Emergency medical evacuation procedures for detainees at the Manus Island detention centre were “ambiguous and deficient” ahead of Hamid Khazaei's death, a coroner’s inquest has heard.
Department of Immigration’s then chief medical officer Paul Douglas told the Brisbane inquest into the death of Iranian asylum seeker Hamid Khazaei the Papua New Guinea hospital meant to care for sick detainees was inspected but not audited as meeting the required medical standards.
He gave evidence it was federal government policy not to transfer detainees off Manus Island, but - if necessary - to first send them to the Pacific International Hospital (PIH) in Port Moresby.
Mr Khazaei was admitted to the medical centre, within the Australian-run Manus Island immigration detention facility, in August 2014 with a fever and small infection on his leg.
Thirteen days later he died in a Brisbane hospital, after first being transferred to the PNG capital Port Moresby.
Mr Douglas, who is now the Department of Immigration’s assistant secretary for health policy and performance, conducted the departmental review of the case and said he was not directly involved and did not have any responsibility for the case.
“Government policy of (the) day was that the regional processing centre, people would stay within the centre and we should ensure they get as much care as (they) possibly could in those environments, rather than have them moved away from those centres, which was against government policy,” he said.
The inquest previously heard Mr Khazaei’s transfer from Manus Island, at the request of doctors from Immigration Department contractor IHMS, was repeatedly delayed, as approvals had to be sought from up to five levels of bureaucrats who did not hold medical qualifications.
Mr Douglas’ report into the case cited a potential contributing factor of “ambiguous and deficient” policies for emergency evacuation.
“What we saw were the deficiencies at that time and what we felt did not allow that emerging picture of a sick and deteriorating patient,” Mr Douglas told the inquest.
“We felt the documentation was lacking in that didn’t give a real picture of circumstance - of what his clinical condition was, it didn’t give clear guidance in what timeframe this gentleman needed to be moved.
"It talked about the next available commercial flight, but it didn’t say within three hours, six hours or 24 hours, and it failed to include what efforts were provided and what the next steps were in the treatment of this patient.”
Mr Douglas told the inquest decisions to move patients within Australia to higher levels of medical care was “clinician to clinician”, but on Manus Island there was also a question of “the cost of spending that money for transport”.
“I think the fact that we’ve made some clear changes in process showed that they could be improved,” he said.
“Processes in place today still do not include clinicians in the approval process, unless the person being transferred is coming direct to Australia.
“At the moment the process goes from the clinician in IHMS [referring] to their internal IHMS process, and the approval to transfer comes back to the department to say ‘yes’,” he said.
“If there are not enough details in request, they may still ask for those details, but if it’s an emergency request, it’s done quite quickly these days.”
He highlighted the case of Sudanese asylum seeker Faysal Ishak Ahmed who collapsed on Manus Island just before Christmas last year and died in a Brisbane hospital days later after a medical evacuation.
“Emergency uplift is a very short process these days,” he said.
“Within PNG, the director of the offshore processing centre has the overall authority to act immediately and it does not go back to chain of command.”
Mr Douglas prepared a “scoping” report for the Immigration Department as the Rudd government was reactivating offshore processing in 2013.
Previous witnesses have said they lacked antibiotics and the functioning equipment on Manus Island while trying to treat Mr Khazaei for sepsis in 2014.
They said before he was flown out, Mr Khazaei was left lying in the sun on a stretcher at the Manus Island airstrip while waiting for the air ambulance.
When he arrived at the Pacific International Hospital, staff were not expecting his arrival and did not intubate him for almost two hours, and then only because of the intervention of Australian nurses.
A IHMS nurse contracted to provided medical care for the Australian Federal Police in PNG who attended Mr Khazaei said the 24-year-old was visibly “distressed” and “turning blue”, equipment at the hospital did not work and local medical staff did not assist the patient despite alarms on machines monitoring his vital signs.
Shortly afterwards, Mr Khazaei had the first of several heart attacks.
During his 2013 “scoping” visit to the PIH, Mr Douglas said he spent a “couple of hours” observing what equipment was in place, but - as it was not an 'audit' - he did not check it was operating. PIH staff were not observed treating or managing patients.
Mr Douglas said there have now been big improvements both on Manus Island and at PIH.
During a visit to PNG in June 2015, Mr Douglas described the Manus Island detention centre’s new medical unit as comparable to “a level of care similar to remote areas of Australia”.
At the PIH, he was “much impressed by facilities and what they had available, compared what they had before".
"This was a major step up,” he said.
Shortly before Mr Khazaei's death, the then Immigration Minister Scott Morrison said detainees on Manus Island and Nauru were being well looked after.
"When someone becomes ill, they receive outstanding care from the people who work as part of our mainland detention network and in the offshore processing centres that are under the management of the governments of Papua New Guinea and Nauru," he said.
Last April, the PNG Supreme Court ruled the Manus centre was illegal and unconstitutional and that be shut down.
Asked if he had been consulted about a timetable for the closure, Mr Douglas said he “can’t comment” but “indications are that they should be closed by the end of the year”.
The inquest continues until next week.