Australia’s Department of Immigration and Border Protection, and its detention health provider, International Health and Medical Services, have appeared in court blaming each other for the healthcare failures and delays that led to the death of asylum seeker Hamid Kehazaei.
Both the department and IHMS have conceded Kehazaei’s treatment was “deficient” and his death caused by a series of unchecked and cascading failures. But they have sought to sheet blame for the critical failure – the 30-hour delay in moving Kehazaei to a hospital – to each other.
Kehazaei, 24, died in 2014 after contracting a treatable infection in his leg in the Manus Island detention centre, which was allowed to deteriorate to sepsis, causing a series of cardiac arrests and, ultimately, multiple organ failure. He died in a Brisbane hospital and his death is currently before the Queensland coroner.
Doctors on Manus Island sought permission to move Kehazaei to hospital at 1.15pm on 25 August 2014, requesting an “urgent medical transfer” and stating he was at “risk of ... life-threatening widespread systemic infection”.
But the immigration department’s director of detention health services, Amanda Little, in Canberra, was in meetings for five hours that afternoon and did not check her emails. At 6.01pm she replied, asking whether he could be treated on the island if more drugs were sent and did not approve Kehazaei’s transfer.
With permission to move him from Manus denied, Kehazaei was forced to stay on Manus overnight, during which time he deteriorated dramatically.
Dr Mark Parrish, the regional director of IHMS at the time of Kehazaei’s death, told the coroner on Thursday the department’s refusal to observe doctors’ clinical recommendations contributed to Kehazaei’s death.
“The point is this gentlemen is unwell, he is getting off the island and the continuing questioning of medical judgement is part of the reason for this gentlemen’s death,” he said. “We weren’t asking for a clinical discussion of this patient, we were asking to move him.”
Parrish told the coroner that doctors’ recommendations to transfer sick asylum seekers and refugees from offshore detention centres to hospitals were regularly overruled by department bureaucrats who did not hold healthcare qualifications. It was government policy that patients should be moved only as a last resort.
“In an ideal world, we would have moved everybody to Australia for care that was greater than that which could be provided at Manus Island,” Parrish said. “The department asked us to review that and to only move patients to Australia who really could not be managed in Port Moresby.”
“The government, or the department, was reluctant [to transfer patients], and as much as possible would want to have patients treated locally rather than coming to Australia.”
Parrish said over months IHMS developed an understanding of what treatments Port Moresby’s Pacific International hospital was capable of administering.
“For other things, we would recommend that patients be moved to Australia. Sometimes that recommendation was accepted, sometimes it wasn’t.”
In earlier evidence, the former chief medical officer of the immigration department, Dr Paul Douglas, said Kehazaei’s transfer was delayed because IHMS failed to make the department aware of the urgency of his situation.
“IHMS should have rung the decision maker within the department. Sending an email with an attached document did not give the department that sense of urgency. If IHMS were concerned they should have been ringing in the department to make sure that happened.”
Douglas said the medical transfer request from IHMS did not demonstrate “a picture of a sick and deteriorating patient”.
“We felt the documentation was lacking in that it didn’t give a real picture of ... what his clinical conditions was, it didn’t give clear guidance about what timeframe this gentleman needed to be moved.”
Under questioning, Douglas agreed the medical transfer process for offshore detainees – which at the time required the approval of five public servants in Australia – was flawed, and that dysfunction in getting approval from Canberra had imperilled Kehazaei by delaying his move to hospital. “The [DIBP] review team found very clearly that this was a weakness.”
Douglas said the process had since been streamlined. “I think the fact that we’ve made some clear changes in process showed that they could be improved,” he said. “Emergency uplift is a very short process these days.”
But he said it remained government policy that, wherever possible, offshore detainees should not come to Australia for healthcare, but be treated in the country where they are held.
Following Kehazaei’s death, both IHMS and the department conducted reviews into the healthcare he received. However, they refused to share the reports from their investigations with each other, instead compiling a list of joint “learnings” for improving healthcare in offshore detention.
The reviews found that doctors failed to keep adequate records on Kehazaei’s condition and so failed to realise he was deteriorating rapidly. The department’s review found that the method for relaying information about sick asylum seekers in offshore detention to decision-makers in Canberra was “ambiguous and deficient”.
Some of the staff charged with caring for Kehazaei lacked emergency healthcare experience, and sufficient clinical skills to treat him. Nor did they know when to call for further help. “The failure to manage Mr Kehazaei was made up of a number of elements, which all came together and resulted in a very poor outcome,” Parrish said.
