Parents still unsatisfied with replies to parliamentary questions

The parents of Andrea Massa, a seven-year-old boy who died of peritonitis after being operated for appendicitis at St Luke's Hospital, are still not satisfied with replies given to a second series of questions tabled in Parliament two weeks ago.

Charles Massa and his wife Josephine explained that they felt that, once the replies to parliamentary questions on the boy's death were "unacceptable and unsatisfactory," they had no alternative but to provide the replies themselves, unless satisfactory replies are given.

"The time has come for all the medical and legal facts surrounding the death of Andrea to rise to the surface so that the whole truth can be analysed. Only this way can we be sure that, in the end, justice would have been made with us and the boy," Mr Massa said.

The case dates back to February 20, 2001, when Andrea was taken to hospital suffering from an abdominal pain and eventually operated on for appendicitis after a pædiatric consultant examined him and requested the operation. But after the operation the boy suffered complications and his health conditions got worse and worse until, on February 28, 2001, he died.

Following a magisterial inquiry the consultant was charged with the boy's manslaughter. A compilation of evidence followed but the charges were dropped when the Attorney General (AG), Dr Anthony Borg Barthet, decided that the consultant had no case to answer and stamped the case nulle prosequi.

On August 11, 2003, parliamentary question no. 1,446, about the case, was tabled and a reply, which the parents had termed "unacceptable," given on September 22.

Another two parliamentary questions were tabled on January 19 and replies given on January 26 this year. In PQ 3,848 the Minister of Health was asked to table a copy of the internal inquiry into the boy's death carried out within the Department of Health.

He was also asked to confirm whether anyone had been appointed to replace the consultant of the Fairyland ward on February 26, 2001, and whether the boy had been administered any antibiotics when he was operated on for appendicitis.

To this the minister replied that an internal inquiry was carried out so the administration would analyse the internal procedures involved in the case with the aim of improving the service offered. Once such inquiries were not public, he could not give a reply.

In the second PQ, no. 3,849, the Minister of Justice was asked, among other things, if Magistrate Abigail Lofaro had been assisted by experts while she was carrying out the inquiry into the boy's death and if the conclusions reached by the magistrate, who had concluded the inquiry on two occasions, were the same.

The PQ also asked whether it was true that during the magisterial inquiry the consultant was cautioned before he gave evidence; whether the foreign surgeon who had operated the boy for laporotomy was to be called to testify a second time during the compilation of evidence and, if so, why not; and why the report that the AG had tabled in Parliament had all names deleted.

Other questions included whether it was true that the consultant failed to give a handover to the surgeon who replaced him or if he ever informed him about the bad state of the boy before he went on sick leave; and whether the roster of the medical staff, exhibited in the proceedings, was defective?

In the reply the minister explained that the AG, who had the exclusive right to decide on such matters, had informed him that he had already made the court document available to the parents, and their medical and legal consultants.

The AG confirmed that Magistrate Lofaro had appointed two pathologists to carry out the post-mortem as well as a medical forensic expert, a consultant surgeon, a bacteriologist and a court expert to assist her in the inquiry. He added that the magistrate had concluded one inquiry and therefore there was only one conclusion.

The AG confirmed that a court expert had warned the consultant that he could choose not to testify and explained that he did not see anything wrong in the proceedings carried out by Magistrate Lofaro and Magistrate Scerri Herrera but, due to the higher level of moral conviction required, he had reached a different conclusion on evaluating the evidence.

He added that when he decided on a nulle prosequi he had studied all the court documents, viewed the report of the internal inquiry and consulted several experts in the field.

This had led him to conclude that evidence would not lead a judging body to attribute guilt to the consultant beyond reasonable doubt. He also explained he did not, and still does not, know of the existence of further evidence that could lead to a different conclusion.

As to the report he had given to the President, the AG explained that the names had been deleted to protect the confidentiality and identity of the boy and also because the names of doctors and consultants involved (as opposed to the facts) did not make a difference to the conclusions reached.

The reply to other questions, he said, depended on the evaluation of the evidence and the different testimonies regarding the medical and factual situation and had to be examined against all the facts. It would be better if one viewed all the case documents and did not lift an incident or a fact out of context, he said.

But Mr Massa was not satisfied with the replies given by both ministers. He defined them as unacceptable as they did not provide the straight-forward answers they requested. He explained that, for example, in asking "Is it true that the boy was not administered antibiotics when he was operated for appendicitis?" the reply just had to be a 'yes' or a 'no'.

The time has come for all the cards to be put on the table so that everybody will have an opportunity to evaluate what led to a seven-year-old boy, described by pathologists as "previously healthy" to end up dead after having spent almost a week in hospital, he said.

Mr Massa appealed to the AG to publish the report with all names included and appealed to the Minister of Health to publish the report of the internal inquiry.

He said he would not initiate civil proceedings or take the case to the Medical Council before he let everyone know what really happened and that if the replies were not provided through the ministers in parliament, he would have no alternative but to provide the replies, and the documents to back them up, himself.

When contacted, the Health Minister stuck by the reply given in Parliament while the Justice Minister added he did not have any power over the AG, who in such cases decided whether to prosecute or not, and referred the matter to the AG.

Attorney General Dr Borg Barthet said: "I feel that I have done my job well and according to my conscience." He explained that he had looked at the case through the eyes of a parent and also through the eyes of a professional and then weighed the case according to law.