The contractor responsible for the health of asylum seekers has been slugged more than $300,000 for problems relating to treatment of tuberculosis and other serious diseases in onshore detention, raising grave questions over the quality of care delivered to vulnerable people behind the wire.
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A report by the Australian National Audit Office into onshore detention also found some detainees at severe risk of self-harm were being reviewed only once a fortnight, rather than every 24 hours as prescribed by official clinical guidelines.
It also found cost-cutting had led to changes to the way medication was distributed, creating the risk of prescribing and dispensing errors.
The findings cast into serious doubt assurances by the federal government and Department of Immigration and Border Protection that healthcare in both onshore and offshore detention meets community standards.
In just six months between July and December last year, health services provider IHMS was charged $309,000 – or 2 per cent of its service fee - for "significant failures" under a penalty and incentive regime.
IHMS failed to fully comply in all but one performance measure.
In a statement the company, which also provides healthcare in offshore detention centres, said the fines related to reporting failures "and not for failures of clinical care", including incident reports not sent to the department within the required timeframe.
The performance of IHMS in such reporting had since improved, it said.
The failings related to, among other measures, identification and treatment of active tuberculosis and serious communicable diseases, and timely provision of healthcare, mental health screening and vaccinations.
Despite those in immigration detention being at high risk of mental illness, clinical guidelines to prevent self-harm and suicide were not followed for a "large number" of detainees.
Between February and November last year, there were 407 instances of a detainee being deemed at high imminent risk of self-harm.
Under the department's own program, such detainees should be clinically reviewed every 24 hours at a minimum – but the audit found they were reviewed, on average, every three days. Some were reviewed once or twice a fortnight.
The report found the department did not formally monitor whether IHMS was properly implementing such procedures.
IHMS said in a statement it was discussing the need for a review of psychological support procedures with the department.
In response to the department's demand for cost-cutting, IHMS implemented a new model under which just 14 per cent of detainees would need a nurse to administer their medication - for reasons such as the risk of self-harm or medication misuse.
However, the number of detainees needing nurse-administered medication was as high as 75 per cent. IHMS "flagged the risks associated with medication administration" to the department in December last year, citing "risks including prescribing and dispensing errors" by overworked nurses.
The report also found the department was failing to monitor the quality of primary healthcare in offshore detention, 15 months after the contract with IHMS was signed.
A department spokeswoman said the report found its administration of health services in onshore immigration detention "has been improved", and that onshore detainees "receive care at a comparable level to that available to the Australian community".
She said the department has accepted the report's recommendations and was working to implement them.
This included identifying risks to the effective delivery of onshore healthcare services and a proposed performance assurance review program to manage these risks.
"The department has also instigated a robust auditing process of detainee complaints relating to the provision of health services delivery, including weekly reporting of detainee complaints and the outcomes of those complaints," she said.
IHMS said its performance in offshore detention system was not within the scope of the audit and rejected suggestions that healthcare in onshore detention did not meet community standards.
