[Correction, 7/1/13: a September 2013 FOIA request by Jason Leopold was actually responsible for the report's release.]
The tenor of the report is captured in the fact that after the report's first page, Latif is almost never referred to by name but only as a number: ISN156. Additionally, the stressors of indefinite detention, "forceful cell extractions" (beatings), isolation, and other forms of abuse and torture are practically never mentioned, while camp medical authorities are quick to label the young traumatic brain injury victim someone who is personality disordered and antisocial.
Last December, U.S. Southern Command (SOUTHCOM) stated that Latif died from a suicidal overdose of a prescription drug, complicated by acute pneumonia. The current report details what drugs were found in Latif's body, and provides the military's version of the events surrounding the Yemeni detainee's death.
The report states that 24 tabs of the antipsychotic drug Invega, or paliperidone, a drug similar to risperidone, were found in the dead man's stomach at the time of his death. Latif was given two tabs each day of the powerful antipsychotic (one tab of 6mg, one tab of 3mg), supposedly for agitation related to manic states of bipolar disorder.
Other drugs were found in his system as well, including another antipsychotic drug, Seroquel. Both drugs are known to cause a cardiac condition that can lead to dangerous heart arrhythmias, and even cardiac arrest, especially when combined as they were. There is no mention in the report of the possible effects of mixing and changing these drugs. Other drugs found in Latif's body included the powerfully sedating antidepressant Remeron, the antidepressant Celexa (which he was supposedly being weaned from), the tranquilizer Ativan, and various painkillers, including Percocet and codeine.
The report confirms that there was an attempt to switch Latif to monthly injections of Invega, "administering the medication against ISN156's will," as the report puts it. The plan was submitted to a "Healthcare Ethics Committee" at the Naval Medical Center in Portsmouth, Virginia. The committee approved the plan in late August 2012, but it appears the changeover to injections had not taken place before Latif died.
Contradictory SOPs, Lax Enforcement
The report confirms statements reported in a Truthout article by Jason Leopold last January that "long-standing standard operating procedures" (SOPs) at Guantanamo were not being followed or enforced.
But the report goes farther than that and states that differences between how SOPs are formulated between Guantanamo's medical and detention/guard commands cause confusion among camp personnel. The report cites failure to adequately train personnel, failure to hold anyone accountable for not following standard procedures, and failure to do anything about this even when similar problems were specified in earlier reports as needing remediation.
The lax protocols on drug administration were particularly dangerous, as drugs would at times be left out on trays and it was not observed if Latif had taken the drugs or not. The report hints Latif was not alone as the recipient of such lax methods. Still, portions of the report that describe how Latif could have hidden drugs despite searches, were heavily censored. The same censorship affected portions of the report that described what happened with the so-called line-of-sight surveillance of Latif the day he died.
The report describes a health care and guard-detention regime at the Cuban-based US military base that is unprofessional, sloppy, confused, and subservient to military command. But even worse is the Joint Task Force - Guantanamo (JTF-GTMO) command, who failed to implement what SOUTHCOM investigators described as "many of the required changes identified in previous detainee death investigations."
The failure was fatal to Adnan Latif, a traumatic brain injury victim falsely labelled a terrorist, and only years later cleared for a release that never came. Instead, it seems, his conditions of confinement and despair over ever being released led him to make numerous suicide attempts and suicidal statements, and carried him into the far reaches of psychosis.
Poor medical practice surely played a role as well, as the report noted that an outstanding request for Latif's records for his head injury from Jordanian authorities remained unmet at the time of his death.
Latif's bizarre and obscene behaviors under the stress of incarceration were known to be too difficult for guards to long witness. "Another guard noted it was 'horrible' to be on line of sight duty for ISN156" because of behaviors so awful or strange they were redacted in the report.
The stress induced on Latif must have been incredible. Beyond the interrogations and the torture, this new report details that he was "moved from camp to camp over 67 times." In other words, his living quarters were changed on average over two times a month for ten-and-one-half years! SOUTHCOM felt it had to address this, and stated (without any supplied proof) "the moves themselves did not contribute to the detainee's death." But they were less sure about the final move, the third move for Latif in the two weeks before his death.
Bogdan Orders the Move
When Latif was told to return to Alpha Block in Camp V, an unnamed detainee told them it would result in Latif committing suicide, due apparently to bad experiences Latif associated with a previous incarceration there.
Instead of raising concerns, the report states Col. John V. Bogdan, the Commander of JTF-GTMO's Joint Detention Group, requested Latif be moved from the Behavior Health Unit at the Detainee Hospital to Camp V for "discipline" three or four days before the Senior Medical Officer and an unnamed official (though most likely either Latif's psychiatrist, psychologist, or primary care doctor) had planned a return of the beleaguered prisoner to a communal section of Camp V.
As the report describes it, on the morning of September 7, the day before he died, Latif refused his medications. He reportedly was quite unhappy because his portable urinal had been taken from him, because in throwing it, he had supposedly splashed a guard with urine. Furthermore, there allegedly had been a long history of such behavioral infractions.
So on the morning of September 7, Latif wrote a note to the Watch Commander that "[redacted]" (from the sense of the report his psychiatrist or another female medical official) was "'rushing him towards death' and that she was the 'cause of the problems in the detainee hospital.'" Latif asked the note be sent to Col. Bogdan.
The report does not say what the Watch Commander did with the note, but that same morning, Col. Bogdan contacted an unnamed medical official (again, I surmise the psychiatrist, but it could have been a different person) and asked "whether there was a medical or psychiatric reason that would prevent ISN156 from serving his discipline time" right away. Seeming to bow to the pressure from a senior officer, the unnamed medical officer responded that Latif's behavioral infractions were "'very volitional behavior' and there was "no psychiatric reason" to prevent ISN156 from serving his discipline time."
Nevertheless, the report also cites a "Force Protection Report" an "analyst" brought to officials the afternoon of September 7 "saying ISN156 was suicidal and was going to kill himself." Apparently, JTF-GTMO's Cultural Advisor got the same report and sent it to Bogdan "and others" in "a high-priority email." Bogdan supposedly never saw it, but indicated to investigators that even if he had it wouldn't have made any difference to him.
Meanwhile, both medical and guard personnel were so worried about Latif's transfer to a solitary cell in Camp V's Alpha Block they took special precautions to move him in such a way "so as not to alert other detainees of ISN153's pending transfer."
The SOUTHCOM investigators stand by Bogdan's decision. "In this instance, COL Bogdan acted reasonably as he had to address the frequent misconduct by ISN156. On balance, the suicidal ideation did not stand out compared to any of the other instances."
Missing Data, "Emergency Medication"
The report notes Latif was put in his cell under line-of-sight surveillance, including by closed circuit camera. According to the report, Latif smeared food to cover the camera lens, but nothing was done about this. Two other detainees in Camp V were reportedly able to see right into Latif's cell, but there is no indication that they were interviewed by Army investigators, leading Latif's attorney to call the new Army investigation "a whitewash." (A separate investigation by the Naval Criminal Investigative Service is still said to be underway.)
According to the AR 15-6 report, confusion over how to implement the line-of-sight protocol, due to lack of training and a generally lax attitude about following SOPs with detainees, and especially with Latif, "contributed to the death of ISN156." Unremarked by mainstream press accounts thus far, the report also notes a disturbing failure to enter crucial data into the Detainee Information Management System (DIMS) the day of Latif's death, even though there is a specific SOP that governs the entry of such data during line-of-sight observation.
No guard stated they saw Latif take medications. They also thought it was strange, in retrospect, that Latif would be sleeping for 12 hours or more.
But elsewhere in the report, investigators describe an August 2012 incident when a period of reported agitation by Latif led to a forceful takedown with "emergency medication." This consisted of three shots, one each of the tranquilizer Ativan, the antipsychotic haldol, and the sedating antihistamine Benadryl, which is applied to counter the negative side effects of the haldol.
Last year a DoD Inspector General report on the drugging of detainees, also released to this author via FOIA, detailed the use of "chemical restraints" upon detainees, and it is likely that such "chemical restraints" and the "emergency medication" used on Latif are one and the same thing.
In any case, the new report describes how Latif "slept from 12 to 14 hours" after the "emergency" sequence of injections. So it is possible guards had good reason not to find it so strange that a detainee might be asleep for 12 hours or more after such chemical "discipline."
The report also details how the final "downward spiral" for Latif began after the U.S. Supreme Court upheld the reversal of his habeas appeal for release in June 2012. Latif was "furious" and "saying 'crazy stuff'" after a phone call with his attorney David Remes, who broke the terrible news to him. Yet this insight by the military investigators is saved for a footnote, while medical authorities describe the depressed prisoner as "manipulative" and "wilful," a behavioral management problem for the guards.
What About the Pneumonia?
In December 2012, an official SOUTHCOM statement concluded, "Mr. Latif died of a self-induced overdose of prescription medication. The medical examiner also concluded that acute pneumonia was a contributing factor in his death."
But in the new SOUTHCOM report, while the cause of death is specified as "paliperidone [Invega] toxicity resulting from an overdose," the autopsy is now described as saying the Armed Forces Medical Examiner "is uncertain to what extent the acute pneumonia contributed" to Latif's death. Accordingly, the report never asks or comments on how Latif was shifted from the Detainee Hospital to solitary confinement in a disciplinary cell in Guantanamo's Camp 5 without anyone noticing he had "acute pneumonia."
The medical regime at Guantanamo appears to reproduce the worst kinds of practices of U.S. managed care. So while the report states the Camp V Officer-in-Charge told investigators she fields "five to seven Code Yellows per week" -- that is, "a potentially life-threatening medical condition requiring an immediate response" -- the Detainee Hospital does not staff doctors on weekends. Latif died on a Saturday.
In a final strange aside to the Army's report, it's revealed that "coincidentally" Latif's mother died on the same day as her son. The report does not state her cause of death.
Originally posted at The Dissenter/FDL