Updated 7.30am with MAM doctors' union reaction 

About 15 elderly patients with hip fractures are reported to be at risk of developing serious illnesses or even dying as a result of having to wait several days for an operation.

Operations are being postponed due to industrial action taken by nurses while these patients remain bed-bound, in pain and disoriented, according to a senior hospital source.

In all, about 50 patients with fractures are awaiting surgery. Fifteen of them are elderly and particularly vulnerable, the source said.

The Association of Orthopaedic and Trauma Surgeons said the number of patients with acute fractures or trauma awaiting surgery has reached “a record number” as a result of the union directives.

Some patients, it said, have been waiting up to a week to undergo surgery.

“Delaying surgery in any bed-bound, immobile trauma patient risks an increase in morbidity and even mortality. This is especially true with elderly patients who have sustained a hip fracture,” the association said.

“The association finds this situation unacceptable and calls on the Malta Union of Midwives and Nurses to allow the theatre staff to perform surgeries in all the available theatres on these acute fractures and trauma patients irrespective of whether they are life-threatening or not.”

While there is always a backlog in operations, the industrial action ordered by the MUMN a month ago has meant fewer operations are being carried out, especially if they are not deemed urgent by nurses. This is leading to the backlog piling up. 

The association expressed its disappointment and frustration at the situation, saying that “while we believe that every worker and union has the right to take industrial action, these actions should not result in significant detrimental effects on the patients we are treating”.

An 'inhumane' situation

The hospital source described the situation as “inhumane”.

“What’s so cruel is that people are being starved day after day in case their operation is happening the following day.”

The Commissioner for Older Persons, Godfrey La Ferla, said the parties involved ought to be more aware of the collateral damage being caused.

“As happens in general whenever there is this sort of industrial action, patients are used as collateral damage and this is not appropriate. Any action must be targeted towards those involved in the dispute. Patients should not be used as leverage,” he said.

In the beginning of March, the MUMN ordered its members not to perform a range of functions in an industrial dispute over the pay and working conditions of nurses and midwives. The government and the MUMN have been in negotiations for a new sectoral agreement since August.

The directives affect all public hospitals, with separate directives targeting each hospital with the exception of the Sir Anthony Mamo Oncology Centre. 

At Mater Dei Hospital, nurses have been asked not to wash patients and to refrain from clerical work. MUMN-represented nurses at care homes for the elderly have been told not to answer any phone calls or handle paperwork. 

Last week, the union issued new directives to nurses at health centres and at Gozo General Hospital.

The health ministry has said that planned procedures are being postponed due to the MUMN deciding “on a day-by-day basis, which theatres should function and which operations will take place”. 

In the latest development, the ministry said it had presented new proposals to the union for a new sectoral agreement on Thursday and discussions were being held.

When asked for an update, a ministry spokesperson said yesterday: “Discussions between health ministry officials and MUMN on the new sectoral agreement for nurses and midwives are indeed ongoing and are progressing.”

Agreement ‘far away’

But MUMN chief, Paul Pace said the union and the ministry were still “far, far away” from reaching an agreement.

When asked why the union had ordered measures that resulted in patient suffering, Pace said: “This is a stupid question. Why not ask the government why it is refusing to pay nurses better?

“Why not ask the government why there are two-year waiting lists in the first place? Why consultants leave the hospital at midday? Why people waiting for an operation are skipped by others? Why there is no transparency in the scheduling of operations?”

Pace explained that the union had no choice but to order industrial action since the pay and conditions of nurses is discriminatory and causing people to leave the profession.

Giving examples of discrimination, he said that, when compared to others in the public sector, nurses worked a 46-hour week paid at a flat rate and if nurses take over 15 days of sick leave, their allowances are reduced.

If a nurse is promoted to being in charge of a department, the responsibilities increase immediately but the salary only goes up after three years.

Nurses take on management duties, they manage wards and departments and have other important duties which are not being recognised, Pace said.

One nurse, who preferred not to be named, said there was a lot of anger among nurses due to the Steward Health Care issue and the fact that the government did not want to budge on their working conditions.

The US company took over the management and operation of St Luke’s, Karin Grech and Gozo General hospitals and the Barts Medical School from Vitals Global Healthcare in 2018, in a deal worth hundreds of millions of euro. Last month, the civil court annulled the concession agreement after finding it was fraudulent.

“There is an uncomfortable feeling at work with other colleagues, such as carers, since we are not helping them with jobs we used to help them with. We are trying to do our best not to impact patients but elective surgeries are being postponed.

“We cannot lose sight of why we are doing this however,” the nurse said.

Doctors' union denies claim about consultants

In a reaction to Pace's comments, the Medical Association of Malta pointed out that about two thirds of consultants have opted for contracts without private practice, and operation lists are jam-packed up to 6.00 pm.

"Some consultants are willing to work until 8pm at operating theatres, however this is being resisted by MUMN," it said.

The MAM said it was concerned that MUMN directives may be causing unnecessary risks to patient safety.

"The MUMN president should make his members aware that trade union directives do not protect from criminal prosecution for negligence, and may disqualify them from the indemnity in the case financial compensation is sought in courts if harm is caused to patients," it said.

The Association of Surgeons in a separate statement also expressed its concern about the industrial action. It said those involved must shoulder responsibility for their actions and be aware of the inevitable collateral damage that will occur causing harm to patients whom they are privileged to be looking after.