[Congressional Record (Bound Edition), Volume 158 (2012), Part 8]
[Extensions of Remarks]
[Pages 11478-11479]
[From the U.S. Government Publishing Office, www.gpo.gov]




   THE EFFECTS OF INCARCERATION ON THE MENTAL AND PHYSICAL HEALTH OF 
               FORMER PRESIDENT CHEN SHUI-BIAN OF TAIWAN

                                 ______
                                 

                         HON. ROBERT E. ANDREWS

                             of new jersey

                    in the house of representatives

                         Tuesday, July 17, 2012

  Mr. ANDREWS. Mr. Speaker, as a strong supporter of Taiwan and a 
founding member of the Congressional Taiwan Caucus, I would like to 
bring to your attention an issue of concern to Taiwanese Americans and 
the people of Taiwan.
  The former President of Taiwan, Mr. Chen Shui-Bian, is currently 
serving a 19-year prison sentence for corruption charges. He has been 
incarcerated for over 1,200 days thus far. Today, I am inserting into 
the Congressional Record a summary report drafted by a three-man 
medical team led by former professor Joseph Lin, Ph.D., and professors 
of the University of California at Davis Medical Center, Ken Yoneda, 
M.D., and Charles Whitcomb, M.D., who visited Mr. Chen Shui-Bian in 
jail in Taiwan last month in their capacity as private citizens. The 
report is titled, ``The Effects of Incarceration on the Mental and 
Physical Health of Former President Chen Shui-Bian of Taiwan.'' A full 
transcript of the report is available here: http://www.fapa.org/public/
CSB_Report_to_TLHRC_12Jul2012.pdf.
  These medical professionals traveled to Taiwan in June 2012 to assess 
President Chen's physical and mental condition, and to inquire into 
reports of inhumane living conditions and confinement. The physicians 
concluded that President Chen's imprisonment conditions are 
contributing to President Chen's health problems. In their 
recommendations the report concludes: ``Former President Chen Shui-Bian 
[should] be released from confinement on medical parole based on the 
above assessments, conclusion and recommendations, and on compelling 
humanitarian grounds.''
  I am entering this report into the Congressional Record and, in light 
of the conclusions, ask that the distinguished Tom Lantos Human Rights 
Commission investigate this important case at its earliest convenience.

 Report to the Tom Lantos Human Rights Commission, United States House 
                           of Representatives

                   An Assessment and Recommendations


   The Effects of Incarceration On the Mental and Physical Health of 
               Former President CHEN SHUI-BIAN of Taiwan

  (By U.S. Citizen Medical Team--Joseph Lin, Ph.D., Ken Yoneda, M.D., 
                        Charles Whitcomb, M.D.)

                             July 12, 2012


                                SUMMARY

       Former President CHEN SHUI-BIAN (CSB) has been in and out 
     of detention since November 12, 2008 and incarcerated in 
     Taipei Prison, Taoyuan County since Dec. 2, 2010. On Monday 
     June 11, 2012 a team of three private United States citizens 
     (a Ph.D. team leader, and two medical doctors) evaluated CSB 
     in Taipei Prison with the purpose of assessing his medical 
     health and the conditions of his confinement amidst reports 
     of his failing health and potential human rights violations. 
     They were allowed to interview and examine him for 
     approximately fifty-five minutes, had access to much of his 
     medical records, and interviewed three independent Taiwanese 
     physicians who had seen him as visitors to the prison but who 
     were not a part of his prison appointed medical team. The 
     visit was followed by detailed discussions with the Taiwan 
     Medical Panel which included the three physicians mentioned 
     above.
       CSB has been imprisoned for over four years; sometime in 
     late 2011 or early 2012 he began experiencing increasingly 
     more severe and debilitating symptoms, which culminated in 
     his transport to two different hospitals for medical 
     evaluation. He described ongoing episodes of severe paroxysms 
     of dyspnea (difficulty breathing) with no apparent triggers, 
     accompanied by a sensation of choking and feelings of great 
     dread, as if

[[Page 11479]]

     he was going to die. These episodes were at times accompanied 
     by chest tightness, a feeling of congestion not allowing him 
     to take either a deep breath in or out. While the episodes 
     have become perhaps less frequent and less severe since he 
     regularly started taking esomeprazole around mid- May, 2012 
     for gastro-esophageal reflux disease (GERD), esophagitis 
     (inflammation of the esophagus), duodenitis (inflammation of 
     the duodenum) and gastritis (inflammation of the stomach), 
     they continued to be quite debilitating in nature. Even at 
     rest he continued to have a sensation of congestion and the 
     feeling that he could not get a good breath in or out. It is 
     notable that he had never experienced similar episodes prior 
     to his incarceration. As well, he described progressive 
     dyspnea on exertion over the prior 6 months. Previously he 
     could jog approximately 1.5 miles but now he could not walk 
     at a normal pace without getting dyspneic.
       Chen is confined to a small cell, approximately 58 square 
     feet that he shares with another inmate, and is allowed to be 
     outside his cell for only one hour a day. Until recently he 
     had been permitted to be outside his cell for only 30 minutes 
     a day. Around May of 20, 2012, it was increased to 60 minutes 
     a day. In contrast, other prisoners are allowed outside of 
     their cells for eight hours a day to work and interact with 
     other prisoners. He stated that his cell is at times cold and 
     damp and at other times hot, humid and damp, having 
     inadequate ventilation and no air conditioning. He sleeps on 
     the floor, which can be cold and damp, and experiences chills 
     despite blankets. He feels depressed, experiencing anger and 
     tearfulness, worries a great deal, has frequent nightmares 
     and feelings of hopelessness that have all worsened with the 
     ailing health of his wife and mother. He denied suicidal 
     ideation, stating the he must fight on for the sake of his 
     family and country. While confined to his cell, he must kneel 
     on the ground to write and consequently suffers from chronic 
     pain in his knees.
       Despite good cooperation from the prison officials, 
     extensive consultation with other local physicians, and a 
     thorough review of the available medical records, the three-
     person team concluded that adequate assessment of CSB's 
     medical condition and his conditions of confinement required 
     further evaluation. They had grave concerns regarding CSB's 
     health and believe that it will continue to deteriorate, 
     should he remain in his present prison confines. Although his 
     evaluations at Taoyuan General Hospital and Chang Gung 
     Memorial Hospital together appear comprehensive and of high 
     quality, his recent hospitalization at Chang Gung Memorial 
     Hospital was limited to around 6 hours and his symptoms 
     remain incompletely explained. His medical evaluation thus 
     remains incomplete. Stress, without a doubt was believed to 
     be a major contributor, if not the major cause of his 
     symptoms, but his symptoms in conjunction with the spirometry 
     (breathing tests) that he was not able to complete 
     satisfactorily, but displayed severely reduced inspiratory 
     and expiratory flows, suggest he may have vocal cord 
     dysfunction (VCD) with severe intermittent vocal cord spasm. 
     This disorder can be very difficult to diagnose and treat and 
     often requires very specialized expertise to accomplish. This 
     problem will likely continue in the presence of his present 
     stressors and will worsen with additional and ongoing 
     stressors. Certainly gastro-esophageal reflux can precipitate 
     and worsen VCD and in his case treatment appeared to have 
     ameliorated, but had not satisfactorily controlled his 
     symptoms. In addition, the bronchiectasis seen on his chest 
     CT, suggests that he may have been chronically aspirating 
     gastric acid into and damaging his airways. Coronary artery 
     disease and structural cardiac disease did not appear to be 
     the cause of his ongoing symptoms, but conditions such as 
     stress cardiomyopathy, evolving pulmonary arterial 
     hypertension and thromboembolic disease are considerations. 
     His chest x-rays reportedly revealed atelectasis and his 
     bronchoscopy revealed a lesion in his bronchus. 
     Unfortunately, the medical team was unable to personally 
     review his radiographs, bronchoscopy pictures, cardiac 
     catheterization films and echocardiogram to help complete 
     their evaluation.
       The individual members (admitted non-experts on 
     international human rights of prisoners) of the medical team 
     all felt that the prison conditions as described to them were 
     unacceptable for the general prison population and they 
     raised concerns regarding the human rights of all prisoners 
     in Taiwan. Furthermore, the team found it deeply disturbing 
     that any prisoner who was this ill, would continually be 
     subjected to these severe conditions. For a former President 
     of Taiwan to be confined under such conditions was considered 
     unimaginable.
       The consensus recommendations of the team were that former 
     President CHEN SHUI-BIAN be evaluated at a comprehensive 
     tertiary care center and that the doctors be allowed to fully 
     evaluate him, to review his records in their entirety, to 
     speak to his previous treating physicians and to have access 
     to directly view any and all of his radiographs, spirometry, 
     bronchoscopy pictures, cardiac catheterization films and 
     echocardiogram. In addition, it was concluded that the harsh 
     conditions of his confinement were an ongoing source of great 
     emotional and physical stress and must be significantly 
     improved otherwise his symptoms and his health will continue 
     to deteriorate. As physicians without specific expertise in 
     psychiatry or psychology they could not determine whether CSB 
     met the criteria for an adjustment disorder, major depression 
     or post-traumatic stress disorder (PTSD), but voiced concern 
     that he could develop such problems if his conditions of 
     confinement remained unchanged. They could not offer an 
     expert opinion as to how much his conditions needed to be 
     improved to avoid psychological damage or whether at this 
     point it was at all preventable.


                            RECOMMENDATIONS

       After careful consideration, the team makes the following 
     recommendations:
       1. That former President CHEN SHUI-BIAN (CSB) be 
     transferred to a tertiary care medical facility where he 
     could receive subspecialty evaluation care.
       2. That consideration be given to the request by CSB and 
     his family that he be evaluated at National Taiwan University 
     Hospital given his familiarity with and trust in the facility 
     where he had previously been evaluated during his Presidency.
       3. That he be evaluated by a team of physicians consisting 
     of at minimum the following:
       a. A physician with specific expertise in vocal cord 
     dysfunction.
       b. A pulmonologist.
       c. A cardiologist.
       d. A psychiatrist.
       e. A primary care physician or hospitalist.
       4. That full pulmonary function testing be conducted 
     including lung volumes and DLCO with particular attention 
     paid to the flow volume loops.
       5. That there be a review of his echocardiogram 
     specifically looking for Takotsubo's cardiomyopathy. That his 
     cardiac catheterization film be reviewed.
       6. That a review of his chest CT be performed.
       7. That a cosyntropin stimulation test, thyroid function 
     tests, ferritin, iron binding capacity and an evaluation of 
     his hepatitis status be considered.
       8. That further evaluation and testing would be at the 
     discretion of the evaluating physicians.
       9. That there be immediate improvement in his confinement 
     conditions at the very least, in accordance with Standard 
     Minimum Rules of the Treatment of Prisoners (Adopted by the 
     First United Nations Congress on the Prevention of Crime and 
     the Treatment of Offenders, held at Geneva in 1955, and 
     approved by the Economic and Social Council by its 
     resolutions 663 C (XXIV) of 31 July, 1957 and 2076 (LXII) of 
     13 May, 1977).
       10. That a full investigation be conducted by independent 
     third parties specifically human rights specialists to 
     determine if the Taipei Prison authorities are in compliance 
     with international standards of incarceration and if CSB's 
     human rights are being violated.
       11. That the Tom Lantos Human Rights Commission convene a 
     hearing to determine the facts and extent of human rights 
     violations concerning the incarceration of CSB.
       12. That former President CHEN SHUI-BIAN be released from 
     confinement on medical parole based on the above assessments, 
     conclusion and recommendations and on compelling humanitarian 
     grounds.
       Submitted by:
       JOSEPH LIN, PH.D.
       KEN YONEDA, M.D.
       CHARLES WHITCOMB, M.D.

                          ____________________