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stacyamy

Health issues - Would I Pass medical?

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Hi im after a bit of advice. We are wanting to apply for a visa but I am worried we will pay the money out for it but i will fail my medical as I have renal damage and high blood pressure. Has anybody else been in a similar situation and what do you think my chances of passing my medical are. Anyone know what grounds they fail you? Its just a lot of money to waste if ive got no chance of passing my medical in the first instance.

 

Any advice big or small would be greatly appreciated.

 

Thanks in advance

 

Stacey :confused:


Growing old is mandatory, growing up is optional :wink:

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Guest threespire

Hi Stacey,

 

Whilst I cannot give you any direct advice on your circumstances, what they are essentially looking for is how much of a drain you will be on teh Australian healthcare system. If it's not a definite "no no" from the outset, They will usually ask for Specialists reports about your condition's history, how its managed and prognosis, in order to give them a clearer picture of what they're dealing with.

 

It may be worth contacting your nearest panel doctor (who would do the medical) and asking their advice before you embark on the whole visa process, just to get a feel for whether it's worth you even applying.

 

Hope that's maybe helped a bit??

 

Good luck with everything, wishing you well,

 

kirsty xx

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I am in the same position! I have a heart problem that may mean that I will need to have the valve replaced at some point? I just have annual checks and I am perfectly fine at the moment - but it could change in years to come. We could pay all the money to apply for a visa and get thrown out on a medical.

 

I spoke to the Australian Embassy and there is no way round it. I have also spoken to the doctor who performs the medicals and he basically said that they just tick boxes - A if you are in perfect health - B if you have a condition that may need some further investigation and C if you are a big no no!

 

The Embassy did say that sometimes if you can prove you have private medical care (which we will have to have to apply for state sponsorship, that may help). sometimes they still accept people with cancer, HIV etc it is not cut and dry.

 

We have decided to just go for it and see what happens! best of luck

 

xx


SS Vic recieved after appeal 8/10/2009, 176 Visa application 9/10/09, OH Electrician, Nov 2010 moved to Cat 2, 9th Nov Case Officer, extra information requested, medicals 18th Jan, medicals finalised now just the police checks!!! We got our visa !!! Yey soooo happy

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Guest Jules2

Hi Stacey

 

Just thought I'd let you know we're in the same situation. Hubby has a bad heart, previous heart attack (1999), double by-pass (2003), and 3 stents put in this year. We have still to do the medicals, just waiting for the nod to get them done. I'm very worried about them, but hope that as the Visa is based on my skills that they may be a bit more relaxed on his medical. Also, as previously said, we are also on a SS Visa 176 so need to have private medical insurance, so won't be a burden on the state.

 

Trying all I can to be as optimistic as possible... will let you know as they will be due any day now and if he passes with all his problems anyone can pass!!:smile:

 

I've still to find anyone that's actually failed the medical and not got the visa.

 

Good Luck

 

Jules

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Hi everyone

 

Thank you very much for this information/advice, it is greatly reassuring and much appreciated. Good luck to everyone who is awaiting on medicals and fingers crossed we not to much of a drain for Oz! Hoping my partners skills should make up/put back anything I may be taking out of the country anyway haha!

 

I will be looking into getting private health care as I have ongoing care in this country and will probably need it forever :sad:. Any advice on this also would be greatly appreciated. (Recommendations/cost ect ect)

 

Think the best thing is to just go for it like everyone says as we will never know otherwise.

 

Good luck with your journeys and may see you in and around the surgerys in Oz someday :eek: haha

 

Stacey

St


Growing old is mandatory, growing up is optional :wink:

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Guest Gollywobbler

Hi Stacyamy

 

The Medical Officer of the Commonwealth can be neurotic about renal problems because of the cost of dialysis, teh shortage of facilities for it and in particularly the shortage of donor kidneys in Oz.

 

I note that you are a legal secretary and I've never met one who doesn't have shedloads of sheer stamina in order to cope with the workload!

 

Presumably you have a Consultant Nephrologist looking after you? S/he should be your first port of call. Please see this link:

 

ParlInfo - Title Details=

 

To give you the background, the Minister for Immigration is Senator Chris Evans. Mr Metcalfe is the overall boss of DIAC (technical title the Secretary of DIAC.) Mr Vardos is DIAC's Head of Policy. The 3 of them were grilled by the Senate Estimates Committee for two days at the end of May 2009. The first day included quite a lengthy Q&A sesh about the medical criteria for migration to Oz. If you scroll down through the document you will find it. To make is easy, though, here is the burble:

 

Senator FIFIELD —Minister and Mr Metcalfe, you would certainly be well aware of the number of high profile cases recently of people with disabilities who have been denied the immigration outcomes they were seeking. That was particularly highlighted by the case of Dr Moeller’s son, who had Down syndrome. I am also aware of the review that the House Committee is undertaking from the reference of yourself and Parliamentary Secretary Shorten. I want to get a handle on the prevalence of these sorts of cases. Mr Vardos is probably the best officer to direct questions to.

Senator Chris Evans —He is the one with public notoriety from defending the Dr Moeller decision.

Senator FIFIELD —That is right. How many people apply for permanent residency in Australia, not specifically people with a medical conditions or a disability, just overall?

Mr Vardos —I could not put my finger on a number to tell you how many permanent residence applications there are in any given year at this moment. I will have to take that on notice unless one of my colleagues has that table handy. The program is announced by the minister and each year there is a ceiling. There are more applicants than there are visas granted.

Senator FIFIELD —Obviously.

Mr Vardos —I cannot put my finger on how many applications we might get.

Senator FIFIELD —I am sure you will provide that to the committee. Can you advise how many are refused permanent residency on the basis of failing to satisfy the health requirement?

Mr Vardos —I do have a brief on that. In the 2007-08 program year, the number who did not meet the health requirement totalled 54. In 2008-09, to 31 March, it totalled 57.

Senator FIFIELD —That is failure to meet the health requirement?

Mr Vardos —Yes.

Senator FIFIELD —Are you able to break those two numbers down further?

Mr Vardos —My colleague tells me I have made an error in my interpretation. I might have to take that on notice to give you a correct figure.

Senator FIFIELD —Is it fair to say that it is something of that order of magnitude; that is, we are talking in the tens rather than the hundreds?

Mr Vardos —I mentioned numbers in relation to visa classes for which we will be looking at introducing a health waiver where one does not currently exist. It is possible that overall the number not meeting the health requirement could be in the tens or in excess of 100, but it is not in the thousands.

Senator Chris Evans —I have seen those numbers before and Mr Vardos is right; that is not the number you are asking for. I think we ought to take that on notice, but we may be able to get it to you shortly. You are after the number of applicants refused on health grounds.

Senator FIFIELD —And if that can be further broken down into those who are refused on the basis of having a disability as opposed to an illness.

Senator Chris Evans —Mr Vardos might be able to take you through that, but I am not sure that we break it down in that sense, in that there is not an effective disability clause.

Senator FIFIELD —You either meet the health requirement or you do not.

Senator Chris Evans —Yes, and it is often misrepresented as being a disability clause when in fact it is a health clause.

Mr Kukoc —We will take it on notice as Mr Vardos has said. But I am pretty sure that we do not break down refusals on the basis of type of illness or disability.

Mr Vardos —The two things that might lead to refusal are having a disease that is a risk to public health, and tuberculosis is the issue there. Normally where tuberculosis exists there would be a possibility for treatment to bring it under control. That might result in someone then meeting the health requirement. The other area—and this is where there can be an intersection with disability—is costs. Another area that leads to refusal is where if a person came to Australia they would impose significant costs on the system. There is a capacity in many visa classes to waive the health requirement; in other words, having acknowledged the cost, choosing to waive the health requirement. In other circumstances—including some of the celebrity cases we have had over the past year—there is no actual capacity within the regulations for the department to waive the health requirement. The only way for those cases to be dealt with is for them to go to the Minister. However, the department has been working towards opening up that area to departmental decision making.

Mr Vardos —The only thing I would add is that if it is a condition that is likely to prejudice access by Australians to health care and community services that may be in short supply—

Senator Chris Evans —The classic there is a kidney transplant, where we have a waiting lists of Australians and that would affect the supply.

Senator FIFIELD —Sure. Mr Vardos, you mentioned that work is being undertaken to provide the capacity for a waiver where that does not currently exist. Can you take us through that a little more?

Mr Vardos —Only certain visa classes have a waiver available to them if someone fails the health requirement. The one that immediately comes to mind is if you are in refugee or humanitarian circumstances. It does not readily apply to skilled visa categories. That is where we had the issue with Dr Moeller. He was applying for a skilled visa and there was no waiver available. That case has focused us on the issue of looking at what would be reasonable in terms of creating a waiver available to a decision maker rather than having an applicant going all the way through the appeal process and ultimately ending up at the Minister’s desk asking for a ministerial intervention.

Senator Chris Evans —We have had negotiations with the states on the waiver issue.

Mr Vardos —We are negotiating with the states. Again, there is a financial threshold, which at the moment might surprise you—it is only $21,000. A state or territory’s reaction is not binding on the Commonwealth, but it is something we would like to do in concert. We are consulting with the state and territory governments to increase that threshold. It is a work in progress.

Senator FIFIELD —Is that just in order to be kind and thoughtful to the state and territory governments?

Mr Vardos —It is recognition of the fact that ultimately if someone has an illness or a condition they will end up in a state or territory health system to be dealt with. The states have a significant stake in this issue.

Senator Chris Evans —I do not want to focus on Dr Moeller’s case, but if his son needed an aid at school that would be a cost that would fall on the state government. Often the costs of these decisions are not directly carried by the Commonwealth, although we might be subsidising health and education costs. But the principle is that you consult with the states, because they are going bear the burden, if there is a burden, in terms of health or other support or community needs.

Senator FIFIELD —Mr Vardos, you mentioned that Dr Moeller and his son were knocked back because there was no waiver possible in that skilled migration category. Dr Moeller’s son was clearly not coming here as a skilled migrant, although his father was. That is just a function of the fact that as a dependant you are subject to the visa or skill category—

Mr Vardos —That is exactly the case. The dependants of the principal applicant are included in the consideration of meeting the health requirement.

Senator FIFIELD —Minister, by the sound of things, you are not waiting for the outcome of the House of Representatives inquiry before taking action to alleviate the situation.

Senator Chris Evans —I made an announcement at the time that I would look to extend those waivers through negotiations with the states. I think I have approved two or three states already and the others are close to signing. That is my information. That allows us to consult with them on the waiver on those small number of categories. I think we have regulated two or three states.

Mr Vardos —The ACT, Victoria and Western Australia have formally agreed to participate. The consultations are based around an estimated threshold of $100,000. That is what we are negotiating around. The arrangements came into effect on 28 March for the ACT and Victoria and 15 May for Western Australia. The consultation is continuing with the other jurisdictions.

Senator Chris Evans —Not putting too fine a point on it, I said that if I have one I will put it through rather than wait for all seven to come to a consensus. We have three through and the others are getting close. I think the previous government found when it had been in this field that the process went on for five or six years. Like many of the commonwealth-state arrangements, it basically just atrophied. I think there are three on board and the others will come on board in the next little while. That at least gives us some capacity to deal with those visa classes, but it does not solve the problem.

I make a point that is important but not widely understood. I get a lot of applications for ministerial intervention in this area from people who have been refused in accordance with the law. This is not about the department being heartless. Mr Vardos had to go out there and be the public face of the department in that particular case.

Senator FIFIELD —A charming face.

Senator Chris Evans —I can assure you that he is a caring and compassionate man, but he was not portrayed that way at the time. But it is important to understand that, first, it is a health issue, not so much a disability issue, but clearly it impacts on people with a disability. The balance for us in a public policy sense—and this is what I hope the parliamentary committee comes to terms with, bearing in mind that there has been a lot of talk about push and pull factors—is that we have one of the best health systems in the world. For all our failings in terms of community services and health services, we have a very attractive health and community services structure, framework and access in this country. One of the things you confront in dealing with the public policy area is that probably 95 per cent or more of people with health and disability issues in the world would get better treatment in Australia than they would where they are living now.

What the committee will have to deal with is exploring that tension between wanting to treat people in a proper and fair way and not discriminating against people because of disability, as well as deal with the fact that we are a very attractive place for access to health and other community services. That is why I am happy for the committee to get stuck into the work—because there is no easy answer. A good airing of those issues in a debate on the public policy options would be helpful. I know that previous ministers have had to deal with this, and it is not easy. It is an important issue. I just put on the record something that is not acknowledged by some groups when they talk or think about this. As I say, I hope the parliamentary committee will do a thorough job on those issues, as it is part of their terms of reference.

Senator FIFIELD —Sure. Thank you for that. In the case of Dr Moeller’s son, I think Mr Vardos mentioned that $21,000 was the threshold for medical costs.

Mr Vardos —We are negotiating a new threshold of $100,000.

Senator FIFIELD —Yes, but at the moment it is $21,000.

Mr Vardos —Yes, $21,000.

Senator FIFIELD —At the moment, it is $21,000.

Senator Chris Evans —That is a different issue, is it not? It is a question of when the medical officer has to make the decision.

Mr Vardos —Yes, ‘does not meet the threshold’.

Senator FIFIELD —In the case of Dr Moeller’s son, was that $21,000 threshold relevant?

Senator Chris Evans —I think someone might take you through how the health waiver works in the officer’s decision making. We are confusing two issues here, in a sense. Maybe Mr Kennedy, who knows about it, might come to the table and just take you through what the department are required to do if they think there is a health cost associated with an applicant or a member of an applicant’s family.

Mr Kennedy —Senator, the three elements of the health requirement have been described in earlier responses. The $21,000 threshold is what is classified as the ‘does not meet’ threshold. If the health costs or community services costs related to a health condition exceed $21,000, a medical officer will find that the applicant ‘does not meet’. The $100,000 figure is the figure at which we are proposing to refer to the states items that might attract a waiver.

Senator Chris Evans —Could you explain why the threshold is $21,000 and how that is assessed by the medical officer? That is the key issue. It is actually not a departmental decision.

Mr Kennedy —The $21,000 is the threshold that the medical officer of the Commonwealth uses to asses eligibility in terms of whether the applicant meets or does not meet the requirement. The medical officer of the Commonwealth considers a range of factors, including health costs and community support costs and, if the medical officer of the Commonwealth assesses those costs as totalling more than $21,000, he will declare that the applicant ‘does not meet’. In that circumstance our visa decision maker must accept the medical officer of the Commonwealth’s decision and must refuse the visa.

Senator FIFIELD —Is that $21,000 a figure that has been negotiated or agreed with the states?

Mr Kennedy —Sorry?

Senator FIFIELD —That $21,000 is agreed—

Mr Kennedy —No. The $21,000 is the ‘does not meet’ threshold.

Senator FIFIELD —It is just stipulated.

Mr Kennedy —Yes.

Senator Chris Evans —I think it would be worthwhile your explaining that this is not an assessment of the individual’s case, because I think that is the other issue here.

Mr Kennedy —Yes. The courts have held that the medical officer has to assess the situation on the basis of what is called a hypothetical person, not the individual circumstances. They have to assess the circumstances as if they apply to a hypothetical person. A medical officer is not able to take into account the individual circumstances of the individual applicants. In the Moeller case, as I think the minister has already mentioned, the other factors that might have been weighed in, such as whether the family was of value to Australia, were not able to be taken into account.

Senator Chris Evans —But also things are taken into account like whether they have private health insurance or whether they have a milder form of whatever the condition is. Effectively, it is not an individual assessment. That is the key issue. I do not think we ought focus on Dr Moeller all the time. When they make an assessment about somebody, it is more a generic costs argument rather than saying, ‘We have examined person A and we think they’re going to cost $300,000 because they’ll need this, this and this.’ It is more of a generic assessment which is applied against that person, and that is where the $21,000 threshold kicks in.

Effectively, what that has meant is that the department has lacked any discretion. Even if a decision maker says, as the MRT did in Dr Moeller’s case, that they thought there was a strong argument, given all the other issues at stake, the department and the MRT have no power. Under our perverse system, the only one who does have the power is the minister in any individual case. But these are the sorts of issues we want to explore through a committee because that has been a longstanding system, as I understand it—Mr Kennedy?

Mr Kennedy —The health requirement has been in place in its current form since the 1990s.

Senator FIFIELD —Sure.

Mr Kennedy —Mr Hughes just reminded me that when I say a medical officer finds that somebody does not meet, there is no discretion in the department. There of course is discretion when a waiver applies. Waivers were spoken about earlier. Generally, waivers apply in the family stream.

Senator FIFIELD —Sure. Thank for that. In the case of Dr Abdi, a case with which you and the minister would be well acquainted, could you take me through the relevant officer and what the situation was there. Dr Abdi had been knocked back by the department in this instance.

Mr Kennedy —As I understand it, Dr Abdi did not apply. He did not have the relevant visa. I think he had taken advice that he would not meet the particular skilled visa that he was applying for and therefore did not apply for that skilled visa.

Senator FIFIELD —Did he apply for a protection visa?

Senator Chris Evans —He applied for protection, was found not to be under Australia’s protection, and then went to the RRT and lost at the RRT. I do not want to go into the details of his case, but this has been in the press. Then the debate came to be about the question of his disability or his blindness, whereas in fact that had not been considered. One of the issues I was going to raise earlier is that one of the effects of the health test is that of course there is a deterrence value: if you know you are not going to meet it, do you apply for a visa? Dr Moeller was in the country on a 457, which had a lower threshold.

One of the issues for us is that different visas have different thresholds in terms of health testing. If you think about the recent debates, there have been debates about people who are already in the country. We tend not to get into a debate about people who are not in the country because they do not get past the first hurdle, if you like. But, with increasingly large numbers of people coming in temporarily on work, student or other visas, we are seeing an increase in debate around these issues. Dr Moeller was here on a 457; Dr Abdi was here originally on a student visa. So you have people already in the country and then it becomes an issue when they are here on a valid visa and they want to move to a permanent visa. I do not want to say anything more about that case because his file is actually before me at the moment, Senator.

Senator FIFIELD —Sure. I appreciate that. I have just two more questions before I yield. I see that the Disability Discrimination Act does not apply to the department of immigration.

Mr Metcalfe —That is correct, Senator.

Senator FIFIELD —Okay. I am not necessarily contending that it should, because I guess the very nature of a lot of decisions by the department are discriminatory in a very neutral sense, in that you are discriminating on the basis of one criterion or another. But does the Anti-Discrimination Act as a whole not apply to the department?

Mr Metcalfe —I do not think so. I will check that, Senator. I think the answer is that we are not exempt from the act. Certainly we are in regular contact with the Human Rights Commission on various matters, but regarding that straight legal question, I must say that I have not looked at that recently. I will check and let you know.

Senator FIFIELD —If you could, please take on notice what elements of the relevant Commonwealth discrimination law the department is exempt from.

Mr Metcalfe —Perhaps if I take that slightly wider, I will look at what aspects of discrimination legislation apply or do not apply to the portfolio.

Senator FIFIELD —That is right. Include it, but do not limit it to disability discrimination legislation. That would be useful.

Mr Metcalfe —Yes.

CHAIR —Just to clarify that, Mr Metcalfe, you mean the programs in the portfolio, as opposed to the department.

Mr Metcalfe —Yes, probably most correctly to decisions made under legislation.

Senator FIFIELD —The decision-making process.

CHAIR —As long as we are clear.

Senator Chris Evans —Not in terms of the treatment of our staff?

Senator FIFIELD —No.

Senator Chris Evans —As far as I know, anyway!

Mr Metcalfe —That is right.

Senator FIFIELD —No, in relation to the decision-making process.

Mr Metcalfe —That is right.

CHAIR —We are just going to try to narrow the investigation.

Mr Metcalfe —The visa decision making.

Senator FIFIELD —The visa decision making, that is right.

Mr Metcalfe —Thank you, Senator.

Senator FIFIELD —Clearly there are a number of cases in which ministerial intervention results are initially brought to the attention of the minister of the day by virtue of media coverage. I am wondering—in the interim, while the House committee is undertaking its work and while your department is looking at the issue of the application of waivers, what processes are in place to ensure that cases similar to the ones that we have discussed today do not require media coverage before sensitive and appropriate consideration is given?

Senator Chris Evans —Senator, it is a good question. I suppose the answer is this: first of all, even in a couple of cases we have discussed, they were not actually generated by media coverage. They had a valid ministerial intervention request in the system. In Dr Moeller’s case, I think there was some communication breakdown and it became a media story, but it was actually being processed. There was some coverage of another case in Perth where there was a press story that was highly critical of our failure to deal with the matter, but I had actually already granted the visa subject to health and security checks.

Most of them do not hit the press. There is a reasonable number, not a large number but a consistent flow, of ministerial intervention requests involving these sorts of issues. Many are at quite low-cost levels, but some are much higher. Given the number of people onshore on temporary visas, I think the numbers are increasing or are likely to increase. As I say, ministerial intervention application is available to people, and they come through in the normal course of events. I would say that the vast majority of the ones I have dealt with have not received any media coverage, but equally I would say that I have not approved them all either.

Senator FIFIELD —Is there an issue of ensuring adequate communication with people who have requests in the system?

Senator Chris Evans —No. I think in one of the cases we talked about, Dr Moeller’s case, there was a communication breakdown and we bore some responsibility for that. In Dr Abdi’s case, I think his advocates highlighted the problem he would have, but had not yet hit, if you like, so there was something like a pre-emptive discussion of the fact that they knew under the current rules that he would have a problem in terms of another visa application. So I do not think that was a communication problem, as it were. Generally, they go to MI then, and the department would assess them against the minister’s guidelines for referral to me.

But they are coming through and I do not know whether the department has figures on the numbers that are MI or come to me for ministerial intervention, but I suspect they are growing as the number of people onshore who do not have permanent visas has grown. The thing about the way the migration program is changing is that you would expect the numbers to increase.

Senator FIFIELD —Sure. Thank you, Chair. Just in conclusion, Mr Vardos, you are taking on notice the number of people who are refused visas because they fail to satisfy the health requirement.

Mr Vardos —Yes, Senator.

Senator FIFIELD —And also whether there is the capacity to break that down further—whether the department does record in any way those decisions in further detail.

Mr Vardos —We will be able to provide that information before this committee rises tomorrow.

Senator FIFIELD —Yes.

Mr Vardos —I would like to apologise for the confusion of my earlier answers.

Senator FIFIELD —That is fine, thank you.

Senator Chris Evans —Senator, I just stress again that I think the deterrence effect would be high, so whatever the numbers are—I would be interested myself in the numbers of actual formal referrals—if you go the department’s portal and work your way through the system—

Mr Metcalfe —Yes.

Senator Chris Evans —It will tell you there is a medical test, and whether or not you are likely to pass it.

Senator FIFIELD —What? There is a bit of a self-assessment opportunity there?

Senator Chris Evans —Yes. People will seek advice and are told that if you have a serious medical condition, you are unlikely to qualify. I make the point only to say that the refusals perhaps will not be a true reflection of those who would have sought a visa, if they did not know the rules.

Senator FIFIELD —Sure. I appreciate that. Thank you, Chair.

 

 

Your best bet would be to discuss the situation with your Nephrologist because the MOC will want chapter & verse about the progonis, for sure.

 

You would need a robust report from your Nephrologist, heading the MOC off at the pass on the subject of costs and the possibility of needing more detailed help at some point in the future.

 

We do have a lady member who has had two kidney transplants. Their visa was refused - out of the blue - on medical grounds because the MOC decided that her anti-rejection drug was very expensive and that she was "bound to" suffer kidney failure and so would be "bound to" need dialysis in the future.

 

Her Nephrologist went mental when he read the MOC's report. The drug was expensive at the time but the Nephrologist knew that the American and European patents on it were about to expire and they have now done so. According o the Nephrologist. generic versions of the drug would be produced as soon as the patents came off and the drug would then be no more expensive than aspirin. He also drove a coach & horses through the MOC's claim that dialysis and/or a transplant would become inevitable because apparently that claim was nonsense as well.

 

They had to make a second visa application but the visa was granted in the end and the family now live in Australia.

 

The whole thing really depends on what your own Nephrologist says and what the long term situation is likely to be.

 

Anotherthing that needs careful consideration is which visa to apply for - and when. The Minister et al described the new State health waiver scheme. It is brand new and although WA is one of the States which has agreed to it in principle (along with every other State apart from NSW and TAS) the details ahve not yet been thrashed out, written down and signed, sealed and delivered. The idea is that it will apply to onshore permanent residency visas for employer sponsored visa applicants. According to the Three Musketeers, the States have indicated that in some situations they will be willing to absorb costs of up to $100,000 AUD.

 

However it is all still very vague as yet. The details could change quite a lot by the time that the formal deal is signed.

 

http://www.minister.immi.gov.au/media/media-releases/2008/ce08114.htm

 

The other issue with it is that the State waiver is intended to apply when the family are already in Oz on a temporary employer sponsored subclass 457 visa. This visa is capable of lasting for up to 4 years at a time. The MOC is able to say, "Mrs Bloggs does not meet the health requirements for migration." DIAC can go back to the MOC asking for an estimate of costs of the medical and associated care for the period of the visa. The MOC will then provide a figure.

 

DIAC can then tell the 457 applicant, "Right. It is up to you. We require your prospective employer to provide an Undertaking that the employer will foot the whole of this bill without resorting to Medicare in any way. We also require evidence that the employer is good for the money."

 

Some employers will provide this Undertaking but not many. Without it the 457 visa will not be forthcoming. In practice I think the State waiver is unlikely to get much use except, say, in the case of a disabled child who is born in Oz whilstt his/her parents are there on a 457 visa.

 

The third point to note is that the Minister has recently commissined an investigation into the workings of the health requirement for migration:

 

http://www.minister.immi.gov.au/media/media-releases/2008/ce08115.htm

 

http://www.minister.immi.gov.au/media/media-releases/2009/ce09039.htm

 

It is a time of uncertainty with the meds for migration.

 

Very few mgration agents really understand any of the issues involved. Very few. I can give you the names of some of the better ones in this area but in your shoes I would discuss the situation with your Nephrologist first.

 

A few weeks ago a family posted on here about a visa refusal based on a completely different medical condition. Nothing to do with kidneys. I'm a solicitor, not a nurse or a doctor, and I know absolutely zilch about kidneys or any other organ. By chance I had a routine appointment with my GP so I picked her brains about the visa refusal. She said that the problem with any potentially serious condition is that the patient can be hale and hearty but if they catch something else then the risk of complications is greater than with a person who does not have a condition involving a major organ and that if complications should arise they can be very expensive to sort out. She reckoned that this would be the thing that any Immigration doctor would worry about. Which seemed logical to me though I claim no understanding of the subject so I am merely passing it on. Again, your Nephrologist is the person to ask about this.

 

Best wishes

 

Gill

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Hi there Gill

 

Wow thanks for that. Now ya got me thinking! Im absolutely fine at the moment I hold down a full time job look after 2 kids and a house but am constantly being monitered and I know that sometime in the future they are going to go completely. I have about 25% function altogther and they have been stable for some years. I have spoken with my Consultant at the hosp and he said he does not see there being a prolem but to make sure I have good private medical insurance and to make sure its firmly in place before I go anywhere. At the moment I am attending 6 monthly check ups and my GP every 6 weeks for BP checks and am worried this may affect my chances of getting in. I am also more than happy with the level of care I am getting at the moment and am just worried I will not get the same level over there. I just dont know wot to do. Ive also spoken with my GP and he basically said the same as my consultant. Is it worth me going for it anyway or would it be a waste of money?? Am so confused:unsure:

 

Stacey


Growing old is mandatory, growing up is optional :wink:

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Guest Gollywobbler

Hi Stacey

 

Nobody except you can decide what you should do, hon. It is your life and your dream.

 

The public health service in Oz is very good indeed in my opinion. They are extremely thorough. It is on a par with France, for sure.

 

Private medical insurance is also readily available but I have no idea what the premiums would be. Please have a look at www.privatehealth.gov.au Only a fraction of the actual number of medical insurers are named on it but if you contact at least 4 of the ones who are named you should get a pretty good feel for the figures.

 

A coule of years back there was a 36 year old man on another forum. His description of his kidneys was that he has two and both were healthy but they were smaller than they should be for a man of his age, giving him about 50% of the renal function which would be normal for a 36 year old man. The MOC requested a kidney biopsy which his own Nephrologist refused to perform. He said it was senseless to interfere with kidneys which were not giving problems, would simply risk infection etc and he said that his clinical judgemen twas that he was not prepared to put his patient at risk for the sake of this unnecessary biopsy.

 

The MOC accepted the argument anad the visa was granted. I don't know how the MOC would react to 25% renal function and the MOC would definitely ask how likely it is that you might need dialysis and/or a transplant within the next 15 to 20 years, given that you are only 30 now.

 

The relevant health criterion for permanent residency in your case wuold be Public Interest Criterion 4005, which reads as follows:

 

4005 The applicant:

(a) is free from tuberculosis; and

(b) is free from a disease or condition that is, or may result in the applicant being, a threat to public health in Australia or a danger to the Australian community; and

© is not a person who has a disease or condition to which the following subparagraphs apply:

(i) the disease or condition is such that a person who has it would be likely to:

(A) require health care or community services; or

(B) meet the medical criteria for the provision of a community service;

during the period of the applicant’s proposed stay in Australia;

(ii) provision of the health care or community services relating to the disease or condition would be likely to:

(A) result in a significant cost to the Australian community in the areas of health care and community services; or

(B) prejudice the access of an Australian citizen or permanent resident to health care or community services;

regardless of whether the health care or community services will actually be used in connection with the applicant; and

(d) if the applicant is a person from whom a Medical Officer of the Commonwealth has requested a signed undertaking to present himself or herself to a health authority in the State or Territory of intended residence in Australia for a follow‑up medical assessment, the applicant has provided such an undertaking.

 

Private health insurance might go some way towards things but it shouldn't - that was never the intention of PIC 4005 and I think the THree Musketers got muddled abut this.

 

If your kidneys should suddenly cause acute problems though, it is like the MHS in the UK. They take the patient to the public hospital which specialises in treating the condition because doctors are on duty 24/7 and that is where most of the facilites would be.

 

Australia is especially concerned about kidney transplants because there is an acute shortage of donor organs.

 

I think you really need to go back to your Nephrologist and get him to read PIC 4005, plus hammer it home that aprox $21,000 AUD over 5 years is the deemed dividing line between whether someone meets the health requirement for migration or not. That figure is based on the notion that the average cost of health care in Oz is $3,600 a year according to the Australian Bureau of Statistics. If the expected cost is likely to exceed $4150 or so per year, there could well be problems with the MOC. What is the rough cost of monitoring you in the UK? The Aussie figures are comparable.

 

Any good migration agent will want to see what your Nephrologist says, so that is definitely the place to start with working this out.

 

Best wishes

 

Gill

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Thank you very much gill, I really appreciate your advice. Its certainly given me something to think about and also act on. Thats why sites like this are essential as we get to meet and take advice from people like yourself. Will speak to my in laws in Perth reitterating all you have told me and take it one step at a time. Am back at the hosp in September so will also ask my consultants the questions you have set out.

 

Once again thank you for your time and very helpful advice I have found it most useful.

 

Kind Regards

 

Stacey


Growing old is mandatory, growing up is optional :wink:

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Hi everyone

 

 

 

I will be looking into getting private health care as I have ongoing care in this country and will probably need it forever :sad:. Any advice on this also would be greatly appreciated. (Recommendations/cost ect ect)

 

 

Stacey

St

 

Stacey

 

Bear in mind that private healthcare here is not the same as in the UK. You still have to pay a lot out when you go to the doctor or healthcare provider and it is limited.

 

For example - we have private healthcare - each time my daughter goes to the physio, from the $75 charge we end up paying around $15. Our plan is a good one, on most you pay a lot more than that. Once we reach the limit of $600 worth of physion per year for her then she gets no more benifit from it.

 

It's something you should look at quite carefully so you will understand the costs involved.

 

Good luck with the medical

 

Love

 

Rudi

x


 

 

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Guest ClaireW

Hi, just thought I'd let you know we are in a very similar situation at the moment. My husband has IGA Nephropathy which is an ongoing kidney disease, he has just had a check up with his consultant and discussed our plans with him - he said he could give a report that would indicate the prognosis to be reasonably good but our problem would be protein in the urine as my husbands is a constant +3 and apparently they don't like this. I have just emailed ASA who have given us a free assesment and we get 3 free questions, I am still waiting for a reply but it may be worth you contacting them to see what they say.

 

We are looking at the possibility of paying for my husband to have a medical before we apply for the visa just so we know we aren't wasting about £4k+ This will probably mean paying for two medicals and obviously there is no guarantee but it would give us a little bit of piece of mind.

 

Also I would like to say thanks to the informative posts on this thread

 

Claire

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Guest Gollywobbler

Hi ClareW

 

Be aware that some agents claim to be experts on visa meds. Then when the whole thing starts to wobble, the truth is revealed. They haven't a clue and all they then do is act as a post box between you & DIAC. You don't get a dime back if their airy assurances at the begining turn out to be nonsense.

 

I'd suggest asking George Lombard because he has a part time doctor on his team:

 

Profile | George Lombard Consultancy Pty. Ltd.

 

Cheers

 

Gill

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Guest Samfire
Hi im after a bit of advice. We are wanting to apply for a visa but I am worried we will pay the money out for it but i will fail my medical as I have renal damage and high blood pressure. Has anybody else been in a similar situation and what do you think my chances of passing my medical are. Anyone know what grounds they fail you? Its just a lot of money to waste if ive got no chance of passing my medical in the first instance.

 

Any advice big or small would be greatly appreciated.

 

Thanks in advance

 

Stacey :confused:

 

Hi Stacey,

 

I'm retired on medical grounds (Hypertension among other things) and I can also vouch for the fact that medical issues are ok as long as (a) they don't put a huge financial strain on the Australian medical system and (b) your medical condition doesn't require frequent overnight hospital stays, where you might deprive an Australian citizen of a much-needed hospital bed. If your renal condition is managed by tablets, or regular visits to the GP for check-ups (reasonably affordable, inexpensive stuff), then you probably don't have much to worry about regarding the medicals. I would suggest however, that you bring as much medical documentation with you to your medical, such as GP letters and consultant reports, to answer any questions that the panel doctor may have on the day. He/she will also include these medical reports which will (a) provide information to DIAC when considering approval of your visa (b) eliminate the need for DIAC to request more information from you at a later date, which will slow up the visa process further. That's what I did anyway, and it worked out just fine! Hope this helps. Best of luck,

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Guest Samfire
Hi everyone

 

I will be looking into getting private health care as I have ongoing care in this country and will probably need it forever :sad:. Any advice on this also would be greatly appreciated. (Recommendations/cost ect ect)

 

 

 

Stacey

St

 

Hi Stacy,

 

I'm with Quinn Healthcare in Ireland (formerly BUPA Ireland) and I contacted BUPA International to find out if I could just transfer my current health insurance over to BUPA Australia (so I would have continuity and be covered for all illnesses that have developed since I first took out my health insurance nine years ago). Much to my delight, I was told that I can do this.

 

I have applied for a certificate of transfer from my current health insurers. I have to send on a scanned copy of this by email to Bupa Australia and they will arrange cover for us (you pay the first month by credit card) and when we arrive in Australia, we must present ourselves at the nearest Bupa Branch and show our official documentation. Then we must set up a direct debit for further monthly premium payments. We looked at a healthcare package at a higher level than we are covered for at the moment (with extras) and it works out at $208 per month for a family of four(this is nearly the same as I am paying at present in (Euro equivalent) for a much lesser package here at home, so all-in-all, you will probably find things very affordable on the healthcare front). If you need contact numbers for Bupa Australia, please feel free to PM me.

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Hi Claire and Sam

 

Thank you very much for your advice and input into my thread, its very much appreciated. Think the best thing is to just go for it and take it one step at a time. If I pass then I will make sure I have very good health insurance in place. It is a lot of money to just fail but think i'd regret not at least giving it a go. Good luck to everyone in a similar position and heres to a happy (and healthy) life in Oz :hug:xx


Growing old is mandatory, growing up is optional :wink:

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Guest Jules2
Hi Stacey,

 

I'm retired on medical grounds (Hypertension among other things) and I can also vouch for the fact that medical issues are ok as long as (a) they don't put a huge financial strain on the Australian medical system and (b) your medical condition doesn't require frequent overnight hospital stays, where you might deprive an Australian citizen of a much-needed hospital bed. If your renal condition is managed by tablets, or regular visits to the GP for check-ups (reasonably affordable, inexpensive stuff), then you probably don't have much to worry about regarding the medicals. I would suggest however, that you bring as much medical documentation with you to your medical, such as GP letters and consultant reports, to answer any questions that the panel doctor may have on the day. He/she will also include these medical reports which will (a) provide information to DIAC when considering approval of your visa (b) eliminate the need for DIAC to request more information from you at a later date, which will slow up the visa process further. That's what I did anyway, and it worked out just fine! Hope this helps. Best of luck,

 

 

Hi Samfire

 

Thanks for this post, very informative. We have our meds booked for next Friday (28th), so do you think it would be best for my husband (previous heart attack, bypass, stents) to go to his GP this week and get a letter or whatever he can from them... what should he ask for, just a letter explaining his current health and previous conditions, treatment, medication etc... I guess I just answered my own question. Is there anything else we should ask for???

 

Jules

x

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Guest Samfire

Hi Stacey,

 

Well that's what we did - we asked the GP for a comprehensive letter (or copies of whatever he/she has on file from specialists etc.). If you could get something from the specialist or surgeon who performed the operation and monitored your husband's post-op care, that would be good too, as they will definitely look for something like this and will need to know things like percentage of necrosis of the heart (if any), level of severity of the attack i.e. mild, medium, severe etc. and long-term prognosis. My dad had a bad heart attack back in 2004, and he has stents also. He suffered quite a lot of necrosis too and wears the patches and takes a series of tablet form medication to control his health issues. I know that he was given a copy of his medical report (Spanish Hospital, not UK). Would you possibly have received the same? Were you given a copy of the medical report after your husband's heart attack and subsequent surgery?? If so, submitting a copy of this would be excellent. The more information you have the better, providing of course it supports your application and that the long-term prognosis for your husband is good. Best thing to do if you haven't got a copy of the medical report would be to request the GP/Hospital to give you a letter for the purpose of visa medical application, outlining that your husband's medical conditions are unlikely to place excessive financial strain on the State/Territory resources. I would even postpone the medical exams if necessary, until you have this documentation ready to bring with you. Best of luck with it - let me know how you all get on.

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I am the main applicant for a 175 visa but my husband has Chronic fatique Syndrome.:SLEEP:

Does anyone know if this will pose a problem for his medical. He manages to work as a police officer - short hours, struggles with this but could do a less demanding job. He takes medication to stop him being depressed. He has never been hospitalised for any problem with this and has no other treatment apart from that 1 med.

What classes as an expense in the system. Medicine would cost about $50 monthly.

 

He will be a house husband, as i am a nurse so i need to work.

Can someone advise and relieve my worries about the medicals.:unsure:

 

Ta


Helen (Business Owner/Nurse) Neil, Connor 10,Natasha 8. Visa granted 15/03/2011, moved and settled Gold Coast, QLD 05/04/2011. Living the dream- Lady Helen of Helensvale:laugh:

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Guest angedoon
Hi, just thought I'd let you know we are in a very similar situation at the moment. My husband has IGA Nephropathy which is an ongoing kidney disease, he has just had a check up with his consultant and discussed our plans with him - he said he could give a report that would indicate the prognosis to be reasonably good but our problem would be protein in the urine as my husbands is a constant +3 and apparently they don't like this. I have just emailed ASA who have given us a free assesment and we get 3 free questions, I am still waiting for a reply but it may be worth you contacting them to see what they say.

 

We are looking at the possibility of paying for my husband to have a medical before we apply for the visa just so we know we aren't wasting about £4k+ This will probably mean paying for two medicals and obviously there is no guarantee but it would give us a little bit of piece of mind.

 

Also I would like to say thanks to the informative posts on this thread

 

Claire

 

 

Hi Claire

 

Could you please let me know how you went with regards to the protien in the urine? Did the ASA respond? Mum has the same problem and has had her medicals done, they sent her for extra scans and tests etc.

 

Thanks

 

Ange

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Guest Gollywobbler
I am the main applicant for a 175 visa but my husband has Chronic fatique Syndrome.:SLEEP:

Does anyone know if this will pose a problem for his medical. He manages to work as a police officer - short hours, struggles with this but could do a less demanding job. He takes medication to stop him being depressed. He has never been hospitalised for any problem with this and has no other treatment apart from that 1 med.

What classes as an expense in the system. Medicine would cost about $50 monthly.

 

He will be a house husband, as i am a nurse so i need to work.

Can someone advise and relieve my worries about the medicals.:unsure:

 

Ta

 

Hi there

 

Welcome to Poms in Oz.

 

The main worry for you won't be the cost of OH's drugs. The worry would be whether the MOC decides that OH would end up receiving Benefits in Australia. "Significant Cost" is deemed to be $21,000 AUD at present. Benefits come to much more than that if you add up the whole of someone's working life and you consider all of them carefully.

 

http://www.pomsinoz.com/forum/migration-issues/67292-have-your-say-health-requirement.html

 

http://www.aph.gov.au/house/committee/mig/disability/index.htm

 

Have a look at the Submissions to the present Inquiry, I suggest.

 

Cheers

 

Gill

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Guest ClaireW

Hi Ange - sorry for the delay - we haven't been on here for quite some time - basically ASA said you have to apply and wait and see because they judge every case individually - very helpful (not)

 

I'm just on here today trying to see if anyone else with a low kidney function has got through. I see people who have had transplants may have a chance but my husband is way too early for that yet!

 

Claire

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Guest angedoon

Thanks!

 

They have asked mum for MORE info, they have everything already! We have asked for more clarification as the 2nd letter is asking for the same as the first! I will let you know how she goes!

 

Ange

:rolleyes:

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Guest micky38

Hi,

 

No worries

Micky

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Guest Gollywobbler
Hi Ange - sorry for the delay - we haven't been on here for quite some time - basically ASA said you have to apply and wait and see because they judge every case individually - very helpful (not)

 

I'm just on here today trying to see if anyone else with a low kidney function has got through. I see people who have had transplants may have a chance but my husband is way too early for that yet!

 

Claire

 

Hi Claire

 

I did say some time ago that some agents claim to be experts on the workings of the Health requirement for Oz but when push comes to shove they actually don't know a thing and they haven't a clue about the meds either....

 

In your own case:

 

New Guidance Notes for the MOC are due to be finalised sometime in 2010. The existing Notes are incomplete and production of them was abandoned in the early 1990, plus the medical information is hopelessly out of date nearly 20 years later.

 

When the new Notes have been completed, they will contain two which are relevant to you. One of them is the General Principles for the MOC and the other is the specific Guidance Note on Nephropathy. Neither of the new Notes are available as yet, though.

 

Only 3 of the new Notes have been finalised and pubished so far. They are the three on HIV+, Opthalmology and some other condition which is not relevant to you, A fourth one that is about Mental Illness is ready for publication but it has not been published as yet.

 

DIAC have decided to hide these new Notes on Legendcom - which is absolutely typical of DIAC's utter lack of transparency about everything relating to Health. I've been in toucjh with Dr Paul Douglas, who is DIAC's Chief Medical Officer.

 

I don't think that Dr Douglas realises that "publishing" the new Notes on Legendcom is actually nothing but an exercise in hiding them. He will understand this very clearly by the time I have finished with him, though, I assure you.

 

Legendcom is only available on subcription if you are outside Australia:

 

LEGENDcom

 

If you are in Australia, apparently access to Legendcom is completely free if you access the site via the State Library in each State and it is also available for free in the Libraries at some of the Universities. Which is all a fat lot of good if you are not in Australia.

 

Registered Migration Agents are required to have professional libraries, though. Membership of Legendcom provides access to most of the documents required for the professional library, therefore most RMAs pay for an annual subscription to Legendcom. Whether they can work Legendcom is another matter but they do at least have access to it.

 

Dr Douglas is able to access Legendcom whenever he likes, completely for free, because he works for DIAC and DIAC are the biggest users of Legendcom. All the DIAC staff can access it for free, even if only some of them are used to doing so. Hence I don't think that Dr Douglas understands that publishing the Guidance Notes on Legendcom only will have the inevitable effect of making these notes invisible to the majority of visa applicants when the Notes ought to be available for free and ought to be in the public domain - ie on the DIAC website. I intend to keep hammering this point home with Dr Douglas and DIAC until DIAC quit their unseemly habit of trying to hide things from the public.

 

According to Dr Douglas, the remainder of the Guidance Notes - including the two that you need - should be available by July 2010.

 

You will almost certainly find that you have to explain all this to your agents and they will probably be too arrogant to believe you, but you will just have to make the mother and father of a fuss with them until they listen to you, I suggest.

 

Your OH's Consultant Nephrologist will need to see the two Notes that you particularly need, once they are available. In your shoes, I would consider it absolutely essential that he sees them.

 

To get this across to your Agents, please see as follows:

 

http://www.aph.gov.au/house/committee/mig/disability/index.htm

 

PIC 4005 is the relevant legal provision and I have quoted it verbatim early in this thread. It treats a disease or medical condition in the same way, and in the same breath, as the way it treats a disability because in both cases, the legislation is only interested in what the visa applicant is likely to cost Australia if s/he is allowed to migrate.

 

DIAC have made a formal submission to the Inquiry. DIAC's contribution is below:

 

http://www.aph.gov.au/house/committee/mig/disability/subs/sub066.pdf

 

Like every civil service Department, DIAC have ensured that there is plenty of obfuscation and far too many words in their Submission. They actually don't want the same things as the Inquiry wants. The Inquiry is considering whether or not to relax the current Health requirements for migration. That is what the Minister asked them to look into.

 

However DIAC have a different idea. DIAC's idea is that the Health Waiver, which is currently not available for skilled visa applications, should be extended so that it covers all applications for skilled visas. I think that the Inquiry Chairman is beady enough to realise that DIAC actually don't want that which he has been told to find out about, and that DIAC would like to do things in their own desired way, not his way.

 

At the same time as wanting control of the Health Waiver, DIAC also plan to persuade the Minister for Immi that the threshold of $21,000 is too low (it is a figure that was introduced in the late 1990s, so it is indeed far too low by now.) DIAC want the threshold increased to $100,000 - which does make far more sense and would decrease the increasing numbers of applicants who are deemed not to meet PIC 4005 simply because looking after them is likely to cost $10,000 a year for the first 5 years rather than the measly sum of just over $4,000 a year.

 

At the top of Page 8 of their Submission, DIAC explain that the legislation does not distinguish between an existing disease (eg cancer) or a condition which might develop into a disease (eg HIV+) or a condition which is simply a disability (eg Down Syndrome.) For this reason, the Inquiry cannot simply be ignored by any competent firm of RMAs, whatever they might imagine, and it definitely cannot be ignored by RMAs whose advertising burble claims that they are "experts" on the workings of the Health criteria for migration.

 

Page 9 is relevant to you, your OH's Nephrologist and your agents as well.

 

The bottom of Page 10 may be crucial to convincing your agents that DIAC are not simply talking about "disability" in the narrow sense. Nobody who is disabled needs an organ transplant, but the need for the transplant might make the person incapacitated for work, at least until after the transplant is done. DIAC are not talking solely about somebody who is "disabled" because on of their legs has been amputated or something.

 

The other thing which is relevant to you are a couple of the Public Hearings:

 

http://www.aph.gov.au/house/committee/mig/disability/hearings.htm

 

Dr Douglas gave evidence to the Committee at the Hearings in Canberra on Feb 24th and March 17th 2010. Don't take too much notice of Mr Torkington's contributions on 17th March. Half the time, he did not understand the Inquiry's questions but he is only a junior honcho and he only attended in order to be Dr Douglas' minder. What Dr Douglas says is important, though.

 

At the first Hearing on 24th Feb 2010, Mr Vardos and Mr Kennedy were the minders for Dr Douglas. Both of those DIAC Officers (Messrs Vardos and Kennedy) know what they are talking about and they know when to butt out instead of waffling. What they say is worth reading, as well as what Dr Douglas said in the first Hearing.

 

One of the questions I plan to grill Dr Douglas about is whether or not the Panel Doctors in the UK are:

1. Going to be told about the existence of the new Guidance Notes; and

2. Given on-line access to them so that the Panel Doctors can receive the promised annual updates of the Notes etc.

 

If the current Plan does not include telling the Panel Doctors about them, then the Plan should be changed and they should be told and they should also have the Notes made available to them.

 

The other thing that I think you should do is to consider the Panel Doctors in the UK because Dr Douglas has recently cut the number of those so dramatically that some people are having to travel many miles in order to get to the nearest one, who may not be the best one.

 

United Kingdom – Panel Doctors

 

Heathrow are due to be axed soon, apparently, in which case the nearest PDs to Heathrow are likely to be the doctors in central London por the ones at the Bridge Clinic in Maidenhead.

 

Dr Ray Million of the Manchester Medical Centre is said to be very good.

 

Dr Helen Bryden of the Spire Clinic in Edimburgh is known to be a genuine expert at dealing with visa applicants where she can see that the person is perfectly OK but it would be easy for the MOC in Australia - who never meets the patient - to form a negative view of the patient/visa applicant based on the papers alone.

 

Which visa have you been advised to apply for/have you applied for/do you intend to apply for, please? If you have been advised to apply for a State sponsored sc 176 visa, which State is providing the sponsorship? (This is important because of the right to appeal to the Migration Review Tribunal if the visa is refused on medical grounds. It is not possible to appeal to the MRT in this situation unless the State concerned is seen to front the appeal. Most of them won't do so when there has been a refusal on medical grounds but some of the States might be more amenable to some wheedling than others.)

 

Cheers

 

Gill

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