waterboarded 183 times in March 2003. They dramatically altered the protocol for waterboarding by March 2003. Specifically, International Committee of the Red Cross report on "High Value" Detainees ("ICRC Report (PDF)") description of the waterboarding of Abu Zubaydah and KSM is almost identical with the exception of one detail. KSM had a pulse oximeter (a device to measure blood oxygen levels) attached to his finger to measure the level of oxygen in his blood during waterboarding, and he noted that there was a "doctor" present in the room each time this procedure was used.

Female interrogators were also present...and a doctor was always present, standing out of sight behind the head of [the] bed, but I saw him when he came to fix a clip to my finger which was connected to a machine. I think it was to measure my pulse and oxygen content in my blood. So they could take me to [the] breaking point.

Again, based upon the paper trail in the 2005 Bradbury memo footnotes, the medical providers helping keep KSM alive for waterboarding were likely contractors rather than career CIA OMS employees. This distinction may not seem so important, but in 2004, after they were informed of the program, the OMS imposed drastic changes in waterboarding protocols to ensure "safety" of those interrogated:

Limits upon the amount of time a detainee could be strapped to the board and suffocated.

A switch from water to saline to prevent electrolyte imbalances.

A requirement of a physician in the room for waterboarding.

A requirement of a tracheotomy kit in the room for waterboarding to conduct emergency surgery if needed.

Thus, this deliberate avoidance of CIA doctors and instead reliance upon contractor psychologists and medical personnel to waterboard shows effort to hide the torture program from oversight.



Conclusion

As Ali Soufan noted in his testimony, the CIA harsh techniques program was experimentation.

The mistake [implementation of enhanced interrogation techniques] was so costly precisely because the situation was, and remains, too risky to allow someone to experiment with amateurish, Hollywood style interrogation methods- that in reality- taints sources, risks outcomes, ignores the end game, and diminishes our moral high ground in a battle that is impossible to win without first capturing the hearts and minds around the world. It was one of the worst and most harmful decisions made in our efforts against al Qaeda.

Indeed, it is clear that it was Medical Experimentation on detainees, not incredibly different than that conducted by past torture regimes.

There are many, many levels of complexity and complicity that will be revealed in the details we are beginning to understand. For example we know that one CIA psychologist was aware of the program before 2004 (and left in disgust), but we don't know whether all the medical personnel involved before 2004 were contractors. Regardless, it is clear that the men who wanted to torture did so with hired experimentalists and made a deliberate effort to keep the CIA medical personnel out of the way.



Update

mimi links the exactly wording of Soufan's oral testimony below.