AMA President Professor Brian Owler has accused the Federal Government of trying to intimidate doctors and other health workers from speaking out about the treatment of asylum seekers being held in immigration detention centres.

The AMA President has mounted a strongly-worded attack on controversial provisions in the Government’s Border Force Act aimed at gagging whistleblowers amid mounting claims that many detainees – including children – have been sexually and physically abused while in custody.

Professor Owler said doctors were ethical and morally obliged to advocate for the welfare of their patients, and the new laws – which threaten up to two years imprisonment for unauthorised disclosures – placed them in an invidious position.

“As doctors, we have an ethical and moral obligation to speak out if we have concerns about the welfare of our patients, whether it be the treatment of an individual or whether it be at a system level,” he said.

Asked if the AMA was advising doctors to refuse to work in detention centres under these conditions, the President said that it “wouldn’t matter what I said, I suspect. I think doctors would vote with their feet and they would go and provide health care to asylum seekers, because that’s what they do”.

“Doctors will always go and look after the patient, and they will put their own interests second.”

The apparent attempt to gag critics has come against the background of ongoing reports of abuse and assault at detention centres.

The independent Moss review of allegations of abuse at the Nauru detention centre, released in March, found evidence of rape, the sexual assault of minors, and guards trading marijuana for sexual favours from female detainees.

Despite this, a separate Senate committee inquiry heard last month that no detention centre staff accused of abusing children have been charged.

Transfield, which has a $1.2 billion contract to operate the Nauru and Manus Island detention centres, said that of 67 allegations, just 12 had been referred to police.

In other testimony, a former senior doctor with Immigration Department contractor International Health and Medical Services, Dr Peter Young, told the Senate committee that medical staff were directed not to report mental health problems.

Dr Young, who was director of mental health for IHMS, said he was told several times not to report that asylum seeker mental health had been harmed by being detained at the Nauru detention centre.

Separately, the Government-appointed Council on Asylum Seekers and Detention has been told that detainees begin to suffer serious mental health problems within three months of incarceration.

Immigration Minister Peter Dutton has sought to provide assurances that health workers who spoke out would not be prosecuted under the Act, but Professor Owler said much more was needed.

“The AMA has been concerned about the provision of health care to asylum seekers, particularly those in the offshore processing centres of Nauru and Manus Island,” he said. “Legal advisers have confirmed that the Act provides penalties, including potential imprisonment for doctors, nurses and other health workers who speak out about abuse or the wellbeing of asylum seekers.”

Professor Owler said that if medical whistleblowers were not liable for prosecution, then “it should be clearly and directly spelt out in the legislation”.

“We call for this exemption because, for a doctor, an asylum seeker is no less a patient than any other patient. If we are willing to compromise the rights of doctors and patients for one group, how can we ensure that other groups will not be compromised in the future?” he said.

Adrian Rollins

Radical plans that could see the Federal Government dump all responsibility for public hospitals onto the States or pay for hospital treatment through a Medicare-style benefit scheme are up for discussion when Prime Minister Tony Abbott meets with his State and Territory counterparts at a special leaders’ retreat later this week.

The Prime Minister called the retreat to discuss reform of the Federation, and the division of responsibility for health services, particularly the funding and operation of public hospitals, is expected to be a central plank of the talks.

Since coming to office, the Abbott Government has engaged in a high-stakes stand-off with the States and Territories over public hospital funding. In its first Budget, it disowned funding guarantees made under the National Health Reform Agreement and reduced the indexation of post-2017 funding to CPI plus population growth, ripping $57 billion out of the public hospital system over 10 years.

The move is seen as part of a broader gambit by the Federal Government to pressure the states into looking at alternate sources of revenue, including increasing the GST or broadening its base.

Treasurer Joe Hockey last week increased the pressure on the States by declaring that each level of government should be responsible for raising the revenue needed to pay for the services they provide.

Mr Hockey said reforms discussed at the leaders’ retreat must include “the States taking responsibility for their own budgets in order to ensure they can afford their ever-increasing expenditure – such as the costs of their public hospital systems as our population ages”.

The tactic has echoes in the Government’s current strategy – likened by AMA President Professor Brian Owler to introducing a patient co-payment “by stealth” – to freeze the indexation of Medicare rebates until mid-2018, forcing many practices to cut bulk billing and introduce or increase patient charges in order to remain financially viable.

The AMA is a fierce critic of both policies, and Professor Owler – who will deliver a nationally-televised address to the National Press Club Wednesday – warned of an “impending crisis” for the nation’s public hospitals unless more money was injected into the system.

Professor Owler said public hospitals were facing a “perfect storm” of increasing demand, missed performance targets and major funding changes.

“The combination of these factors will have devastating consequences for our public hospital system,” he told the AMA National Conference in late May.

State and Territory leaders, particularly NSW Premier Mike Baird, are similarly outraged by the Federal Government’s tactic. Mr Baird warned earlier this year that the States simply “do not have the capacity to meet those health costs on their own”.

The Queensland Government estimates the Commonwealth’s decision to claw back public hospital finding will leave the State $11.8 billion worse off by the middle of next decade, with serious consequences for the quality and availability of care.

“Unless these federal funding cuts are reversed, there will be a shortfall in funding for Queensland hospitals – and a resultant decline in the quality and timeliness of services – from July 1, 2017,” it warned.

It is in this heated atmosphere that the leaders are expected to discuss ideas for future hospital funding, including those prepared by the Department of Prime Minister and Cabinet.

In its Green Paper it makes five suggestions, including the Federal Government shifting full operational and funding responsibility for public hospitals onto the States and Territories, the creation of an MBS-style hospital benefits scheme, jointly funded individualised patient care packages, or the establishment of a single national or regional agencies to purchase health services.

Grattan Institute Health Program Director Professor Stephen Duckett and colleague Peter Breadon said introducing a Hospital Benefits Schedule was a promising idea that could see a return to shared incentives by exposing both the Commonwealth and States to the cost of growing demand for hospital care.

Although many of the factors forcing health costs up have little to do with the structure of the Federation, the Reform of the Federation Green Paper 2015 said improving the way the health system was funded and operated could improve prevention and care while making better use of funds – particularly by providing funding on the basis of outcomes rather than activity.

Professor Owler said that, whatever the funding model that might be developed, it needed to ensure public hospitals were given the resources they need to meet the growing demand for care while also providing the quality teaching and training that the next generation of doctors required.

He said that pushing responsibility for public hospital funding back to the States and Territories without providing them with the means to generate more revenue would be “irresponsible”.

Mr Baird declared public hospital funding was the most significant finance issue facing the States and Territories, and Professor Owler said he was particularly concerned about prospects for the smaller jurisdictions, some of which had areas of significant disadvantage and inequitable access to care, but which had limited revenue-raising capacity to fund improvements on their own.

“If the planned changes [announced in the 2014 Budget] go ahead, there will be serious consequences for frontline clinical services,” he said.

Adrian Rollins