Kristina Keneally (NSW, Australian Labor Party, Deputy Leader of the Opposition in the Senate) Share this | Hansard source

I rise to speak on the Migration Amendment (Repairing Medical Transfers) Bill 2019. I say from the outset that the name of this bill is a fallacy. There is nothing to repair when it comes to the medical transfers of sick people from regional processing countries to Australia. The name of this bill, like so many pieces of legislation from this visionless government in the post-truth era, is untruthful, misleading and misdirected. I will speak to those matters shortly.

Last week I received an email from an Australian doctor. His name is Dr Chris Jones. He is a doctor who worked on Nauru in August last year, only 16 months ago. Let's remember Dr Jones was working on Nauru only six months before the law, now known as 'medevac', came into existence. Having worked an earlier stint on Nauru, Dr Jones kept a diary during his second stint—a diary I have now read. It shines a light on the conditions he was working in and the pressures he faced, including from officials of the Australian Border Force and the Department of Home Affairs, as well as on the lengths that Dr Jones had to go to in securing medical transfers for patients.

On 18 August last year, after less than two weeks on Nauru, he wrote about his experience: 'It is like being witness to people dying on a palliative care ward—slowly fading away, physically and emotionally. The only difference here is they do not have the dignity of palliative care.' The diary records a teleconference update Dr Jones had with an orthopaedic surgeon who had operated on a child to remove metalwork from their left forearm. He wrote: 'The operation went really well, but the surgeon could only remove one of the two plates due to a 12-month delay in the procedure. The remaining plate had become embedded in bone and attempting to remove it would do more damage. The call didn't go well, with the family distraught, venting their anger and frustration against the surgeon.'

This diary sheds light on how doctors, contracted by Australia and being paid with Australian taxpayer dollars, were being disregarded by departmental bureaucrats. Let's reflect on that for a moment. Doctors—the people we all trust when we're sick, where we're unwell, when we're struggling mentally—were being ignored by people with no medical qualifications. How did we get here? How did we in Australia end up in this position?

In June 2015, the secretary of the then Department of Immigration and Border Protection issued a directive to the staff of the then Australian Customs and Border Protection Service. It said:

Unless there are compelling medical reasons, supported by second opinions, to do with life and death situations, or situations involving the risk of life time injury or disability, transfers to Australia should be avoided as a general rule and should in any event become increasingly rare.

I repeat: a general rule that providing medical treatment to people should become increasingly rare in any event. That was over four years ago. It was before the Australian Border Force came into existence on 1 July 2015. It was before Minister Dutton was handed his custom-made Department of Home Affairs. It was before prime ministers Morrison and Turnbull; Tony Abbott at this time was still Prime Minister. And it was only the beginning of the medical transfer process for sick people and asylum seekers and refugees in Australia's care on Nauru and PNG being frustrated by the current government.

Minutes from internal meetings at the then Department of Immigration and Border Protection in 2016 revealed this directive effectively stopped medical transfers to Australia. The documents released under freedom-of-information laws described the impact of this measure as 'significant'. There was a 92 per cent drop in medical transfers. Transfers dropped from close to 550 in 2014-15 to approximately 50 in 2015-16. That's a drop of 550 to just 50 in one year. In those same minutes from the Department of Immigration and Border Protection, they admitted that they and the government had in fact created a problem. Quote:

Despite the work done to reduce the instance of transfer to Australia for medical care, the cases we continue to see are unique and complex (physical health, mental health and child protection all combined) and there exists a high likelihood that they will become the subject of legal proceedings.

The alarm bells were sounding back in 2016, and what did the Minister for Home Affairs do? Nothing. Just like with many of his ministerial responsibilities, Mr Dutton did nothing.

In fact, the secretary of the department doubled down in April 2016 and issued another directive. It stated:

… the aim should be to avoid to the maximum extent possible such transference to Australia ... This instruction is to be overridden only if and when there is a reasonable apprehension that inaction would result in an immediate threat to life, or the occasioning of permanent debilitating injury.

On Manus Island, broader PNG and Nauru, requests for medical transfer by hardworking, honest and committed doctors started being ignored. People without medical knowledge were deciding if sick people received any treatment or not. Over time the problem grew, and medical transfers were denied time and time again. People's physical injuries were left to worsen, often to the stage where people were facing lifelong disabilities. Children were denied transfers because they didn't want to be separated from their parents, quite understandably. Women were denied the opportunity to have their reproductive health seen to. Mental health across the greater cohort of Manus, and later border PNG and Nauru, diminished terribly. It is because of all these circumstances that Labor and the crossbench moved to put provisions in place—medevac—to fix the issues this third-term Liberal-National government created all on its own.

For those who aren't familiar with medevac, I want to explain how the process works, particularly because the government has been loose with the truth about these important provisions. Under medevac, two treating doctors can recommend a transfer to the Secretary of the Department of Home Affairs. The request is then considered by the Minister for Home Affairs. The minister can deny on national security grounds as defined within the ASIO Act or if they have concerns on serious character grounds as defined in the Migration Act. The decision does not get reviewed and cannot be overturned. If the minister denies on national security or character grounds, that request for transfer is rejected.

The minister can also deny a transfer on health grounds if they think the treatment can be provided in PNG or Nauru, including via telemedicine or by flying a specialist to the patient. If the minister denies it on health grounds, it goes to the Independent Health Advice Panel, or IHAP, for review. The IHAP includes the Commonwealth Chief Medical Officer, the Home Affairs chief medical officer, doctors from Australia's peak medical bodies, including the Australian Medical Association and the royal colleges. All of these doctors are appointed by the minister. The panel is able to review cases on medical grounds only. If they believe a medical transfer is necessary, they can require the transfer to happen. At the end of the day, the government or government appointed doctors control who comes to Australia under medevac, and that is why Labor supports medevac. Medevac allows sick people to get the medical care they need and ensures that the minister or doctors appointed by the minister control these transfers.

On 4 July 2019, the bill now before the Senate was referred to the Legal and Constitutional Affairs Legislation Committee for inquiry, which reported on 18 October 2019. Like all legislation referred to committees, the government agreed to this bill being sent to an inquiry, along with the timing of the inquiry. The Minister for Home Affairs has described this important inquiry process as 'a tactic' and a way of 'delaying the bill'. He ignores the fact that the government agreed to the reporting time line for the bill and could have changed it, if they wanted to. I want to thank my fellow senators for their involvement in the committee's inquiry, as well as Senator Lambie's commitment that she wanted that important process to be followed before the legislation was debated in the Senate.

The Senate inquiry highlighted the evidence that medevac should not be repealed. Don't take my word for it. By the government's own admission—in the report that the government senators agreed to—it states:

The majority of the evidence to the inquiry argued that the medical transfer provisions enacted in March 2019 should not be repealed…

Of the submissions made to the inquiry, only one submission recommended that medevac be repealed. Whose was the one submission? Who supports the repeal of medevac? Surprise surprise, it is Minister Dutton's own department, the Department of Home Affairs—the people who wrote this bill on behalf of the government. All other stakeholders said that medevac should not be repealed.

Despite this wait, the government dominated committee only made one recommendation: that the Senate pass this bill. Labor senators, Greens senators and Centre Alliance senators all made dissenting reports. They actually listened to the evidence presented at the inquiry, and all three parties made separate recommendations to oppose this bill. In the past week, my crossbench colleagues and I accepted a petition of 51,000 Australians who are in support of medevac. A letter from over 5,040 doctors in support of these provisions was also delivered to this place last week. And a newly released Guardian Essentialpoll shows that 62 per cent of Australians support medevac. The evidence continues to grow, despite the Morrison government's brazen, desperate and dishonest attempts to discredit medevac.

We saw the beginnings of this when an authorised disclosure of sensitive national security advice was made to The Australian newspaper—a leak that occurred for blatant political gain. Former head of ASIO Duncan Lewis described that leak as 'seriously damaging', adding 'it undermines all that we, ASIO, stand for'. When it comes to leaks, I have been appalled at the number of times the front pages of newspapers have been splashed with the personal medical records of vulnerable people. Can you imagine having your medical history, your most private details being leaked to the media for political gain? And yet this is exactly what has occurred under the Morrison government and under Minister Peter Dutton and his Department of Home Affairs. We have seen the names, the backgrounds, the ages and the ethnicities of asylum seekers and refugees published in papers. And let's not forget, these are people who—in the majority of cases—have fled persecution and have been found to be owed refugee protection. We've seen their medical conditions misconstrued and exploited for political gain. These people have had their photos published, the treatment they have undergone shared and their information exploited by the government without their permission. How would Minister Dutton feel if he woke up one morning to see his personal medical details on the front page of a national newspaper? An investigation would be launched within minutes. But when it comes to the private medical details of vulnerable people in Nauru or PNG who need medical transfers, there is clearly a different standard by this government.

And it doesn't take a genius to work out the origins of these leaks. To those people who have had their personal medical details shared in this fashion, I am sorry. It is clear that the government has been loose with the truth when it comes to medevac. They have falsely claimed that two doctors from Nimbin or doctors on Skype could approve transfers. They have claimed that Australians would be kicked off waiting lists at hospitals. They have even claimed Australia's border protection will fall apart—something that has not happened in the 10 months since these laws came into existence earlier this year.

Senate Estimates confirmed that the Morrison government has transferred 982 people to Australia outside of the medevac process. I note that the majority of these transfers were before the Department of Home Affairs issued their 2015 directive to stop transfers to Australia. This compares to some 160 transfers under medevac. The government has been blatantly—and I dare say purposely—misleading when it comes to matters of medevac. I have spoken at length in this place about the mistruths that the Minister for Home Affairs, the immigration minister and the Prime Minister have spread, and continue to spread, about medevac.

Here are the facts you won't hear the government say about medevac. All medevac transfers to Australia are done with Mr Dutton's permission or the permission of doctors that the minister has appointed. Minister Dutton has extensive powers to refuse a medevac transfer on national security and character grounds with no appeal. He has used these powers before and he can use them again. If a person doesn't require medical treatment the independent health advice panel would deny the transfer. All medevac transferees must be detained in immigration detention by law, unless Minister Dutton approves their release from detention in Australia. This is in fact designed to keep the Australian community safe. Medevac transfers are for a temporary purpose and Minister Dutton has the ability to return a transferee to a regional processing centre at any time. These are the facts.

The system is working as it was designed to do. No amount of protest or outlandish claims from the Minister for Home Affairs or the Prime Minister have proven otherwise. Despite the government's claims, this debate has nothing to do with border protection. Let's not forget that offshore processing was always intended to be exactly as its name suggests—processing. Instead, under this third-term Liberal-National government, it has become indefinite detention. The architecture of border protection includes boat turnbacks where safe to do so, offshore processing and regional resettlement—all of which Labor strongly supports. It works cohesively. It works well. All of those aspects are of equal importance. Former Prime Minister Kevin Rudd and Minister Morrison in his former role as immigration minister both put in place policies to stop people risking their lives crossing one of the most perilous oceans on leaky boats. However, since the member for Dickson, Mr Dutton, became the Minister for Immigration and Border Protection in 2014 he has failed, as in so many other areas of policy, to do his job. He has failed to deliver on third-country resettlement options such as the New Zealand offer, which has been on the table since 2013. Since 2013 this government has had the option to take up the New Zealand offer to move refugees from Manus and Nauru to New Zealand and it has failed to do so.

Ever since Mr Dutton became the minister responsible, he has left refugees to languish in indefinite detention. They are now in their seventh year in PNG and Nauru. This languishing is the reason why the mental and physical health of asylum seekers and refugees have diminished so profoundly. It is why medevac was needed and required—to ensure people who are sick receive the medical attention they require. Denying people medical care is un-Australian. It is inhumane. It is uncompassionate. If any member of this Senate were sick, we would see a doctor. If any member of our family were sick, we would send them to a doctor. Vulnerable people who are in Australia's care who have already suffered significant trauma in their lives should not be forced to the brink of death to receive the medical treatment that they require. These decisions should never have been left in the hands of people without any medical training let alone concentrated in them. Labor strongly supports medevac. Medevac is working as intended. These laws should not be repealed.

I want to finish where I started, with Dr Chris Jones' diary of his time on Nauru. On 17 August he wrote: 'Does it really take the possibility of sudden death to persuade our government of the right thing to do?' Labor opposes this repeal bill for that very reason. I implore the crossbench to oppose this bill.