23 August 2014
At 5.30pm the 24-year-old Iranian asylum seeker Hamid Kehazaei arrives at the clinic at the Manus Island regional processing centre. He says he has been sick for two days, and complains of fever, chills, a sore throat and an aching body. A small, infected sore is noticed on his lower leg, and another in his groin. He is put on intravenous antibiotics and pain relief medication. His fever does not abate.
24 August
Despite continued antibiotic treatment, Kehazaei’s fever remains high. His blood pressure drops, heart-rate increases and the infection worsens and appears to spread. By the end of the day, he is vomiting and needs to be taken to the toilet by wheelchair.
25 August
8am: Kehazaei is worse still. A Manus Island senior medical officer, Dr Marten Muis, and an emergency doctor, Leslie King, examine him and consult about his proposed treatment. They agree he should be evacuated on scheduled commercial flight at 5.30pm that afternoon. Another doctor whose rotation has ended, Dr Richard McGrath, is booked on that flight and agrees to act as medical escort.
Muis speaks by phone with the area medical director for offshore processing, Dr Anthony Renshaw, who agrees that Kehazaei should be evacuated at 5.30pm.
9.11am: Muis calls International SOS to request the “urgent” medical transfer of Kehazaei to hospital. The International Health and Medical Services coordinating doctor in Sydney agrees that he should be evacuated at 5.30pm. International SOS doctors say Australia would offer “gold-standard” care but that the Department of Immigration and Border Protection is reluctant to transfer asylum seekers to Australia and often rejects those requests, so suggests Port Moresby as a secondary option.
12.29pm: Renshaw calls the department’s assistant director of detention health services, Caroline Gow, in Canberra to discuss Kehazaei’s transfer. He says he told her about 5.30pm flight. Gow claims he said next flight was at 11am the next day.
1.15pm: Gow sends an email to Amanda Little, the Canberra-based director of detention health services, requesting the “urgent medical transfer” of Kehazaei to hospital. Medical staff on Manus state:
This client has exhausted all antibiotic treatment that is available on Manus Island. The client is deteriorating despite treatment with antibiotics available. There are risks of the infection spreading, leading to sepsis – life-threatening widespread systemic infection.
Afternoon: Doctors debate giving Kehazaei gentamicin, a different antibiotic, that may have helped his condition. They decide against prescribing the drug because the blood chemistry analysing machine in the clinic is broken and without it they believe the drug’s use risks renal failure.
5.30pm: Little is in meetings throughout the afternoon, and has not seen the transfer request. Gow calls Little to alert her to the email.
6.01pm: Little responds to the email but does not escalate the request for approval. She says:
I am wondering why this can’t be managed at Lorengau hospital? 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.
6.30pm: Renshaw responds to Little’s email, calling her to emphasise the critical nature of Kehazaei’s condition.
7.24pm: Little emails the immigration department assistant secretary Paul Windsor in Canberra with the “escalation” of the transfer request. Windsor has gone home for the day and does not read the email until 13 hours later.
26 August
8am: King and Muis examine Kehazaei. His case is upgraded from “urgent” to “emergency”. King tells Muis: “There’s no doubt he’s now an emergency, he’s deteriorated very rapidly in the last few hours. We need to get this guy out fast.”
8.30am: Windsor reads the transfer request email from Little and escalates request to the first assistant secretary, John Cahill.
8.41am: Kehazaei’s transfer is approved by the department. His condition has deteriorated to the extent he cannot fly on a commercial plane. The latest recommendation from doctors is that he be taken directly to Brisbane by air ambulance.
Late morning: Kehazaei is now septic, according to doctors. He is moaning in pain, and is confused and distressed. He has pulled his intravenous lines from his arm and is combative with staff who try to give him oxygen. Driven to the airfield in an ambulance, he is left lying on a gurney in the sun, waiting for the plane.
Lunchtime: Kehazaei is flown by air ambulance to Port Moresby’s Pacific international hospital, in defiance of doctors’ recommendation who have said he should fly directly to Brisbane.
Overnight: Kehazaei has three heart attacks in hospital in Port Moresby.
27 August
Morning: Kehazaei is flown by air ambulance, now unconscious, to Brisbane’s Mater hospital. He is checked in at 10pm. He does not regain consciousness.
2 September
Kehazaei is declared brain dead. His family are consulted.
5 September
The family give permission for Kehazaei’s life-support machine to be switched off. They give instructions that his organs are to be donated. At 7.25pm Kehazaei dies.
