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The medical understaffing and under-stocking of Abu Ghraib were felt most acutely after the prison came under shelling by insurgents. A doctor who served there recalled an attack last April when a mortar landed on an outdoor pen holding prisoners, killing at least 16 outright and wounding more than 60. Former prison personnel described how those attacks produced pandemonium, with panicked prisoners seeking treatment from what were at times very few, poorly equipped medical workers. "When somebody died, we just took out their chest tube and inserted it into another, living person," said National Guard Captain Kelly Parrson, a physician's assistant at Abu Ghraib in late 2003 and 2004 who experienced three such attacks and was seriously injured by a mortar. "There was no other choice because we did not have enough."
Parrson cited a dearth of catheters, correctly sized breathing tubes and orthopedic supplies, including casts used to treat bone fractures caused by shrapnel from high explosives. Items had to be reused with minimal sterilization or done without, he said. Glucose strips, used to measure blood sugar, were chronically in short supply, leading to haphazard insulin dosing for diabetics. On occasion, said Parrson, internists and he and other nonphysicians carried out amputations and other procedures usually performed by surgeons. "I took off an ankle and a lower leg," he recalls. "There was no one else, and if it was death or amputation, you just had to do it."
By the estimate of an officer who frequently visited Abu Ghraib and is a psychologist, some 5% of the prisoners suffered from mental illness. Yet, according to Dr. David Auch, commander of the reserve company supporting medical operations at the prison in 2003, for long periods there was no one to treat mental-health problems among the inmates, no doctor qualified to prescribe antipsychotic drugs and other medications that could have calmed mentally ill detainees and perhaps diminished the guards' use of physical restraints. Often the only psychiatrists or psychologists on site were part of so-called behavioral-science consultation teams, or "biscuits," which monitored interrogations and custom-designed methods to make them more effective. Those specialists do not function as physicians, the Army says.
Among the most disturbed prisoners at Abu Ghraib was a man--probably psychotic, according to a medical staff member--who habitually coated his body in fecal matter and repeatedly tried to harm himself--for instance, by banging his head against cell walls. At one point, Auch says, medics asked his advice on restraining the prisoner, reporting that they had used a helmet to protect his head and improvised padded gloves and plastic handcuffs to secure his arms. The medics wanted to know whether using a tether would be appropriate, and Auch recalls that he gave his assent, saying, "The priority is to safeguard the prisoner." A military spokesman told TIME that U.S. military personnel in Iraq do employ tethers--sometimes loosely affixed around a leg or an arm--to restrain some detainees undergoing medical treatment.