US v. Pfc. Manning is being conducted in de facto secrecy. For more information on the lack of public and press access to United States v. Pfc. Manning, visit the Center for Constitutional Rights, which filed a petition requesting the Army Court of Criminal Appeals (ACCA) "to order the Judge to grant the public and press access to the government's motion papers, the court's own orders, and transcripts of proceedings, none of which have been made public to date."
See Transcript of US v Pfc. Manning, Article 39(a), 11/29/12
the calling, swearing in, and a few initial questions by the defense to Colonel
Ricky Malone, former Quantico Brig forensic psychiatrist, based at Walter Reed
Medical Center in Washington.
Malone stated that he has supervised for approximately ten years. He does so by discussing the case and
reviewing reports. He performed
services at the Quantico Brig and conducted 706 board related functions
concerning Pfc. Manning on site. As
a forensic consultant he specializes in policy issues. He became Pfc. Manning's
treating forensic psychiatrist when Captain Hocter deployed. Before that he consulted with Captain
Hocter as a reviewing psychiatrist. He recognized appellate exhibit 420(a) as a
general form that Captain Hocter used when he consulted with Col. Malone.]
okay for him to, you know, be free within the confines of the ward, but not be
able to leave the ward, and then can leave the ward. So, those are that's sort of the
gradation that we use from a clinical standpoint. So, there's sort of a gap in that model
to defined the facility.
you looking at from a clinical standpoint to see that somebody is in fact
warranted in being reduced down from the various grades.
from the severity of their condition, based on the signs and the symptoms--
what they're reporting. It's what
they will share with us about, you know, their thoughts of self-harm-- you
know, their plans or instances they might have. And, then any observable
behaviors that you might see that they are actually actively contemplating or
making some arrangements to harm themselves.
also-- retrieving appellate exhibit 420 alpha from the witness, and handing the
witness appellate exhibit 420 charlie, which is dated 27 August. You also consulted with Captain Hocter
on that day, is that correct?
you tell the Court why you consulted on that day?
When he consulted with me that was an ongoing process, so that I stayed engaged
in that consultation for a few weeks.
Okay. Tell us about that then.
recall, I did go back and do follow up visits with Private Manning. I don't recall how [missed a few words]
or how many. I think it was
probably every week or two, and then I made probably a couple of those follow
up visits. And, then was really
just discussing the case with Captain Hocter, but also based on what-- what he
appellate exhibit 420 charlie, it indicates that Captain Hocter was
recommending now taking Pfc. Manning off of all precautions. And, you concurred with that. Did he accurately reflect you
but he mentioned the idea of being checked every fifteen minutes. So, that was were from making the
comparison to what we would do on a psychiatric ward, and the [missed word]
fifteen minute checks, and that in essence that's what was happening because of
his MAX custody status.
Now I want
to talk just real briefly about medication that Pfc. Manning was under. When Pfc. Manning arrived at the Brig, he
was under Celexa and clonazepam, and I would like to handle those in turn. What is Celexa?
an anti-depressant or anti-anxiety medication. It's what we call an SSRI, a
selective serotonin reuptake inhibitor.
It's something that, you know, has to be [missed word] into the an
effected dose over a period of time.
Generally takes anywhere from two to six weeks to start having an
for Celexa, he was-- according to the records, and correct me if I am wrong--
he was given that at the very beginning of July 2010, while he was still in
say it would take two to six weeks for that medication to take effect?
And from a
clinical standpoint, when you say take effect what do you start to see when the
medication starts to take effect?
You see a
decrease in the symptom side of the-- lowering anxiety. In his case it was more of anxiety than
depression, so that the lowering anxiety and then any symptom-- signs or
symptoms that you might have, in terms of anxiety-- like [missed word]
shakiness or just subjective feelings of nervousness-- those go down-- sleep improves.
And from a
clinical standpoint, if somebody is sleep deprived and very anxious, will this
medication help them?
not. I mean it's not going to take
a normal reaction and blunt that. All
it does is if somebody is having a pathological level of anxiety it's gonna let
them have a normal range of emotions.
So, they'll still react to the environmental conditions or things that
might happen to them.
about clonazepam? What is that for?
is a-- it's basically a sedative in the valium family. So, it's something that has an effect
right away-- you know, calming people down.
So, by the
time that Pfc. Manning arrived to the Quantico Brig, he had been under this
medication for approximately four weeks.
Would his improvement be something that you would expect to see based
upon receiving the medication?
the changes in his conditions. I
mean that a-- just by the-- at Camp Arifjan--you know, you know you are in a
temporary circumstances and things are going to change. You know, getting moved back to the
States-- now you know you are going to be there for a certain period of
months. So, there is a certain
degree of stability in your environment, but things that happen to you on a day
to day basis are going to start becoming more routine. So, that decreases the level of stress,
and then the medication is also having an effect on the serotonin receptors
over that period of time.
was there a time when you assumed sole clinical care for Pfc. Manning?
did. In the January-- Captain
Hocter was deploying, and since I had already been involved, I filled in for--
for Private Manning and then we also-- some of my trainees were coming out
there to deliver care to the other detainees as well. So,
during the course of those visits, supervising them-- and then I would
do some-- I had some sole care up by Private Manning.
you say January, you are saying January 2011?
you took over the sole clinical care for Pfc. Manning, how frequently would you
long would your weekly reviews be?
would I spend with him?
an hour. Frequently, more.
was involved with these weekly reviews?
there was-- you know, just a-- clinical assessment. That's what is was. So,
getting an idea of what sort of problems he was experiencing-- what sort
of symptoms he was exhibiting. You
know, how his sleep might be. What
his mood was like, those sorts of things.
And then, you know, also-- I mean it was therapeutic as well, and that--
you know, I would sort of focus on the things that were bothering him, and try
to help him to cope with those things.
part of your treatment, did you consider any observations by the Quantico Brig?
did. Typically when I arrived at
the Brig, I would talk the detention staff about what their observations might
have been the past week. Sometime
[missed a few words] review, and then if anything had happened medically that
would have gotten me to review the medical records.
this a formal sit down-- let's say like the Brig OIC [Officer in Charge] or the
DBS [Duty Brig Supervisor], or was this more informal were you talked to
whoever was on staff at the time and looked at the log books?
it was typically more informal.
this a more informal thing by your choice or was this by the Brig's position?
would that be?
guess, you know, I get better-- a better idea of what is going on under those circumstances. You know, anytime I am getting someone--
a third party's observations of behavior, I realize that they are going to put
a certain, you know, interpretation on it, and I am not really interested in
interpretation. I just want to get
a picture of what happened and make my own interpretation of it.
Okay. Now as part of your weekly reviews, did
you make recommendations to the confinement facility regarding Pfc. Manning's
risk of harm-- self harm?
I-- I didn't
specifically make recommendations.
I kind of provide them the input
that I thought they needed about his mental condition, in order-- in
order to make that decision.
than actually recommending that he be on some certain status, you know-- so
after a short period of time it was my impression that he had little or no
clinical risk of self-harm, and that was what I was trying to communicate.
your standpoint, if-- if someone has little or no risk of self-harm, is that
someone who needs to be on prevention of injury status?
from a psychiatric standpoint.
you convey that to the Quantico Brig?
I would always do a report from one of these Classification & Assignment
forms, and then you might notice that I actually revised that form after I had been there for a short period of
time. So, I thought it [would]
provide more, you know, useful information to them.
usually if the-- if Chief Warrant Officer Brig-- Barnes was available I would
actually talk to her about, you know, what I had seen and what my impressions
were. So, basically do a little out
brief with her before I left.
out briefs with Chief Barnes, how long would they normally last?
five and thirty minutes?
you were expressing to her the fact that Pfc. Manning didn't represent a risk
of self-harm from a clinical standpoint, and POI was not necessary, did she
respond to that?
explained to me that there were other criteria that she had to take into
account. So that my input was just one piece of that.
word] she [missed word] that in order to make that determination. And, she would give me her impressions
of what his behavior-- again, the things that they had seen.
know, how they looked at that. And that
would be the general-- some of the behaviors that they would-- they would
attribute more risk to that than I would as a clinician.
talk about some of those observed behaviors. Did the Brig ever share with you the
fact that they saw Pfc. Manning talking to himself.
staring at the wall while he's in his cell?
playing peek a boo with the mirror while he's in the cell?
he's lifting weights while he is in the cell?
tell you about the-- apparently one time licking the bars while he was sleepwalking?
I don't recall that.
other ones that you do recall, how-- how was the Brig explaining them to you to
suggest that there was an elevated risk to those behaviors?
was just that it was unusual behaviors, and when they would ask him about it,
he couldn't adequately explain it to their satisfaction. So, just adding a degree of uncertainty
your clinical perspective, why weren't these behaviors something that was
discussed in, you know, I didn't see any intent for self-harm behind
think they were-- it was sort of the defense he would used in terms of
intellectualizing things, and so he could-- he would have rationalizations with
justifications for some of those behaviors.
I think sometimes, I mean it was just being a bit-- I don't want to say
non-compliant-- but, you know, it would be a bit provocative, and that-- he
just didn't want to do exactly what
they wanted him to do or sometimes he could actually do just the opposite, and
think in-- there was some expectation of getting a reaction.
Do you think
the-- from the standpoint of just being in his cell and playing peek a boo or
staring at the wall, can that be explained by just being bored?
Absolutely. A lot of the things that I heard I
thought were just a way of him to try to, you know, provide some sort of stimulation.
he's an extremely intelligence young man.
He-- he, you know, has a tendency to sort of intellectualize, so he can
get very bored.
in fact, a lot of the time we spent in our sessions, was really was my effort
just to-- to do that.
talk about things that you might not see any therapeutic value to the-- but I
knew that-- that was giving him some interaction and some intellectual
stimulation that-- that he wasn't getting during the rest of the week.
Now from a
clinical standpoint, you indicated that you did not believe POI status was
required. I want to talk about some
of the other special precautions that they took to see whether or not you
believed those were required, okay?
believe that Pfc. Manning needed to have a suicide mattress?
think he needed suicide precautions [missed a few words].
So that would
included having his clothes removed from him at night?
to have-- being forced to wear a suicide smock at night?
not being allowed to have toilet paper in his cell?
meaning that he should have been allowed to have that?
Correct. I saw no reason for any types of safety
even tried to communicate that, you know, in a clinical analogy that, you know,
if I were treating him as an outpatient, I wouldn't be concerned and taking
these sort of precautions.
if I was seeing him in my clinic, I would probably only be seeing him once or
twice a month, at that point. I
wouldn't have any concerns about his behaviors in between. That was-- I tried to communicate that
way was as well.
you tried to communicate that to the Brig what was their response?
you.' 'Thank you for your input.'
feel that your input was-- was not being followed, and ignored?
I-- I felt
that there were other considerations that were outweighing whatever my input
might have been.
those other considerations transparent to you?
Some of it
was. Some of it, I think was
I do know that there was a great deal of risk aversion there during that time,
because they had had a suicide there the year before.
know, they were determined to not have that happen again under any
you see the same risk aversion with other detainees besides Pfc. Manning.
No, I did
ever tell Chief Barnes that Pfc. Manning custody status was becoming another
stressor for him?
did you mean by this?
was just something else that would add to this degree of stress, and since I
was treating him for anxiety, that is just another obstacle for me to have to
was Chief Barnes' response?
acknowledged that and felt that it was necessary.
Quantico Brig ever follow your recommendations regarding the fact that Pfc.
Manning was not a risk for self-harm?
Well I-- I
believe they left him on prevention of injury status the whole time, so in that
from the Quantico Brig explain in any detail why they-- they believed the
opinion from their forensic psychiatrist regarding risk to self harm was not
than, 'We just don't want to have another suicide on my watch.'
clinical standpoint, is being held the way Pfc. Manning was held detrimental to
a person's mental and physical health?
general being held, you know, in alone in a cell for 23 hours a day is going to
have detriment of anybody.
case, because I was treating him for anxiety disorder-- again, you know, any
additional stressor just makes it harder to overcome that-- but, you know, as
you can see, he did-- because, he did eventually got into full remission
will talk about full remission-- but, from your standpoint, did Pfc. Manning's
custody status place him in unnecessary risk from a medical standpoint?
say that it placed him in risk.
it is just one other factor that I would consider.
an additional stressor. And, so I
mean what is-- what is the, you know, the marginal implement that this stressor
adds compared to all of the other stressors that he is undergoing?
realize anybody can find that for whatever has a certain degree of stress.
extra restrictions have much more, does that add? So, it's-- it's increased stressor,
which makes it tougher to treat anxiety, but I wouldn't go so far as to say
that it elevates the stress.
Okay. During your time there did-- did you
ever document to suggest that Pfc. Manning was a risk of escape?
ever document any behavior to suggest that Pfc. Manning was a disruptive
ever document any behavior to suggest that Pfc. Manning was a violent detainee?
ever document any behavior to suggest that Pfc. Manning was at all a danger
detainee to himself of others?
early on there was some risk of self-harm; but, once that had resolved there
was no risk of harm to self or others.
Manning ever taken off of his medication?
certain point of treatment that-- you know, I don't recall exactly how long--
but, several weeks-- maybe a couple of months, he was basically symptom free
from his anxiety disorder.
He had expressed
a desire to come off of the medication, which is always an important
consideration for being-- whether a person actually wants--
And, so we
had a discussion about risks and benefits of-- of the medication-- that in
general I would have recommended that he stayed on it for a longer period of
that he was symptom free, he wanted-- he preferred to come off of the
medication. And, I knew he was
under close observation, so I had a lot less-- I had no risk aversion about,
you know, the downside of taking him off of the medication.
know, I felt it would be very therapeutic to, you know, give him-- get him that
reference, and to come off of it.
he actually taken off of the medication?
was. I [missed a word] recommended
over a period of time, and then he came off of it.
Barnes ever speak to you about the decision to take Pfc. Manning off of his
I do not
ever tell you that she thought her decision to allow that they take him off of
medication was a mistake?
don't recall that. Well, we might
of-- we might of discussed it.
From your perspective
would it be typical for a Brig OIC to question the decision over whether a
detainee needs medication or not?
quite common-- you know, a Brig OIC or a company commander, because their
concerns about the people under their charge-- you know, might have questions
about that, and ask for additional explanation.
ultimately though, obviously those questions, you would as the expert respond
to say why your decision was the appropriate one, correct?
have any issues with Pfc. Manning once he was taken off of his medication?
remained in complete remission-- symptom free after that.
Did you ever
hear about an order being given by Colonel Oltman to keep Pfc. Manning in MAX--
in MAX custody and POI?
I think I might have heard about that second hand from Captain Hocter. I was not-- I mean I wasn't there at the
perspective, if such an order where given would that cause concern as a mental
just a moment. [to prosecution]
your Honor. Not exactly sure what
the order we're discussing is? I
mean he wasn't there, he's already said that it was second hand and now we are
getting pretty far away from first hand knowledge.
overrule and let him ask the question.
that it's-- it's a-- it's like an additional consideration for making that
determination, and actually one's that gonna, you know, obligate any need for the
expression if he can handle it-- because, it's not going to matter.
would be concern in that regard.
If-- if you want the concern just from a military standpoint, that--
it's sort of getting out of one's lane to then start directing medical care.
your perspective when it comes to medical care, who should own that lane?
sort of more of a philosophical question.
I mean to me that's a partnership between the me and the patient
obviously has the ultimate decisions of, you know, what they're going to do
with the care that I try to give them.
understand the military-- that, you know, commanders have a vested interest in
that as well, so, you know, I do sort of take that into consideration-- but,
ultimately when it gets down to the clinical part of it, that's up to me.
other factors that the Brig was considering that were outweighing your clinical
recommendations that they actually set down with you and said, 'Here are those
factors that we are considering'?
word]-- Chief Warrant Barnes did explain to me that there were other criteria,
and I believe she did discuss what some of those were.
just some in terms of, you know, any custodial decision that she might have to
would include the clinical piece-- you know, the clinical assessment of the
condition, and then things like, you know, risk of flight; risk-- or
vulnerability to exploitation; the severity of the charges; and, a host of
when you said she kind of explained it, did she actually show you, you know,
'Here are my issues,' or the one's you just--
mentioned is how she expressed it to you?
meaning? I'm sorry, sir.
No. She didn't-- she did not go through all
of her reasoning and tell me why she was-- she was going to keep him on POI
you ever see other detainees come into the Brig that were on a, say, MAX and
suicide risk-- or MAX and POI status and then eventually downgraded?
recall one other during that time period, but I wasn't involved in his care,
but one of my fellows was. So, we
would discuss his case in terms of supervising her, the fellow.
ever treated other patients that were held in their cell basically 23 hours a
have. I provided coverage at the DB
[Disciplinary Barracks] at Leavenworth over a period of a year.
stationed in San Antonio, and we would have a psychiatrist up there for one of
[missed a few words] and they would do [missed word] medication [missed a
word]-- you know, I did treat a couple of the inmates on death row there. They were in similar circumstances.
inmates on death row at the DB were under similar circumstances as the kind of
status of Pfc. Manning?
terms of being MAX custody and the restrictions that that would have-- in terms
of how much time in the cell, and how much time out of the cell.
I want to
ask you a couple of questions about and incident that took place on the 18th
January 2011, okay? Do you recall
an incident where Pfc. Manning might have had an anxiety attack while on
Hocter told me about that incident.
do you-- what do you-- what do you recall based upon that conversation?
I recall-- I don't recall exactly what had happened, but I do recall that that
there was some [missed word] disturbance and Captain Hocter actually, you know,
at the Brig at the time. I believe
he was probably over in the clinic at Quantico. He came over-- did an assessment, and he
did have concerns. I believe that
there was some increase in risk at that point, and recommended some restrictions.
from the witness, what has been marked 420 charlie-- appellate exhibit 420
charlie, and handing the witness appellate exhibit 423 alpha. Do you recognize this?
is this form?
is from one of those Classification & Assignment boards. And, this was-- I mean a couple of days
later I was at the Brig and Captain Hocter had not filled out any of these
forms for that incident, and they were asking for one for the records.
So, all I
could do at that point was review what Captain Hocter had done. And he did document in his
clinical note that he had made those recommendations. So, I documented that-- that he had made
And, so in
this instance that indicates that Captain Hocter recommended 24 hour POI?
from the witness appellate exhibit 423 alpha and handing the witness 423
bravo. Can you tell me what this
another of the-- the Classification & Assignment forms. The one that I had filled out on January
why did you fill out this document?
reassessing him after that incident, and at that point I had assumed his care.
was your recommendation regarding whether POI was needed?
that there was no psychiatric reason to keep him on POI.
was this your recommendation?
thought that his risk of suicide at that point was, you know, at an acceptable
base line-- I mean, you know, low risk. Not zero -- it's never zero, but it was
low, like in terms of observation.
I want to
ask you a few questions about some of the precautions then-- that in this
instance that the Brig took base upon an incident that took place on 2 March
Do you recall
on that day Pfc. Manning making any sort of comments to the Brig staff
concerning his underwear?
that point he had made a comment that, you know, if he really wanted to kill
himself that he could use his underwear to do that.
talk to Pfc. Manning about that comment?
after the fact.
upon your conversation with him how did you view that comment?
I didn't think that, you know, it expressed any plans or intent to commit
really just sort of a-- a comment that-- you know, 'If you think I'm gonna
increase your suicide-- well these are the things-- that if I wanted to commit
suicide, I could.'
the way that I viewed it. Again,
it-- it represents some lack of insight knowing that the scrutiny that he's
under that he is still going to say something like that-- yet on the other
hand, it's basically an honest answer to what was going on.
indicated in your notes that Pfc. Manning was simply intellectualizing his
frustrations with POI precautions.
Can you explain why you felt that way?
He-- he was
experiencing a great deal of frustration and he was trying to cope with
you-- if you consider defense mechanisms from a psychological stand point-- you
know, one of his favorites is intellectualization.
order to deal with that, he would think about it in those terms. And, so-- so he could make
comments that would be, you know, purely from an intellectual standpoint
without considering, you know, other ramifications about what that might be
communicating to somebody else.
you give us an example of-- of that behavior, just in the abstract of somebody
doesn't have to be a hardcore example as far as-- but why would somebody do
that I guess-- you know, have that intellectualization of something and not
understanding how it might be interpreted?
it's-- it's really sort of a compartmentalizing.
the feelings that go along with that are-- are intolerable-- the frustration
and, you know, anxiety might go along with that. And, so to-- for the-- so, to divorce
yourself from that you look at it purely from an intellectual standpoint.
think the-- this example sort of shares that-- where you want to talk about
you sort of the-- it's an intellectual argument about-- or 'Here's this. Here's that.' And we can go back and forth, without
considering that-- the people are going to interpret this differently.
going to interpret this as, 'I'm thinking about this,' or they might retaliate
somehow. You know, any-- any other
considerations that might come into [missed word].
experience if someone is actually planning to commit suicide-- or harming themselves,
would they voice that and tell others?
towards the end. When somebody has
made up their mind that they are going to commit suicide, they don't talk about
they don't want to be stopped.
There is no ambivalence.
most people when they're feeling suicidal are gonna have some ambivalence about
it, because they hurt so bad they want to die, but yet they don't want to
want to stop hurting, and that would be lead them to have-- have observable
behaviors or-- or say things about.
somebody is really made up their mind, 'This is it,' they typically actually feel a bit reassured
'Okay it's gonna be over with now.'
And, they wouldn't do anything that would help somebody to stop them.
from the witness 423 bravo, and handing the witness appellate exhibit 423
charlie. Can you tell me what this
the revision of the Classification & Assignment form that I had made.
did you revise the document?
mean basically I took a DA 3822 Report of Mental Status Evaluation and customized
it in order to provide the input that I thought that they would need in the--
in the-- in an administrative type of determination I guessed.
the name of that form you just said?
A DA 3822.
of Mental Status Evaluation.
explain your findings section-- just go through each of your findings and
explain what it means?
section under the word, 'findings'?
disorder was resolved meaning that at this point his anxiety disorder that I
was treating before was in complete remission, and risk for suicide or self harm
was low, and that's because is never non existent, but it is at least down to
where the general population would be-- it's based on. This X was, is, and always was low.
behavior disturbance is or is not a treatable mental disorder. I mean the whole idea of having that--
that there, helps us to distinguish basically anti-social behaviors,
personality disorders-- you know, things that people are going to do anyway,
not due to anxiety or depression or psychosis-- something that we could treat.
marked that one applicable, because at that time he did not have a mental
there was no need to segregate him from the general population due to a mental
disorder, realizing that there are other considerations for segregation. And, requiring routine follow up.
what is the date of your evaluation?
recall the Brig trying to have you be present when Pfc. Manning was receiving
his new charges, right [missed a word] along [missed a word] the Article 138
response on the 2nd of March-- two days earlier to this eval?
I-- I do
recall that going on. I mean I
haven't seen my clinical notes.
I don't recall
exactly what I did there. I-- I do
see that this-- this evaluation reflects that with all that additional stressor
that he had, I didn't see any change in his condition. So, that he was-- he was coping normally
at that point.
aware of any sort of push from Quantico, to contact your higher command, in
order to force you to be present on either the 2nd or 3rd of March?
that time period, where were you at on the 2nd or 3rd of March?
recall. I was probably at the old
Walter Reed Hospital on Georgia Avenue.
some documentation that you were on emergency leave?
March your schedule time to see Pfc. Manning?
I am not
sure. If you could determine what
day of the week that was-- I don't recall.
I think in general I was seeing him on Fridays at that point.
I believe that
is a Friday.
your standpoint, nobody tried to contact you and say that you were deficient in
anyway for not being present on the 2nd and 3rd of March?
Not that I
was aware of.
from the witness appellate exhibit 423 charlie. Thank you, sir that's all the questions
I have for you at this time. I
think the Government will have some questions.
me a second here-- I'm gonna try to organize myself. Sir, you were initially brought on as a
consult to Captain Moore, regarding risk management?
Hocter, excuse me.
January 2011 you took over as the treating psychiatrist for Pfc. Manning?
want to talk a little bit about your initial-- once you became the treating
psychiatrist-- some of that Classification & Assignment forms. Mr. Coombs earlier handed you a
Classification & Assignment form dated 21 January 2011?
objection to this going on line with the same appellate exhibit D-E-F?
objection from the defense, your Honor.
objection, your Honor. I am handing
the witness what has been marked at appellate exhibit 423 delta. Sir, please look over this form for a
date of that form?
you read the remarks please?
at moderate risk of self-harm, which has improved since arrival. Would not require a higher level of
psychiatric care to mitigate risk at this point. Requires routine outpatient follow
up. Frustration tolerance has
improved, but still somewhat below average. Limited ability to express or understand
his feelings. Risks and benefits of
POI are not further detrimental at this time.'
begin with the first sentence. You
said he 'remains at moderate risk of self-harm.' You were aware that-- and actually you
were as a consult-- as a consult to Captain Hocter you were aware that he was
recommending removal of POI sometime after August. Is that correct? August 2010?
that time he was indicating that Pfc. Manning was at a lower risk of self-harm?
you say that he remained at a moderate risk of self harm? I realize, you know, we are talking
semantics-- but, I was wondering whether you thought that, that was a change in
any way from what Captain Hocter had-- had previously indicated?
there was a temporary increase in his risk after that anxiety attack episode in
January. This was in the aftermath
So, it was
sort of recognizing that-- Yes, that degree of anxiety increases risk some, but
I called it moderate, but it was still, you know, less than what he came in
with-- which was-- was, I think, unequivocally higher when he first got there.
also said that the risks and benefits of POI are not further detrimental at
this time, what did you mean by that?
you look at the additional stressors created by the additional restrictions of
being of that POI status and whatever benefit that they might provide in terms
of lowering his risk of self harm-- sort of balanced out.
you know-- recognizing that, 'Yeah.
That is an additional stressor.
And, that is something, you know-- you know, we want to-- to do as
little as possible'-- but, yet there is also some [missed word] risk here-- so
there is some benefit to, you know, mitigating that risk with these
restrictions-- and that, that would balance out [missed a few words].
Retrieving the appellate exhibit.
Sir, as you-- as you became acquainted with the Quantico Brig staff, it
became somewhat apparent to you that they were concerned about the risk of
suicide. Is that correct?
was a-- or is a fairly high profile concern of many people in the DoD
[Department of Defense] community?
specifically in the Brig, because they had had a suicide previously in the
Brig, and so they were sensitive to that problem?
also thought it was uncommon for the Brig not to listen to clinical advice--
thought it was-- you thought it was uncommon for the Brig not to listen to
clinical advice-- or to listen to
the clinical advice, but not to follow the clinical advice--excuse me. So, I
just want to back up.
it was uncommon for the Brig to listen to the clinical advice, but not follow
the clinical advice? Is that
think in my experience, most of the time clinical advice is followed-- but
certain, you know-- some fraction of times, you know, commanders, Brigs,
whatever are going to have other considerations and not follow that clinical
agree that your clinical opinion or any other doctor's clinical opinion is-- is
a piece of-- of the decision?
you were discussing-- or when you were the treating psychiatrist for Pfc.
Manning, you indicated that you would meet with the Brig staff prior to being
with Pfc. Manning?
would discuss there observations?
you would meet with Pfc. Manning-- and,
then afterwards you would also discuss sort of your impressions of-- of your
being with Pfc. Manning with the Brig afterwards?
Frequently. I mean I always provided that written
guidance if Chief Warrant Officer Barnes wasn't available or, you know, his--
his counselor at-- if they were available I would, you know, make sure that--
if they had any questions about what I was saying, or explain to them, I would
give them, you know, additional input.
was sort of the typical-- but meaning before and after was the typical routine?
that was my typical routine.
during your meetings with Pfc. Manning he was obviously frustrated by his
status. Is that correct?
would sort of give his version of events?
would give his version of events [missed word]? He would explain to you, what he perceived
to be what was going on?
Yes. In that-- I mean he was-- he would
describe the same events that I had heard about from the Brig staff.
also get their interpretation, sir.
would talk to the staff about their interpretation of it, and then I talked to
him about his interpretation of it-- and eventually I had to rely on him.
you were-- you were-- you were getting the-- sort of both sides of the story,
whenever you would meet with Pfc. Manning?
some point it became clear to you that Pfc. Manning was contributing to the
issues at the Brig as much as the Brig staff made them?
know if I could say, 'as much as,' but he was certainly contributing something
he was provocative?
At times. And,
although the Brig staff was a little rigid, they were professional?
suicide had weighed-- weighted heavily on their minds?
Sir, I want
to talk to you about the form used at the Brig for the weekly visits with Pfc.
indicated earlier that you-- sometime after you took over as the treating
psychiatrist, you changed the form.
Is that correct?
It was-- it was just a local-- I mean homemade form that they were using, and--
and I didn't think it was actually provided useful information-- or as useful
as it could be. That is why I chose
to revise it.
And you wanted--
you wanted to make the form more standardized?
to the form to communicate relevant clinical information?
Brig staff appreciated the change?
Yeah. They did.
provided them more information?
provided them more helpful information. [Missed a few words] indications about
different, you know, clinical impressions that I might have had, as well as
some free form remarks; whereas the other form was mostly free form remarks.
you recall- I think you testified earlier that, you used some of your meetings with
Pfc. Manning to talk about the days events. That you felt it was helpful to have him
be intellectually stimulized [sic]-- is that correct?
do you recall making sort of that same recommendation in a form?
did. I-- I think on one of those forms I noted that
he would benefit from increased intellectual stimulation, whether that was
from, you know, books or, you know, whatever else that might be available at
you know if the Brig ever followed up on that recommendation?
that he told me that they did provide him some limited books or magazines, but
they were very limited and not very stimulating-- as I remember.
gonna ask about sort of a clinical opinion as to-- certainly you would agree that
reasonable minds could differ over the precautions necessary for pretrial
some cases it might be appropriate for a detainee or pretrial confinee to be
under prevention of injury status, even if the clinical opinion was that the
risk of self harm was low or moderate?
can certainly, you know, reach a reasonable conclusion, that the-- the risk was
greater than a clinical opinion might be.
moment, sir. There are a couple of
random questions. Mr. Coombs
mentioned toilet paper earlier.
aware of any-- you said from a clinical perspective it didn't make sense for
the Brig to take away toilet paper.
Are you aware of any correctional reason for someone not to have toilet
paper in their cell?
Yes. I mean I understand from a risk
standpoint-- you know, I'll say not in-- risk precautions in general at that
point I didn't think were necessary from a clinical viewpoint.
understand that-- I mean there was a suicide within the last couple of years, where
a detainee had stuffed toilet paper down his throat, and manage to asphyxiate
himself that way.
could have been a reason why the
Brig could have decided, 'Better to just keep the toilet paper outside the
that reason for it, yes.
finally sir, I just want to talk about Pfc. Manning transfer to the Joint
Regional Confinement Facility. Do
you recall-- can you tell us about that time at least? Do you recall traveling
with Pfc. Manning?
you describe how that came about?
don't recall specific details.
Somebody had asked if I would be available to do that-- just incase there
was any--any problems along the way.
was an additional stressor it might provoke an anxiety attack-- that sort of
thing. And, you know, I was
available-- you know, I'm a flight surgeon-- you know I fly a lot anyway.
So, I did
do that. And, I did it with the
understanding that it was helping to alleviate the staff's anxiety as much as
it might be alleviating any he might have.
felt it was a good idea?
recall whether that was-- you were requested to do that through the command or
through trial counsel from the command?
I do not
recall who requested that.
surprise you if-- if it was trial counsel that had asked you do that?
because, I do remember a that time that trial counsel from MDW [Military
District of Washington] was-- you know, coordinating a lot of that-- those
Honor. Sir, I want to ask you a
couple questions based upon the Government's cross. You said, reasonable minds can differ
on-- on medical opinions-- mental health opinions.
experience would reasonable minds differ for nine consecutive months?
And what would
you expect to see in that nine consecutive months or if anything to justify
I am not
sure I understand.
people are looking at the same activity-- and you had earlier testified that you
didn't see anything from Manning that said he was trying to harm himself; harms
others; trying to escape-- what would you expect if somebody other than you
came in and had a different opinion-- in order to have a reasonable
would expect it to be based on some observation of behavior or something he had
this instance, would you expect to have a reasonable mind differ from you months
after month if they also were seeing what you are seeing?
say. There's so many things that go into--
know, at some point you say it's unreasonable.
there come a point?
this is a difficult area here, where I was developing clinical opinions to the
lay person, who is also placing just as much value on their own observations as
what my opinion might be.
realize that sometimes I am never going to convince somebody of what-- you
know, they have strongly held beliefs about something, well now the
interpretation or explanation on my part is going to change that.
Moore had testified about learned helplessness. Are you familiar with that term?
what is that term from your perspective?
concept that a -- related to depression-- that a-- you know, somebody is in a
situation where repeated efforts to improve their situation are
point they give up. And-- or even
do those things which they can do to help themselves.
you see when someone has learned helplessness, maybe then be acted out or
acting aggressive towards guards in a correctional standpoint?
typically its a much more passive sort of a-- so it wouldn't-- acting out would
be something different.
you expect to see from learned helplessness?
apathy-- withdrawal-- just total acquiescence to whatever is requested.
Manning ever express to you a desire to be out of the confinement conditions
that he was in?
did he do that?
would explain to me how he felt that some of these restrictions were
unreasonable-- that they were unnecessary.
And, that they just increased his level of frustration.
would you tell him in response to that?
I could agree with it from his standpoint-- that that's true. I would try to offer him different ways
of looking at things. Things that
he might try to change that-- realizing that he limited options, because of his
questions from the Government?
Colonel Malone, I have some questions for you. You said that Pfc. Manning told you that
he believed his restrictions were unreasonable and unnecessary.
working with Doctor Hocter when Pfc. Manning first arrived in late July, early
August to the Brig. Is that right?
you became his treating psychiatrist in January. When did these-- when did Pfc. Manning
first begin to tell you that he was frustrated with these conditions.
in February-- you know, at that point that I was seeing him regularly-- [missed
a few words] relationship with him.
When you saw
him earlier with Colonel Hocter-- Captain Hocter, excuse me-- did he voice any
of those-- that he wanted to be off of the POI or maximum custody?
recall. I don't think so.
he was at a higher risk, and we talked about those things. It was his thoughts and what was-- what
was behind him engaging in behaviors or saying things that would make others
think that he was suicidal-- as much as, you know, what precautions might have
know Chief Averhart?
did. I mean he was there when I
first showed up [missed two words].
And, then I-- then I had, you know, doing other forensic evaluations
there over the entire year of two-- he was the-- the OIC during that time.
during that time-- that was when Colonel Hocter was recommending that Pfc.
Manning come off of POI, and Chief Averhart and the C&A board were recommending
that he stay on POI.
have any discussions with Chief Averhart as to why the Brig was continuing on
with those precautions?
that point my role was just as a consultant to Captain Hocter. So, my discussions were with him.
have any observations as to the rapport between Captain Hocter and Chief
No. I never saw them interacting.
respect to Pfc. Manning, what is your understanding of-- so whether he was on
maximum custody whether he is on POI or not, what restrictions were in place on
POI that would be different from just being in regular MAX custody with no POI?
It was my
understanding that POI entailed extra precautions, such as the suicide mattress
and the smock-- those-- those sorts of things.
the limitations of what he might have in his cell. And, with MAX is there is a certain
amount of time in the cell-- limited time out of the cell-- and being checked
on-- I think it was at least every fifteen minutes.
I want to
go back to your-- it was in-- 423
bravo and 423 delta.
bailiff would please give the witness that-- that is the 21 January 2011 and 28
January 2011 forms.
a little confusion following the timeline here. As I understand it, the 18th of January
was when there was an incident where-- I guess in the exercise room.
we got your form saying, 'No current suicidal thoughts or intent. Come off
POI.' And, then a week later we have the second form that says, 'Remains at
moderate risk,' and 'Risks and benefits of POI sort of balance out.'
happened between the 21st and the 28th to make, I guess, your diagnosis-- your
clinical assessment more in line with POI?
recall. I mean that would be documented
in my actual clinical notes in the medical record. I mean this is just the part that the
Brig was going to see.
medical records they didn't see.
Those went straight back to medical facility. You know, that's where I typically
document like what all of my clinical reasons might have been.
And, I-- I
don't recall when I wrote the note is an increase over that week. I haven't seen those records since I
they? Do you have any idea?
were maintained at the Brig, and then I believe they keep them at the-- branch
clinic that was redesigned.
under the impression that they were suppose to go on to Leavenworth with him.
that you took Pfc. Manning off of his meds. Do you remember when that was?
exactly. I mean I did-- I can see
the C&A form there where by March 4th he had been off of them for some
period of time and was stable. So,
it was over the weeks before that.
recall how long of a taper I did-- but typically that's a [missed word] too--
to they actually taper somebody off of their medications so that they don't
have symptoms from-- from the withdrawal of it.
And then I
would probably wait a couple of weeks to see how they were doing off of it
before I would make some observations about it.
Captain Hocter talk to you about his frustration that he believed that the Brig
was not following-- was not considering his recommendation?
sound in the affirmative, 'mm-hmm']
was just that he was just talking about how frustrated that he was-- I-- I'm
not-- I'm not sure-- he might have attributed that to just risk aversion about
suicide because of the incident the year before.
aware that while Pfc. Manning was in Kuwait-- the records indicated that he was
making nooses and saying things the doctors that, 'I am a patient man. I can wait'?
that impact your evaluation-- your point of view of how [missed a few words] as
time went by?
was certainly a big consideration early on when he first arrived from
believe even we talked about those things in my initial consultation with
he wouldn't-- he wouldn't divorce himself from those things. He would acknowledge that, 'Yes. That's true I said things like that.
And, it is always true that I can always-- suicides always an option'-- that
sort of thing.
sort of intellectually talking about it-- not necessarily from an emotional
talked with Chief Barnes about other criteria that was causing her to keep Pfc.
Manning on POI status, did she ever mention statements about being a patient
man-- or anything of that nature when she was--
believe she did.
ever ask you your thoughts about that?
believe she did.
I mean certainly I was taking those into consideration, but to me-- I mean that
is just one piece of evidence.
I'm not gonna
make any single piece of evidence totally to make my decision.
So, over a
period of time that I-- you know, get to know him better-- I understand more how he thinks-- you know, how he
reacts emotionally and what he is telling me-- and anything that I see over a
period of time-- those become more and more important to my decision making and
this other high risk information gets, you know, a little bit more in the
become less important for my decision making. Now I think there-- and there were--
other people might think that, that piece outweighs everything else.
point it didn't for me.
testified earlier that you would have out briefs with Chief Barnes when she was
available, was she available more often that not when you went down to visit?
half the time, I would think.
you also talk to Chief Blenis as well-- or I mean Gunnery Sergeant Blenis?
did. He was one I would typically talk to as a in brief
to get his observations. If he
wasn't available, I'd-- I'd talk to the guards, you know, back on the unit, and
see what they're offering to say.
opinion, when you had these out briefs with Chief Barnes, who was ultimately--
would make the decision on whether Pfc. Manning would stay in maximum custody
or POI status, which would be your realm.
believe that those were meaningful discussions and engagements-- I mean where
their questions answered?
trying to probe-- you know on just the form-- on what you thought?
were. We would have extensive
discussions and I-- I would talk to her about, you know, my reasoning.
talk to me some about hers. I mean
there were certainly times when it sort of took the flavor of she didn't really
didn't like what I had written on the form, and she wanted to make sure it
was-- 'I can't change your mind, but let me make sure I understand this.'
would spend some time justifying it to her.
she like what was written on the form?
because it was-- was-- it-- it made it more difficult for her to justify her
decision to keep him on POI status.
that was when I said, that this is just another stressor adding to his anxiety.
was her response?
me to explain that to her, and I did.
After you explained
it, did it appear that she understood your rational?
did. I think we sort of reach a
point where we would agree to disagree or, you know, acquiescence but not
me the POI-- of POI and maximum security status are adding stressors-- it
appears that you were weaning Pfc. Manning off of his medication and his
stressful condition was getting better.
confused with what seems like a crossroads a little bit.
some point-- even in spite of these additional stressors, he reached full
remission. [Missed a few words]-- I
mean my point was just that-- that, it-- Okay. It makes it a little more difficult for
me to do my job-- or him to improve, but not insurmountable.
say what-- how much more rapidly would he have remitted had that not been a
factor. I couldn't say that.
that is all I have. Any follow up
based on that?
Honor. Sir, looking at appellate
exhibit-- I believe its 423 delta-- you indicated there that the risk and
benefits of POI are not further detrimental.
saying there that POI is warranted?
I guess I
worded it that way to say that looking at the risks and benefits-- it was sort
of a wash.
always some risk-- when you take somebody off of precaution. There is always some risk. If he had a little bit of an elevation
in the risk then some of that would be warranted.
you believe that at the time that you made that recommendation that you were
telling the Brig that, 'Yes, you should keep him on POI?'
No. I think at that point I was-- what I was
trying to say is that-- that whatever consideration they gonna to give to the
psychiatric piece to that is a wash.
whatever other criteria you're going to.
And you know, I made it a point to try to avoid saying, you know, 'He
should be on POI,' or 'He should not be.'
To me that
was a custodial status. And, my
role was just to provide this one piece of input that-- that, that would be
equivalent to me adhering [missed a few words]-- to [missed a few words]. How much time [missed a word] I think he
should get-- that's not my role.
It's just to provide that one piece.
So, that I
tried to limit it to that, and to be as helpful as I could-- realizing that,
that is the probably the single most important piece of information that they
were going to consider-- or at least I thought it should be.
Retrieving from the witness 423 delta and then 423 bravo. That is all the questions I have your
else from the Government?
Alright. Colonel Malone you are physically
permanently excused. I am going to
ask that you leave a cell phone number with the representative from the
Government, so in case we need to contact you by telephone to ask any
additional questions if we do that.
don't discuss your testimony or knowledge of the case with anyone other than
the lawyers or the accused, while the proceedings are still going on. [to
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