The Ombudsman has called on the authorities to conduct an urgent and detailed review of waiting list management that would enable them to set in place a system based on transparency, accountability and best practice.

His appeal was made in a report following repeated complaints by a foreign detainee at the prisons about delays for a knee operation. The detainee was referred for the operation in 2002 and submitted his first complaint to the Ombudsman in 2003. Following the Ombudsman’s intervention, the operation was tentatively set for February 2004 but in March 2008 the operation had still not been carried out.

In June 2008 the hospital authorities told the Ombudsman that the surgeon would perform the operation in a couple of weeks. They also reported that the surgeon objected to what he termed ‘outside pressure’ by the Office of the Ombudsman, which, in his view, would result in complainant ‘jumping the surgery queue of about 400 Maltese citizens.’

The Ombudsman said he resented the consultant’s attitude and the snipe at his integrity, more so when he had merely requested an explanation from the hospital over why complainant’s case had been put off for so long. He never hinted that anyone should jump the queue.

In discussing the situation of waiting lists, the Ombudsman said the authorities admitted that they had no control on the way that waiting lists for operations at the hospital were established and on managing the admission of patients on these lists.

“Waiting lists are kept on the appointments diary of individual consultants and only in ophthalmic and cardiac cases are the lists of pending operations recorded in a centralized system.

“The officials disclosed that only consultants establish the urgency of any particular case and determine priorities for individual patients who need to undergo an operation.”

The Ombudsman said, however, that the current state of affairs was attributable to failure by the authorities to exercise control over consultants “who keep a stranglehold on current waiting lists in their departments that does not allow an independent check on how these active lists are compiled and managed.”

He insisted that the management of the healthcare system was, and should continue to be, subject to the scrutiny of a review mechanism.

“In a situation where specialists have full rein to exercise their own discretion, the hospital management should disseminate good practice and ensure the existence of a fair and equitable verification process that would remove any shade of suspicion of preferential treatment of patients. This system would guarantee transparency in the management of waiting lists.

”These safeguards are even more necessary when consultants who determine the order of patients to undergo interventions in state hospitals and perform these operations themselves are also allowed the private practice of their profession,” the Ombudsman wrote.

“These arrangements are a fertile breeding ground to give rise to situations that are likely to constitute a conflict of interest.”

He therefore proposed that guidelines should be established to which clinicians would refer, and they would also give due recognition to the role of consultants in decisions about patients who deserved priority. The ultimate objective of the exercise would be to allow an audit trail of cases.

The Ombudsman said that following the submission of his report, he understood that the consultant in question was severely admonished by the health authorities. It was also understood that a working group had been set up to make recommendations to the ministry on waiting list management.