Dysfunction within the Department of Immigration and Border Protection in Canberra left the critically ill asylum seeker Hamid Kehazaei stranded on Manus Island a full day after doctors recommended he be urgently transferred to hospital, an inquest into his death has heard.
The sixth day of the inquest into Kehazaei’s death in 2014 from an infection contracted in the Manus Island detention centre heard conflicting and contradictory advice from within the department, as the Queensland coroner focused on the bureaucratic delays in approving Kehazaei’s transfer to hospital.
The coroner heard urgent medical transfers to move seriously ill asylum seekers needed to be “escalated” through at least five immigration department bureaucrats on Manus Island and in Canberra before an asylum seeker could be sent to a hospital, a process that generally took up to 72 hours.
The immigration department’s former assistant director of detention health operations Caroline Gow told the coroner that, on the morning of 25 August 2014, she was asked to seek approval for Kehazaei’s transfer “on the next available commercial flight”. She was told it was at 11am the next day.
However, there was a scheduled flight leaving Manus Island at 5.30pm that day.
Her evidence directly contradicted the evidence of four doctors involved in Kehazaei’s care, as well as that of her department colleague Jessica Costello, who have all told the coronial inquiry it had been decided – and directly communicated to Gow and other medical officials – that it was intended for Kehazaei to be transferred from the island on the 5.30pm flight.
Area medical director for offshore processing Dr Anthony Renshaw relayed details of a phone call he made to Gow on the morning of 25 August, during which he said he specifically told her about the 5.30pm flight and recommended Kehazaei be approved to fly on it.
“If we miss today’s flight, it may be a problem,” he told the coroner he told Gow. “We need it to happen today, because there’s a slot in the afternoon flight. There’s already a doctor on the flight, so we need a quick turnaround on this one.”
Gow disputed that Renshaw mentioned the 5.30pm flight. She said he told her the next available flight was at 11am the next day.
Asked whether it was possible that Renshaw mentioned the 5.30pm flight: “No, not at all.”
As the afternoon of August 25 progressed, and approval for Kehazaei to travel was not forthcoming, Gow said she didn’t inquire as to its progress because she did not want to “undermine” her superiors, nor the department’s chain of command.
“My responsibility is to send it to the director and it’s the director’s responsibility to escalate it up the line to the assistant secretary.”
But the court heard Gow received an email at 3.20pm from her department colleague Costello, the Manus-based transfers officer, asking for an update on the progress of Kehazaei’s transfer approval.
Gow replied: “This case has gone to the executive for approval.”
Costello said she then telephoned Gow at 5.15pm, again inquiring as to the progress of Kehazaei’s approval. She said she was told the request was with superiors and that the approval would be emailed when it was made.
Gow claims Costello never called her.
The approval process to move an ill asylum seeker from detention on Manus Island to advanced medical care off the island was convoluted and time-consuming, the coroner’s court heard, needing to pass through at least five separate immigration department officials.
Requests for an urgent medical transfer needed to be “escalated” from Manus transfer officer Costello to assistant director Gow, to director Amanda Little, to assistant secretary Paul Windsor and, finally, to first assistant secretary John Cahill and back down again.
In Kehazaei’s case, the email sent by Little to Windsor at 7.24pm on 25 August seeking approval for Kehazaei’s transfer was not read for more than 13 hours.
Windsor told the coroner he did not check emails on his department-issued iPhone overnight on 25 August and did not see the email until he arrived at work at 8.30am on 26 August. Windsor said he was often called out of hours about emergency medical cases on Manus but was not called in Kehazaei’s case.
He defended the delay before the coroner.
“The time it took me to put something forward was not something that would significantly delay the process,” Windsor said. “You could argue that the process could be streamlined so it didn’t have to pass through the hands of four officers. I would argue that the process worked well on many occasions.”
Kehazaei’s approval to travel was granted on the morning of 26 August and he was flown off the island at lunchtime that day. By this time, his condition had deteriorated so badly that he could no longer fly on a commercial flight but needed an air ambulance.
In defiance of doctors’ recommendation he be transferred immediately to Brisbane, he was instead taken to Port Moresby’s Pacific International Hospital. Overnight there, he suffered three heart attacks. The next morning – now unconscious – he was finally transferred to Brisbane.
He died eight days later without ever regaining consciousness, aged 24.
Costello, the department official who actually worked on Manus Island, told the coroner the process to move unwell asylum seekers would be improved by giving authority to department and medical staff on the island, rather than waiting on the imprimatur of non-medically trained staff in Canberra, which usually took days.
“I think one of the things that could be recommended is that the lead-on-island [the senior department official on Manus Island] could be given more autonomy to have that decision making ability and approval ability ... that could be beneficial.”