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Asylum seeker death raises serious concerns about care

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The death of an asylum seeker while under the Federal Government’s care has heightened concerns about the provision of health care to people being held in immigration detention centres.

Iranian asylum seeker Hamid Kehazaei, 24, died in Brisbane’s Mater Private Hospital on 5 September, where he was transferred after falling ill while being held on the Manus Island detention centre.

The death has reinforced concerns within the medical profession about the health care being provided to Department of Immigration and Border Protection detainees after it was revealed the detention centre’s medical clinic was not stocked with crucial antibiotics, and there was a critical 19-hour delay in the evacuation of the Mr Kehazaei from Manus Island to Port Moresby.

AMA Vice President Dr Stephen Parnis said the detainee’s death raised serious questions about the provision of health care to asylum seekers held in Australia’s immigration detention system.

“All of these individuals are the responsibility of the Australian Government, and the provision of health care is something we cannot compromise on,” Dr Parnis told The Australian. “The AMA does have concerns about this specific case. It raises a number of serious questions relating to the care that was provided not only to this gentleman, but may be provided to other asylum seekers.”

Mr Kehazaei was admitted to the Manus Island detention centre’s medical clinic on 23 August for what was described as “high fever and generalised unwellness”. An abscess on his left leg had developed severe cellulitis.

Two days after he was admitted, medical staff at the centre recommended he be immediately transferred to Port Moresby for treatment, but The Australian reported that medical records indicated the evacuation ended up taking 19 hours, and he did not arrive at Port Morseby until 26 August, with indications that staff were “waiting on a visa before he can be transferred”.

While at Port Morseby’s Pacific International Hospital, Mr Kehazaei had a heart attack and was transferred to Brisbane’s Mater Private Hospital on 27 August. He was confirmed brain dead on 2 September and three days later his family chose to turn off his life support.

In a medical report obtained by The Australian, staff at the Manus Island detention centre clinic said Mr Kehazaei had “exhausted all antibiotic treatment that is available on Manus”.

Doctors for Refugees co-founder Dr Richard Kidd said the fact that he had not received the antibiotics Gentamicin and Chloramphenicol while on Manus raised serious concerns about the adequacy of the on-island health service, which is provided under contract by International Health and Medical Services (IHMS).

“The PNG Guidelines are clear that Hamid should have been having Gentamicin and Chloramphenicol either immediately, or certainly within 24 hours, of oral antibiotics not making a significant improvement,” Dr Kidd told The Australian. “Yet these [medical] notes suggest these antibiotics were not available in the detention centre clinic. If IHMS has not provided supplies of Gentamicin and Chloramphenicol in that environment, I would say that’s serious negligence.”

Earlier this month, the Immigration Department announced it had renewed its contract with IHMS to provide detention centre medical services for a further five years.

But leaked documents obtained by the ABC indicate that earlier this year the Department had significant concerns about the performance of IHMS.

They show that departmental officials thought IHMS medical staff were “risk averse” and too quick to recommend the transfer of detainees to Australia for treatment, which “places the Department in a difficult position as it is very difficult to reverse a medical recommendation once made”.

“IHMS need to ensure medical staff who do reviews are not against Offshore Processing Centres (OPC),” the documents show officials said, citing the example of a psychologist who “regularly deemed transferees were not fit to return to an OPC”.

The issue of the care provided to asylum seekers has been further inflamed by the case of an Iranian man being held in Darwin’s Wickham Point Immigration Detention Centre whose health is rapidly deteriorating after being on hunger strike since 1 November.

The man has so far lost more than 23 kilograms and has refused to eat or be fed intravenously. He is on anti-nausea medication.

A lawyer for the man, who has been refused refugee status, said the Immigration Department was pressuring him to voluntarily return to Iran, but the man believes he will be imprisoned or killed if he does so.

There has not yet been any move to try to force feed the man, and the AMA recently updated guidelines on the issue, recommending that doctors respect the wishes of people who have made a voluntary and informed judgement to refuse food and refuse to force-feed hunger strikers.

In its Position Statement on Health Care of Asylum Seekers and Refugees (see position-statement/health-care-asylum-seekers-and-ref…), the AMA recommended that, “Where an individual voluntarily refuses nourishment and is considered by a medical practitioner to be capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, the practitioner should be free to refuse to co-operate in artificial feeding.

“The decision as to the capacity of the individual to form such a judgment should be confirmed by at least one other independent medical practitioner. The practitioners must explain to the individual the consequences of refusal of nourishment.”

Similarly, in its Position Statement on Medical Ethics in Custodial Settings, (see position-statement/medical-ethics-custodial-settings-2013), the AMA said, “Doctors should respect a competent individual’s decision to enter into a hunger strike. Doctors should continue to provide care to the individual while respecting their voluntary refusal of nourishment.

“Where a prisoner or detainee refuses nourishment and is considered by the doctor to be capable of forming an unimpaired and rational judgement concerning the consequences of such a voluntary refusal of nourishment, the doctor should refuse to co-operate in artificial feeding. Forced feeding contrary to an informed and voluntary refusal is not justifiable. Artificial feeding with the hunger striker’s explicit or implied consent is ethically acceptable.”

Adrian Rollins

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