‘Significant risks’ to health of asylum seekers in firm’s failure to meet targets

Children on Christmas Island were vaccinated only 7% of the time when needed, according to documents. Photograph: Stephen Smith/Getty Images

Asylum seekers needing referrals to specialists and children needing vaccinations were failed multiple times by their healthcare provider at Christmas Island detention centre, and its solution was for the department to loosen standards of healthcare.

An independent audit of healthcare records kept by International Health and Medical Services (IHMS) on Christmas Island in 2012 has been leaked to Guardian Australia and shows IHMS repeatedly failing criteria set by the immigration department on how to look after the health of asylum seekers in its care.

Failures include:

  • Asylum seekers saw a GP within three days of making the request only 29% of the time.
  • Vaccinating children when needed only happened in 7% of cases.
  • When an asylum seeker was involved in a critical incident, a report was provided within four hours only 56% of the time.
  • An accurate and complete summary of an asylum seeker’s clinical history was only kept in 25% of cases.
  • A screening for mental health concerns, substance dependence problems and torture and trauma history occurred 71% of the time.

IMHS was expected to reach meet a target of 95% in each case.

The independent audit, done by business risk consulting group Protiviti, notes that IMHS’s rates of non-compliance are putting the welfare of asylum seekers at risk.

“The extent of non-compliance introduces significant risks to the department and their clients, for which it owes a duty of care,” it says.

“This is particularly poignant when non-compliant practices are considered in the context of the level of risk they present, where even relatively low levels of non-compliance can have significant consequences for the health and welfare of PiD [people in detention].”

IHMS’s response was to suggest the immigration department loosen its standards on healthcare for asylum seekers.

In its official response, addressed to the assistant secretary of detention health services at the department of immigration, IHMS suggests the removal of several standards of criteria.

Performing a health induction within 72 hours of an asylum seeker arrival, having an asylum seeker checked by a GP within 72 hours of requesting an appointment, completing a mental state examination as part of the health assessment, providing an initial report within four hours of a critical incident, were all criteria IHMS suggested be scrapped.

In instances where reasons were given for wanting the criteria removed IHMS cited the surge in arrivals – mostly by boat – and the difficulty in creating reports if there were no other asylum seekers to witness a critical incident.

In notes made in a draft report by a doctor for IHMS, he defends the non-compliance rates by questioning whether IHMS is being held up to health standards or industry standards.

“I expect we would benchmark well against other health services but that the strict contractual requirements are impossible to comply with at the level they are set,” he wrote.

The audit says that providing health services to people in detention is governed by the principle the asylum seekers have access to clinically recommended care, at a standard generally commensurate with health care available to the Australian community, but “taking into account the diverse and potentially complex health needs of those in immigration detention”.

It lists the challenges of providing health care in a detention environment on Christmas Island including the “highly operational” environment, the remote location with limited access to resources and infrastructure, the cultural and linguistic diversity of clients and the rapidly changing population.

“These challenges have the potential to impact on the quality of health care service delivered to PiD on CI, however also highlight why adequate standards of record-keeping are essential,” the audit says.

The chief operating officer of IHMS, Ian Gilbert, defended the organisation’s failure to respond to asylum seeker health concerns in a timely manner, saying most of the factors were beyond IHMS influence.

“For example, the timeliness within which IHMS can complete health induction assessments and mental state examinations on Christmas Island largely depends on the volume of clients that IHMS processes,” he wrote in a letter to the immigration department.

“This has been evidenced by the recent activity over the last two months, where IHMS has routinely been unable to process clients within the 72-hour thresholds. This is due to the unforecasted spike in activity levels and the complicated logistics rather than a design fault with record-keeping.”

He said the record-keeping would “self correct” when the volume of asylum seekers arriving by boat returned to normal levels.

In a response a spokeswoman for IHMS said in a statement: “IHMS has at all times complied with internal, external and departmental audits.”

A spokeswoman from the immigration department said: “The department has and continues to work with its service provider, IHMS to regularly review its reporting frameworks.”

“On 11 December 2014, the department commenced a new contract with IHMS. The new contract includes a strengthened performance management framework which includes both abatements and incentives and focuses on detainee health and service outcomes.”

“The department remains committed to ensuring that it has the best available information and expertise to manage the health of those in detention, particularly children.”