Hasan and War Crimes and Congressional Briefings
At first, I didn’t make too much over this report that Nidal Hasan may have gone on a killing spree because his requests that his patients be investigated for war crimes was denied.
Fort Hood massacre suspect Nidal Malik Hasan sought to have some of his patients prosecuted for war crimes based on statements they made during psychiatric sessions with him, a captain who served on the base said Monday.
Other psychiatrists complained to superiors that Hasan’s actions violated doctor-patient confidentiality, Capt. Shannon Meehan told The Dallas Morning News.
[snip]
It wasn’t clear Monday what information Hasan received from patients and what became of his requests for prosecution. ABC News, citing anonymous sources, reported that his superiors rejected the requests, and that investigators suspect this triggered the shootings.
But then I got interested that the same article reported that the Senate Armed Services Committee briefing on the killing was postponed yesterday.
That’s because the House Intelligence Committee has just given Chair Silvestre Reyes’ explanation for the postponement.
Due to the high visibility of the issues surrounding the tragic event at Fort Hood, the President has instructed the National Security Council to assume control of all informational briefings. The NSC has directed that the leadership, as well as the chairmen and ranking minority members of the relevant congressional committees receive briefings first.
I have been told that the Director of National Intelligence is still committed to providing the full membership a briefing on the activities within the jurisdiction of this Committee. I believe that this will occur, and I will push to schedule a briefing before the end of this week. [my emphasis]
As Spencer reported last week, John Brennan got put in charge of reviewing what the IC knew of Hasan last week.
On November 6, 2009, I directed that an immediate inventory be conducted of all intelligence in U.S. Government files that existed prior to November 6, 2009, relevant to the tragic shooting at Fort Hood, Texas, especially anything having to do with the alleged shooter, Major Nidal Malik Hasan, U.S. Army. In addition, I directed an immediate review be initiated to determine how any such intelligence was handled, shared, and acted upon within individual departments and agencies and what intelligence was shared with others. This inventory and review shall be conducted in a manner that does not interfere with the ongoing criminal investigations of the Fort Hood shooting.
The results of this inventory and review, as well as any recommendations for improvements to procedures and practices, shall be provided to John Brennan, Assistant to the President for Homeland Security and Counterterrorism, who will serve as the principal point of contact on this matter for the White House. Preliminary results of this review shall be provided by November 30, 2009.
But back when Obama made that decision, it did not object to the many briefings scheduled. Only now it’s NSC–presumably Brennan–dictating what briefings the various committees will get, and making the decision to postpone the general committee briefings.
The NSC has just basically made this a Gang of Eight type of briefing (though they seem to be including other Chairs besides Intelligence)–if only for the moment. It may be they’re hiding more extensive known ties to al Qaeda than has been reported (by everyone except Crazy Pete Hoekstra). Or it may be they’re trying to keep something else quiet.
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I’ll put my money on the “something else.”
The idea that reporting a crime violates confidentiality does not make sense to me. There are many crimes which psychiatrists are obligated to report, including child abuse. They must also report threats of suicide. Is it that, specifically, they did not want him reporting war crimes?
Isn’t anyone concerned about the 13 victims and their families?
And your evidence that no one is concerned about the victims is?
I’m also concerned about preventing similar events in the to do if we understand–to the extent possible–why Hasan did what he did and whether that was really discoverable.
Bold prediction: John Brennan, after much thought, will decide that this is all too important to national security for even the Gang of Eight to be briefed. He will assure us that it is for own security that we never find out about the
war crimesreasons for Hasan going off.I think that there was a briefing this morning.
So it’s too late for that.
But did he tell them anything other than that he wouldn’t tell them anything?
Does this mean we can look forward to a “gee-we’re-chagrined-as-all-heck-about-this-but” covering up of the gist (not the confidentiality-violating particulars) of what Hasan has to say?
This story looks like it, though I’d make a minor bet on the if-X-gets-out-then-Y-could-be-discoverable action.
Again with Obama, declaring transparency in this investigation, and again with an about face.
Well, if he requested charges be brought based on statements made in a confidential session then he certainly did violate the Dr-Patient relationship as I understand it.
That said, if he made a formal referral something should have happened. He was an officer in good standing at the time. And whatever happened should be available via a FOIA request.
Boxturtle (I hope to live long enough to see it released!)
How do you understand Dr-Patient confidentiality? No one claims it is limitless. Doctors have an affirmative responsibility to report certain crimes and potential crimes. I am just a little surprised war crimes are not on the list.
The exceptions often relate to past crimes against children and the realistic possibility of the patient committing future crimes involving the infliction of grievous bodily harm.
There’s also the issue of where crimes took place, involving jurisdiction responsible for law enforcement. But one would think that within the Army, questions concerning past crimes amounting to war crimes or crimes against humanity would be reportable, where the clinician regards them as credible rather than artifacts of a troubled mind.
I thought that there are exceptions in certain states when a crime has been committed by someone?
And I think @11 is correct from what I have experienced.
I will bet that this will be brought up by his attorneys in his court-martial as an affirmative defense for his mental state. I’m sure that they would have tried to squelch this if he had died, but he’s still alive, and there is no way there could be a cover-up.
Interesting. This is not regulated by Federal Law but state-to-state.
Here’s the D.C. law, with an interesting exception.
DISTRICT OF COLUMBIA: D.C. Code 14-307 and 6-2511 address legal privilege of physicians and surgeons and mental health professionals except where they are outweighed by “interests of public justice.” Public mental health facilities must release records to patient’s attorney or personal physician (21-562).
HOW TO PREVENT FUTURE NIDAL HASANS
We have read with concern the many signs Major Hasan provided which would indicate an unstable and potentially dangerous frame of mind. Our concern is that those who actually saw and heard the signs and those to whom the signs were reported did not act upon them. From Hasan’s contact with a radical imam, to the initials SoA (Son of Allah) on his business card, to his comment that he was a Muslim first and a soldier second – there is no doubt the signs that he was potentially dangerous were there for all to see.
Furthermore, he was under surveillance by two Terrorist Task Forces, one with Department of Defense oversight and the other with FBI oversight. So why wasn’t he stopped?
The answer is quite simple – The military does not have an objective and culturally neutral system that collects information and evaluates it to determine the degree (or level) of aggression an individual is displaying, nor has it people who have a clear responsibility to observe and report this information within an objective system nor a team who is responsible to evaluate it and respond. The military does not have the AMIS solution and it desperately needs it! Major Hasan has illustrated out vulnerable we are, learn more about the problem and the solution by reading our Blog: http://blog.aggressionmanagement.com.
Well, it is dandy that you have flown by out of nowhere to apprise us of this wisdom, but it sure sounds like you are setting up a profiling system targeting muslims, irrespective of your glossy words. In fact, what you are arguing is that the system was too neutral and was not cognizant enough of muslim terrorist signs (even though what you point out are nothing of the sort). And by the way, your link goes to a blank page. If this is the best you got, you don’t have squat. Thanks for playing.
Well, it would be helpful to know the basis for NSC asserting exclusive jurisdiction. If it is not credible, actionable ties to a terrorist organization, I’d like to know what it is. Because in the absence of such information, this looks like damage control and a cover up.
A psychiatrist, for example, could become aware of the most cruel and troublesome behavior of his soldier clients of all ranks. If some of what he was told led him to plead for war crimes investigations, and the Army refused or buried those requests and the alleged facts underlying them, we have one smelly kettle of fish.
Can we assume that the psychiatrists who complained to superiors were also covering up war crimes?
Here’s an interesting detail.
I wanted to see if Crazy Pete was bitching about the delay in the briefings.
No, not really. In a letter dated today (so it was almost certainly after briefings got canceled, though it unclear whether it was written after today’s briefing, to which Crazy Pete would have been invited), Crazy Pete demands that Nancy open an investigation. But he doesn’t bitch about canceled briefings.
Everyone is involved with war crimes. I can hardly maintain my personal equilibrium knowing what I know about the conduct of these wars. Imagine what is going on among doctors. Doctors are either: 1. complicit (as in torture); or 2. covering up and trying to help salve the psychic wounds of soldiers who did and saw what should not have been done; or 3. trying to identify the psychos who enjoyed it. No healthy choices.
I believe in the end we will find that the snake pit that was Walter Reed Hospital — revealed in a Washington Post expose/series earlier this year — took a tremendous toll on all involved: neglect and poor treatment of enlisted men/women/patients, and a stress and burn-out of the caregivers.
In mental hospitals and wards, something happens that those in the field call “parallel process”: this means that the craziness that patients bring into the clinic infects the caregivers. The craziness of the patients, in this case, is in fact the craziness of the battlefield, which infects them, and through them, their doctors and other caregivers.
When I was in training many a moon ago, I remember there was a case of some suicide prevention volunteers who went out to a chronic suicidal caller’s home and tried to kill him. No one in my agency wanted to talk about it. It hit too close to home, and treaded upon difficult psychic and emotional issues that perplex those in the mental health field.
Nidal Hasan may have very well dealt with individuals who committed what you and I would consider war crimes. Every psychiatrist and psychologist knows they are not in the business of bringing justice to those who have committed past crimes, even murder. They must keep the community safe, and protect the individual from serious self-harm, but that is the sum total of their ethical responsibilities outside the clinical realm.
But in the super-heated atmosphere of an understaffed clinic (at Walter Reed, where Hasan spent 6 years, until earlier this year), full of the tensions and psychotic energies brought to it by individuals too full of the insanity of war, killing, and fear, Nidal Hasan may have thought he was a harbinger of justice.
The entire situation echoes strongly Nietzsche’s dictum: if you stare too deeply into the abyss, the abyss will stare back into you.
– A limited privilege exists between persons subject to the Uniform Code of Military Justice and psychotherapists (Jaffee v. Redmond, 116 S.Ct. 1923 (1996) and MRE 513). Such limited privilege protects only confidential communications made to a psychotherapist (or assistant) for the purpose of diagnosis in cases arising under the UCMJ. Exceptions include: when the patient dies; if the communication is evidence of spousal or child abuse or neglect and there is an allegation of such misconduct; or law or regulation imposes a duty to report the information
Communication between a patient and psychotherapist (or assistant) made in assisting diagnosis or treatment of the patient’s mental or emotional condition are confidential and protected from unauthorized disclosure (AFI 44-109).
A limited privilege also applies to active duty military members ordered to undergo a sanity evaluation (RCM 706 and MRE 302). Limited privilege (AFI 44-109) also exists in confidences made after notification of an investigation or of suspicion of commission of a criminal act, and placement into the LPSP program (Limited Privilege Suicide Prevention).
Hey, thanks for that. If correct, and if what you related in the second paragraph does not supersede that in the first paragraph, then Hasan would have a duty to report because there is a general duty of service members to report war crime evidence and/or conduct they are aware of.
Not sure, because what does it mean “communications made to a psychotherapist (or assistant) for the purpose of diagnosis in cases arising under the UCMJ“?
I see I’m going to have to look into the case of military confidentiality ethics more closely, as it may be quite different from that which covers civilian therapists like myself.
Please do; I didn’t find anything definitive and am dying to know the real answer. My gut inclination is that it is along the lines of my @24 above, but that is pulled mostly from my backside.
I commented 2 flights upstairs on the Crazy Pete post that if this report is true, then some folks will likely try to corral the public investigation of Hasan in order to prevent the war crimes meme from getting out there, using a fear-of-retalliation rationale to cover up what’s really a fear-of-discovery motivation.
Jeff, psychiatrists may not be in the business of reporting past crimes, even murder, but would it make a difference if someone who had committed war crimes was going to be redeployed? Would it make a difference if the war crimes had been against children? I would not have much more sympathy for those confidentiality claims than I did for the claims of Judy Miller.
The professional ethical obligation (which unlike Miller’s is encoded into law) is to not report anything unless specifically directed to by statute or rule; your or my sympathies are completely irrelevant.
This is a very difficult question. Usually, the question of breaking confidentiality bears upon imminence of a break in public safety, but not entirely.
Who is a war criminal? by the way. By many accounts, probably many of the soldiers who went house to house in Fallujah may be considered war criminals. Where is the line that one steps over in a war?
In the end, the psychiatrist or psychologist must do what they think is right. If we really cared about protecting children, we would not go to war. You are speaking of something akin to making a report to Child Protective Services if you know a child abuser were going back to an environment (like a school or family setting). I don’t know if having a soldier return to the theater of operations is the same thing.
I believe — and have nothing to base this on than my own clinical experiences in out of control clinical settings, and my gut instinct — that it was the psychotic anxieties, that is, the extremely intense fears generated by listening to stories of murder, dismemberment, loss, shitting one’s pants, accidental killing, guilt over invading another’s land, etc., that became too much for the understaffed and overworked clinicians at Walter Reed. Of course, there had to be something specific or unique in Hasan’s own background that in retrospect will help us understand why he snapped. I don’t think you’ll find commitment to a terrorist agenda to be one of those things (I’ll need solid proof to believe that). The FBI tries to profile these kinds of people, but they’ll be the first to tell you that you can’t reliably single these people out when they’ve done nothing yet.
The real war criminals — Cheney, Bush, Rumsfeld, Feith, Powell, etc. — did not make it into Hasan’s consultation room.
As for the issue of confidentiality and therapy in a military setting, I’ll look into what is taught on the subject and get back to everybody, or pass it on to bmaz and/or EW.
All right, I will put my sympathies aside. I would be surprised if there is not a legal obligation to report a soldier who has committed war crimes and is going to be redeployed, especially if those crimes were against children. It sounds to me like the psychiatrists who reported Hasan to his superiors were making a blanket claim of confidentiality for psychiatrists–that is the Judy Miller comparison. She tried to act as if all claims of confidentiality were equal. They are not.
Right.
Just a follow-up for those interested in the issue of military psychology and patient confidentiality, from an article, “Multiple Relationships and Military Psychology.”
And this may be of interest, from a talk given to psych grad students:
For further info, see this selection in Ethical Reasoning in the Mental Health Professions, which notes that DoD rules re access to information makes confidentiality more limited in military than civilian settings.