Doctors have described the accident and emergency department at Mater Dei hospital as being a “disaster” that is well “beyond its breaking point”.

A doctor currently working inside emergency told Times of Malta the department is “always understaffed” and under serious amounts of pressure on a day-to-day basis.

“It’s a complete disaster!” the doctor said.

While doctors are dealing with an overcrowded and understaffed emergency department, the doctors’ union has been at loggerheads over what it claims to be a lack of consultation about the outsourcing of emergency services to private hospitals.

Last week, the Health Ministry announced a new partnership with three private hospitals that will see the outsourcing of emergency services in a bid to ease wait times at Mater Dei hospital.

But the Medical Association of Malta (MAM) immediately issued directives to its members – including ordering them to halt the transfer of patients to private hospitals. The union said it planned to escalate these directives on Wednesday, after a meeting with the government about understaffed health centres went sour.

Separately, a group of roughly 200 doctors have asked the union for an emergency meeting, expressing concern among other things about the wording of directives and their motivation.

Meanwhile, doctors at the emergency department said they barely have the time to take a break during a 12-hour shift. Health ministry sources said between 200 and 350 patients visit A&E daily. Out of these, around 165 are admitted each day. Since 2019, demand is up almost 20%.

“Many people come to emergency, but they don’t have anything serious, which only adds to the pressure,” they said.

Due to the dire work conditions, the doctor said many workers are quitting and going to private hospitals, where the work conditions are better.

‘Sometimes you forget to pee’

Another doctor, who left the emergency department a few months ago, described the emergency department as a “continuous barrage of disaster” that was taking a toll on his mental health.

“The whole system… is completely and utterly overloaded way beyond its breaking point,” he said.

He explained how frustrating it was to work in an environment where there was always a “bottleneck” somewhere that was stalling things. Most of the time, doctors are juggling with management and logistical issues rather than actually treating the patient.

“Sometimes you forget to pee… either you don’t have the time, or you don’t think.”

Given the pressure, some doctors opposed these directives, stressing it was an attempt to halt a measure that could have eased the burden on emergency doctors.

However, they acknowledged that “it’s a sad situation that we have to privatise,” arguing that the focus should instead be on improving Mater Dei’s resources to better accommodate patients.

Doctors need to know the ‘details’

A surgeon who works at Mater Dei admitted the hospital is “stretched to the limit”.

The doctor lauded the government’s proposed plan but criticised the way it was rushed and lacked transparency.

“No one is really aware of the fine details,” they said.

They noted how doctors’ main concern is the ownership of the patient. As things stand, doctors are not aware how this system is going to work and who is going to have responsibility for the patient.

They underlined the need for a clear trail of who is responsible for the patient, stressing it would be unacceptable for doctors at Mater Dei to be responsible for patients who are transferred to private hospitals.

“If this is not clear and a patient dies, doctors can be easily sued,” they said.

Directives putting people’s lives at risk

Saint James Hospital doctor and former leader of Partit Demokratiku Anthony Buttigieg dismissed the MAM directives as a “joke” and labelled them “criminal”, saying it all comes down to ego.

“Shrug your shoulders and get on with it as lives are on the line,” was Buttigieg’s reaction to the partnership deal, which he said, also came as a surprise to him.

“If there are people dying you have to be flexible and pull your weight to fix the problem. It’s something you do for the country,” Buttigieg said.

Regarding concerns about who will take responsibility for the patient, Buttigieg said that once the patient is transferred, all responsibility falls on the private hospital.

Buttigieg clarified that Saint James Hospital will only takes cases that it can handle.

“We only take safe cases… I don’t know what these other doctors are concerned about,” he said.