Refugee and Custodial Health
15-16 October 2016 - RACV City Club, Melbourne
Ms Linda Kirk – Doctor on Wire: Walking the Legal and Ethical Tightrope in Immigration Detention Centres
The Australian medical profession has played a critical health and public interest role informing other professionals and the community about conditions affecting their patients inside Australia’s immigration detention centres. The paper will outline the medical law framework governing health practitioners working in Australian and offshore immigration detention centres, and the ethical dilemma they face in working in an environment where there are conflicting demands and obligations from their patients and their employer. The ‘secrecy’ provisions in the Australian Border Force Act 2015 (Cth) that came into effect in July 2015 make it an offence punishable by two years’ imprisonment for a medical professional or other detention centre worker to record or disclose information about conditions in detention centres. This new law potentially leaves doctors exposed to civil liability or subject to professional misconduct proceedings as it could prevent them from complying with the standards and codes of conduct set by the Medical Board of Australia. The paper will discuss the ethical and legal tightrope that doctors who work in immigration detention centres must walk, and how the ‘secrecy’ provisions of the Border Force Act have made the required balancing act even more of a challenge.
Prof. Roy Beran & Prof. Frank Vajda – Inappropriate Eponymous Recognition of War Crimes
Download the presentation: inappropriate-eponymous-recognition
When considering detainees and prisoners and the treatment thereof, one should not ignore the false praise afforded those who conducted experiments, of the most heinous nature, on detainees and prisoners during the Nazi era. As emphasised by Vajda et al, the recognition of medical criminals, because no other description seems appropriate, should be to their detriment rather than lauding those unworthy of such eponymous praise. Kondziella identified 400 Nazi doctors responsible for acts of barbarism, including transgressions against children, pregnant women and those in concentration camps.
Hallervorden-Spatz syndrome, neurodegeneration with excessive iron accumulation in the brain, acknowledges Julius Hallervorden and Hugo Spatz, who obtained 110,000 autopsy specimens from 2,800 psychiatric patients who were gassed. Reiter’s syndrome, associated with reactive arthritis, uveitis and renal inflammation, was originally named after Conrad Reiter, who oversaw unmentionable ‘research’, including killing 200 prisoners in Buchenwald with typhus vaccine. Wegener’s granulomatosis, ANCA associated granulomatous vasculitis, relates to Friedrich Wegener, a German pathologist, who joined the Nazi party in 1932 and about whom there is incriminating evidence. These examples identify the horrors that befell detainees and prisoners during the Nazi era and the honours that have, but should not, follow such atrocities.
 Vajda F J E, Davis, S M, byrne E “Names of infamy: Tainted eponyms” J Clin Neuroscience 2015; 22: 642 – 644
 Kondziella D “Thirty neurological eponyms associated with the Nazi era” Eur Neurol 2009; 62: 56 – 64
 Harper P S “Naming of syndromes and unethical activities- the case of Hallervorden and Spatz” Lancet 1996; 348: 1224 – 5
 Panush R S, Wallace D J, Doffe R E et al “Reactions of the suggestion to use the term ‘Reiter’s syndrome’ sixty-five years later: The legacy of Reiter, a war criminal, should not be eponymic honour but rather condemnation” Arthritis Rheum 2007; 56:693
 Woywodt A, Matteson E L “Wegener’s granulomatosis – probing the untold past of the man behind the eponym” Rheumatology 2006; 45: 1303 – 6
Dr Georgia Paxton – Child Refugee Health
More than 50,000 people arrived by boat and sought asylum in Australia over 2009 – 2013. These individuals were subject to mandatory immigration detention, and in many cases, experienced prolonged detention. The number of children in detention peaked in July 2013, with nearly 2000 children in detention, however at this time, the mean duration of detention was 72 days. Subsequently, while numbers reduced, the duration lengthened, reaching 400 days by September 2014, and remaining at this duration for many months.
The Royal Children’s Hospital (RCH) Immigrant Health Service has provided clinical care in refugee health for sixteen years, and in recent years, we have worked extensively with children and young people seeking asylum. This session will present the RCH experience of providing care for the children and families who have experienced Australian held detention, and the issues arising for their physical and mental health.
Prof Erwin Loh & Dr Jessica Dean – Lost in Translation: The Liability of Unaccredited Interpreter Use
Download the presentation: lost-in-translation
Australia is one of the most culturally and linguistically diverse nations in the world, with over 300 languages spoken collectively. Effective interpreting is therefore essential for the delivery of appropriate health care, however, a large proportion of clinical interactions with patients from non-English speaking backgrounds occur in the absence of an accredited interpreter. A clinical consultation in the absence of an accredited interpreter carries the obvious potential for miscommunication, as well as potential breaches in confidentiality and distress for the individual. Most current hospital policies and guidelines softly recommend the use of an accredited interpreter in preference to a family member for important content. Some permit the use of non-accredited interpreters for interpreting of ‘non-critical content’. There are numerous reported adverse events that have occurred as a result of miscommunication of ‘administrative’ content.
A recent NSW case, Biggs v George  NSWCA 113, reminds us of the complexity of obtaining informed consent in the presence of profound language barriers. Irrespective of the patient’s competency in English, medical practitioners have a duty to adequately inform patients of the material risks of any treatment. At first instance, the trial judge provided a rich discussion of the inherent miscommunication risks associated with ad hoc interpreting. At appeal, the court considered whether a misunderstanding held by the patient regarding their illness and treatment amounted to negligence on behalf of the doctors for a failure to warn. Ultimately, the defendants were able to establish that the material risks of the surgery were communicated and understood by the plaintiff during a series of consultations, and therefore, any misunderstandings held by the plaintiff did not amount to a breach of duty of care. This case suggests that current attitudes towards ad hoc interpreting, both culturally and reflected in guidelines, require reconsideration and reform. Furthermore, more work is needed to overcome the remaining barriers to effective accredited interpreter use in Australia.
Dr Donna Button – Custodial Medicine: An Alternative View on Custodial Indigenous Health
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Correctional Centres appear to vary significantly throughout Australia. From rolling hills, market gardens, steel cages, tropical storms, work crews, school classes, to various interpretations of maximum security. Each Centre is violent and manipulative and all Units having an underlying hum. The threat of riot at any particular moment is constant as is the ongoing trade of drugs and sex. Presentations to the medical clinic will be discussed comparing Indigenous vs. Non Indigenous patients both in Jail and in Custody.
Dr David Onu – Fitness to Plead and Stand Trial
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There are occasions in the court of law when the question is asked about an accused person’s “fitness to plead” or “fitness to stand trial” in order for him/her to be found guilty of a criminal offence. This generally implies that the accused person does not have any significant mental impairment or insanity which could have impacted on the “mens rea” or “guilty mind” at the time of committing an offense. In this paper I will outline the legal framework and clinical tools required for assessment of fitness to plead/stand trial and will illustrate with a case involving a Tasmanian prisoner.
Dr Adam Griffin & Ms Ainslie Kirkegaard – Health Care Related Death Invesigation
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In Queensland, fewer than 10% of health care related deaths proceed to autopsy and formal coronial findings as most are triaged out of the coronial system following a fast-track desktop review of patient records with independent clinical input. This session examines the opportunities provided by Queensland’s novel triage mechanism to identify patient safety issues and effect health system changes to prevent future deaths through innovative coronial investigation.
Dr Maria Dudycz – Salient Lessons and Implications from the VCAT Disability Act cases on the Use/Misuse of Seclusion, Chemical and Mechanical Restraints on Civilly Detained Persons
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Victorian Parliament strengthened the accountability, protection and rights of disabled persons by enacting the Disability Act 2006. The Act provides a new civil “Supervised Treatment Order” made by VCAT to detain a disabled person to receive treatment when they pose a danger to themselves or the community.
The VCAT cases demonstrate the consequences for the human rights and health of disabled persons of inadequate oversight and accountability of treatment plans with respect to Seclusion, Chemical and Mechanical Restraint.
Lessons and implications from these cases can extend beyond disabled persons to the ageing population and “detention-like” settings such as nursing homes.