74 F. Supp. 3d 16
D.D.C.2014Background
- Abu Wa'el (Jihad) Dhiab, a Guantanamo detainee cleared for release in 2009, filed a habeas petition and sought a preliminary injunction (2014) challenging specific force-feeding practices after participating in a hunger strike.
- The 2014 application narrowed over litigation and discovery; several contested practices were resolved (e.g., wheelchair access granted; change of lubricant), leaving five main disputes at hearing.
- Remaining contested practices: twice‑daily insertion/removal of nasogastric (NG) tube rather than leaving it in place for days; use of auscultation (bubble/stethoscope) vs. x‑ray to confirm tube placement; use of a Five‑Point Restraint Chair during feedings; whether force‑feeding occurs absent imminent risk of death/serious harm; and whether non‑medical military personnel have final authority to order force‑feeding.
- The Government produced medical affidavits and evidence of security risks and past incidents when tubes were left in place, and represented that force‑feeding decisions originate with medical staff and require medical determinations before command approval.
- At the October 2014 hearing, the Court reviewed classified and unclassified evidence, expert testimony, and procedural materials before denying the preliminary injunction.
Issues
| Issue | Plaintiff's Argument (Dhiab) | Defendant's Argument (Government) | Held |
|---|---|---|---|
| Frequency of NG‑tube insertion | Daily reinsertion causes pain, infection risk, and increased misplacement risk; tube may safely remain ≥3 days | Daily removal reduces infection risk in detention, prevents manipulation/purging and security risks observed when tubes left in | Court: No deliberate indifference; daily insertion justified in detention setting; no irreparable harm shown |
| Method to confirm tube placement (auscultation vs x‑ray) | Auscultation is unreliable; x‑ray is standard and safer to avoid lung placement | Auscultation combined with water test is acceptable; daily x‑rays pose radiation risks and are impractical given double insertions | Court: Use of auscultation not deliberate indifference given context and safeguards |
| Use of Five‑Point Restraint Chair during feedings | Chair exacerbates back pain; requests less restrictive single‑point restraint | Chair needed for positioning, preventing vomiting/purging, preventing assaults on staff; past incidents support restrictive practice | Court: No evidence of intent to cause suffering; practice not deliberately indifferent |
| Authority to authorize force‑feeding | Commander approval allows non‑medical final decision; only physicians should decide | Medical recommendation/SMO approval is required before commander signs off; emergency medical actions permitted without delay | Court: SOPs require medical determination before force‑feeding; petitioner failed to show likelihood of success |
| Force‑feeding absent imminent risk | SOPs use weight thresholds that can authorize force‑feeding before imminent risk; May 2014 resumption was based solely on weight | Weight thresholds trigger further medical review; SMO considered weight plus clinical signs, refusal to eat, muscle weakness; decision consistent with DOD instruction | Court: No deliberate indifference; evidence shows multi‑factor medical determination, so challenge fails |
Key Cases Cited
- Aamer v. Obama, 742 F.3d 1023 (D.C. Cir. 2014) (Guantanamo detainees may challenge conditions of confinement in habeas proceedings)
- Hatim v. Obama, 760 F.3d 54 (D.C. Cir. 2014) (jurisdictional discussion consolidating related appeals)
- Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference standard for inadequate medical care claims)
- Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference requires culpable state of mind)
- Winter v. Natural Res. Def. Council, 555 U.S. 7 (2008) (preliminary injunction standard: extraordinary remedy requiring clear showing)
- Turner v. Safley, 482 U.S. 78 (1987) (prison regulation validity tested by reasonable relation to penological interests)