Monday 25th April 2016

The Australian Government contract to provide healthcare to detainees has already cost taxpayers more than a billion dollars, but doctors say the medical care provided offshore in Manus Island is dangerously inadequate.

"I can think of very few times in recent history where doctors have been so united about a particular issue." Former Government Adviser

On Four Corners some of Australia's most senior doctors and medical staff with experience in the offshore detention system are speaking out. They say the Border Force Act could see them risk two years in jail for disclosing information about Australia's asylum seeker detention system.

"There is a lot of anxiety about that piece of legislation and how it applies to doctors." Senior Doctor

Despite this, the doctors have chosen to talk.

"The doctors have been appalled at attempts to silence them." Doctor

Their story centres on the case of a Manus Island detainee, Hamid Khazaei, who died following a bacterial infection in 2014.

"I feel like to prevent further harm there are some details that I can offer to the story of what happened." Doctor

What started as a skin infection poisoned his body, leaving him brain dead.

"I think that if he had this exact infection and the same conditions in all other ways and he was in Australia at the time, he's unlikely to have died." Former Government Adviser

The details of his rapid decline and the treatment he received are shocking.

Doctors involved in his care are speaking publicly for the first time, giving a rare inside account of the medical treatment available in our offshore detention centres:

"I feel like I've actually weighed the ethics of the case quite heavily for the last eighteen months and now I believe that there actually is a clear benefit for people to understand how the system works and the reason why what happened, happened." Doctor

Bad Blood, reported by Geoff Thompson and presented by Sarah Ferguson, goes to air on Monday 25th April at 8.30pm EDT. It is replayed on Tuesday 26th April at 10.00am and Wednesday 27th at 11pm. It can also be seen on ABC News 24 on Saturday at 8.00pm AEST, ABC iview and at abc.net.au/4corners.

Transcript

Bad Blood - 25 April 2016

SARAH FERGUSON, PRESENTER: Hello and welcome to Four Corners. I'm Sarah Ferguson.

Since Australia's offshore detention regime was restarted by Labor in 2012, governments from both sides have gone to extraordinary lengths to prevent scrutiny of how detainees are treated on the remote tropical outposts of Manus Island and Nauru.

The secrecy was tightened last year with a new law, the Australian Border Force Act, threatening prison terms to anyone working in the detention system who discloses information about it.

Tonight a number of senior medical professionals have decided to break their silence to tell the powerful story of a young man detained on Manus Island, whose death from blood poisoning they say should never have occurred.

The case lays bare a system doctors believe is dangerously inadequate to manage the health of more than 1,300 asylum seekers who remain in offshore detention.

Geoff Thompson reports.

(Footage of reconstruction of events occurring on 26 August 2014)

GEOFF THOMPSON, REPORTER (voiceover): Lying on a stretcher at Manus Island's airport, a young man is fighting for his life.

PARAMEDIC 1: Hamid? Can you hear me?

GEOFF THOMPSON (voiceover): He is half a world away from the home he fled and more than 1,000 kilometres from Australia, the country where he sought asylum.

PARAMEDIC 1: Hamid?

PARAMEDIC 2: No response.

GEOFF THOMPSON (voiceover): What started as a small skin infection on his leg is now poisoning his body.

Within 10 hours he will have three heart attacks. Within 20 hours his brain will be as good as dead.

(Footage ends)

BERNARD HUDSON, ASSOC. PROF., INFECTIOUS DISEASE SPECIALIST: I think it was likely "game over" before he was shipped out of Manus. He's got, you know, low oxygen levels and he's had a protracted period of high heart rate, low blood pressure.

I think coming back from that with sepsis, it's... pretty unlikely that he was going to survive.

BRIAN OWLER, PROF., PRESIDENT, AUSTRALIAN MEDICAL ASSOCIATION: He was otherwise healthy with his whole life in front of him. He was trying to seek a better life.

And you can question the motives and whether or not he should've been an asylum seeker in the first place. Those are- those are separate issues.

But as a human being in that sort of circumstance, why do we accept a lower level of healthcare for that person? Why do we accept that, um, his death may have been inevitable? It wasn't.

Could have been saved and he could've been treated properly. Um, but he wasn't.

(Geoff Thompson stands outside the Department of Immigration and Border Protection's headquarters in Canberra)

GEOFF THOMPSON: Looking after the health of Australia's detained asylum seekers is an expensive business, so far costing Australian Taxpayers more than $1.6 billion.

But Australian doctors and health workers say that the case of Hamid Khazaei lays bare the dangerous inadequacy of medical care in offshore detention centres.

DAVID ISAACS, PROF., CONSULTANT PAEDIATRICIAN, UNIVERSITY OF SYDNEY: It was a tragedy. This was a previously healthy, perfectly healthy, soccer playing, soccer loving 24-year-old man who got an infection of his leg and died as a result of it.

By the time he got to Australia, he was brain-dead. And he was brain-dead because of severe, overwhelming sepsis.

Would that have happened if he'd been in remote Australia? Almost certainly not.

(Footage of rally and march in support of asylum seekers, Sydney, 20 March 2016)

CHANT LEADER: Say it loud, say it clear.

PROTESTERS (chanting): Refugees are welcome here.

GEOFF THOMPSON: You don't expect to find Australia's doctors marching alongside protesters. But some feel the passing of the Border Force Act last year has left them with little choice.

(David Isaacs speaks at rally, Belmore Park, Sydney, 20 March 2016)

DAVID ISAACS: The Government has tried to silence us. The Border Force Act of July 2015 threatens us with imprisonment if we tell the truth about what is happening to those our Government imprisons.

GEOFF THOMPSON: David Isaacs was one of the first doctors to test the legislation by speaking out after treating asylum seekers detained on Nauru.

The Act says that anyone disclosing information after working within Australia's asylum seeker detention system risks two years' jail.

DAVID ISAACS: Why haven't I been prosecuted? My feeling is that this legislation is not about actually imprisoning doctors: it's about silencing doctors - and others.

(Footage of march, Sydney, 20 March 2016)

CHANT LEADER: Say it loud, say it clear.

PROTESTERS (chanting): Refugees are welcome here.

GEOFF THOMPSON: Now Australian doctors familiar with Hamid Khazaei's case are also choosing to challenge the Border Force Act, by telling the inside story of his death and how it might have been prevented.

JOSH DAVIS, DR, FORMER GOVERNMENT HEALTH ADVISER: I think that if he had this exact infection and the same conditions in all other ways and he was in Australia at the time, he's unlikely to have died or certainly much less likely to have died.

STEWART CONDON, DR, FORMER ISOS SENIOR COORDINATING DOCTOR: I feel like I've actually weighed the ethics of the case, um, quite heavily for the last 18 months. Um, and now I believe that there actually is a clear benefit for- for people to understand how the system works and the reason why what happened, happened.

PETER YOUNG, DR, FORMER MENTAL HEALTH MEDICAL DIRECTOR, IHMS: In a circumstances where there's an unjust law and there's a, you know, there's a, a good reason to, to break it - which I believe there is in this case - that's what should occur.

BRIAN OWLER: What we've seen is, progressively, doctors' opinions being shut out. And then we had the- the Border Force Act, which, ah, many doctors, uh, working with the system saw as being a method of intimidation.

Now, I know that the Department of, ah, Immigration and Border Security have, have responded to that and I know the Minister has responded, saying that they won't prosecute anyone. But still there is a lot of anxiety about that piece of legislation and how it applies to doctors.

GEOFF THOMPSON: The global medical conglomerate behind the healthcare of Australia's detained asylum seekers is International SOS, or ISOS.

ARNAUD VAISSIE, CO-FOUNDER, CHAIRMAN AND CEO, INTERNATIONAL SOS (ISOS promotional video): I think the really unique point of this organisation is the way that we work together as a network. We are really transforming the life and the outlook of the people that we are dealing with. And every day is special.

GEOFF THOMPSON: ISOS owns International Health and Medical Services - IHMS - which operates the medical clinic within the Manus Island Regional Processing Centre.

PETER YOUNG: It's a wholly owned subsidiary of, ah, International SOS. Um, it's a private company, um, ah, and it- it came about, you know, specifically to, to manage the, er, Immigration Detention Healthcare contract.

GEOFF THOMPSON: Dr Peter Young held a senior position within IHMS for three years, before resigning in 2014.

PETER YOUNG: That was after a period of time in which, ah, there'd been a, a lot of changes that had occurred, um, which have, I think, had sort of fundamentally undermined the- the medical independence of the service delivery.

There's certainly a conflict of interest, um, and that's- ah, that's one of the, th-the fundamental difficulties in this type of situation: um, where medical staff and particularly doctors there, ah, have a duty of care to the patients that they have to look after, ah, but they also have a duty to, ah, the Department of Immigration who, ah, are contracted to, um, to meet the needs and the policy, ah, aims of the Department.

DAVID ISAACS: Part of their interest is in making a profit. Um, and that's always going to, um, affect their interest in helping people. So personally, I believe that the profit motive in healthcare is potentially disadvantageous.

Having said that, I have no reason not to believe that IHMS is interested in the health of the people they're looking after. I do believe that they are. I think that... nevertheless, they're hamstrung to an extent, because some of the damage is being done by prolonged detention - and IHMS has no control over that.

STEPHEN BROOKER, FORMER MENTAL HEALTH SERVICES DIRECTOR, IHMS: IHMS doesn't necessarily need to have a conflict of interest if they put the clinical service first. If they put the clinical service first and the operational model second to support the clinical service and they market the service that they've developed: that's a good- that's a win for all.

But the trouble is: they put the marketing first, the operations second and the clinical third. So if you're third as clinicians, then you're not gonna do very well within the organisation.

GEOFF THOMPSON: In 2014 the Manus Island medical clinic was basic, at best.

Psychiatric nurse Stephen Brooker is a former IHMS mental health services director and has worked at the clinic during eight visits to Manus Island.

STEPHEN BROOKER: It wasn't an emergency setting. It was, er, a basic triage area, er, where you could hold and monitor people - but for, not- not for prolonged periods of time. It was really inadequate for that.

It was very, very basic. It was just dongas: adapted dongas with some beds and, er, chairs, tables, computers, desks. Pretty hot environment.

BRIAN OWLER: I mean, you transplant people from half a world away and you put them on a tropical island under those sorts of conditions: they're going to get sick. Uh, you've got to expect that.

And it's not the normal illnesses that people develop in society: they're going to get tropical illnesses.

GEOFF THOMPSON: Hamid Khazaei was sent to Manus Island after arriving at Christmas Island on a boat from Indonesia.

By August 2014 the 24-year-old had been on Manus for almost a year.

(Footage of Goldaneh Khazaei speaking in Farsi)

GOLDANEH KHAZAEI (Hamid's mother; voiceover): My son was full of emotion: full of emotion.

GEOFF THOMPSON: Hamid's mother lives in Tehran. We spoke to her via Skype.

GOLDANEH KHAZAEI (voiceover): I loved him and I still love him. I still feel him: feel he is at home. I talk with him. I talk with his picture. He was like this since he was a kid: he was very kind and polite.

BENHAM SATAH, MANUS ISLAND DETAINEE (voice recording): His family had many dreams for Hamid. They wanted him to be... to become what he wanted to be and he- they wanted him to be safe: to be in a place that he feels safe and that he can live.

GEOFF THOMPSON: Benham Satah first met Hamid Khazaei in Indonesia, before they both ended up on Manus Island.

He spoke to us from there on the phone.

(To Benham Satah) What did Hamid want to do with his life?

BENHAM SATAH (voice recording): Actually, we were talking a lot about this, even in Indonesia and in Manus. He always said, "I couldn't become a good person in my country because I, I didn't feel safe to talk about nothing."

He was telling me he wanted to be a person that Australia will be always proud of. But Australia didn't give him the chance to prove that.

GEOFF THOMPSON: Just five days before he was evacuated from Manus Island, Hamid Khazaei was still fit enough to play football with his friends.

BENHAM SATAH (voice recording): He was one of the strongest and healthiest and one of the good athletes on Manus.

GEOFF THOMPSON: He was feeling well enough to play soccer in the days before he went to IHMS, when he got very sick?

BENHAM SATAH (voice recording): During those days he could still do- play soccer and go to gym and do all those things.

(Footage of reconstruction of events occurring on 23 August 2014)

GEOFF THOMPSON: But suddenly Hamid fell ill. Late on Saturday the 23rd of August, he saw a doctor at the IHMS clinic.

Without the help of an interpreter, he complained of fever, chills and body aches.

Hamid Khazaei was diagnosed with a throat infection and kept overnight on intravenous antibiotics.

BERNARD HUDSON: So if he came in and he, he particularly did have symptoms with- generalised infection with fever and feeling unwell, then you ask yourself: "Well, what's the source of the infection?" And if his most prominent symptom was a sore throat, then obviously that could be the likely cause and you would examine the patient.

GEOFF THOMPSON: During the night Hamid's condition worsened. The next morning, he was examined by a doctor in the company of a Farsi interpreter.

(Footage of reconstruction of events occurring on 24 August 2014)

INTERPRETER (reconstruction): He's been feeling sick all the night.

GEOFF THOMPSON: An abscess was found on the top of the lower part of his left leg.

Hamid tells the interpreter there is a similar skin infection in his groin, but refuses to let the female doctor examine it.

INTERPRETER (reconstruction): But he says you can't see it.

(Footage ends)

BRIAN OWLER: The circumstances in which the care is being provided, uh, obviously provides some limitations in ability to diagnose. And there may be some cultural issues, ah, involved in that as well.

But clearly, the presence of abscesses, um, ah, on someone's body and the presence of a fever and, um, ah, symptoms of- other symptoms of systemic infection should raise concern about, um, whether there is, ah, a more significant infection and illness that's developing.

GEOFF THOMPSON: Bernie Hudson is one of Australia's leading infectious diseases specialists and has worked in Papua New Guinea.

BERNARD HUDSON: He's actually got worse despite, um, them keeping him overnight and maybe giving him some antibiotics.

Now we find that he's got, um, some skin lesions and that's when we should be starting to think about: well, is that really the source? That might not look so bad, but the bacteria from the skin lesion may have got into his bloodstream and that might be making him so sick.

GEOFF THOMPSON: Throughout that Sunday, Hamid's condition got worse.

Unable to walk, he was taken to the toilet in a wheelchair. He vomited twice.

JOSH DAVIS: He started on whatever the antibiotic treatment was. If he's getting sicker in any way, that should raise alarm bells. And that doesn't just mean the leg's looking worse: it means if he's vomiting or if he's feeling like he can't walk, ah, or getting worse fever. All of those things should mean that he should be re-evaluated and, um, the diagnosis should be rethought. The treatment should be rethought.

GEOFF THOMPSON: After a change in antibiotics, Hamid's condition briefly improved. But by dawn the next day, Hamid Khazaei is going downhill fast.

One of his abscesses spontaneously bursts.

At 9.30 that Monday morning, the senior IHMS doctor at the Manus clinic requests that his patient be transferred to Port Moresby on the next commercial flight.

An hour-and-a-half later, the IHMS office in Sydney authorises Hamid Khazaei's transfer to Port Moresby.

It states: "This client has exhausted all antibiotic treatment that is available on Manus Island," concluding that he is at "risk of infection spreading, leading to sepsis - life-threatening widespread systemic infection."

Sepsis is a bacterial poisoning of the blood. Left unchecked, it attacks the organs, lungs and brain, eventually overwhelming the human body.

BRIAN OWLER: Sepsis can lead to, ah, infections elsewhere in the body, ah, but more significantly can lead to death. And even in, um, mainland Australia, if someone develops significant sepsis, ah, then the mortality associated with sepsis is very high. It can be up to 20 per cent. So that to me is a sign. If someone develops sepsis, it requires prompt and thorough treatment and appropriate antibiotic usage.

GEOFF THOMPSON: At 1.15pm on Monday, the urgent transfer request was forwarded to a bureaucrat in the Department of Immigration and Border Protection.

There was a commercial flight leaving Manus for Port Moresby at 5.30pm that Monday night, with an IHMS doctor booked on it and ready to escort Hamid there.

Almost five hours would pass before the evacuation request was responded to.

The 5.30 flight left that afternoon without Hamid Khazaei. And doctors were told that "visa hassles" prevented him leaving.

The next flight out of Manus Island was not until the next day.

BRIAN OWLER: A patient with sepsis can deteriorate very quickly. And that's exactly what happened. Um, you know, I think that was the decision that really sealed, ah, his fate.

Um, if he had been transferred to Port Moresby: um, ah, to a hospital where he could've received more thorough, ah, treatment and support, he may still be alive today. I- I really question what the reason was: why h- the transfer was delayed. I mean, if there was a flight leaving that afternoon at 5.30 with a doctor that was going to be on that flight, why not take advantage of that?

GEOFF THOMPSON: Half an hour later, at 6pm on Monday, the Canberra bureaucrat responds to IHMS, asking why Hamid Khazaei can't be treated at a local hospital on Manus Island.

She writes: "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 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."

PETER YOUNG: It was a routine response. That's the sort of- that's the response you got pretty much every time.

GEOFF THOMPSON: "Deal with it locally"?

PETER YOUNG: "Deal with it locally".

STEPHEN BROOKER: I think there was a, a policy of keeping people on island for medical treatment. So they didn't want to medivac people off island unless... and there was absolutely no other way.

BERNARD HUDSON: Someone presenting with those symptoms to a hospital in Australia - an emergency department - people wouldn't be asking questions like that. We know that, if you don't act quickly, person's got a high chance of dying.

DAVID ISAACS: So if I've made a medical decision that a patient needs urgent care, I don't think any bureaucrat should be querying that decision. To me, that's a medical decision. And if that gets queried and there's a delay, then that risks a patient's life.

BRIAN OWLER: I mean, who is the bureaucrat in Canberra that's questioning that advice? Um, what training do they have? What authority do they have that allows them to override, um, a medical advice or recommendation? Ah, it's just a- a ridiculous set-up.

GEOFF THOMPSON: According to Peter Young, the Department was well aware that Lorengau Hospital on Manus Island could not help Hamid Khazaei.

PETER YOUNG: When the, ah, the centre was set up and there- there were... there were scoping reports done and, um, ah, provided to the Department which- which outlined all of these things, um, ah, so that was well known and understood and communicated: that, um, you know, that these were the sorts of facilities that could be available through the local hospital, which were very limited. And if more was required than that, then tha- it just wouldn't be available, er, without someone going to Moresby.

GEOFF THOMPSON: So the Department should've already known the limitations of the Lorengau Hospital?

PETER YOUNG: Oh, of course they already knew that. They, they, they'd, ah... The people from the department has visited the hospital on previous occasions. They were well aware of that.

GEOFF THOMPSON: As night falls on Canberra, the bureaucrat at the Department of Immigration forwards the request to evacuate Hamid Khazaei further up the chain to a more senior department official.

But he had left the office for the day and would not see the email for another 13 hours.

BRIAN OWLER: Well, to be honest with you, it strikes me as fairly pathetic. I mean, hospitals and medical services run 24-7. People get sick in the middle of the night: that's why doctors are on call; that's why we have staff in our hospitals 24-7. I mean, if bureaucrats want to take responsibility for people's medical care, the least they could do is be available 24-7.

GEOFF THOMPSON: It would be another night of agony for Hamid Khazaei.

BERNARD HUDSON: He's in pain and he's got abscesses, so he would be in continuing pain and he would generally be feeling absolutely terrible: like he was going to die.

GEOFF THOMPSON: The evacuation is finally approved at 8.41 am on Tuesday morning. No longer well enough to travel on a commercial flight, Hamid's Khazaei's transfer off Manus is upgraded to a medivac.

It's almost 24 hours since the request was first made.

BERNARD HUDSON: Well, y-you... you basically missed the boat.

We know sepsis. We have an aphorism: "Sepsis kills." He's got sepsis and if you don't get him onto appropriate antibiotic therapy within six to eight hours, h- he's likely to s- to succumb.

And so 24 hours is too long a period of time. You've, you've got to get them out of there sooner than that.

He needs support for his cardiovascular respiratory system, ah, and he needs to get that in a place, ah, with good intensive care facilities. And a day is just way too long to leave him there with those abnormal signs.

GEOFF THOMPSON: As the evacuation to Port Moresby was being approved by Canberra that Tuesday morning, Dr Stewart Condon was arriving to work at International SOS.

When IHMS needs a medical evacuation, it's ISOS which organises it.

In 2014 Stewart Condon was one of ISOS's senior coordinating doctors.

STEWART CONDON: Although we had a recommendation to move him off with one of the site doctors on one of the charter commercial flights from Manus Island down to Port Moresby, um, with the site doctor escorting him effectively down to Port Moresby, that hadn't happened.

And then I've come on on that Tuesday morning and quite quickly understood that that option is no longer possible. It wasn't taken, firstly; and secondly, it probably wasn't medically appropriate to follow that option anymore. Um, this man was quite sick. He- he was having a quite low blood pressure, showing signs of, ah, severe infection. And he needed an air ambulance movement.

GEOFF THOMPSON: Why are you deciding to speak publicly about this?

STEWART CONDON: Mm. In the last almost two years since I've seen some of the case, ah, come to light in the public domain, um, there are some details that are missing. And I feel like, to prevent further harm, um, there are some details that I can offer to the story of what happened to Hamid that could benefit more people.

Um, there's a system involved between International SOS and IHMS and the Department of Immigration that unfortunately causes harm. And it did that day, um, or over they- over those days.

GEOFF THOMPSON: Dr Stewart Condon left ISOS last year. He is currently the president of Médecins Sans Frontières Australia (MSF).

He spoke to Four Corners as an independent doctor.

(To Stewart Condon) Did this case have a bearing on your decision to leave?

STEWART CONDON (sighs slowly): In part, I would say yes. Um, I- I saw a company that in some places was doing the best they could; and in other ways that they were just, ah... how to put it nicely? I think they were more interested in the business imperative.

GEOFF THOMPSON: On the morning of that Tuesday, the 26th of August, Stewart Condon reviews the recommendation to send Hamid Khazaei to Port Moresby. He updates it, recommending instead that Hamid be medivaced directly to Australia as the nearest centre of medical excellence.

Condon writes:

"This would involve admission to hospital in Brisbane, with further medical care as warranted."

(To Stewart Condon) So let me understand that correctly. Are you saying there was a recommendation on the Tuesday that he go to Australia?

STEWART CONDON: Correct.

So we, we'd made that recommendation 9.30 in the morning. That's certainly something that I strongly felt about some of these cases: that our recommendation to move to Port Moresby was inadequate, knowing the level of medical care available in Port Moresby, um, and knowing that many of the similar cases we worked around the world would move to a place like Brisbane.

GEOFF THOMPSON: Stewart Condon's key recommendation that Tuesday morning to send Hamid Khazaei to Brisbane is ignored.

STEWART CONDON: We chased through IHMS - um, our colleagues, essentially, in the same building - um, to see what was happening; if they'd received any approval.

And then the first thing we heard regarding an approval was that there was an approval, but it was a- approved for him to move to Port Moresby. Um, this was a little disturbing because, in fact, it was reacting to the day before's recommendation, um, which at that stage may have been appropriate, but on the Tuesday - on the day that I'd started working that case - was inappropriate. He was too sick to be managed in Port Moresby.

GEOFF THOMPSON: On Manus Island Hamid Khazaei's condition is deteriorating further. As oxygen levels fall, he becomes increasingly agitated. He yanks out his IV lines and has to be held down by three security guards.

JOSH DAVIS: When people get agitated and confused, it's generally a bad sign meaning the sepsis is progressing and often can be caused by low levels of oxygen to the brain if the lungs are, are starting to fail.

BERNARD HUDSON: They're extremely agitated and it's... basically means that the infection has taken control of their body and they're not getting appropriate blood flow or oxygen to their brain. So that's quite a common thing to see in people that are, ah, very unwell with infection.

GEOFF THOMPSON: When Hamid Khazaei is taken to the airport on Manus, he is not given oxygen during the journey.

BERNARD HUDSON: To move him, ah, especially to a flight without oxygen would be quite a dangerous thing.

BRIAN OWLER: I mean, to be transferring a patient in that sort of circumstance: it just wouldn't happen here. And if it did happen, ah, there would be consequences for the people involved in that transfer. So I think we've really got to question the quality of the healthcare that was being provided, ah, during the transfer.

GEOFF THOMPSON: The air ambulance jet arrives at Manus Island at 1.50 pm. A delirious Hamid Khazaei is left waiting by the airstrip, sometimes without shelter.

STEPHEN BROOKER: And when he got to the airport he was left out in the sun, either because the flight was delayed or they got there too early. But he certainly wasn't - again, from my understanding - protected against the sun. And it's fierce tropical sun, um, at a point at which you've got an extremely vulnerable patient waiting for a flight to arrive, who's already deteriorated.

GEOFF THOMPSON: Hamid is eventually boarded on a stretcher and the jet takes off for Port Moresby.

When Hamid Khazaei arrives in Papua New Guinea's capital, he's taken to Pacific International Hospital just before 5pm.

STEPHEN BROOKER: I was, ah, in the head office at the time and was party to some of the conversations around it.

It's my understanding that, when he arrived at Pacific International Hospital, that he was put in the corner for an hour. They weren't expecting him the day he arrived; they were expecting him the day before. So when he did arrive, they just weren't prepared. So they put him in the corner. He had to wait an hour before he was actually- something was sorted out.

GEOFF THOMPSON: Hamid Khazaei is now critically ill with severe septicaemia. His blood oxygen levels are dangerously low.

BERNARD HUDSON: If you've got a oxygen saturation of 63 per cent, you're profoundly lacking in oxygen: profoundly lacking in oxygen.

So if he'd been on the flight and he'd been in the ambulance and he had oxygen saturations at that level, then his brain wouldn't have been getting enough oxygen during that whole period of time.

BRIAN OWLER: If that's allowed to persist, then obviously damage occurs to the brain that is irretrievable. And it appears that's what was happening in his particular circumstances.

It is almost expected that that patient will arrest and die. Ah, and so I think that's the, ah, perilous state or state of extremis, um, that Hamid was in at that particular time.

GEOFF THOMPSON: Hamid has three heart attacks while in Port Moresby on Tuesday night.

STEWART CONDON: Maybe even by that time he's already brain dead, although he hadn't been declared that way.

GEOFF THOMPSON: Finally, on Wednesday the 27th of August, the Immigration Department agrees to evacuate Hamid Khazaei to Australia. Four hours later, he reaches the country he sought asylum in a year before.

But when he arrives at the emergency department of Brisbane's Mater Hospital at 10pm, he is barely alive.

He never regains consciousness.

BRIAN OWLER: Unfortunately, I think it was too late by that time. I think it's fairly clear by the time that he reached Brisbane, um, ah, he was essentially brain dead. And while he was, ah, supported for a number of days on life support, um, it was very clear that nothing further could be done for him by that time.

GEOFF THOMPSON: The Australian Government makes contact with Hamid's family in Iran. From Tehran via Skype, Hamid's brother, Mehdi, recalls the conversation.

(Mehdi Khazaei speaks in Farsi)

MEHDI KHAZAEI, HAMID'S BROTHER (voiceover): When they called us, they told us that he was alive with the help of life support at that time. They said, "We are unable to do anything for him. At the moment there is no hope. The infection has spread all over his body. The virus has spread all over his body. We can't do anything now."

GEOFF THOMPSON: Scans confirm that Hamid Khazaei is now brain-dead.

MEHDI KHAZAEI (voiceover): At the beginning, my Mum said: "Do whatever you can for him." Later, when we were contacted from there, the doctor called us and said: "There is no hope. He will not survive at all." They said he had cardiac arrest and he was brain-dead. Then my mother said, "OK. Donate his body organs."

(Goldaneh Khazaei speaks in Farsi)

GOLDANEH KHAZAEI (voiceover): I hope it doesn't happen to any mother. It was like the world collapsed on our heads. It was like I was not in this world. It was like I was really not in this world. It was like I slept for a moment, in a dream. For a moment I saw Hamid was there; and then, in another moment, I saw Hamid was not there.

GEOFF THOMPSON: The bacteria which took over Hamid's body is identified as a relatively rare, water-borne bug, chromobacterium violaceum.

JOSH DAVIS: I think it's a mistake in Hamid's case to focus in on the fact that he had this unusual bacteria. If he had a... a golden staph infection and was getting worse and worse, it would be exactly the same as if he had chromobacterium violation. He would have had the same symptoms. Ah, he would have required the same treatment.

And it's certainly possible that he could have had the same problem due to a different bacteria. Th- the outcome would have been similar in terms of the delay in transfer.

GEOFF THOMPSON: Dr Josh Davis was a member of a committee asked to help review Hamid Khazaei's case for the Immigration Department's chief medical officer.

He quit that role, in part, because of how it was handled.

(To Josh Davis) How much bearing did the Hamid Khazaei case have your decision?

JOSH DAVIS: Ah, a lot of bearing. I mean, it was probably... certainly what made me start thinking about it. Ah, it was... I'd only recently joined the committee when I had to review that case. And that report was handed in and just nothing continued to happen. And in fact, the department didn't even reply to emails asking: "What is happening about this?"

SCOTT MORRISON, IMMIGRATION MINISTER 2013-2014 (5 Sep. 2014): I can confirm that an... at an adult male transferee from the Manus offshore processing centre was transferred for urgent medical care to Port Moresby and subsequently transferred to the Australian mainland and, as you know, would, would- is here in Brisbane.

GEOFF THOMPSON: On the morning of September the 5th, Hamid Khazaei is still technically alive.

Then-immigration minister Scott Morrison fronts the media.

SCOTT MORRISON (5 Sep. 2014): Um, when someone becomes ill they receive outstanding care from the people, um, who work as part of our, ah, mainland detention network and in the offshore processing centres that are under the management of the governments of Papua New Guinea and Nauru.

Ah, IHMS who work as part of that team there do an out- outstanding job.

Our focus and care, eh, has been on this young man, ah, from the moment he presented to medical officers at Manus Island and on focusing on the interests and engaging with the family. That's where our attention has been. And, ah, that young man, um, is- is still with us, but his condition, as you know, is extremely, extremely parlous.

GEOFF THOMPSON: That night, with his family's permission, Hamid Khazaei's life support is turned off.

Hamid was pronounced dead, 13 days after he was first treated at the Manus clinic.

Scott Morrison ordered an internal review of Hamid Khazaei's treatment by the Immigration Department's chief medical officer.

Four Corners has seen a copy of that unreleased preliminary report. It raises issues, such as the failures to quickly identify the source of infection, take samples of it and to follow Australian therapeutic guidelines for antibiotic choice.

It criticises the delay in identifying and managing septic shock; and the failure to give the patient oxygen before his transfer to Port Moresby.

Communications about the need for an urgent medical transfer are labelled as "ambiguous and deficient".

But the review stops short of conceding that the Immigration Department's own bureaucratic processes may have also contributed to the death of Hamid Khazaei.

STEPHEN BROOKER: I think it, ah, my only surprise was it didn't happen sooner. In Hamid's situation it was a cut on the leg and of course that is, um, a preventable death. It could have been dealt with quite simply, quite easily. Shouldn't have happened: full stop.

STEWART CONDON: People need to understand: eh, this could happen again. And- and in my experience, I- I don't see the system having changed that much that it can't prevent this happening again.

GEOFF THOMPSON: We already know it was bad blood that killed Hamid Khazaei. These Australian doctors feel that their relationship with their Government is being poisoned too.

DAVID ISAACS: The doctors have been appalled at attempts to silence them - not just them, but, ah, to, ah, silence anyone. But they've taken that very personally.

If you see something that you think is truly immoral and that is hurting the health of patients under your care and you're not allowed to talk about it, it's just wrong. Um, openness is part of the medical practice. We want to be open about what we see.

JOSH DAVIS: I can think of very few times in recent history where doctors have been so united about a particular issue, a political issue, as- as now. Um, and I guess that kind of highlights how important doctors see this: the health of asylum seekers and the care of asylum seekers, um, and the way that the Government's treating them as, ah, such an important issue.

BRIAN OWLER: We've got to get back, ah, in this arrangement to putting the medical profession back in charge of the medical treatment. And until that happens, any sort of assertion that people, ah, who are asylum seekers, particularly in offshore processing facilities, are receiving the same level of treatment, ah, as an Australian citizen - or level of healthcare as an Australian citizen - uh, is plainly wrong.

GEOFF THOMPSON (to Brian Owler): There's always the argument, which a lot of Australians will make, is that this young man tried to come to Australia without a visa, without invitation. Why does he deserve Australian-level healthcare?

BRIAN OWLER: Well, because he's under our care. He- he's in detention and the Australian Government has a responsibility, um, if they're going to put people on Manus Island in detention, to provide an adequate level of healthcare.

Um, it's just... it's not, um, moral or ethical to lock people up in detention, ah, on a tropical island and then not provide them with adequate healthcare.

SARAH FERGUSON: Immigration Minister Peter Dutton and the medical contractors declined to be interviewed for tonight's program because Hamid Khazaei's death will be the subject of a coronial inquest.

You can find a statement from the Immigration Department on our website.

Next week: the fast-fading Australian dream. With so many Australians locked out of the housing market, home ownership and negative gearing are shaping up as big issues in the election campaign.

See you then.

END

Background Information

STATEMENTS

RESPONSE FROM DIBP - Read the response to Four Corners from a Government spokesperson at the Department of Immigration and Border Patrol. [pdf]

Health Care of Asylum Seekers and Refugees - Revised Dec 2015 | AMA | The Australian Medical Association affirms that those who are seeking, or who have been granted, asylum within Australia have the right to receive appropriate medical care without discrimination. >>Read more.

NEWS AND MEDIA COVERAGE

Manus Island: 'Pathetic' bureaucratic response blamed for asylum seeker Hamid Khazaei's death, by Four Corners | ABC News | 25 Apr 2016 - https://www.abc.net.au/news/2016-04-25/manus-island-blunder-blamed-for-asylum-seeker-death/7355858

COMMENT Nauru and Manus Island are Australia's Guantanamo Bay, by Professor David Isaacs | SMH | 29 Feb 2016 - http://www.smh.com.au/comment/nauru-and-manus-island-are-australias-guantanamo-gay-20160228-gn5qtg

AMA President Brian Owler lashes Department of Immigration over health services to asylum seekers | SMH | 21 Feb 2016 - http://www.smh.com.au/federal-politics/political-news/ama-president-brian-owler-lashes-department-of-immigration-over-health-services-to-asylum-seekers-20160221-gmzj34.html

Hamid Khazaei: Iranian asylum seeker going into brain death before Australian arrival, coroner told | ABC News | 25 Aug 2015 - https://www.abc.net.au/news/2015-08-25/iranian-asylum-seeker-hamid-khazaei-pre-inquest-conference/6723300

Doctors, health professionals call on Federal Government to repeal laws that prevent them speaking out about detention centres | ABC News | 11 Jul 2015 - https://www.abc.net.au/news/2015-07-11/doctors-protest-detention-centre-laws-at-sydney-town-hall/6612532

World medical leaders join condemnation of detention centre gag laws | AMA | 3 Jul 2015 - https://ama.com.au/ausmed/world-medical-leaders-join-condemnation-detention-centre-gag-laws

Border Force Act could see immigration detention centre workers jailed for whistleblowing | The World Today | 1 Jul 2015 - https://www.abc.net.au/news/2015-06-30/detention-centre-workers-face-imprisonment-for-whistleblowing/6584392

Open letter on the Border Force Act: 'We challenge the department to prosecute' | The Guardian | 30 Jun 2015 - http://www.theguardian.com/australia-news/2015/jul/01/open-letter-on-the-border-force-act-we-challenge-the-department-to-prosecute

Detention centre laws: Doctors warn Border Force Act clashes with Medical Board of Australia Code of Conduct | ABC PM | 19 Jun 2015 - https://www.abc.net.au/news/2015-06-19/doctors-warn-detention-centres-conflict-medical-code-of-conduct/6559940

VIDEO Hamid Khazaei: Rare bacterial infection killed Iranian asylum seeker detained on Manus Island | ABC Lateline | 4 Oct 2014 - https://www.abc.net.au/news/2014-10-04/iranian-asylum-seeker-died-of-rare-infection/5790364

Iranian asylum seeker Hamid Kehazaei brain dead in Brisbane hospital: Refugee Action Coalition | ABC News | 5 Sep 2014 - https://www.abc.net.au/news/2014-09-03/asylum-seeker-hamid-kehazaei-brain-dead-in-brisbane-hospital/5716292

Scott Morrison rejects negligence claim over brain dead asylum seeker Hamid Kehazaei | ABC News | 5 Sep 2014 - https://www.abc.net.au/news/2014-09-05/scott-morrison-reject-negligence--hamid-kehazaei-manus-island/5721848

Immigration detention psychiatrist Dr Peter Young says treatment of asylum seekers akin to torture | ABC News | 6 Aug 2014 - https://www.abc.net.au/news/2014-08-05/psychiatrist-says-treatment-of-asylum-seekers-akin-to-torture/5650992

WATCH RELATED 4 CORNERS PROGRAMS

The Manus Solution | 28 April 2014 - Geoff Thompson's account of the violent confrontations at Manus Island processing centre, that left one man dead and dozens injured. >>Watch Online

No Advantage: Inside Australia's Offshore Processing Centres | 29 April 2013 - inside Australia's offshore refugee processing centres on Nauru and Manus Island, by Deb Whitmont. >>Watch Online

SUPPORT AND ADVOCACY

Australian Human Rights Commission - http://www.humanrights.gov.au/

Asylum Seeker Resource Centre - http://www.asrc.org.au/

Lifeline Australia 13 11 14 - https://www.lifeline.org.au/

Refugee Action Coalition - http://www.refugeeaction.org.au/

The Refugee Council of Australia - http://www.refugeecouncil.org.au/

UNHCR - http://www.unrefugees.org.au/