An investigation has been opened after an elderly woman died a few days after falling in an ambulance and hitting her head as she was being transported home.

The family of Mary Anne Pavia say they have been left waiting for answers and justice for more than two months.

The 82-year-old was carried into an ambulance last January to be taken home after spending a few weeks of respite in a care home for the elderly.

Her wheelchair was secured to the floor of the ambulance, but she was not strapped to the wheelchair and nobody noticed because she was covered in a blanket on a cold day.

During the trip to her home, the ambulance driver braked and Pavia fell head-first onto the vehicle floor. She died in hospital four days later.

The care home has denied any responsibility for the incident and a health ministry spokesperson told Times of Malta that an internal investigation has been launched into the case. However, the ministry made it clear that the ambulance did not belong to Mater Dei Hospital, but to a private contractor.

The victim’s niece, Sandra Formosa, described her aunt as a smart woman who would communicate fairly normally. She had spent most of her adult life in Australia, working as an assistant head at a school and as a Maltese interpreter in Australian courts.

Pavia had been living at her home with a live-in carer who had moved in with her just before the pandemic. But last December she was taken to St Thomas Community Living – a care home for the elderly – for a few weeks of respite while her live-in carer returned to her home country, the Philippines, to visit her family for the first time since the pandemic.

Formosa had applied for a few weeks of respite through a government scheme. The government selected that particular home for her aunt because it was close to her house, and made arrangements for an ambulance to take her to the care home and back to her house.

The care home is privately run but the government rents out its beds to be able to offer a respite service to the elderly who are cared for at home.

On January 27, the ambulance arrived outside the care home to pick Pavia up and take her home. Formosa said the live-in carer and herself were also there.

“But I was not allowed inside the home. They told me to wait outside because it wasn’t during visiting hours. For some reason, when she was lifted off the bed and into her wheelchair, they did not strap her to her wheelchair. I only saw her covered in her blanket when she was wheeled outside and hurriedly carried into the ambulance.”

Formosa said the ambulance driver and another ambulance worker secured the wheelchair to the floor of the vehicle. The live-in carer sat in the ambulance behind the wheelchair and the other ambulance worker sat on the side.

The trip to Pavia’s home was relatively short and Formosa drove in front of the ambulance to lead the way.

“As soon as we arrived in front of her house, the ambulance driver came out of the ambulance, panic stricken. I asked him to park closer to her door but he told me ‘no, we have a problem’,” Formosa recalled.

“He opened the side door of the ambulance and I saw my aunt lying on the floor, shrieking in pain. The other ambulance worker was lying behind her trying to hold her.”

Formosa said the live-in carer was panicked and told her that her aunt was thrown from her wheelchair and fell head-first onto the floor of the ambulance when the driver hit the brakes. Both the carer and the ambulance assistant were strapped to their seat and could not do anything to stop her from falling.

Together they managed to lift Pavia off the floor, wheel her across the street, inside her home and into her bed.

They did not strap her to her wheelchair

Initially, Pavia appeared to have calmed down, spoke to her niece and even drank a cup of tea.

“The last thing she told me before I left was to not forget her. To come and visit, like I used to when she was at the care home,” Formosa recalled, tearing up.

“Less than half an hour later, I called the live-in carer to check up on my aunt and she told me the situation had taken a turn for the worse. She was screaming again and appeared to have lost eye contact.”

Shortly afterwards, Pavia was back in an ambulance and rushed to hospital, where Formosa was told her aunt was suffering from high blood pressure and dehydration.

“Then a priest came by and administered the last rites on her,” Formosa recalled.

The following day, Formosa received a phone call from a doctor telling her that her aunt was suffering from a chest infection and would probably succumb to it within three days.

“We had not heard her cough, sneeze or even wheeze before. She never opened her eyes again and never spoke to us again. She died four days later,” Formosa said.

The family have since tried to understand what happened and who was responsible for the incident. When she called the authorities, they asked her for information about the incident but by a few days after the funeral, all went completely quiet.

Replying to Times of Malta questions, the health ministry said it launched an internal investigation “to establish the facts of the case” but said the ambulance transporting Pavia was not a Mater Dei Hospital ambulance but a private contractor service which is usually offered to the elderly as means of transportation to and from hospital appointments.

Mary Anne used to be strapped to her wheelchair constantly.

The management of St Thomas Community Living said it conducted its own internal investigation which concluded the home was not to blame. Rather, it was her family or private carer who should have checked she was safely strapped to the wheelchair.

“After being discharged, in her private wheelchair (not belonging to our home) she was covered before she left the building into the ambulance together with her personal private carer, in the presence of Ms Pavia’s niece,” the management said.

“The ambulance was not booked by us or our representatives. Since her private carer took over once she was discharged from our home, it is normal practice that it is the private carer and family members taking over who would be responsible for making the necessary checks as to the safety of the method of transportation being used.”

Once an individual is discharged from the home, the home is no longer responsible for the safety and well-being of that individual, the management said, since neither it nor its staff have any further control of that person.

But Formosa said she was never handed a discharge form and was not even asked to be there that day.

Everything was arranged beforehand between the authorities and the home and the carer and herself only showed up out of their own initiative.