Archive - 2015

1
Why I’m Proud of my Profession and Ashamed of my Country.
2
Doctors Rebel Against Australia’s Evil Act
3
Doctors face jail for reporting asylum-seeker abuse. The Australian Border Force Act 2015
4
Shenanigans at the Medical Journal of Australia
5
Australia’s Abuse of Refugee Children on Manus & Nauru Documented

Why I’m Proud of my Profession and Ashamed of my Country.

Kids in Detention
Australian Doctors Speak Out Against Children In Indefinite Detention

Doctors at the Royal Children’s Hospital say they cannot effectively treat severe disturbances among children in detention while they are being detained and have refused to discharge an asylum seeker and her child because the immigration department would have sent them back to detention at the expense of their health.

The woman, aged in her 30s, was suffering post-traumatic stress disorder and post-natal depression, which also affected her infant child’s development. Both were flown from detention in Nauru to Australia in late 2014 for hospital treatment.

Louise Newman, director of mental health at the Royal Women’s Hospital, first treated the woman in December and has followed her condition since.

Doctors at the Royal Children’s Hospital refused to discharge a mother and child into detention.
Doctors at the Royal Children’s Hospital refused to discharge a mother and child into detention. Photo: John Gollings
She said the pair was discharged to an immigration transit centre in Broadmeadows, where their condition immediately deteriorated.

They were readmitted to a mother and baby unit at the Royal Children’s Hospital.

Professor Newman said even though the pair’s health had improved by mid-2015, their doctors refused to discharge them unless the Department of Immigration agreed to not return them to detention.

“It was a situation of having to negotiate her and her family’s treatment needs, and it was very much agreed that it was against their interests to be returned to detention,” said Professor Newman, who is also vice president of the group Doctors for Refugees.

“How can we recommend that people go back into detention when we know they’re not going to get proper health care?”

Professor Newman said the woman and her baby were eventually released into the community and were living in Melbourne with “considerably improved’ health. Details of the extraordinary stand-off comes after nearly 1000 doctors, nurses and staff at the Royal Children’s took an unprecedented stand against children being held in detention.

In a letter published on Sunday, the hospital’s doctors said detention took an enormous toll on children’s health, and called on the federal government to abandon its policy of locking up minors.

Victoria’s Health Minister Jill Hennessy threw her support behind the doctors who kept asylum seekers out of detention.

“I’m extremely proud to be the health minister in a state where its doctors and nurses are putting the interest of children first,” Ms Hennessy said on Sunday.

“If the staff of the Royal Children’s Hospital come to the clinical view that it is not in the interests of those children to go back into detention, then we will support them.”

The doctors’ actions also earned them the praise of thousands of people at a rally in support of refugees at Melbourne’s State Library on Sunday, who erupted into cheers when the hospital was mentioned.

The Australian Medical Association said it had a “fundamental problem” that children were in detention and had been asking governments to look for “any alternative” to it for years.

“We acknowledge the evidence that children in detention face circumstances which are very harmful to their health, their growth and their development,” vice president Stephen Parnis said.

He said that if children did need to be detained, then they should be released “in weeks” at the absolute most.

Dr Parnis said the AMA was aware that a “number” of doctors who had provided care to children in detention had been quite distressed.

Children were presenting having self-harmed, with anxiety, severe depression and not growing in a healthy or normal way, he said.

Dr Parnis said doctors were constrained in the care that could be offered to these children. “It flies in the face of our ethical obligation to provide good care.”

Sydney paediatrician David Isaacs, who runs the children’s refugee clinic at the Children’s Hospital at Westmead, also backed the Royal Children’s Hospital staff.

Dr Isaacs visited Nauru in December 2014 and saw a six-year-old girl try to hang herself. He said his visit to the island left him deeply troubled, and he experienced nightmares on his return.

“These are very traumatic cases where children are severely suicidal and in a lot of trouble,” Dr Isaacs said.

Immigration Minister Peter Dutton said he understood the doctors’ concerns, but did not support a change in government policy.

“The Defence and Border Force staff on our vessels who were pulling dead kids out of the water don’t want the boats to restart,” he said.

Royal Children’s Hospital chairman Rob Knowles said he supported the doctors’ stand to protect the health and safety of children.

Fairfax Media understands there are not currently any asylum seekers who are inpatients at the Royal Children’s Hospital.

http://www.theage.com.au/victoria/royal-childrens-hospital-refused-to-discharge-mother-and-child-to-detention-20151011-gk6exf.html#ixzz3oJf2xkj6 @theage on Twitter | theageAustralia on Facebook

Doctors Rebel Against Australia’s Evil Act

 

Border Force

 

Open letter regarding the Border Force Act 2015:

Today  (1 July 2015) the Border Force Act comes into force. It includes provision for a two-year jail sentence for “entrusted persons” such as ourselves if we continue to speak out about the deplorable state of human rights in immigration detention without the express permission of the minister for immigration and border protection. This strengthens the wall of secrecy which prevents proper public scrutiny.
We have advocated, and will continue to advocate, for the health of those for whom we have a duty of care, despite the threats of imprisonment, because standing by and watching sub-standard and harmful care, child abuse and gross violations of human rights is not ethically justifiable.
If we witness child abuse in Australia we are legally obliged to report it to child protection authorities. If we witness child abuse in detention centres, we can go to prison for attempting to advocate for them effectively. Internal reporting mechanisms such as they are have failed to remove children from detention; a situation that is itself recognised as a form of systematic child abuse.

Evidence of the devastating effects of institutional self-protection and blindness to child abuse has been presented before the current royal commission. We are determined not to collude with a system that repeats these same mistakes.
There are currently many issues which constitute a serious threat to the health of those in detention for whom we have a duty of care. The Department of Immigration and Border Protection is aware of these problems and has for years failed to address them adequately.

We are aware that in publishing this letter we may be prosecuted under the Border Force Act and we challenge the department to prosecute so that these issues may be discussed in open court and in the full view of the Australian public.

Dr John-Paul Sanggaran, MBBS M.H.Med B.H.Sc, former IHMS medical officer

Dr Richard Kidd, BHB, MBChB, Dip.Obs., FAMA, Deputy Chair AMACGP, former IHMS medical officer

Dr Grant Ferguson, MBBS B.Sc (Hons), former IHMS medical officer

Dr Ben Hew, MBBS B.Sc, former IHMS medical officer

Dr Alison Bleaney, MBchB FRACRRM OBE, former IHMS medical officer

Dr Merrilyn Williams, MBBS, M. (GP Psych) FACRRM, former IHMS medical officer

Dr Ai-Lene Chan, MBBS FRACGP ObsSC MPH&TM, former IHMS medical officer

Dr John Vallentine, MBBS MRCP, former IHMS medical officer

Dr Jill Maxwell, MBBS OAM, former IHMS medical officer

Dr Sally Manuell, MBBS FRACGP, former IHMS medical officer

Prof Bernard Pearn-Rowe, BSc (Hons), MBBS, FAMA, former IHMS medical officer

Tracey Donehue, secondary school teacher

Judith Reen, secondary school coordinator

Jane Willey, former secondary school teacher

Evan Davis, former senior secondary school teacher

Dr Peter Young, MBBS FRANZCP, former IHMS medical director mental health services

Steve Brooker, BSc MA, former IHMS director of mental health services

Dr Rodney Juratowitch, MBBS FRANZCP, former IHMS psychiatrist

Dr Amanda Trenaman, MBBS, FRANZCP, former IHMS psychiatrist

Prof Robert Adler, PhD MBBS, former IHMS psychiatrist

Ryan Essex, BHSc, Grad Dip Psych, BSocSc (Psych), (Hons), MHL, MPH, former IHMS counsellor

James Harris, former case manager and residential youth worker

Toby Gunn, former child and youth recreation officer

Samantha Betts, BA, former child and youth recreation worker

Martin Reusch, former humanitarian worker

Timm Knapp, former humanitarian worker

Amanda Lloyd-Tait, former humanitarian worker

Jennifer Dennis, former humanitarian worker

Amy Marden, former humanitarian worker

Prof David Isaacs, MBBChir MD FRACP FRCPCH, former IHMS paediatrician

Dr Hasantha Gunasekera, MBBS FRACP, former IHMS paediatrician

Alanna Maycock, BN RN, former IHMS paediatric nurse

Prof Louise Newman, MBBS PhD FANZCP AM, former DEHAG consultant IHMS psychiatrist

Dr Micheal Dudley, AM MBBS BD FRANZCP, former DEHAG consultant

Prof Caroline de Costa, PhD MPH MBBS BA FRANZCOG FRCOG, former DEHAG consultant

Viktoria Vibhakar, MSW, LCSW, AASW, former senior child protection and support worker

Ashleigh Millard, former adult case manager and social worker

Jaime O’donovan, former social worker, child protection team

Hamish Tacey, BBehavSc, former unaccompanied minor team leader and refugee assistance program case manager

Serena Hansen, former case manager and residential team leader

Marc Isaacs, BA (Com), BA (Int.S), former recreations manager

Doctors face jail for reporting asylum-seeker abuse. The Australian Border Force Act 2015

Broken Arm

 

 

 

 

 

 

 

 

 

Under the Border Force Act 2015 it is Unlawful to Reveal this X-ray: A Law that Australia’s Doctors Cannot Ethically Obey.

Why would I, a senior medical specialist, past AMA(NSW) State Vice-President, Board Member of Doctors for Refugees, a registered psychologist who also holds a law degree – part of the status quo, Mr Establishment – advocate this? If my parents’ experience as Holocaust survivors and that of the six million who were not has any lasting meaning it is this: laws that encourage evil must be opposed. Make no mistake, the Australian Border Force Act 2015 (the Act) (http://www5.austlii.edu.au/au/legis/cth/num_act/caolabfa2015597/) is evil in intent and in its likely, foreseeable effect.

In the post-war period, institutions and mechanisms that protect and enhance freedoms and ethics have flourished. For doctors one of the most important has been the Declaration of Geneva, the touchstone of modern medical ethics.

The Declaration of Geneva (Physician’s Oath) was adopted by the General Assembly of the World Medical Association in Geneva in 1948 (revised 2005 & 2006. It is a declaration of a doctor’s dedication to the humanitarian goals of medicine, a declaration that was especially important in view of the medical crimes that had been committed in Nazi Germany.

The most relevant points (to the current matter) are:

At the time of being admitted as a member of the medical profession:

  • I solemnly pledge to consecrate my life to the service of humanity
  • I will practice my profession with conscience and dignity.
  • The health of my patient will be my first consideration.
  • I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.
  • I will maintain the utmost respect for human life.
  • I will not use my medical knowledge to violate human rights and civil liberties, even under threat.

Such ethical demands are alien to politicians but for Australian doctors, they are mandatory. They are reinforced by those enunciated by the specialist medical colleges and the Australian Health Professionals Regulation Authority (AHPRA) (http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx)

Among other provisions, the latter requires doctors to:

1.4: …protect and promote the health of individuals and the community.

3.6.4: (Be) alert to children and young people who may be at risk, and notifying appropriate authorities, as required by law.

8.11: Conflicts of interest: A conflict of interest in medical practice arises when a doctor, entrusted with acting in the interests of a patient, also has financial, professional or personal interests, or relationships with third parties, which may affect their care of the patient. When these interests compromise, or might reasonably be perceived by an independent observer to compromise, the doctor’s primary duty to the patient, doctors must recognise and resolve this conflict in the best interests of the patient (my emphasis).

This is additional to legislation in every State that requires mandatory reporting, a requirement this Commonwealth Act undermines.

In 2005 I proposed a motion that was accepted by majority vote of delegates at the Federal Conference the Australian Medical Association. This required us to:

  • Recognise that the indefinite detention of children is child abuse;
  • Recognise that it is unethical to provide psychiatric services in a setting where the provider is under the direction, influence or control of the abuser;
  • Release immediately all children detained in immigration detention facilities;
  • Release immediately all immigration detainees suffering mental disorders into appropriate psychiatric facilities.

The medical profession’s ethical requirements in relation to children (and adults) in detention cannot be stated more clearly, yet under the Act (Part 6), it is a criminal offence, punishable by imprisonment of up to two years, for any person working directly or indirectly for the Department of Immigration and Border Protection to reveal to the media or any other person or organisation anything that happens in detention centres like Nauru and Manus Island.

Potentially then, the Act encourages criminal behavior by providing protection for abusers in the form of secrecy for their alleged crimes.

A spokeswoman for the Immigration Department said doctors may (my emphasis) be exempt from prosecution if their reporting was in the public interest but that: “Depending on the contractual arrangements existing between a healthcare worker and the [Department] … that healthcare worker may fall within the definition of an ‘entrusted person’, to whom Part 6 of the Act will apply.

Where a doctor or other healthcare worker is considered an entrusted person under the Act, there are appropriate mechanisms for reporting misconduct or maladministration.

For example, the Public Interest Disclosure Act 2013 provides protections for officials who wish to report maladministration through the PID Act. The ABF Act does not override the protections of the PID Act.” http://www.australiandoctor.com.au/News/Doctors-face-jail-for-reporting-asylum-seeker-abuse

This, as the Department’s PR flak must know, is rubbish. There is no way of knowing which Act will take precedence, until decided by the prosecution of a doctor before the Courts. Nor is a report made to the alleged perpetrator’s employer a satisfactory replacement for the ethical standards required of doctors, nor for the protections offered to children by reporting to independent outside organisations.

Former and current medical staff, teachers and social workers who signed and released a letter last month (http://www.theguardian.com/world/2015/apr/07/nauru-staff-call-for-closure-of-asylum-centre-and-royal-commission-into-abuse) that referred to abuse occurring at Nauru could now be charged and prosecuted under the Act, as the ‘responsible’ Ministers Peter Dutton & George Brandis are undoubtedly aware and arguably intend. The ethical and moral bankruptcy demonstrated is truly breathtaking.

Further, by blocking any transparency of their quality assurance procedures, the standard of care is unregulated until it becomes a crime or a death, as it did with Reza Barati.

Doctors working at detention facilities will be subject to a secrecy oath that requires them to seek permission from the Australian Border Force Commissioner to discuss any details of their work, in direct contravention to registration requirements, ethical constraints and State child protection legislation.

No doctor should accept any work within the Immigration Department and especially in its detention facilities, if required to obey the provisions of this repellent Act. The AMA should declare its unequivocal support for any doctor in the employ of this Department who chooses to follow our ethical obligations in defiance of this offensive law.

 

 

Shenanigans at the Medical Journal of Australia

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Dr Stephen Leeder didn’t take the job of Editor in Chief for the income or to improve his resumé. With a career spanning more than five decades, including a stint as dean of medicine at the University of Sydney, he was already one of the most well-known and respected academic physicians in Australia. It was, instead, an objective that guided his decision — two objectives, actually.

Those objectives were expressed in the very first issue of the Medical Journal of Australia (MJA), published more than a century ago: to keep physicians abreast of advances in their profession; and to provide evidence to inform discussions on health policy. These values aligned with his own, so in April of 2013, Leeder accepted the position of editor-in-chief of the journal.

He enjoyed the work — the writing, seeking comment on current events in medicine, tweaking the journal’s design. Encouraging authors, whether young or not-so-young, also made the job rewarding. He had plans to improve the journal, to introduce more formats, to usher it further into the information age.

Those plans, however, were curtailed on Apr. 29, when he was fired by the board of the Australasian Medical Publishing Company (AMPCo), the subsidiary of the Australian Medical Association that publishes the journal. Leeder had disagreed with the board’s decision to outsource some production, copyediting and administrative work to Elsevier, a large academic publishing house.

“I was escorted from the termination interview to my office, asked to identify my goods for packing and dispatch to my home, and then escorted from the building. No member of the AMPCo board was present. Virtually all the editorial team watched this aghast,” Leeder wrote in an email to Canadian Medical Association Journal (CMAJ). “We were making progress. That has been cut short. I feel bereaved and deeply hurt.”

In response to a request for comment on the situation, a public relations representative for AMPCo forwarded two media releases to CMAJ. The first, dated Apr. 23, announced the decision to outsource work to Elsevier. The change was made to improve efficiency and provide the journal access to Elsevier’s “expertise and digital experience to the production process.” AMPCo promised there would be “no change in the MJA’s editorial independence and control over content development.” The second press release, dated Apr. 29, stated that Leeder “will conclude his tenure” effective immediately because he and the board could not agree on “the necessary steps required” to ensure the journal’s future success.

“There are many ways to cut costs, but cutting core staff has been shown repeatedly not to work,” Leeder wrote in an email. “MJA could in my view work with an enlightened, entrepreneurial board to create new revenue lines, as many association-owned journals have done.”

Word of Leeder’s dismissal spread quickly, not only in Australia’s medical community but around the world. And it raised many questions among those interested in scholarly publishing. How can medical journals remain financially viable in an age of declining advertising, subscriptions and medical-association membership? Does outsourcing to an academic publishing company affect editorial quality? Is reducing staff without an editor-in-chief’s consent a violation of editorial independence?

More than a few people are also wondering how the MJA will attract a new editor-in-chief, considering that, less than three years ago, Leeder’s predecessor had also been fired after a dispute with the AMPCo board. As Dr. Richard Smith, former editor of the BMJ, put it on his blog: Who would want to run a journal that goes through editors like a professional soccer team goes through coaches?

Read the full story here: http://www.cmaj.ca/site/earlyreleases/19may15_backlash-at-mja-for-firing-another-editor.xhtml

Australia’s Abuse of Refugee Children on Manus & Nauru Documented

Manus.jpg-large

Journal of Paediatrics and Child Health
Volume 51, Issue 4, pages 353–354, April 2015

Australia has had controversial legislation for mandatory detention of asylum seekers since 1992 and legislation since 2001 allowing indefinite detention of such persons on the mainland, Christmas Island or ‘offshore’ on Manus Island in Papua New Guinea and on the small Pacific island nation of Nauru. Despite frequent protests from lawyers, doctors and humanitarian organisations that such policies infringe human rights and blatantly contravene the 1951 United Nations Refugee Convention, to which Australia is a co-signatory, both major political parties have persisted with these cruel policies. The clear aim is deterrence. Asylum seekers are demonised as potential terrorists or as economic migrants, callously and inaccurately referred to as ‘illegals’, and imprisoned indefinitely with no knowledge of when and where they will be released. The reason for such poor morality is political: the issue of asylum seekers who arrive by boat wins and lose elections: votes are more important than children’s lives.

Read the full article here:

http://onlinelibrary.wiley.com/doi/10.1111/jpc.12872/full

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