A patient with a life-threatening heart condition whose free surgery at a London hospital was cancelled due to an administrative error has been reimbursed the costs of the €35,000 procedure.

The money is payable by the Maltese medical authorities.

In February 2015, the woman, in her early 60s, was diagnosed with a very serious condition known as ‘aortic aneurysm’, resulting in an enlargement of the major artery to over 10mm above the normal diameter of 50mm.

Medical tests by her personal physician, cardiac surgeon Alex Manché at Mater Dei Hospital, led to concern and the specialist began the administrative process to refer the patient for urgent surgery at Barts Hospital, London.

He contacted a cardiac surgeon abroad and also handed over case details to the chairman of the Treatment Abroad Committee Board so that the patient’s application would be processed under the ‘National Highly Specialised Overseas referral programme’.

On February 26, 2015, a committee representative informed the UK surgeon that the necessary intervention qualified under that programme, meaning that it was to be state sponsored.

That same day, the surgeon scheduled a pre-operation appointment at Barts Hospital on March 2 at 4pm.

The woman and her husband travelled to London after being assured that medical expenses were to be covered by the state and upon arrival and after their meeting with the surgeon, the operation was scheduled for March 7.

The day before, the patient was admitted to Barts Hospital and the necessary routine preparations for the surgery got under way.

However, late that evening the couple were informed by the surgeon that the surgical appointment had been cancelled because of some administrative problem with the Maltese authorities.

Woman risked dying

The shocked couple immediately contacted their cardiac surgeon back home who advised them against returning to Malta unless the patient first underwent the necessary urgent surgery, explaining that the woman risked dying unless she was operated immediately.

All attempts to sort things out with local authorities and seek an alternative solution proved futile.

Given the urgency of the situation and with help from both the UK surgeon and Prof. Manché, the patient managed to secure a private appointment at the Wellington Hospital in London for the surgery to be performed on March 11.

The couple ended up shouldering the costs of that surgery which totalled £25,333, equivalent to €35,644, together with additional accommodation and travelling expenses.

Later, they tried to recover the funds from local authorities, claiming it was only due to their negligence and lack of professionalism that the patient was left with little option but to pay for the urgent surgery at the private hospital.

In 2017, the patient and her husband instituted a civil action for damages against the health minister, the director of institutional health, the superintendent of public health and the chief medical officer.

The respondents rejected all claims, arguing that the applicants knew very well that only specific interventions under the NHS scheme were offered free of charge and the procedure was governed by strict rules.

In this case, after the patient’s application had been fully processed and approved, she was subsequently informed by a representative of the Maltese Board, after her original appointment at Barts was cancelled, that she would have to apply afresh.

Malta failed to provide guarantee

It turned out that the London hospital had cancelled the scheduled appointment because the Maltese authorities failed to provide the requested guarantee to cover payment for the surgery.

Mr Justice Francesco Depasquale observed that the patient’s application had been processed successfully under the NHS scheme.

When testifying, the chairman of the Treatment Abroad Committee could not explain why that quota number had been cited by local authorities, instead of the guarantee demanded by the London hospital. Nor was the witness aware of the fact that the couple had been told to wait until a fresh application was processed by the board.

The court found it “very strange” that none of the witnesses summoned by the respondents could explain why a fresh application was necessary after the Barts appointment was cancelled.

The court weighed those testimonies on the one hand and Manché testimony on the other, confirming the very serious and urgent condition of the patient.

Contrary to what the respondents argued, the court concluded there was evidently a lack of communication and coordination by the respondents.

Such lack of communication and negligence on the part of the respondents effectively gave rise to the circumstances which resulted in damages suffered by the applicants.

The respondents were thus ordered to pay €35,644 in damages.

Lawyers Jonathan Thompson and Roberto Montalto assisted the applicants.