Updated 7.30pm with ambulance information

An independent inquiry will investigate the circumstances of the death of a 55-year-old man at Mater Dei Hospital's emergency waiting room where he was left waiting despite allegedly complaining of chest pain. 

Stephen Mangion, a retired police officer, died at around 11pm on Tuesday.

In a Facebook post, his niece Claire Mangion wrote: "Reality hits home... my dearest uncle Stephen Mangion was asked to wait and wait even though he had chest pain until he collapsed and died at the emergency of Mater Dei. A failed system that needs to change." 

According to lawyer and former MP Jason Azzopardi, the man was asked to go to Mater Dei's emergency unit with his private car after seeking assistance at the Floriana health centre.

Social media users who said they witnessed the death said the man complained of intense chest pain but was asked to wait and collapsed and died before he was seen to.

Azzopardi claimed the man's death was manslaughter. 

However Mangion's former wife Miriam Attard, who was at the hospital when the incident happened, appealed on behalf of the family for the public to "refrain from using this situation for political advantage or making any related comments".

Initial investigation

According to police sources, a preliminary investigation into the incident at Mater Dei shows Mangion went "voluntarily" to the hospital at 8.30pm because he was not feeling well.  

At 10.30pm he complained with reception of a sharp chest pain. CPR was performed and Mangion died at 11pm.

He suffered from high blood pressure and was accompanied by his former wife and two children at the hospital.

The police investigation has been widened to look into what happened at the Floriana health centre. 

Health sources told Times of Malta that he had previously been accompanied by family members at the Floriana Health Centre. 

An ambulance was sought to transfer him to Mater Dei Hospital but none could be immediately dispatched.

He was accompanied by family members to hospital instead.  

A magisterial inquiry by magistrate Joe Mifsud is underway and Forensic Doctor Edward Cherubino is assisting. 

'Fully transparent'

On Thursday morning health minister Jo Etienne Abela said an independent inquiry had been launched and its findings will be published.

"As a ministry, we want transparency and while we praise what is good, we also want to treat shortcomings with justice," he said. 

The inquiry will look into the way Mangion was treated but also at general shortcomings, he said.

"As has happened before, we will be fully transparent - so if there were shortcomings, be they individual or systematic, we will not hide those. And if there are shortcomings, responsibility must be carried," he said.

The inquiry was launched on Wednesday and the conclusions will be drawn by the end of September. 

The board leading the inquiry will be led by retired Judge Joseph D Camilleri and includes Herbert Felice and Sylvia Spiteri.

Staff shortages

The health minister said the government is working to address staff shortages in the emergency department.

"It's no secret that the health system is understaffed in several specialised fields. We know that and we need to address it," he said.

The measures include incentivising staff to work in emergency.

"That includes money, and in the last two months, emergency staff have seen a pay increase, and our plan is to keep increasing those wages," Abela said.

The health minister was also asked about an urgent call to the private sector to outsource emergency care but said he is not involved in the tendering procedure. 

"There is an ongoing evaluation process that I cannot comment on," he said. 

Abela said he is waiting for the results of the evaluation, which is a four-week process.

"I wish the service was available many months ago," he said.

'Heartbreaking' and 'enraging'

Speaking during a news conference on Thursday morning, Opposition health spokesperson Adrian Delia said Mangion’s death – in a place where he had gone to seek help - was “heartbreaking” and “enraging”.

“Do we have to have deaths to take action in this country?... Even in the health system, government had to wait for a tragedy to happen to do something - as has happened in the construction industry and in the domestic violence field,” he said.

He was referring to the death of Jean Paul Sofia in December 2022 in a construction accident and the femicides of Bernice Cassar in November 2021 and Nicolette Ghirxi earlier this month.

In all three cases, the tragedies led to inquiries to improve flawed systems.

Delia said the minister had announced an independent inquiry into Mangion’s death, but what guarantee did the minister give the public that the situation would not remain the same or get worse until then?

“The family is broken. They are hurt. They lost their loved one… The public deserves to know what happened and who is responsible… This has long been coming,” he said as he went on to read several newspaper headlines that highlighted the strain on the hospital emergency system.

Delia said government was not investing in the health sector that was under strain due to the increasing population.

Chest pains 'high priority'

When a person goes to the Emergency Department they are asked to wait in a waiting area until a triage nurse calls them in.

 “In most cases, chest pain cases would be assigned as a high priority. Only a few chest pain cases would be assigned low priority. These would be clear muscular pain, rather than something cardiac,” according to sources close to the emergency department.

If a chest pain patient is assigned high priority, the patient is escorted to an ECG room in the main area.

The ECG result is shown immediately to the doctor in charge of leading the emergency department who will, in turn, decide if something needs to be done immediately or not.

“Having said that, an ECG alone sometimes is not enough and you would still need blood tests to be taken to identify whether the chest pain is actually coming from a cardiac cause,” the person said.