Medical Ethics and Detainee Operations

How often, at a minimum, should a detainee's weight be checked while in the detention facility?

Daily Twice a week Weekly Monthly**

Which of the following procedures is NOT part of the detainee in-processing medical examination?

Rectal cavity search* Height and weight check Dental screening Chest x-ray

Article 3 of the Geneva Conventions protects prisoners of war and wounded combatants from all of the following EXCEPT:

Mutilation during interrogation Murder Execution after receiving a fair trial** Cruel treatment and torture

In Middle Eastern culture, the _____ is considered the most unclean part of the body.

Thumb Sole of the foot ** Right hand

The Qur'an is the holy book of Islam and it guides Muslims in the following areas:

Modesty Dietary restrictions Prayer All of the answers are correct**

Screening Requirements include all of the following EXCEPT?

Physical exam Body cavity exam** Medical history review Chest x-rays and immunizations Routine vital signs Dental screening Height and weight measurement

Key points about dealing with the language barriers include which of the following?

Use translators with some medical expertise Make sure detainees understand what care you are providing to them Ensure that detainees don't agree to care they don't understand All of the answers are correct**

Which of the following statements is/are TRUE about the role healthcare personnel would play in interrogations? Select all that apply.

Healthcare personnel can serve as medical provider and as part of the Behavioral Science Support (BSS) team at the same time Medical personnel who help interrogation team should not be a part of the healthcare team** Healthcare personnel are prohibited from assisting detainee interrogation teams** Healthcare personnel are encouraged to assist detainee interrogation teams

Which of the following behaviors would NOT be considered rude or inappropriate according to Middle Eastern culture?

Leaning against a wall Crossing your legs in the presence of an elder Standing extremely close to a person during a conversation ** Pointing your shoe sole at someone

The Principles of Medical Ethics require healthcare personnel to avoid which of the following acts?

Participate actively or passively in acts in an attempt to commit torture or other cruel, inhumane or degrading treatment or punishment ** Maintain strictly professional relationships with detainees for the sole purpose of evaluating, protecting, or improving their physical and mental health Provide treatment for prisoners and detainees to the same quality and standard as those who are not imprisoned or detained Restrain detainee patients for medical reasons as necessary for the protection of the health and safety of the detainee

Which transfers require the following minimum documentation: Operative Note (SF 516), Transfer Narrative Summary of Care (SF 502), and radiographs?

None of these documentations are required Detainees' transfers from Role 1 to Role 2 treatment units Detainees' transfers from Role 2 b to Role 3 treatment units**

Detainee medical records do not need to be at the same standard as those for U.S. and coalition service members.

FALSE

When specialty care is available to coalition forces, specialty care should also be available to detainees in theater.

TRUE

When the Laws of War are broken (breached), there are simple and grave breaches, depending on the severity of the violation. Which of the following is a grave breach?

Poisoning wells and streams Torture ** Maltreatment of corpse Pillaging

The detaining forces have an obligation to provide certain groups with either medical care or to ensure that they have access to medical care. Which group should be ensured access to care?

Civilian Population** Civilian Internees Enemy Prisoners of War (EPWs) Other Detainees Retained Personnel (RP)

Which of the following is NOT a responsibility of Military Intelligence personnel?

Serve as translators or interpreters Clear compassionate release requests Review detainee medical information ** Provide direct assistance to prisoner interrogations

According to the Hague and Geneva Conventions, American Soldiers are required to:

Treat Enemy Prisoners of War humanely ** Inflict unnecessary destruction to accomplish your mission Obey unlawful orders All of the answers are correct

What should you do during medical examinations to ensure the respect for dignity of the detainee?

Use graduated levels of privacy that are appropriate for the type of examinations Make every effort to provide same gender medical examiners and security support Position patients to minimize exposure of their private regions consistent with security requirements All of the answers are correct **

During a detainee ground transfer, healthcare personnel are in charge of a detainee's restraints.

FALSE

Which of the following statements is/are TRUE about the roles between healthcare personnel and military intelligence? Select all that apply.

Military intelligence (MI) personnel are always authorized access to detainee medical information BSS Teams personnel assigned to military intelligence are not a part of the healthcare team and will not provide care to detainees** BSS Teams personnel assigned to military intelligence are allowed to review detainee medical records Healthcare personnel are prohibited from assisting detainee interrogation teams **

Who makes the determination whether an autopsy will be conducted after the death of a detainee?

Regional Combatant Command Senior Medical Officer Facility Commander Armed Forces Medical Examiner ** Attending Medical Officer

Which of the duties listed below are owed to Enemy Prisoner of War in accordance with the Geneva Conventions?

Duty to protect Duty to respect Duty regarding abandonment All of the answers are correct **

Which of the following individuals is considered a civilian?

Elderly man appears to be in his 60s and has a limp Young man, early 20s, appears angry Middle aged man, mid 40s, dressed like a field worker Small boy around the age of 5**

Treat enemy casualties and detainees with the same ethics and medical standards of care as for multinational forces. Triage by medical condition only

TRUE

Members of the ICRC arrive to perform an inspection of the medical treatment areas of the detainee facility and ask to visit patients and view medical data. What should you do?

You deny the requested for information You forward the request for access to the facilities through your Chain of Command ** You provide the requested information and you guide them around to visit the patients

Which of the following actions would NOT be considered a form of physical abuse?

Using physical restraint for safety of staff ** Using physical restraint as a punitive measure Kicking a prisoner in the back Slapping, if it does not cause a bruise

Which of the following stipulations is TRUE regarding the verification of a detainee as being impaired?

Any member of the medical staff may take this determination Two members of the medical staff must agree to the determination** Only a behavioral science specialist may make the determination The senior medical officer must approve the verification

Which of the following is the correct order for the standard steps for challenging an unlawful order?

Request rescission of the order. State your disagreement with the act. Present all moral arguments. Seek to get the order changed. Ask the senior leader to stop the act. Repeat the order. Request clarification of the order State you disagreement with the act. Ask the senior leader to stop the act. Repeat the order. Request clarification of the order. Present all moral arguments. Seek to get the order changed. Request rescission of the order Repeat the order. Request clarification of the order. State your disagreement with the act. Present all moral arguments. Seek to get the order changed. Request rescission of the order, and finally, ask the senior leader to stop the act **

Which of the following statements regarding the Health Insurance Portability and Accountability Act (HIPAA) is TRUE?

Detainees are not covered under HIPAA, so there is no need to maintain detainee records in accordance with its guidance Detainees are not covered under HIPAA, but they are guaranteed the same standards of care, so this should apply to medical records as well ** The rules and regulations contained in the HIPAA also apply to detainees

Which medications are detainees allowed to have in their possession? Select all that apply.

Heart medication Albuterol inhalers** Insulin Moisturizing creams**

Detainees who have been physically or sexually abused must receive a through medical examination before being released to CID or MPs.

TRUE

Although your shift has just ended, before you may leave you are tasked to screen the detainees so that they can be transferred to another location. They have just knelt for mid-day prayer. The MPs tell you that this procession usually requires about half an hour. What do you do? Select all that apply.

Wait for the prayer to be over to do the screening** Determine if it is an emergency screening before interrupting the prayer Leave a note for the next shift to do the screening after the prayer Interrupt the prayer to do the screening

Which records should be traceably mailed to the Washington National Record Center in Suitland, MD?

Both inpatient and outpatient records Outpatient records upon release or final disposition of the detainee from detention** Inpatient records

Which of the following makes up the general legal obligations for military operations worldwide?

The Law of War** The Hague Conventions The Geneva Conventions The Martens Clause

Per AR 190-8 Paragraph 1-5a (4), inhumane treatment of EPW, CI or RP is a serious and punishable violation under the international law and the Uniform Code of Military Justice (UCMJ).

TRUE

When visiting detainee compounds, the International Committee of the Red Cross looks for all of the following EXCEPT:

Completeness of medical records** Treatment of detainees Material conditions of detention Overall legal framework of detention

Which of the following statements is TRUE regarding the separation of Military Police and healthcare responsibilities?

Healthcare personnel dictate to Military Police acceptable security procedures Healthcare personnel will not carry guns in the detention facility ** Healthcare personnel may be alone with detainees who are not considered to be a threat Healthcare personnel can discipline a detainee but only if the infraction occurs in the medical treatment facility

ATP 4-02.46, Army Health System Support to Detainee Operations give specific guidelines for identifying signs of abuse and procedures to follow should you suspect a detainee has been abused.

TRUE

Which of the 4 Ps of Abuse Prevention states that a system should be in place to reduce the potential for abuse.

Priorities** Policies Practice Procedures

The following are reasons for complying with the Law of War EXCEPT:

It can cause people to question our motives** It is the law It can shorten the length of conflicts It sets an example for other countries to follow

One of the detainees is an insulin-dependent diabetic, who has been moved from level one security to level four for misbehaving. Now he is refusing his insulin and has been admitted to the ward for monitoring. The medic needs to draw the detainee's blood for baseline results but the patient refuses citing cultural and religious conflicts. What should the medic do? Select all that apply.

Skip the patient and continue passing medications to the rest of the patients Explain to the patient the reason for drawing his blood and for administering insulin to him** You do not have informed consent, notify the MTF Commander of the situation** Restrain the patient, give the insulin, and draw the blood

While examining a young female detainee, you discover bruising to her genital area. You ask her if she has been sexually assaulted and she says no, but it is obvious she is scared. What should you do?

Report the incident immediately** Keep questioning her until she tells you how she got the injury Nothing. You've fulfilled your obligation Instruct her to be more careful

Non-Muslim male physicians are not allowed to treat women in many Islamic societies. Please note that for many Muslims treating the illness takes precedence, and seeking permission from the patient and male guardian, will likely result in allowing treatment for illness.

TRUE

In order to be classified as an EPW, a guerilla fighter must do which of the following? Select all that apply.

Commit war crimes Wear fixed, distinctive insignia** Operate under a responsible command** Carry arms openly**

In Middle Eastern cultures, largely Muslim, there are no rules regarding eye contact between the sexes.

FALSE

Prolong handshakes, kissing of the face, grasping elbows, and even prolonged hand holding by two men in public is a sign of friendship and respect.

TRUE

Which of the following is TRUE regarding detainee identification numbers?

Identification numbers are required to order medical tests and provide prescriptions No detainee will be refused care because of an identification number cannot be provided up front The Military Police unit in charge of in-processing governs identification numbers All of the answers are correct**

Being thorough with detainee records helps provide the best care and it helps us to comply with our legal and ethical obligations.

TRUE

You are the triage officer for a detention camp which has just taken a mortar attack. There are a large number of wounded (Coalition Forces and EPWs) and the supply of painkilling drugs is getting low. What should you do?

Ensure the most seriously wounded Coalition Forces and EPWs are given drugs first, and give any remaining drugs to Coalition Forces who need it Dispense the drugs on a first come, first serve basis Ensure all the Coalition Forces who need it are given the drugs first, and then take care of the EPWs Ensure the most seriously wounded, regardless of whether they are Coalition Forces or EPWs, are given the drug**

Which of the following statements is/are TRUE about the Behavioral Science Support (BSS) personnel? Select all that apply.

They are exclusively assigned as operational support to detainee operations and intelligence interrogations in the DoD** They can be identified to detainees as healthcare providers They will not provide training in first aid, sanitation, or other health matters** They will not be used as a medical monitor or safety officer, or to supervise, conduct, or direct detainee operations or intelligence interrogations**

When you are in a deployed environment, which of the following issues can hinder patient identification?

The detainee's name may vary from the initial to the return visit The detainee was treated prior to formal processing and then returned to Level III medical unit for follow-up care The detainee's initial pseudo SSN may not reconcile with the actual ISN All of the answers are correct**

Which of the following is NOT true about the International Committee of the Red Cross?

They direct and coordinate international relief activities They are delegated by the Geneva Conventions to accomplish their mission They carry out their mission under the direction of the host country They provide assistance to victims of war and internal violence

When a detainee dies, the attending medical officer is responsible for which of the following? Select all that apply.

Completing DA Form 2669 (Certificate of Death)** Determining whether an autopsy will be performed Reporting the death to the responsible investigating agency Furnishing a statement detailing whether or not the detainee's death was caused by his own misconduct**

Healthcare personnel are authorized contact with detainees EXCEPT during:

Routine sick calls Interrogations** Emergency medical care Initial screenings

Before a detainee can be transferred from a Role 2 to a Role 3 medical unit, what conditions must be met? Select all that apply.

Transfer must be authorized by accepting physician Detainee must be medically stable** Accepting physician is not required to document the detainee's capture information Each medical treatment facility commander certifies that the transfer documentation for the detainee is complete** Physician's documents on detainee capture information has been received

Threatening or humiliating an individual either verbally or non-verbally can be considered what kind of abuse?

Emotional Abuse** Sexual Abuse Physical Abuse

Only Geneva Conventions III has an Article 3 that states that the following acts are, and shall remain, prohibited at any time and in any place whatsoever: violence to life and person, in particular cruel treatment and torture, and outrages upon personal dignity, in particular humiliating and degrading treatment.

True False**

When it comes to the 4 Ps of Abuse Prevention, which of the following is NOT a correct statement?

Practice - Continuously exercising a professional demeanor and with professional conduct Priorities - The command philosophy must place honor and dignity at the top of its priorities Procedures - A system should be in place to reduce the potential for abuse Policies - Telling people to do the right thing is more important than putting the policy in writing

Which of the following is NOT prohibited under the Geneva Conventions?

Participating in the prisoner interrogations Conducting medical and scientific experimentation on detained personnel Transplant procedures for blood and skin grafts with informed consent** Photographing detainees without informed consent

A supervisor enters with an interrogator. You are ordered to delete potentially damaging information from the medical record. What do you do?

Challenge Order*** Accept Order

MPs provide valuable input regarding the medical care and concerns of detainees. Which statement below is TRUE?

Military police usually do not assist during medication distribution or sick call Military police know which detainees repeatedly do not come up for head count and can point them out for medical evaluation**

Medical personnel have specific protections and rights under the Geneva Conventions including:

Protection from intentional attack and the right not to be held longer than 24 hours by the enemy if captured Protection from intentional attack and the right not to be retained by the enemy Protection from intentional attack and the right to continue to perform medical duties if retained by the enemy** All of the answers are correct

Which of the following guidelines are applicable to body cavity searches and exams?

Body cavity exams may be performed for valid medical reasons with the verbal consent of the patient Body cavity searches are to be conducted only when there is reasonable belief that the detainee is concealing an item that presents a security risk Both of these answers are correct**

A group of detainees has just been escorted in for screening. A few were coughing and one is on a stretcher and had to be wheeled in. You've been asked to screen them all and that the two obviously uninjured detainees need to be interrogated. Do you complete and process the two uninjured detainees first?

no

When detainees are transferred between roles of care, all these individuals are required to accompany the detainee except?

One security person A driver A medical attendant A chaperone**

While screening a detainee during in-processing, he mentions through the interpreter that he was beaten up by the Iraq National Guard last year. You may ignore his statement since he is a detainee.

FALSE

A large scale operation has just been conducted in your area. The detention facility needs to prepare to screen a large number of detainees. The following resources are available: a dentist, a nurse to administer immunizations, a medic for vital signs and lab specimen station, a medic to perform past medical history interviews, an NCOIC, and a provider. What resources do we need to add? Select all that apply.

OR tech 2 more providers** Dental tech** Behavioral health provider**

During the initial screening exam, it's important that you take pictures of a detainee's existing and pre-existing injuries and wounds.

TRUE

Military Police may make the initial decision to classify a detainee as being on suicide watch. Is this statement correct?

Yes, Military Police may make the initial decision before a detainee is given a mental health assessment** No, the decision can only be made by healthcare personnel

Which of the following groups of people are NOT entitled to both medical and dental care?

Enemy Prisoners of War Retained Personnel Civilian Population** Other Detainees

Detainee medical records do not need to be at the same standard as those for U.S. and coalition service members.

FALSE

There are 4 Geneva Conventions which cover the protections and treatment of people caught up in armed conflict. Which of these Conventions lists the rights and protections of Prisoners of War?

Geneva Convention III

When recommending treatment to a detainee, they have the right to refuse treatment. If they do decline treatment, which documents does NOT need to be completed?

DD Form 93 (Record of Emergency Data)** SF 88 (Report of Medical Examination) SF 600 (Chronological Record of Medical Care) DA Form 3444 (Treatment Record)

Sick call at detention facilities must be held:

Once a day** Every other week Once a week Two times a week

One of the detainees in your treatment facility is about to be released from detention and has requested a copy of his medical records. What should you do?

Give him a copy which has had all the diagnostic information edited Deny the request. Detainees are not entitled to take their medical records with them when they leave Give him a copy which has had the unit and healthcare provider personal information edited** Give him an unedited copy of the medical records