Senior immigration department official says medical transfer request didn’t identify sepsis as an immediate risk

This article is more than 3 years old

This article is more than 3 years old

A doctor’s urgent request to transfer Hamid Kehazaei off Manus Island, warning he faced a risk of “life-threatening widespread systemic infection”, was not escalated by a senior immigration department official because it “did not paint a picture of urgency”, the inquest into his death has been told.

Amanda Little was the immigration department’s Canberra-based director of detention health operations on 25 August 2014 when a request was sent to her to move Kehazaei immediately to hospital because his condition was dramatically worsening despite 36 hours of antibiotic treatment for a bacterial infection.

Doctors on Manus Island were planning to move Kehazaei on a scheduled commercial flight, accompanied by a medical escort, at 5.30pm that afternoon.

Hamid Kehazaei inquest told immigration bureaucracy left asylum seeker stranded extra day Read more

An email, sent to Little at 1.15pm, requested Kehazaei’s “urgent medical transfer” from the island:

There is a lack of microbiological investigative diagnostics at Lorengau [local hospital]. There is a lack of appropriate antibiotic treatment at Lorengau. 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.

Little had been verbally told Kehazaei’s medical transfer request was imminent, but was in meetings for five hours that afternoon, and did not check her emails to see the request until a subordinate rang her to tell her about it.



She replied at 6.01pm, after the 5.30pm flight had left without Kehazaei on it, and without approval for him to be moved.

I am wondering why this can’t be managed at Lorengau hospital [on Manus]? 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.

Under questioning from Emily Cooper, the counsel assisting the coroner, Little said her response was not a disputation of the doctor’s recommendation.

“My questions are not challenging that statement, but seeking clarification,” Little said.

“Did that statement indicate any urgency at all to dealing with this request?” Cooper asked.

Little: “It paints a picture of the gentleman being unwell, it doesn’t paint a picture of urgency.”



Challenged that the medical request said Kehazaei faced a risk of “life-threatening widespread systemic infection”, Little said the risk was not “immediate”.

“The form ... didn’t state that it was an immediate risk, nor did it say Mr Kehazaei was suffering from sepsis.”

Stephen Keim SC, representing Kehazaei’s family, put it to Little that her “clarification” was not that, rather a rejection of the clinical advice and “denying the request for transfer”.

“I don’t agree with that,” Little said.



“And that by seeking clarification and delaying the transfer, you were ignoring the risk that had been clearly spelled out to you?”

“I don’t agree with that.”

Much of the coronial inquest has focused on the systemic bureaucratic delays in moving asylum seekers from offshore detention to hospital. Kehazaei was not moved off Manus Island for more than 60 hours after he first presented as unwell at the detention centre clinic, and more than 36 hours after his urgent transfer was first requested by doctors.

Little said the approval process for moving asylum seekers from offshore detention to hospital needed to be “escalated” through five immigration department officials “to ensure that the officer commanding Operation Sovereign Borders, and subsequently the minister, were aware of transferee movements”.

Former first assistant secretary of the department John Cahill – who was required to give ultimate authorisation for Kehazaei’s transfer – was asked by counsel assisting whether the initial urgent transfer request sent to Little was sufficient to approve the transfer without needing further clarification.

“Yes, I believe it would be ... in broad terms terms I would say it stands on it own.”

He said the process to transfer asylum seekers from Manus Island to hospital in Port Moresby could have been streamlined, rather than requests passing through four immigration department officials before coming to him. “I believe they could have been made more routinely without coming to my level,” he said.

Little ultimately escalated the request to move Kehazaei to her immediate superior, assistant secretary Paul Windsor, at 7.24pm. But he had gone home for the day and did not check his emails for 13 hours.



Delay to treatment of Hamid Kehazaei before he died revealed in leaked files Read more

Kehazaei’s evacuation was ultimately approved on the morning of 26 August, by which time his condition had deteriorated so dramatically he could not fly on a commercial flight, but needed an air ambulance.

Kehazaei was now unable to walk or sit up, was moaning in pain, and was suffering from a lack of oxygen to his brain.



He was distressed and confused, doctors reported. He had pulled the intravenous lines from his arm, was combative with staff and was refusing to wear an oxygen mask.

He was also left, the inquest has heard, lying on a gurney in the sun at the Manus airfield, without shade.

In defiance of doctors’ recommendations Kehazaei be taken immediately to a Brisbane hospital, he was flown to Port Moresby’s Pacific International hospital.

There he suffered three heart attacks overnight before he was finally moved – now unconscious – to Brisbane’s Mater Hospital on 27 August.



He never regained consciousness. He was declared braindead on 2 September. On 5 September, his family gave permission for his life support machine to be turned off, with instructions his organs be donated.

The inquest continues.