Attempts by Australia’s peak medical association to assist sick asylum seekers detained on Nauru continue to be stymied by complicated immigration processes that “lack transparency”, a Senate inquiry has been told.
In September the Senate committee on legal and constitutional affairs launched an inquiry into allegations of abuse, self-harm and neglect of asylum seekers in Australia’s offshore processing centres after the Guardian’s publication of the Nauru files.
In its submission to the inquiry, published on Friday, the Australian Medical Association said it was routinely contacted by asylum seekers with concerns about their healthcare but the process required by the department for them to assist was “complicated and lacks transparency”.
In several cases the AMA claimed the department provided advice on a person’s condition that contradicted their own information.
The AMA was also concerned there was “insufficient follow-up and reporting” from the department after it raised a number of concerning individual cases directly with it and the chief medical officer of Australian Border Force, Dr John Brayley.
“While the department does provide brief responses on some asylum seekers, the AMA is not always able to ascertain whether quality and appropriate health services, management and treatment is being provided as there is no independent, transparent body of clinical experts that can verify or report on this,” the submission said.
Among the cases cited, the AMA said it had contacted the department several times with concerns about the physical and mental health of one woman who had been in detention for more than three years and was possibly at risk of suicide.
According to the AMA the department’s response to its concerns included a finding that: “Whilst [redacted] did state that she continues to hear voices, these are much less than previously and the voices did not contain any derogatory or command hallucinations.”
The department increased the woman’s anti-psychotic medication and recommended another review in a month’s time, according to the response.
“At the time of writing this submission, the AMA has no further information about this asylum seeker, whether she continues to self-harm or if her hallucinations and ‘voices’ indicates more severe mental illness requiring specialist psychiatric care.”
In another case, first revealed at a conference in February by the then AMA president, Prof Brian Owler, a 70-year-old Rohingya man was brought to the organisation’s attention after he suffered extremely ill health on Manus Island. Owler recommended to Brayley that the man needed immediate healthcare or he was “likely to die”.
After being told that a transfer request “should have been put in train” the previous week, the AMA received no further information.
Another asylum seeker held on Manus Island spoke with an endocrinologist via teleconference in January. According to an account given to the AMA, the specialist hadn’t seen the man’s records and forgot to ask him about his symptoms until the man mentioned it.
When the AMA subsequently received the man’s records, they were on a password protected disc with no password supplied.
The AMA said the cases listed were “some, but by no means all” of the asylum seekers who asked for its help and it acknowledge not all information could be independently verified.
However, it said: “The AMA does not believe those detained on Manus and Nauru, either within detention facilities or within the community, are able to access a healthcare service of the same standard that a person in the Australian mainland would receive.”
It said refugees and asylum seekers on Nauru were still not receiving adequate medical care and it reiterated calls for a national statutory oversight body.
In another submission to the inquiry, the Royal Australasian College of Physicians said it wasn’t consulted before the government’s recent change to the Border Force Act.
The change, made on the eve of a high court challenge, removed health practitioners from laws that made it a jailable offence to disclose information about conditions on Nauru, outside of internal channels.
The college said it received no formal communication about the change either before or after, and there remained “ambiguity” about what protections actually existed for health and medical professionals.
“The amendment to the determination was not subject to parliamentary process and does not represent a substantive legislative amendment,” it said.
The Royal Australian and New Zealand College of Psychiatrists also called for the disclosure provisions to be repealed and recommended independent oversight, improved policies around reporting, investigating and transparency, and for allegations of abuse to be reviewed by the current royal commission into child abuse.
The inquiry is due to report in March and is taking submissions until Monday.
