appear to have either been caused or exacerbated by the time spent detained in hotel APODs. This included individuals being overweight, having high cholesterol levels, lacking vitamin D, suboptimal type II diabetes mellitus care, and mobility issues. The lack of exercise and access to outdoor spaces, as well as variable food quality, were identified as contributing factors to these health issues. Community health providers also invariably described the former detainees that they saw as having significant physical and mental health issues, and reported that in a substantial number of cases there were dental or medical issues that required urgent attention. The evidence presented to us suggests that there were significant limitations in the way that medical needs were addressed in hotel APODs. It was also suggested that some of the unaddressed health issues that were seen in former detainees gave rise to questions about the clinical governance and medical responsibility in the hotel APODs, and were indicative of a lack of urgency when dealing with observed medical issues. For example, following the release of detainees from hotel APODs some community health organisations described ‘urgently arranging dental reviews, optometry, outpatient medical specialist appointments, dietician and physiotherapy appointments for their chronic conditions’ and from the issues they were seeing concluded that ‘[t]here has not been any patient-centred care and little ongoing management of these patients’ chronic medical needs’. Care appeared to be principally reactive to patient identified needs, with the holistic preventative primary care health approach needed for complex and chronic conditions often missing. A number of specific examples were given to illustrate these concerns, including there being several individuals who had been diagnosed with latent tuberculosis only after being released from hotel APODs. When asked about these particular examples, IHMS staff indicated that all detainees would be screened for tuberculosis as part of a full screening process conducted prior to their transfer to Australia, and that this should have been identified either in this initial screening or in one of the subsequent ongoing assessments that are regularly conducted. The Commission was informed that it would be ‘incredibly rare’ for this not to be identified, and yet it appears that there were at least several examples of this occurring. A further issue that was commonly raised was the difficulties in accessing care outside of the on-site operating hours. Detainees described designated medical staff as not being available on weekends or outside of business hours, and that this led to significant delays in receiving medical care at those times. A number of individuals stated that they were only ever provided with Panadol after hours, and it was acknowledged by staff that when the IHMS staff were not on site, the security staff were only authorised to distribute Panadol in response to detainee requests. (b) Access to specialist health care When people in detention require specialist health care that cannot be provided by the IHMS health service – such as dental, optometry or physiotherapy – IHMS will either contract external providers or make referrals through the public health system. IHMS staff have informed the Commission that they aim to provide a standard of health care in immigration detention that is broadly comparable to that available to the general Australian community through the public health system. The Use of Hotels as Alternative Places of Detention (APODs) • 2023 • 39