The court concluded that the directives issued by the Malta Union of Midwives and Nurses endangered patients. Not one or two directives. Fifty-seven directives issued by the nurses’ union were judged by the court to put patients’ health at risk.

But MUMN’s Paul Pace declared victory. Why? Because not all of its directives were struck down. Some were allowed to stand.

That is no victory. It is a horrific indictment of the reckless disregard for patients’ safety by a union purporting to represent healthcare professionals who are trusted to care for us at our most vulnerable.

Of course, many of the nurses and midwives MUMN claims to represent are appalled at the shocking insensitivity of the union’s actions, especially in the middle of a pandemic.

Those members of staff are exemplary and outstanding professionals who have dedicated their life to caring for sick patients. They put their patients’ interests above their own.

For that alone, they deserve to be treated fairly. For that alone, they should have been honoured on Republic Day.

They deserve equivalent working conditions as other allied healthcare professionals of equal qualifications and experience. They have every right to fight for their rights and equal working conditions. The country is behind them in their legitimate and reasonable demands.

But they cannot tolerate the ruthless and hare-brained actions of the union leadership. They cannot participate in executing directives which, as the court has decided, endanger the health of patients entrusted to their care.

Nor can they tolerate the sheer cruelty of some of those directives: do not participate in feeding patients, do not change ‘nappies’, do not inform relatives about patient discharges, do not shroud.

The court has now, thankfully, put a stop to health-endangering union directives. Those directives had already been implemented. It was only the legal challenge mounted by the ministry of health’s permanent secretary that prevented MUMN from continuing to hurt patients.

This had been going on for too long. The MUMN repeatedly used patients as pawns in an interminable litany of damaging and risky directives. This time,  even the legal-averse ministry of health was compelled to act. No reasonable well-meaning person could stand by as vulnerable patients were put at risk.

Apart from the 57 directives deemed health-endangering, another 67 union directives have been allowed to stand. The court concluded that these did not endanger the patients’ health.

In fact, some of them pose an imminent risk to patients’ lives and limbs. One of the most obviously dangerous is one that allows only four operating theatres to function.

In normal circumstances, there are over 18 operating theatres working simultaneously. Even that is insufficient to cater for the needs of the nation. This is why, even at the best of times, there are waiting lists for patients to be operated.

Because of the pressures of the current pandemic, that number has been cut down to 12. Besides, most of those 12 theatres only function until 2pm because anaesthetic and nursing staff have been diverted to caring for the increasing number of COVID patients in intensive care.

With only 12 theatres on a drastically reduced schedule, all non-urgent elective operations were cancelled. Only patients with limb, sight or life-threatening conditions are being treated. These include patients with cancer, strokes, kidney failure and other potentially fatal conditions.

In this dire and desperate situation, MUMN has instructed its members to only run four theatres. Since only the most urgent cases were being operated with 12 theatres, cutting theatre time further means cancelling or postponing limb and life-saving procedures.

Nothing endangers a patient’s health more than being deprived of essential surgery- Kevin Cassar

Yet, the court has decided that this directive does not constitute a danger to patients’ health. Can the decision be more misguided? How can delaying life-saving procedures not endanger patients’ health? This is plain dumb.

You don’t need to be a healthcare professional to realise that delaying a limb or life-saving procedure will lead to… guess what? Loss of limb and loss of life.

Had any patient or patient-representative group been asked to testify they would have provided compelling evidence to the court that delaying life-saving surgery endangers health. Sadly, those most harmed by MUMN directives, patients, played no part in the submissions.

The court did include a clause that specified that in cases where a patient’s health is in danger nurses and midwives must ignore all directives. But what does “endangering a patient’s health” really mean?

The court refers to patient’s health not life. By definition, patients have medical conditions that are already endangering their health – that is why they are hospitalised and why they require surgery.

The court’s decision can only mean that any MUMN directive that prevents or delays effective treatment of patients is illegal. Nothing endangers a patient’s health more than being deprived of essential surgery.

MUMN’s claimed victory is only a pyrrhic victory for a small group of egocentric, callous attention-seekers ordering their members to commit dereliction of their duty to the sick and dying.

It is, however, a small real victory for our most vulnerable fellow citizens and the multitude of dedicated selfless nurses who care for them. It is also a small victory for the weary public – a public that has had enough of the disgraceful irresponsible actions of a militant union, determined to exploit patients’ health for its own cause.

The message from the court to MUMN could not be clearer. Stop endangering patients’ health. Stop using patients as pawns in your battles.

Patients have more than their fair share to contend with as they grapple with the anguish and anxiety caused by their illness. Capricious harmful union directives, amid a pandemic, inflict further unnecessary hardship on the sickest.

More importantly, it deprives them of their potential health and life.

When it takes a court sentence to ensure that our sick and dying receive the care they deserve, something is very wrong – it is called MUMN.

Kevin Cassar is a professor of surgery and former PN candidate.