Doctors treating the asylum seeker Hamid Kehazaei inside the Manus Island detention centre debated giving him gentamicin – an antibiotic that might have countered the rare bacteria that had infected him – but decided it was too dangerous because the laboratory equipment needed to monitor its use was broken.
Kehazaei, 24, died in a Brisbane hospital in 2014 after he developed sepsis from a small infection in his leg that was contracted inside the Manus detention centre. His transfer to hospital was postponed a full day by bureaucratic delays and his body went into septic shock. He suffered three heart attacks and ultimately died because of a lack of oxygen to his brain.
Much of the coronial inquest into his death, being held in Brisbane before the Queensland state coroner Terry Ryan, has focused on the delays in moving Kehazaei to a hospital, and the decision to take him to Port Moresby rather than Brisbane as his doctors recommended.
But several doctors who treated Kehazaei have been asked about prescribing him gentamicin while he was still on Manus. The medical clinic in the detention centre had a limited supply of the broad spectrum antibiotic.
Kehazaei’s initial infection was ultimately found to be chromobacterium violaceum. Gentamicin is regarded as effective in treating the rare water-borne bacteria, but the drug is potentially toxic to kidneys, and is usually prescribed only in a setting where its effect can be monitored with blood chemical testing.
The Piccolo Xpress blood chemistry analysing machine inside the Manus Island detention centre was broken. Kehazaei was prescribed several different antibiotics – though not gentamicin - during the 68 hours he was in the Manus Island detention centre medical clinic.
The emergency doctor Leslie King said she and her colleagues debated prescribing gentamicin.
“I specifically remember having a long conversation about it,” King told the coroner.
“We decided against it just at the time, because we had no labs, we had no chemistry. We could not monitor his renal function.
“We knew he was dehydrated, we knew he was febrile, we were really afraid for his kidneys ... if we used that drug. I thought we needed to be careful with that particular medication.”
King said the analyser in the detention centre medical clinic was broken and could perform only a basic white blood-cell count, not any of the functions needed to monitor gentamicin’s effect.
“The entire time I worked there it did not function,” she said.
The required equipment at a laboratory within Lorengau hospital, on the other side of Manus Island, which the detention centre medical clinic sometimes used, was also broken at the time.
The senior medical officer on Manus, Dr Marten Muis, said he found some gentamicin in a cupboard in the Manus Island clinic, but he had never prescribed the drug. He said it was a therapy he was more familiar with being prescribed in a hospital setting, where its effects could be monitored.
The inquest heard on Friday that when the critically-ill Kehazaei was finally moved from Manus Island – by then in septic shock – he was left lying in the sun at the island’s airfield, had torn out the IV lines in his arm and did not have an oxygen mask on.
The inquest continues.