Cardinal George Pell will not be ordered back to Australia to testify to the child abuse royal commission, a ruling met with scepticism by abuse survivor groups.
Cardinal Pell will remain in his new home at the Vatican in Rome, with commissioner Peter McClellan accepting an Italian doctor's evidence he is too sick to fly to Australia.
The decision has been met with suspicion by lawyers for former Melbourne school principal Graeme Sleeman, who resigned in 1986 in frustration over diocese inaction about an abusive parish priest.
Barrister Paul O'Dwyer, for Mr Sleeman, asked Justice McClellan on Monday to make Cardinal Pell's medical report public.
"One of the issues in this case is the fact the church and particularly Archbishop Pell has a continuous history of non-disclosure and we would contend that this report, this medical report, is more of the same," Mr O'Dwyer said.
Justice McClellan made some of Cardinal Pell's medical details public but refused to release them in full.
He revealed the Italian report said Cardinal Pell was suffering high blood pressure and ischemic heart disease complicated by a previous heart attack.
The report said a long plane journey "could induce an episode of heart failure and were this to occur during a flight it would also be difficult to treat".
Cardinal Pell said he had always planned to appear in person and "wished things were different".
"I have always expressed my willingness to assist the Royal Commission in its work," he said in a statement from Rome.
"I have appeared on two previous occasions and many months ago made it clear I was willing to appear again."
Abuse victims' support group Broken Rites was sceptical of the report, with spokesman Bernard Barrett saying Cardinal Pell had been "hostile towards the commission from day one".
"Now, he refuses to re-visit Australia to give evidence in person, citing health reasons. Yet he was healthy enough to fly to Australia on a private trip last year," Dr Barrett told AAP.
Care Leavers Australia Network executive officer Leonie Sheedy also questioned why Cardinal Pell was able to last year visit his former school, St Patrick's College in Ballarat.
"All the victims have had to appear personally but Cardinal Pell, he gets to be in the comfort of his suite in the Vatican," she said.
"It's not an arduous journey to travel on an airplane first class."
Cardinal Pell will now give evidence via video link over three days from February 29, after the commission's hearing into abuse of children in the Victorian dioceses of Ballarat and Melbourne begins on February 22.
The former Bishop of Ballarat, Ronald Mulkearns, has also been ordered to give evidence and will be questioned via video link.
Justice McClellan said a doctor had assessed Bishop Mulkearns as seriously ill with bowel cancer and kidney disease and also suffering from poor memory and anxiety.
Bishop Mulkearns is in a Ballarat nursing home and able to walk only short distances with a walking frame, the commission was told.
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