04-309: Death from Torture

Meet "04-309." I don’t know his name–DOD redacted that from the reports on detainee deaths it released to ACLU some time ago. "04-309" is the number DOD assigned to the autopsy they did on him in Mosul on April 26, 2004, just two days before the Abu Ghraib story broke.

When 04-309 was captured by Navy Seals around April 2, 2004, he was around 27, a "well-developed, well-nourished" man, 6 foot and 190 pounds. He had no visible scars. He was, apparently, healthy.

04-309 did, however, show signs of minor injury: cuts and bruises around his head and belly and right shoulder and arm. These wounds may have come when he was arrested–his autopsy summary says "Q by NSWT [Navy Seals], struggled/interrogated" before it describes he, "died sleeping."

But 04-309’s Final Autopsy Report–completed on November 22, 2004, long after Abu Ghraib broke and the CIA’s Inspector General concluded the CIA’s interrogation program was cruel and inhumane (though not all that long after a criminal investigation of homicides committed in 2002 concluded, on October 8, 2004, that the deaths were partly caused by sleep deprivation and stress positions)–doesn’t conclude how he died. It does, however, describe these "circumstances of death:"

During his confinement, he was hooded, sleep deprived, and subjected to hot and cold environmental conditions, including the use of cold water on his body and hood.

Later in the document, the Opinion section explains,

Based on the available investigation and complete autopsy examination, no definitive cause of death for this approximately 27-year old male Iraqi civilian in US custody in Iraq could be determined. There is evidence of multiple minor injuries; however, there is no definitive evidence of any trauma significant enough to explain the death. The injuries include bilateral periorbital ecchymoses ("blackeyes"); abrasion and contusions of the face, torso, and extremities; contusion on the side of the neck’ and subgaleal hemorrhage of the scalp.

There is evidence of restraint, consisting of "flexicuffs" around the wrists with associated minor contusions, and asphyxia from various means cannot be completely excluded in a restrained individual. 

There are non-specific cardiac findings, including mild medial thickening of the sinus nodal artery and focal mild dysplasia of the penetrating branches of the atrioventricular nodal artery. However, there is no associated increased septal fibrosis, which can be a potential substrate for cardiac arrhythmia. There is no gross evidence of atherosclerosis of the coronary arteries. A cardiac arrhytmia related to ion channelopathies or coronary vasospasm cannot be excluded. 

The decedent was also subjected to cold and wet conditions, and hypothermia may have contributed to his death.

Therefore, the cause of death is best classified as undetermined, and the manner of death is undetermined.

Now I’m no doctor–and I definitely can’t make sense of the cardiac findings. But it sounds like "stress positions," "sleep deprivation," "walling," and "water dousing" are all leading candidates to have caused the death of 04-309. Or, to use the terms used for techniques approved for use by one Special Forces group in Iraq until May 18, 2004, about a month after 04-309’s death, "safety positions," "sleep adjustment/sleep management," "change of environment/ environmental manipulation," and "mild physical contact." It doesn’t really matter what you call the techniques, though, because they amount to torture that–in the case of an apparently healthy 27 year old man–appear to have killed him in three days time.

A lot of people–from the CIA to Cheney to the torture apologists–want this debate to be about waterboarding, a technique they’ve only admitted to using with three detainees, and a technique that–as far as we know–did not kill anyone in US custody. But that distracts from the other techniques that just as much torture, the ones that were killing Iraqi civilians in a matter of days. 

Update: From drational, who confirms my suspicion that this autopsy report was a cover-up.

Marcy, I took a look at this autopsy as well. The final autopsy report notes Cerebral edema (swollen brain) and microscopic evidence of “early acute neuronal injury”. It also shows pulmonary edema (water in the lungs).

The autopsy report looks like a cover up. Arryhthmias cause death acutely; you will definitely not see brain injury as described.

The autopsy is more consistent with partial suffocation leading to brain injury, followed by heart failure. He had to have been alive for at least 4-8 hours after the lethal brain injury (hypoxia) in order to develop the edema and neurpathological changes observed.

Also, a bunch of us are trying to focus attention on the non-waterboarding torture today. Here’s a diary that drational did over at DKos, translating some of the medicalese into English.

Update: Glenn’s got a great post on this too.

image_print
73 replies
  1. Rayne says:

    Something seems odd about the existence of a subgaleal hemorrhage of the scalp with no corresponding epidural hemorrhage along with the blackened eyes, but I’m not a doctor. Sure hope one of our medical crew shows up and gives this a look-see.

    • emptywheel says:

      The neck bruise sounds like it might have come from the hooding collar, in which case it might well have caused a head injury.

      Remember two things. First, when the ICRC report came out, there was a report that the Administration was most worried about the revelations of hooding, which suggest there were some problems with it.

      And also, this autopsy was done in Mosul, the same place he died (it looks like on others the body was flown elsewhere fore an autopsy). Given that the autopsy was done just before Abu Ghraib and the report much later, I’m not sure I trust the autopsy report.

  2. tjbs says:

    Thanks for still dealing w/ Torture/ Murder/ Treason EW because it makes me sick.

    Don’t rule out crucifixion via stay-ties. Crucifixion doesn’t require nails just suspending the victims body supported by the arms alone. The hanging body weight causes slow suffocation and you over stress the heart to the point of failure. Hanging someone for three days by their arms will kill ya, check out the wrists. I’ll bet there was a creepy doctor working to hide the swollen wrists resulting from this treatment.

    I demand nothing less than Nuremburg 2.0 to give these war criminals the chance to prove their innocence or spend the rest of their life in solitary, stripped of their citizenship.

    • skdadl says:

      There’s a famous photo from Abu Ghraib that made me think crucifixion the first time I saw it — the fellow whose arms are hooked behind him on either side around what looks like the upper bar of a bunk bed, which is forcing his chest forward unnaturally. That would cause slow suffocation, or crucifixion.

      • Rayne says:

        But such crucifixion would leave marks on the arms which aren’t suggested in the autopsy report we have, at least I don’t seen anything of the sort as a layman without medical training.

        I’d lean more towards walling as one of multiple contributing causes, given the bruising to head, hemorrhage of scalp, intramuscular hemorrhage of right shoulder. Would like to know what exposure to cold and suffocation looks like in medical terms, and also what physical effects we might see in extreme sleep deprivation since the kind of damage one might find from either restraints or blunt force trauma are rather limited in scope.

        There’s also the real chance these results are “not accurate.”

        • skdadl says:

          Oh, I agree — I wasn’t suggesting that position as a specific diagnosis in this case. I just think that a number of the things the double-talkers called “stress positions” add up to crucifixion, and they deserve to have that word thrown back at them.

          • Rayne says:

            Think an example of the kind of “crucifixion” you mentioned was the death of Manadel al-Jamadi. I have to be offline for a while so I can’t look for an autopsy of al-Jamadi, wonder if it might be helpful to have it for comparison.

            drational (6) – I saw the edema, but couldn’t readily find any info to tell me if the descriptions were unusual and causal, versus incidental. The use of “microscopic” to describe the “early acute neuronal injury” also didn’t set off any flares for me, but it’s this find of fuzzy description which seems like an opportunity to mislead a reviewer.

            EW (7) – wrt Manadel al-Jamadi – he was also hooded during his crucifixion, if memory serves, died a relatively short time after being put in stress position. But al-Jamadi was at Abu Ghraib. Another possible issue with this autopsy is the broken ribs attributed to CPR; al-Jamadi had been smashed or pressed hard in the chest area by an interrogator. Could someone call this “consistent with CPR”?

            • drational says:

              Microscopic sections demonstrate multiple sections of grey and white matter, cerebellum and spinal cord/medulla. Sections show widened pericellular and perivascular spaces and scattered neurons with cytoplasmic eosinophilia and shrunken, pyknotic nuclei, most prominent in the dentate nucleus and cerebellum. These morphologic features represent cerebral edema and early acute neuronal injury.

              Here is my reasoning:
              Widened pericellular and perivascular spaces= edema.
              Cytoplasmic eosinophilia and shrunken, pyknotic nucleii are pathological features of cell death. Both these changes take 3-4 hours to begin to manifest from the time of injury.

              Arrythmias kill you acutely (minutes), unless you are resuscitated. There are no brain changes when a person dies of a single arrythmia event (absent resuscitation). There are zero cardiac arrythmias that, without any rescuscitation, can cause prolonged ischemia to result in irreversible brain injury, yet keep the person alive long enough to allow cerebral edema and other brain injury changes (edema and eosinophilia/pyknosis are not postmortem changes, they require at least 3-4 hours of survival after injury).

              His liver congestion and pulmonary edema would certainly be consistent with heart failure. It is not uncommon to see acute pulmonary edema and heart failure in an otherwise healthy person after a major cerebral insult such as global hypoxia (near drowning, strangulation). But the microscopic brain changes can only be the result of hours of survival after the initial injury.

              So I would say with reasonable certainty, the brain injury came first and was likely due to suffocation.

              • Rayne says:

                Thanks for that, crystal clear explanation.

                Looks like I’m going to be on line spottily anyhow, so I’ll poke around more for autopsy info to compare ME04-309 with other deaths certified as suffocation.

                There’s one other tidbit which I noted when evaluating the al-Jamadi case for comparison. The Mayer article says “blood came gushing out of his nose and mouth, as if a faucet had been turned on,” when the interrogators lifted his hood to check to see if he was “playing possum.” But the photos of his corpse don’t show blood, as if his body had been cleaned up. Wonder if you noted anything in the autopsy which might suggest similar effort to clean up ME04-309 which might not have been clearly pre- or postmortem?

  3. drational says:

    Marcy, I took a look at this autopsy as well. The final autopsy report notes Cerebral edema (swollen brain) and microscopic evidence of “early acute neuronal injury”. It also shows pulmonary edema (water in the lungs).

    The autopsy report looks like a cover up. Arryhthmias cause death acutely; you will definitely not see brain injury as described.

    The autopsy is more consistent with partial suffocation leading to brain injury, followed by heart failure. He had to have been alive for at least 4-8 hours after the lethal brain injury (hypoxia) in order to develop the edema and neurpathological changes observed. A primary cardiac cause will simply not do that.

    I wonder with all that fluid in the lungs whether he might have been waterboarded by his captors. The Navy Seals holding him certainly would have had the SERE experience…..

      • drational says:

        Could be collar, but not described as linear. Both Habibullah and dilawar had “parallel linear abrasions/contusions” on their necks which made me think of the collar or just a simple ligature to threaten with choking.

        In this case 6×6 neck contusion may just be evidence of a bat/baton or fist blow.

      • drational says:

        They are talking about an artery to the sinus node of the atrium, where the heart conduction starts. They are fantasizing about aberrant anatomy to make it look possible he had a dysrhythmia, but the Neuropathology (which was done by different specialists at AFIP) makes arrythmia as the first cause of death medically improbable. Within a reasonable degree of medical certainty, he was suffocated.

  4. tjbs says:

    Then again it may be all of the above if he was “high value” w/ info to stop the ticking time bomb and all that.

  5. BOHICA says:

    Anybody been prosecuted yet??

    * United States Code
    o TITLE 18 – CRIMES AND CRIMINAL PROCEDURE
    + PART I – CRIMES
    # CHAPTER 113C – TORTURE

    U.S. Code as of: 01/19/04
    Section 2340A. Torture

    (a) Offense. – Whoever outside the United States commits or
    attempts to commit torture shall be fined under this title or
    imprisoned not more than 20 years, or both, and if death results to
    any person from conduct prohibited by this subsection, shall be
    punished by death or imprisoned for any term of years or for life.

    (b) Jurisdiction. – There is jurisdiction over the activity
    prohibited in subsection (a) if –
    (1) the alleged offender is a national of the United States; or
    (2) the alleged offender is present in the United States,
    irrespective of the nationality of the victim or alleged
    offender.

    (c) Conspiracy. – A person who conspires to commit an offense
    under this section shall be subject to the same penalties (other
    than the penalty of death) as the penalties prescribed for the
    offense, the commission of which was the object of the conspiracy.

    The new Justice Department Motto:
    Hear no evil
    See no evil
    Prosecute no evil

  6. timtimes says:

    Shorter: Virtually any one of the myriad of horrible sins we inflicted upon this guy might have killed him. We did so much evil shit to him we can’t even narrow down the cause of death to any single item.

    Enjoy.

  7. BoxTurtle says:

    I note they redacted the name of the examining physician. Wonder if that’s to prevent Feingold from inviting him to testify?

    Boxturtle (Or to prevent the AMA from pulling his license)

  8. lesserdevil says:

    I wonder if people know how terrible some of our jails are. I get the feeling a lot of people just don’t want to think about the terrible things our government did during Bush’s presidency. It’s ridiculous to think torture wasn’t taking place here as well, on a widespread and regular basis.

    People don’t want to hear about what happened abroad or here, with the justification that the people involved were dangerous or criminals. It’s a lot like the snake that eats its own tail though. The torture begets more dangerous people.

    I can’t get anyone in charge to listen. I know that for sure. I may have to walk into the ACLU office in New Orleans, Louisiana, in person…

  9. wavpeac says:

    Ecological humankind-ness.

    We cannot continue down the path that bush set us on…

    It’s not about revenge. Its about truth. It’s about being able to change our course and to make amends where damage was done. Why is it that so many people believe that the proper course is to simply put a blindfold on. The only possible result of blindfolding ourselves to this truth, is to continue down this path and to make the same mistakes over and over again. I hate reading these posts…they make me sick, and yet, I know that we cannot change what we refuse to accept.

  10. Mary says:

    Thank you EW.
    Thank you drational.

    From the more analytical reports, there are discussions over and over about the “effectiveness” of “making” the detainee torture themselves – in particular with respect to stress positions. What they don’t mention much, though, is that rather than assymetrical warfare, the multiple suicides and suicide attempts have been some of the most extreme examples of their successful human experimentation. First you experiment with making a detainee torture themselves, and then you up the experiment, to see what it takes to make your detainees kill themselves. There you have the true ulitmate crime – your victims kill themselves and you collect your Patriot Badge and tuck your OLC opinion under your pillow.

    Given how early on it was crystal clear to the WH that many they were holding at GITMO were innocent (they knew that definitively by at least August 2002) there are two related pieces of info they had to know as well, both at the time and over time. First, that there were likely to be even more “mistakes” at their prisons in Afghanistan and later Iraq and that there were likely to be mistakes, although fewer, with their black site program – that is inescapable from what they learned in 2002. Second, that their experiments were being conducted on innocent people – knowingly. Whether that knowledge was specific (we know this guy is innocent, lets torture him anyway and see what happens) or nonspecific (we know our group of experimentation subjects has both terrorists and non-terrorists) it was absolute.

  11. Rayne says:

    Here, before I go offline for the next hour or so — here’s Jane Mayer in New Yorker from Nov. 14 2005 regarding the Manadel al-Jamadi case.

    Info seems awfully consistent with what this autopsy shows, although there must be something missing and/or different; if ME04-309 was in a stress position, should there be some sort of marks indicating restraint at time of death, more than that reflected in the autopsy report? Also seems like there’d be more indication of chest contusion in presence of broken ribs “consistent with CPR”, too.

    Here’s the list of autopsies from ACLU, which includes ME04-309; would like to know if the description here in this table was furnished by DOD or generated by ACLU. Note how some descriptions contain more info about victims’ conditions, including injury from restraint or chest injuries; here is the preliminary* description from the chart of ME04-309:

    Autopsy: ME 04-309; 27 year old male civilian presumed Iraqi national died in US custody 72 hours after being apprehended. Cause of Death: pending. Manner of Death: pending. Injuries: minor abrasions and bruises of extremities. Bruise on right side of neck. No evidence of natural disease, no evidence of drug abuse. Final autopsy report of this individual with more details is at DOD 013279. DOD 003323 lists an autopsy of the same date with the notation “Q[uestioned] by NSWT [Navy Seals], struggled/interrogated/died sleeping.”

    He just plain died while sleeping. Jeebus.

    (Also going to point out that Dr. Cyril Wecht was asked about al-Jamadi’s autopsy report; can’t remember when USA Mary Beth Buchanan went after him…)

    * edit: should have included the word “preliminary”; the final summary appears in same table document.

  12. NMvoiceofreason says:

    Thanks Marcy, BMAZ, and DRATIONAL, for the great work.

    I can only hope someone will listen before they come for me.

    • ghostof911 says:

      I can only hope someone will listen before they come for me.

      Is it coming to that? Currently reading a story about the Nazi occupation in Denmark. Perhaps what occurred then was not a once-in-a millenium aberration. The parallels between what happened then and what is occurring now are unmistakeable.

  13. Rayne says:

    Was there a description anywhere of the overall process of capture/custody/interrogation/detention/death of ME04-309?

  14. scribe says:

    To kick into the discussion, you my want to consider the known risk – from immobility – of clot-driven pulmonary embolism from the combination of immobnility and leg edema inherent in long-duration passenger air travel, particularly in coach. You have doubtless heard of people suffering from blood clots when they sat 8 or 10 or 12 hours in a coach seat, pinned in place by the sardine can that is coach travel. It’s a known risk for travelers, and frequent fliers are advised to get up and walk around, if only to the can and back, in flight, to get a little activity and avoid clot formation. An immobility box, shackling to a chair or forced standing for days would have much the same, if not more severe, effect in causing the formation of clots in the leg veins.

    I suggest, further, that the clots brought into being could have been sent on their way to the heart and lungs to become the pulmonary embolism, by the very beatings to the legs which appear to have taken place. In other words, kick someone in the legs and you might knock loose the clots which had formed there while you had him immobile for the last 8 or 10 hours.

    I therefore posit (IANA doctor, but I’ve read enough medical and autopsy reports as a lawyer doing PI cases) that the mode of killing 04-309 was this:

    he was brought in to captivity, declined to be interviewed, and was immobilized through one or more of the known methods – forced (Shackled) standing, tied to a chair, or just tied up. He was doused and knocked around a bit during this time, but was not beaten up too badly. After a day or so of being immobilized, one or more clots started forming in his leg veins. Their formation may have been accelerated by some blows to the legs in the capture/inprocessing experience (i.e., he may have gotten a bruise or two then, which led to speeding clot formation), but we know that 8 hours in a coach seat is enough for some people to get fatal clots formed. Someone came in to either rough him up, or bring him for interrogation, and along the way his legs were beaten and/or kicked, such that the clot or clots which had formed were knocked loose, either immediately or as a delayed result of the blows. The clots then went to his heart and plugged (incompletely) the heart-lung connections, resulting in a relatively slow (possibly half an hour or so, as opposed to almost-instantaneous from a full blockage) death from pulmonary embolism.

    Oh, and the Mary Beth Buchanan going after Cy Wecht on bullshit charges came after he opined on the causes of detainee deaths. It always was seen as a political hit.

    • drational says:

      scribe, I think you are describing what may have happened to A02-93, Habibullah, who is the subject of my kos diary kindly linked by EW above.

      04-309 here did not have any pulmonary embolism.

      • scribe says:

        You are correct.

        It’s just that there are so many dead, tortured bodies that one gets a bit confused after a while.

        But, going back to my “flying coach” hypothesis: any disagreements on that part?

  15. NMvoiceofreason says:

    Yes, we can all agree that he died due to torture. But we have a federal appeals judge who is a mass murderer and war criminal, who no one will touch. Disbar The Torture Lawyers Now has not resulted in a single torture conspirator losing their license, much less standing trial under the felony murder rule (18 USC 1117) or the torture resulting in death statute (18 USC 2340A).

    Nor will we.

    • ghostof911 says:

      Thanks for the link, Mvoiceofreason. We have villians of the first order embedded within the judicial system. Since you feel they can’t be touched, the only hope is that they will devour themselves.

      • NMvoiceofreason says:

        You are welcome, ghostof911.The villains of the first order are not embedded in the judicial system. They ARE the judicial system.

        We must pull on the levers that do nothing so that there will be a record that we tried. We must show that lawyers and judges are incapable of policing themselves, so that they can be given a system which will. Hoping that the evil ones will self destruct seems like a very Warsaw ghetto interpretation of the Nazi invasion. I do not share such views, and probably wasn’t what you intended either, but I’m very good at misreading things. A talent, I guess.

  16. Rayne says:

    scribe (29) – agreed with drational at (30), there’s no indication of embolism or adequate bruising.

    Just noted the autopsies are numbered by year and case in the ACLU doc containing death certificates. Example, beginning pg. 27 through page 29 of that doc:

    04-012 01/08/2004 (beginning of sampling; gap: 04-013)

    04-014 01/09/2004

    04-038 01/16/2004 (gap: 04-015 thru 04-037)

    04-101 02/19/2004 (gap: 04-039 thru 04-100)

    04-110 03/08/2004 (gap: 04-111 thru 04-308)

    04-309 04/05/2004 (gap: 04-310 thru 04-356)

    04-357 04/28/2004

    04-358 05/11/2004 (gap: 04-359 thru 04-385)

    04-386 05/22/2004

    04-387 05/10/2004

    04-388 05/24/2004 (end of sampling)

    Are all the other numbers in between each of these some other death in Iraq which required a certificate? Are they accounted for, ruled out as unrelated to detainees or interrogations?

    • drational says:

      The numbers are the identifiers for the individual autopsies performed by the Regional Medical Examiner. The other numbers will be other autopsies performed, and will probably include servicemen, NGOs, and non-detainee Iraqis who died from other than obvious causes, but for whom a cause of death needs to be established.

  17. robspierre says:

    “Now I’m no doctor–and I definitely can’t make sense of the cardiac findings.”

    I’m not either. But I had enough biology in college to wonder about a couple of things.

    First, the reference to asphyxia due to restraint suggests to me either hanging by the wrists (as in the torture technique called “strappado”) or hog-tying. Both techniques restrict breathing and are known to be popular with CIA and the Sadistic Forces.

    Second, as an avid climber and back-country skier in my youth, I know a little about hypothermia: dying from it is easy to do, especially when you are wet. I had a close call once. I can’t imagine that there is any way of deliberately inducing it safely outside of a hospital setting using hospital equipment. The line between cold and dead can be surprisingly hard to detect until it is too late.

    More speculatively, the reference to “cardiac arrhytmia related to ion channelopathies” makes me think of waterboarding and the hyponatremia problem, when ingestion of large quantities of water causes electrolyte imbalances. “Ion channelopathy” is a genetic condition, according to Wiktionary. But anything related to sodium, potassium, or calcium levels in the body seems suspicious in this context.

    Ugly, vicious business.

      • robspierre says:

        You mean “unprosecuted thus far.” I never thought that Emmet Till’s murderers would face prosecution. Milosevic didn’t think he would ether.

  18. Blub says:

    I’m not a medically-trained person, but on the surface of it sounds to me like suffocation, head trauma and a heart attack from the temperature torture are all possible causes of death. I think they bashed him around with some type of blunt implement, suspended him by the wrists, and possibly intentionally half-strangled him. This medical description gave me the chills – it reads like a litany of precisely the types of scars left on torture victims in places like Pinochet’s Chile. We saw a lot of reports just like this when I used to be a volunteer doing human rights casework and advocacy. I don’t even want to imagine what was done to this guy… We have become everything we once detested.

      • Blub says:

        ‘cept for Senator-for-Life Pinochet himself. Despite his adventures on a London runway, he was never actually prosecuted if I recall correctly. The Senator-for-Life will just have to get his commuppance in the afterlife, whatever sort of afterlife monsters get. I wonder if these thoughts ever run through Cheney’s head, as he sits around in his dotage.

        so ’stress positions’ apparently includes strappado and crucixion, huh? I’m surprised they didn’t just rack people… ‘probably couldn’t find a rack. Also.. no electrocution? ‘course Iraqi cities tended not, at that point, to have regular currents, so perhaps insufficient electricity.. What on earth did we do?

        • NMvoiceofreason says:

          We tortured people to death.

          “Command’s Responsibility documents a dozen brutal deaths as the result of the most horrific treatment. One such incident would be an isolated transgression; two would be a serious problem; a dozen of them is policy. The law of military justice has long recognized that military leaders are held responsible for the conduct of their troops. Yet this report also documents that no civilian official or officer above the rank of major responsible for interrogation and detention practices has been charged in connection with the torture or abuse-related death of a detainee in U.S. custody. And the highest punishment for anyone handed down in the case of a torture-related death has been five months in jail. This is not accountability as we know it in the United States.”
          —John D. Hutson
          President and Dean, Franklin Pierce Law Center
          Ret. Rear Admiral, JAGC, USN

          Human Rights First Report

          We tortured over twenty five people to death, and maybe more than 100:

          1.On 6/18/2008, during the sworn testimony before the House Judiciary Subcommittee on Civil Rights hearing on torture Rep. Jerrold Nadler (D-NY) was shocked to find out that over 100 homicides of detainees have occurred :
          NADLER: Colonel Wilkerson, in your prepared testimony, you write that “as I compiled my dossier for Secretary Powell, and as I did further research, and as my views grew firmer and firmer I had to reread that memo (of February 7, 2002), “I needed to balance in my own mind the overwhelming evidence that my own government had sanctioned abuse and torture, which at its worse had led to the murder of 25 detainees and at least 100 detainee deaths. We have murder at least 25 people in detention. That was the clear low point [lower end of the range] of the evidence.” Your testimony said 100 detainees have died in detention; do you believe the 25 of those were in effect murdered?
          WILKERSON: Mr. Chairman, I think the number’s actually higher than that now. Last time I checked it was 108, and the total number that were declared homicides by the military services, or by the CIA, or others doing investigations, CID, and so forth — was 25, 26, 27.
          NADLER: Were declared homicides?
          WILKERSON: Right, starting as early as December 2001 in Afghanistan.
          NADLER: And these were homicides committed by people engaged in interrogations?
          WILKERSON: Or in guarding prisoners, or something like that. People who were in detention.
          NADLER: They were in detention, not trying to escape or anything, declared homicides by our own authorities.

          • Mary says:

            Thanks for this – I had missed the exchnage with Nadler completely.

            @39 and @40 – this piece (long lead in before you get to the piece) by Martha Rosler talks about a video response she had done in the 1980s in response to a pro-torture op piece in Newsweek that shocked her, an put it in some context with current Krauthhammer. Here she is quoting from her old documentary, but the observation on the victims of the “response” to terrorism vs the victims of terrorism can’t help but conjure up the prices being paid in Afghanistan and Iraq, where no one can even tell you how many we kill on any particular bombing of a village.

            “In the last and fully totalitarian stage … the concepts of the objective enemy and the logically possible crime are abandoned, the victims chosen completely at random…. The innocent and the guilty are equally undesirable. The change in the concept of crime and criminal determines the new and terrible methods of the totalitarian secret police ,,, undesirables disappear from the face of the earth; the only trace they leave behind is the memory of those who knew and loved them, and one of the most difficult tasks of the secret police is to make sure that even such traces will disappear….”

            The voiceover continues:

            “Disappearance was used by the Nazis in the occupied territories in the Forties under the Nacht und Nebel (Night and Fog) Decree to dispose of people ‘endangering German security’ by means of what Field Marshal Keitel described as ‘effective intimidation.’

            “At the First Latin American Congress of Relatives of the Disappeared, held in Costa Rica in January 1981, the estimate given for disappeared men, women, and children over the past two decades was 90 thousand. By contrast, the CIA’s recent estimate of the total number of deaths resulting from ‘international terrorist’ violence for the period 1968 to 1980 is 3,668, or about 4 percent of the disappeared in Latin America alone. Although the Congress on the Disappeared presented testimony from 12 Latin countries, it wasn’t mentioned in the U.S. press. If there were a similar congress on East Bloc disappeared, with mothers reporting on their disappeared children, would the media overlook it?

            “On June 21, 1980, 30 Guatemalan labor leaders were seized by para-military forces, packed into trucks, and disappeared; no mention in the U.S. media. Suppose that Lech Walesa and 29 others Polish labor leaders had been seized by the Polish authorities and disappeared like the 30 Guatemalans — imagine the U.S. response.”

            It was an old piece, but with leaders like Bush and Obama, everything old is new again.

      • ghostof911 says:

        It ain’t over till it’s over. This is not the Warsaw ghetto, with a population of self-rightous, complicit Poles milling around doing nothing. There exists a passionate, vocal opposition in possession of communcation tools which earlier resistance movements did not have at their disposal. We have no excuse for not bringing these villains to justice.

        • NMvoiceofreason says:

          I’m just having a tough time figuring out how to win. I worked to elect Obama, only to find no accountability and “moving forward”. I thought bar associations would see how bad it was, but none of the torture lawyers have been disbarred. Judicial complaints likewise. Marcy keeps laying down facts and testimony keeps building, but most Americans don’t care that people over there were tortured to death, because they were people we went over there to kill anyway. The system is broken and there seems to be no way to fix it. My excuse, when the time comes, will be that I pulled all of the handles and none of them worked (# “The pump don’t work ’cause the vandals took the handles” © 1965 Bob Dylan (from TalkLeft)

  19. bobschacht says:

    Quick reply via smartphone:
    Don’t jump to conclusions about heart arrhthmias. They are often benign. I have had many episodes myself. However, when combined with other trauma, the results can be critical.
    Bob from HI still in AZ

  20. Valley Girl says:

    drational- re: your kos diary- here’s a bit of perspective- I am guessing that deep vein thrombosis then = pulmonary embolism.

    I can’t find the original links right now, but I did a bit about the venous skeletal pump in my human physiol. class. The “perspective” part, fwiw, is that I learned that DVT had been responsible for some deaths of airline passengers- lack of movement, etc. I am in no way differing with your conclusions- just to add that in some cases, really seemingly innocuous circumstances can lead to death- like, a death waiting to happen, and to make the point with an “ordinary” reference point (jet travel).

    I have a partial .pdf of one report I found- snippets:

    Title: Preliminary Evaluation of Recommended Airline Exercises
    for Optimal Calf Muscle Pump Activity

    The calf muscle and the veins within the leg, both superficial
    and deep are referred to as the calf muscle
    pump. Its action may be compared to that of the left
    side of the heart.

    Failure to exercise the calf muscles for prolonged
    periods may result in limited or poor blood circulation
    in the lower leg and increase the risk of deep
    vein thrombosis (DVT). An association between long
    distance travel and increased risk of DVT has been established.
    3e5 The World Health Organisation (WHO)
    recommends that passengers at high risk from DVT…

    from wiki The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency, present in the lower extremity there is 3% chance of a PE killing the patient.[1] A late complication of DVT is the post-phlebitic syndrome, which can manifest itself as edema, pain or discomfort and skin problems.

    edit- oops, I missed scribe’s comment at 29

    • Blub says:

      I actually think it likely that poor 04-309 could’ve just been simply and grotesquely suffocated – a frequent occurence among the torture victims of Latin American dictators in the 70s and 80s. By their own admission, they put a bag over his head and then brutally tortured him, subjecting him to unequivocally medieval methods (strappado, suspension, probably partial crucifixion to effectively obstruct his air flow), possibly all while beating him senseless.. and nowhere in the report does it say that the bag was removed during any of this break-taking(literally)/heart-rate inducing savagery. Quite a few Pinochet and Galtieri victims died exactly this way, if I remember correctly.

      DVT, heart problems, etc, gives these evil thugs partial cover they may not deserve (we might’ve helped him along but he ultimately died for reasons out of our control/understanding). With suffocation (or head trauma) they have no excuses whatsoever. They would’ve simply and unequivocally tortured a man to death using medieval methods.

      • Valley Girl says:

        Ah, I was not talking about 04-309- mine was a response to drational’s dKos diary re: another victim- I’m not a kos member, but as Marcy linked the kos diary I left the comment here.

      • NMvoiceofreason says:

        From a legal standpoint, Its irrelevant whether he died during the torture, or the next day, if it was the “proximate cause”:

        18 USC § 2340A

        “Section 2340A. Torture
        (a) Offense. – Whoever outside the United States commits or
        attempts to commit torture shall be fined under this title or
        imprisoned not more than 20 years, or both, and if death results to any person from conduct prohibited by this subsection, shall be punished by death or imprisoned for any term of years or for life.
        (b) Jurisdiction. – There is jurisdiction over the activity
        prohibited in subsection (a) if –
        (1) the alleged offender is a national of the United States; or
        (2) the alleged offender is present in the United States,
        irrespective of the nationality of the victim or alleged
        offender.

        (c) Conspiracy. – A person who conspires to commit an offense under this section shall be subject to the same penalties (other than the penalty of death) as the penalties prescribed for the offense, the commission of which was the object of the conspiracy.”

        So if death results from torture, you’re on the hook for the death penalty.

        • earlofhuntingdon says:

          If death results from the application of “torture”, it’s prison or death. Lots of wriggle room to avoid the death penalty, starting with hiding what was done and finding that the cause of death was “indeterminate”. Which gets back to having rational actors in the DoJ, not political hacks for whom a prosecution only has value if it increases votes for Republicans (or any other party).

      • drational says:

        DVT because of OLC (Bush)-approved immobility puts the torture architects on the hook for the torture death. Just like they would be on the hook if anyone suffered bad outcomes from waterboarding.
        They decided to do dramatic things with severe medical risk, without “Good faith” consultation of physicians. This is the liability of the lawyers and decision makers.

        Otherwise it is just a “few bad apples” being banally brutal, which is exactly the outcome of most of these deaths so far= only enlisted men convicted. No officer was charged with the Afghani deaths I cover in my Kos diary, and no one was charged with murder.

  21. earlofhuntingdon says:

    While purportedly “undetermined”, the cause of death was not natural causes or accident. It was induced, induced by the maltreatment administered by the US Government or its agents. It seems likely to be a homicide, unless he swallowed his tongue or hanged himself. If that had been so, it would have been noted; it wasn’t. If homicide, the question is the level of intent: negligence, reckless disregard for the physical injuries induced by “enhanced interrogation”, or intentional death.

    I’m also surprised at the apparent lack of other findings, such as bleeding of the small blood vessels in the eyes, bluish coloration, bruises around the neck, etc. If apoxia/asphyxia are indicated, then something induced a lack of oxygen so severe and prolonged, it led to lethal brain damage. The various approved techniques – in combination – seem the most likely cause, which would demonstrate their lethality and that that lethality was known across the chain of command or intentionally covered up.

  22. MarkH says:

    Who (before the Bushies) does this kind of stuff?

    We have easier ways to kill or interrogate, so there was clearly other motivations and/or purposes.

    I think they wanted to inflame the Islamic militants, so they would come out of the woodwork to fight us. I think Bush was serious when he said, “Bring it on!”

    It’s disgusting that an American leader would think of such a thing. Add that he knew it was Al Qaeda and they weren’t in Iraq and you have a truly horrific crime.

    • KenMuldrew says:

      You wrote,

      We have easier ways to kill or interrogate, so there was clearly other motivations and/or purposes.

      “The purpose of terrorism is to produce terror”. V.I. Lenin.

  23. pdaly says:

    I’m late to this postmortem. I’ll defer to drational’s expertise about changes in nuclei and brain swelling pre and post-death. I continue to wonder why the 21 day delay in performing the autopsy of an unexplained death in capitivity–how much information is compromised by the body’s decomposition 3 weeks out?

    I’d like to highlight the comment someone above made that in a preliminary summary of this person’s death (Red Cross summary?) that there was a mention he had ‘died while sleeping.’

    I didn’t see this mentioned in this final autopsy report, so I am wondering if that ‘died while sleeping’ was misinformation provided to the Red Cross at the time or subsequently suppressed information?

    Misinformation would be for the obvious reason to suggest no one was bothering him at the time of his death. But since when did the US allow detainees to sleep?

    Supressed information, because if he were dead and asleep, why would anyone try to resusciate a dead man who had been gone for unknown amount of time?

    I think it more likely prison guards or contractors were present when he died (maybe he was hooded and stopped making noises for longer than normal) and so they assumed there was time to attempt resuscitation–or if he died while hypothermic, so they knew he could not be pronounced dead until his body reached room temperature. A well known saying in hypothermia medicine: you are not dead until you are warm and dead.

    Other thoughts:
    Were the black eyes of 04-309 (lower lids more than upper lids) a result of blood tracking down the skin of his face, under the force of gravity from the his contusions on the left and right sides of his forehead?

    If “yes” this suggests he was “sleeping” upright (on his feet or in a chair/box/tub) or while “sleeping” on his stomach. I doubt blood would track reliably to the lower lids if he had been on his back.

    The evidence of (medical) therapy is consistent with someone who has undergone a standard code for cardiac arrest: Endotracheal tube in place (in the emergency rooms, a deceased patient is left intubated although unhooked from the machine or hand-compressible “ambu bag” so that a coroner can confirm the placement of the endotracheal tube was in the lungs and not accidentally in the esophagus), 3 adhesive EKG tabs on the body (also called telemetry–to monitor the cardiac electrical rhythm to know if it is time to shock a person or not), IV catheter in the left antecubital fossa (IV in the inside crease of the left elbow), IV catheter in the right inguinal region ( usually this is a larger diameter IV in the R groin for infusing fluids and medications very rapidly. Arteries and veins in the groin are larger in diameter and easier than arm veins to find and catheterize during CPR compressions), curvilinear abrasion on the upper right side of the chest, consistent with defibillation attempts (If defibrillation attempts were with use of electric paddles to deliver the shocks, then “skin burn” is what they mean by “abrasion”), and cracked ribs near the sternum (ribs 2-4 for sure can crack during CPR with manual chest compressions , uncertain about rib 6)

    But as I mentioned above, why perform this on someone who “died” in his sleep?

    Unlike medical TV shows, a flat line on the telemetry/ecg monitor is not an indication to zap someone with electrical paddles.
    If the resusciation team were following routine ACLS protocol, they would have seen on the cardiac telemetry monitor that 04-309 had a “shockable” electrical rhythm such as ventricular tachycardia (v-tach) or ventricular fibrillation (v-fib)on the monitor. The lidocaine medication in his urine suggests as much–that he received IV lidocaine and it perfused through his body long enough to be filtered through his kidneys and into his urine.

    [aside: In 2004, I think the medication IV amiodarone had already supplanted IV lidocaine in most ACLS algorithms for cardiac resuscitation. Lidocaine is still used as an alternative to amiodarone, although some studies in 2000 showed survival in patients given lidocaine was 50% less than patients resuscitated with IV amiodarone. However Lidocaine is cheaper and probably more readily available worldwide so I assume the military still uses lidocaine. I’d be curious to hear.]

    • Rayne says:

      Wow, thanks for that. Definitely feel more suspicious about the broken ribs “consistent with CPR” now that you’ve pointed out location of rib 6, hadn’t checked it earlier and only surmised it was rather too far from ribs 2-4 for what I would have assumed was normal chest compression under CPR. Nor can we rule out any or some of the broken ribs having been contributory to suffocation, having possibly been broken not during CPR but well before.

      What’s your guess on timing of the lidocaine perfusion? it’s probably not important, but it wouldn’t hurt to have a solid guess on time from IV insertion to appearance in urine if we tried to draw a timeline on ME04-309’s last moments.

      Your observation well taken about the bruising around eyes; I’ve closed the PDF to the autopsy report, will check in the morning as I remember reading a mention about lividity which at the time didn’t raise as many flags as the subgaleal hemorrhage.

      And yes, why do all this CPR on someone who is already perceived as having died in their sleep?

    • Rayne says:

      Okay, went and re-read the autopsy report. Page 4, External Examination indicates, “Lividity is present and fixed on the posterior surface of the body, except in areas exposed to pressure.”

      Don’t know if that tells you anything in addition to the indications of lower lid ecchymosis.

      • pdaly says:

        The pattern of fixed lividity tells us what position he remained in after he died. In this case, he remained on his back after death. So had someone place him after death on his right side, for example, the lividity would have appeared on his right side (’except in areas exposed to pressure’ points).

        The periorbital ecchymoses (black eyes) is from bleeding while alive. The blood follows the laws of gravity. It appears he was upright or on his stomach for this pattern to develop.

        The rib fractures, including rib 6 after further thought (especially if they are including the cartilage extension of rib 6 to the sternum as their definition of a ‘rib fracture’), are explainable by CPR effort, but as you say, this does not rule out bad faith targeting of those areas for torture.

        Lidocaine works rapidly on the heart after injection–seconds to minutes. The time it takes for lidocaine to reach the bladder I don’t know–probably under an hour? I also do not know the amount that needs to accumulate before a urine toxicology screen can detect it in the urine. We’d need a pharmacologist or medical examiner to weigh in on these questions.

        However, the liver is the body’s main source of elimination of lidocaine once it is in injected into the blood stream. The liver metabolizes lidocaine to at least two smaller metabolites MEGX and GX. These metabolites are then cleared by the kidneys and end up in the bladder. So in order for 04-309 to have lidocaine in his urine, he has to have a functioning liver, some blood circulation, and functioning kidneys. He was still ‘alive’ when resuscitation efforts began.

        Electrical paddle burn and presence of lidocaine in the urine implies 04-309 had a vtach or vfib arrest. Use of these resuscitation options implies 04-309 was hooked up to telemetry at the time. To clarify what I wrote late last night, lidocaine and electric paddles are used for specific heart arrhythmias (vtach & vfib for example) and not for someone who has flatlined.

        Of note, someone in a coma would be monitored on telemetry. Such a comatose person might even be described as ’sleeping’ by a nonmedical observer. Brain swelling can lead to malignant heart arrhythmias and require ACLS resuscitation efforts. If 04-309 was in a coma and his telemetry monitor alarmed with vfib, medical personnel would have started the ACLS code to revive him.

        This scenario would support drational’s assertion that the brain swelling predates 04-309’s death.

        • drational says:

          I am really bothered by his diagnosis of pulmonary edema. True, both lungs are too heavy; but look at the microscopic of the lungs- no edema.

          LUNGS: The alveolar spaces and small air passages are expanded and contain no significant inflammatory component or edema fluid. The alveolar walls are thin and slightly congested. The arterial and venous vascular systems are normal. The peribronchial lymphatics are unremarkable.

          Maybe a typo, but what do you make of his lung weights? 700 right and 900 left. I have seldom seen a left lung heavier than a right lung and never by 200 grams.

          If this was simple pulmonary edema at 900 or even 700 grams, I’d expect both lungs to be equal weight and for there to be florid alveolar edema and vascular congestion. The guy has in total 600 cc of extra fluid in his lungs, where is it?

          It’s another suggestion to me that he may have been waterboarded, and that head deviation or positioning led to assymetric aspiration of the water…
          The extra water may have been in bronchioles and is thus lost to microscopic.

          Thoughts?

          • pdaly says:

            Not sure what to make of it either. And I would have expected, as you probably did, the right lung to weigh more than the left if he had aspirated –since, anatomically, the right lung is more at risk for such an occurrence.

            I was bothered by ‘focal skin slippage of the arms.’
            Wasn’t sure how body decomposition would affect delicate organs like the lungs (including their weight) so I ignored the findings as potentially unreliable. I am surprised to see microscopic examination even could be performed on lungs 3 weeks postmortem. If his body was immediately frozen to preserve the tissue, would there be slippage and greening of the abdomen? I don’t know.

  24. earlofhuntingdon says:

    If pain associated with organ failure is a John Yoo requirement for there to be torture, would Mr. Yoo concur that when ALL the organs fail – as in death – that the enhanced interrogation techniques used amount to “torture”? Or is that why the ME tried to say that the cause of death was indeterminate?

    Does it also mean that NPR, the WaPoo and the NYT can stop using blinding euphemisms, and in at least the cases of these more than 100 deaths, call the treatment what it is: torture? The opinions of Democratic opponents of Mr. Bush or Mr. Obama or “some people”, or mere activist liberals aren’t what make it so, the facts are.

  25. earlofhuntingdon says:

    Is more than a hundred “accidental” or “undetermined” causes of death enough to suggest systemic brutal abuse was high policy? That number is almost certainly an undercount. Even where the examiners concluded death was a homicide, little or no action has been taken either against the individuals involved or to reform the system that permitted such a high number of deaths – again suggesting agents following policy set on high.

    The number of badly injured prisoners must far exceed the number of deaths. Which also means that the consequences were well known and were accepted as part of the policy set on high. There isn’t even a fig leaf now separating Mr. Bush and Mr. Cheney from their torturers. They should be aware that “shit happens” is not an adequate defense to committing, authorizing or condoning torture.

  26. exmedic says:

    Just a thing to note that I have not seen posted. Not that I have every single post.
    One of the things that can cause sudden death in a bound or suspended victim is when the release of a restriction, eg tourniquet/binding that has restricted circulation to any major degree, this introduces back into the core organs a toxic mixture. The toxins are produced by the process of anaerobic metabolism. This same process causes death in victims that are trapped in building collapse etc. Any time anaerobic metabolism is sustained for a period of time, each individual varies to some degree here, and then released back into the rest of the aerobically metabolized core, the shock is too much for the body to compensate for and cardiac arrest is usually the outcome. If the person performing the autopsy does not look for the toxins then obviously there will be no noticeable cause of death directly related to the bindings. Just note I have also heard of similar cases involving hypothermic patients succumbing to cardiac arrest when attempting to remove them from the water by lifting their hands and arms above their heads. Don’t know how relevant this is in this situation but it may be a missing piece of the puzzle.

  27. Rayne says:

    drational (69) — wouldn’t we also see some indication in nasal or throat areas of stress if he’d been waterboarded? It seems like something is missing here, like pieces have been left out of the picture.

    Could explain some of the bruising around his neck if he’d been restrained at the neck during waterboarding…

    The other question I asked up thread was about blood seen streaming from al-Jamadi’s nose when he was de-hooded after becoming non-responsive in a crucifixion-like stress position. Could this have happened to ME04-309, but have been “cleaned up” with considerable amount of water, perhaps even postmortem at time of death? Again, would probably see some indication here in other body parts besides fluid in lungs.

    pdaly (70) – they also said that al-Jamadi had been “frozen” in the mens’ shower area, but what the Abu Ghraib photos all show is his body packed in ice. I suspect similar treatment of ME04-309, so decomposition would be more marked than if he’d been put into an actual freezer.

  28. drational says:

    He was refrigerated, which will pretty much halt decomposition over a few weeks, but looks like he was unrefrigerated for 24-36 hours to allow for passage of rigor and onset of skin slippage and greening. Decomposition at this stage should not affect lung weight, there was no autolysis of any of tissues by microscopy.
    So I hold the lung weight discrepancy as significant, but its just a curiosity. As you know there are dictation templates, and the pathologist might have just dictated normal lungs but really there was edema. Or the pathologist might have seen 400 cc of water come out of the left lung airways after wieighing, and chosen not to document as part of a cover-up.

    Continuing with the drowning possibility, intubation of the right main bronchus (versus trachea) at the time of resuscitation might have decompressed some of the water from the right lung but not the left.

    • Rayne says:

      Don’t know about the decomposition halted by refrigeration. Pot roast left in my fridge by oversight for that long don’t keep.

Comments are closed.