Critically ill asylum seeker Hamid Kehazaei flown to hospital more than a day after doctor sought transfer, coroner hears
Australia’s Department of Immigration routinely rejects doctors’ advice to move critically ill asylum seekers to hospital, and refuses permission for offshore detainees to be transferred to Australia, an inquest has heard.
The fourth day of the inquest into the 2014 death of the Iranian asylum seeker Hamid Kehazaei has again focused on the bureaucratic delays in transferring the critically ill asylum seeker from the Manus Island detention centre.
The transfer of Kehazaei, who was suffering from a bacterial infection, was initially delayed by more than a day, and he was then taken, in defiance of doctors’ advice, to the Papua New Guinea capital, Port Moresby, instead of Brisbane.
After suffering three heart attacks in Port Moresby, he was flown by air ambulance – by then unconscious – to Brisbane, where he died a week later.
Yliana Dennett, a co-ordinating doctor with International SOS, the company subcontracted to organise medical transfers from offshore detention, told the Queensland state coroner on Thursday that Australia’s Department of Immigration and Border Protection routinely refused doctors’ recommendations to move critically ill asylum seekers to Australian hospitals.
“Experience has shown the department is very reluctant to bring patients to Australia … If we recommended someone transferred to Australia, we knew it would not be approved,” she told the inquest.
On 25 August 2014 Dennett recommended the transfer of Kehazaei, who was suffering a severe and worsening infection that was not responding to any antibiotic treatments available on Manus, to Port Moresby’s Pacific international hospital.
She told the inquest that while the medical care in Port Moresby was a “step up” from that available on Manus, it was “not the best option”, and that transfers to Port Moresby were not used for any patients except asylum seekers from the detention centre.
“We usually do not recommend medical transfer to Port Moresby,” she told the inquest. “The medical care in Port Moresby … and the expertise of the local doctors is not up to Australian or international standards.”
The inquest has previously heard that the Pacific international hospital in Port Moresby was unhygienic, that it had an insufficient number of staff, and its doctors and nurses were inadequately trained.
But Dennett said she had recommended the transfer to Port Moresby because “we knew that a transfer to Australia would not be approved by the department”.
“We have had several cases prior to that case where we have recommend Australia as a first or only option, and the majority of cases – these have not been approved, or have not been approved in an adequate timeframe, or have had considerable delay,” she said.
Under questioning from counsel for the commonwealth, Dennett said she had personally dealt with cases in which she had recommended urgent transfer for patients with serious heart conditions or psychiatric illnesses, but their transfer had been refused by the department.
In other cases, she said, approval had been delayed for several days or a number of weeks.
In the case of Kehazaei, the department – which retains ultimate control over asylum seekers detained offshore – received a request for his urgent transfer at 10.55am on 25 August.
The department was urged to approve Kehazaei’s travel immediately for a flight leaving the island that evening and was told the 24-year-old had a “risk of infection spreading, leading to sepsis – life-threatening widespread systemic infection”.
The department did not respond until 6.01pm – after the flight had left – when its director of detention health operations, Amanda Little, emailed the area medical director for offshore processing, Dr Anthony Renshaw, who had recommended Kehazaei be moved.
The email, which was presented to the coroner, said: “I am wondering why this can’t be managed at Lorengau hospital [on Manus]? Even using something ‘unusual’ should be able to be managed locally. Is there a [drug] supply issue that we are unaware of? Again, these should be brought in, rather than the person being transferred if this is the case. DIBP staff on island are being pushed for this urgent transfer in the next 18 hours, however I don’t have adequate information to be able to escalate at this point if this is still warranted.”
Renshaw told the inquest he was surprised at the response. “I felt we had made the rationale very clear to the department that Lorengau was not a suitable location. As a doctor, I had provided sufficient rationale for this man to be moved offsite.”
Little, along with several other immigration department bureaucrats who handled Kehazaei’s case, will be called before the coroner next week.
Kehazaei was not moved from Manus until lunchtime on 26 August, more than a full day after his transfer was requested, and three days after he first presented to the detention centre clinic.
By that time he was reportedly suffering septic shock and acute respiratory distress syndrome. Doctors say he was confused, distressed and moaning in pain.
Leslie King, the emergency doctor who treated Kehazaei at the Manus Island detention centre, said if he had been moved on the first day his transfer was requested, “he would have had a very different outcome”.
“I wish he could have left that day, by whatever means,” she told the inquest. “I really feel strongly that if he could have left that day, gotten to a place that had a laboratory, that had facilities we didn’t have, he would have had a very different outcome … he would have had much more of a fighting chance.”
King also said that on two consecutive nights in the detention centre clinic, her directions to give Kehazaei intravenous paracetamol were ignored by night staff.
The department, successive immigration ministers and the offshore detention health provider International Health and Medical Services have consistently maintained asylum seekers and refugees held in offshore detention are afforded international-standard healthcare.
IHMS’s regional medical director, Mark Parrish, told the inquest in a statement that asylum seekers held in offshore detention were afforded health services “broadly comparable” with those available in Australia.
But IHMS’s own medical evacuation response plan – an internal document presented to the coronial inquiry – imposes a two-tier health system, where detention centre staff who fall ill are immediately transferred to Australia, but asylum seekers are kept in Papua New Guinea.
The plan says detention centre staff working on Manus – known as “stakeholders” – who require medical treatment beyond the capability of the detention centre clinic should be transferred immediately to an Australian hospital.
The document states, “for transferees [asylum seekers and refugees held in detention] consideration should be given to the possibility of treatment for PNG. Recommendations for transportation to Australia can be made only once local options have been exhausted.”