Self-proclaimed waterboarding fan Dick Cheney called it a no-brainer in a 2006 radio interview: Terror suspects should get a "a dunk in the water." But recently released internal documents reveal the controversial "enhanced interrogation" practice was far more brutal on detainees than Cheney's description sounds, and was administered with meticulous cruelty.

Interrogators pumped detainees full of so much water that the CIA turned to a special saline solution to minimize the risk of death, the documents show. The agency used a gurney "specially designed" to tilt backwards at a perfect angle to maximize the water entering the prisoner's nose and mouth, intensifying the sense of choking – and to be lifted upright quickly in the event that a prisoner stopped breathing.

The documents also lay out, in chilling detail, exactly what should occur in each two-hour waterboarding "session." Interrogators were instructed to start pouring water right after a detainee exhaled, to ensure he inhaled water, not air, in his next breath. They could use their hands to "dam the runoff" and prevent water from spilling out of a detainee's mouth. They were allowed six separate 40-second "applications" of liquid in each two-hour session – and could dump water over a detainee's nose and mouth for a total of 12 minutes a day. Finally, to keep detainees alive even if they inhaled their own vomit during a session – a not-uncommon side effect of waterboarding – the prisoners were kept on a liquid diet. The agency recommended Ensure Plus.

"This is revolting and it is deeply disturbing," said Dr. Scott Allen, co-director of the Center for Prisoner Health and Human Rights at Brown University who has reviewed all of the documents for Physicians for Human Rights. "The so-called science here is a total departure from any ethics or any legitimate purpose. They are saying, ‘This is how risky and harmful the procedure is, but we are still going to do it.' It just sounds like lunacy," he said. "This fine-tuning of torture is unethical, incompetent and a disgrace to medicine."

These torture guidelines were contained in a ream of internal government documents made public over the past year, including a legal review of Bush-era CIA interrogations by the Justice Department's Office of Professional Responsibility released late last month.

Though public, the hundreds of pages of documents authorizing or later reviewing the agency's "enhanced interrogation program" haven't been mined for waterboarding details until now. While Bush-Cheney officials defended the legality and safety of waterboarding by noting the practice has been used to train U.S. service members to resist torture, the documents show that the agency's methods went far beyond anything ever done to a soldier during training. U.S. soldiers, for example, were generally waterboarded with a cloth over their face one time, never more than twice, for about 20 seconds, the CIA admits in its own documents.

(After this story was published, Salon learned that Marcy Wheeler, the author of the blog Emptywheel, and several other bloggers have written about many of the documents released over the past year.)

These memos show the CIA went much further than that with terror suspects, using huge and dangerous quantities of liquid over long periods of time. The CIA's waterboarding was "different" from training for elite soldiers, according to the Justice Department document released last month. "The difference was in the manner in which the detainee's breathing was obstructed," the document notes. In soldier training, "The interrogator applies a small amount of water to the cloth (on a soldier's face) in a controlled manner," DOJ wrote. "By contrast, the agency interrogator ... continuously applied large volumes of water to a cloth that covered the detainee's mouth and nose."

One of the more interesting revelations in the documents is the use of a saline solution in waterboarding. Why? Because the CIA forced such massive quantities of water into the mouths and noses of detainees, prisoners inevitably swallowed huge amounts of liquid – enough to conceivably kill them from hyponatremia, a rare but deadly condition in which ingesting enormous quantities of water results in a dangerously low concentration of sodium in the blood. Generally a concern only for marathon runners , who on extremely rare occasions drink that much water, hyponatremia could set in during a prolonged waterboarding session. A waterlogged, sodium-deprived prisoner might become confused and lethargic, slip into convulsions, enter a coma and die.

Therefore, "based on advice of medical personnel," Principal Deputy Assistant Attorney General Steven Bradbury wrote in a May 10, 2005, memo authorizing continued use of waterboarding, "the CIA requires that saline solution be used instead of plain water to reduce the possibility of hyponatremia."

The agency used so much water there was also another risk: pneumonia resulting from detainees inhaling the fluid forced into their mouths and noses. Saline, the CIA argued, might reduce the risk of pneumonia when this occurred.

"The detainee might aspirate some of the water, and the resulting water in the lungs might lead to pneumonia," Bradbury noted in the same memo. "To mitigate this risk, a potable saline solution is used in the procedure."

That particular Bradbury memo laid out a precise and disturbing protocol for what went on in each waterboarding session. The CIA used a "specially designed" gurney for waterboarding, Bradbury wrote. After immobilizing a prisoner by strapping him down, interrogators then tilted the gurney to a 10-15 degree downward angle, with the detainee's head at the lower end. They put a black cloth over his face and poured water, or saline, from a height of 6 to 18 inches, documents show. The slant of the gurney helped drive the water more directly into the prisoner's nose and mouth. But the gurney could also be tilted upright quickly, in the event the prisoner stopped breathing.

Detainees would be strapped to the gurney for a two-hour "session." During that session, the continuous flow of water onto a detainee's face was not supposed to exceed 40 seconds during each pour. Interrogators could perform six separate 40-second pours during each session, for a total of four minutes of pouring. Detainees could be subjected to two of those two-hour sessions during a 24-hour period, which adds up to eight minutes of pouring. But the CIA's guidelines say interrogators could pour water over the nose and mouth of a detainee for 12 minutes total during each 24-hour period. The documents do not explain the extra four minutes to get to 12.

Interrogators were instructed to pour the water when a detainee had just exhaled so that he would inhale during the pour. An interrogator was also allowed to force the water down a detainee's mouth and nose using his hands. "The interrogator may cup his hands around the detainee's nose and mouth to dam the runoff," the Bradbury memo notes. "In which case it would not be possible for the detainee to breathe during the application of the water."

"We understand that water may enter – and accumulate in – the detainee's mouth and nasal cavity, preventing him from breathing," the memo admits.

Should a prisoner stop breathing during the procedure, the documents instructed interrogators to rapidly tilt the gurney to an upright position to help expel the saline. "If the detainee is not breathing freely after the cloth is removed from his face, he is immediately moved to a vertical position in order to clear the water from his mouth, nose, and nasopharynx," Bradbury wrote. "The gurney used for administering this technique is specially designed so that this can be accomplished very quickly if necessary."

Documents drafted by CIA medical officials in 2003, about a year after the agency started using the waterboard, describe more aggressive procedures to get the water out and the subject breathing. "An unresponsive subject should be righted immediately," the CIA Office of Medical Services ordered in its Sept. 4, 2003, medical guidelines for interrogations. "The interrogator should then deliver a sub-xyphoid thrust to expel the water." (That's a blow below the sternum, similar to the thrust delivered to a chocking victim in the Heimlich maneuver.)

But even those steps might not force the prisoner to resume breathing. Waterboarding, according to the Bradbury memo, could produce "spasms of the larynx" that might keep a prisoner from breathing "even when the application of water is stopped and the detainee is returned to an upright position." In such cases, Bradbury wrote, "a qualified physician would immediately intervene to address the problem and, if necessary, the intervening physician would perform a tracheotomy." The agency required that "necessary emergency medical equipment" be kept readily available for that procedure. The documents do not say if doctors ever performed a tracheotomy on a prisoner.

The doctors were also present to monitor the detainee "to ensure that he does not develop respiratory distress." A leaked 2007 report from the International Committee of the Red Cross says that meant the detainee's finger was fixed with a pulse oxymeter, a device that measures the oxygen saturation level in the blood during the procedure. Doctors like Allen say this would allow interrogators to push a detainee close to death – but help them from crossing the line. "It is measuring in real time the oxygen content in the blood second by second," Allen explained about the pulse oxymeter. "It basically allows them to push these prisoners more to the edge. With that, you can keep going. This is calibration of harm by health professionals."

One of the weirdest details in the documents is the revelation that the agency placed detainees on liquid diets prior to the use of waterboarding. That's because during waterboarding, "a detainee might vomit and then aspirate the emesis," Bradbury wrote. In other words, breathe in his own vomit. The CIA recommended the use of Ensure Plus for the liquid diet.

Plowing through hundreds of pages of these documents is an unsettling experience. On one level, the detailed instructions can be seen as helping to carry out kinder, gentler waterboarding, with so much care and attention given to making sure detainees didn't stop breathing, get pneumonia, breathe in their own vomit or die. But of course dead detainees tell no tales, so the CIA needed to keep many of its prisoners alive. It should be noted, though, that six human rights groups in 2007 released a report showing that 39 people who appeared to have gone into the CIA's secret prison network haven't shown up since. The careful attention to detail in the documents was also used to provide legal cover for the harsh and probably illegal interrogation tactics.

As brutal as the waterboarding process was, the memos also reveal that the Bush-era Justice Department authorized the CIA to use it in combination with other forms of torture. Specifically, a detainee could be kept awake for more than seven days straight by shackling his hands in a standing position to a bolt in the ceiling so he could never sit down. The agency diapered and hand-fed its detainees during this period before putting them on the waterboard. Another memo from Bradbury, also from 2005, says that in between waterboarding sessions, a detainee could be physically slammed into a wall, crammed into a small box, placed in "stress positions" to increase discomfort and doused with cold water, among other things.

The CIA's waterboarding regimen was so excruciating, the memos show, that agency officials found themselves grappling with an unexpected development: detainees simply gave up and tried to let themselves drown. "In our limited experience, extensive sustained use of the waterboard can introduce new risks," the CIA's Office of Medical Services wrote in its 2003 memo. "Most seriously, for reasons of physical fatigue or psychological resignation, the subject may simply give up, allowing excessive filling of the airways and loss of consciousness."

The agency's medical guidelines say that after a case of "psychological resignation" by a detainee on the waterboard, an interrogator had to get approval from a CIA doctor before doing it again.

The memo also contains a last, little-noticed paragraph that may be the most disturbing of all. It seems to say that the detainees subjected to waterboarding were also guinea pigs. The language is eerily reminiscent of the very reasons the Nuremberg Code was written in the first place. That paragraph reads as follows:

"NOTE: In order to best inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented: how long each application (and the entire procedure) lasted, how much water was used in the process (realizing that much splashes off), how exactly the water was applied, if a seal was achieved, if the naso- or oropharynx was filled, what sort of volume was expelled, how long was the break between applications, and how the subject looked between each treatment."

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March 9, 2010