Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe

J Med Ethics doi:10.1136/medethics-2015-103326
Authors: John-Paul Sanggaran, Deborah Zion
“Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.”
Find abstract here.

Australian police accessed phone records of asylum whistleblower

The Guardian, online 24 May 2016
Author: Paul Farrell
“Australian police investigated an immigration detention whistleblower and accessed his phone records in part because of his criticism of the country’s asylum seeker policies.
Guardian Australia can reveal that the Australian federal police (AFP) compiled hundreds of pages of investigative file notes and reports surrounding Dr Peter Young following two news reports by the Australian Broadcasting Corporation and the Australian newspaper in December 2014 that disclosed the medical records of Hamid Khazaei, an asylum seeker on Manus Island who died following a skin infection on his leg. Young, who is a former medical director of mental health for Australia’s detention centres, urged workers from inside the system to be “angry and defiant” about attacks on whistleblowing.”
Find article here.

New measures set to support whistleblowers in primary care

NHS England, statement 1 April 2016
“NHS England is today taking significant steps to make it easier for primary care staff to raise their concerns so that action can be taken and improvements made. Firstly new whistleblowing guidance has been drawn up which will now be consulted on for the next five weeks.  The guidance comes after Sir Robert Francis recommended that the principles outlined in his Freedom to Speak Up report be adapted for primary care, where smaller work settings can present challenges around anonymity and conflicts with employers.”
Find information here.

Scandal as a Sentinel Event — Recognizing Hidden Cost–Quality Trade-offs

N Engl J Med 2016; 374:1001-1003March 17, 2016DOI: 10.1056/NEJMp1502629
Author: M. Gregg Bloche, M.D., J.D.
“In 2014, Americans reacted with outrage to reports that personnel at Veterans Health Administration (VA) medical centers had schemed to feign compliance with targeted waiting times for appointments. Whistle-blowers outed miscreants, alleging that clinical delays had caused scores of avoidable deaths. …The prevailing narrative was one of breakdowns of character and culture: dishonesty, callousness, and ineptitude. Several years earlier, a similar scenario played out in Britain’s National Health Service (NHS), which had set waiting-time and quality-of-care targets that many facilities struggled to meet. The struggles of one facility, in the county of Staffordshire, became a scandal. …As with the VA scandal, politicians blamed individual perpetrators and one another, and the prevailing narrative highlighted lapses of character and culture.”
Find article here. See also “Beyond the VA Crisis — Becoming a High-Performance Network” (N Engl J Med 2016; 374:1003-1005 March 17, 2016DOI: 10.1056/NEJMp1600307).

Trust pays cardiologist £1.22m for unfair dismissal

BMJ 2016;352:i787
Author: Clare Dyer
“A whistleblowing consultant cardiologist who fought a 14 year battle against the NHS trust that employed him has won £1.22m for unfair dismissal. Raj Mattu was suspended by the University Hospitals Coventry and Warwickshire NHS Trust in February 2002, five months after he spoke to the BBC about the death of a 35 year old patient in an overcrowded bay at Walsgrave Hospital, Coventry. The trust accused him of bullying two junior doctors in an attempt to persuade them to join him in his dispute with management.”
Find extract here.

Helping professionals and Border Force secrecy

‘Helping professionals and Border Force secrecy: effective asylum-seeker healthcare requires independence from callous policies’, Australas Psychiatry January 27, 2016 1039856215623354
Author: Michael Dudley
“Prolonged immigration detention and policies aiming to deter irregular migration cause maritime asylum-seekers undeniable, well-publicised harms and (notwithstanding claims about preventing drownings) show reckless indifference and calculated cruelty. Service personnel may be harmed. Such policies misuse helping professionals to underwrite state abuses and promote public numbing and indifference, resembling other state abuses in the ‘war on terror’ and (with qualification) historical counterparts, e.g. Nazi Germany. Human service practitioners and organisations recently denounced the BFA that forbids disclosure about these matters. Continuing asylum-seeker healthcare balances the likelihood of effective care and monitoring with lending credibility to abuses.”
Find abstract here.

Freedom to speak up: whistleblowing policy for the NHS

Monitor, NHS Trust Development Authority and NHS England, 16 November 2015
“In response to Sir Robert Francis’ Freedom to Speak Up review, Monitor, NHS TDA and NHS England are proposing to introduce a national whistleblowing policy. We intend for the policy to be adopted by all NHS organisations in England except for primary care providers. We also hope it will also be adopted by independent providers of NHS healthcare.”
Find policy and consultation information here. The consultation closes 8 January 2016.

Doctors silenced over Australia’s immigration centres

The Lancet, Volume 386, No. 10007, p1932, 14 November 2015
Author: Chris McCall
“A new law potentially threatens health workers with jail if they reveal too much about what really goes on inside Australia’s immigration detention centres. Chris McCall reports.  Nurse Marianne Evers lasted 3 weeks when she went to work in the Pacific island nation of Nauru. It sounded like a dream nursing job, but in revelations that subsequently made headlines, Evers described suicides, fights, beatings, and lack of proper toilet facilities at a centre holding would-be immigrants to Australia that Australia had kept out. She calls the place a “concentration camp”.”
Find article here.

Veterans’ health care: a call of duty

The Lancet, Volume 386, No. 9998
“Last week saw the US Department of Veterans Affairs (VA) hit by yet another health-care scandal. On Sept 2, the VA’s Office of Inspector General (OIG) published its report reviewing alleged mismanagement at the Veterans Health Administration’s Health Eligibility Center. In response to a whistle-blower’s claims, it investigated whether the centre had more than 850,000 health-care applications in a pending status, whether more than 47,000 veterans had died while their applications were pending, whether 10,000 health records were purged or deleted, and whether thousands of unprocessed applications, spanning a 3-year period, were discovered in January, 2013. On all four counts, the OIG found the VA guilty.”
Find editorial here.

Taking action to support doctors who raise concerns

GMC, online 4 August 2015
How we deal with complaints about doctors who are whistleblowers.
“We have published our action plan (pdf) in response to Sir Anthony Hooper’s independent review (pdf) of how we deal with complaints about doctors who are whistleblowers. The review recommended that we should better understand the background when an employer refers a doctor to us, where the doctor has raised a concern with or about their employer. We are considering these recommendations carefully in our action plan, so we can make sure that we deal with the concerns about the doctor fairly and appropriately.”
Find link to action plan and related information here.