Issue link: https://maltatoday.uberflip.com/i/1468438
maltatoday | SUNDAY • 22 MAY 2022 9 INTERVIEW administer medication, when there isn't any to administer. It is exactly the same in this scenario, too. As things stand: we have about 60 'Level-1' cases in Mount Carmel – and another 70 at Mater Dei – when, quite frankly, there aren't anywhere near the '60 nurses' that are needed to actually provide Lev- el-1 care. It's as simple as that, really. Nurses are 'out of stock'… Excuse my ignorance, but: what does a 'Level 1 case' mean, ex- actly? To put it as simply as I can: 'Level 1' is when a doctor pre- scribes that a particular patient needs dedicated, 'one-to-one' care: which, in this context, means being within one metre of a nurse… at all times, 24-7, every day, every night. Which is no joke, believe me… But it's a necessary procedure, of course; usually prescribed for highly critical patients, where there is real danger of death or injury. And as I was saying: we currently have 60 of those at Mount Carmel… and 70 at Ma- ter Dei. This is why, for us, this has all along been a 'ticking timebomb'. We knew, from beforehand, that there simply aren't enough nurs- es, to provide Level-1 care for all the patients that need it. So it was inevitable, that we would sooner or later end up with cas- es like Joe Pace's. Because he isn't the only one. There were, in fact, another three similar cases before this one. And those are the ones that ended up in court… where patients either died, or self-harmed, etc. The stark truth, however, is this sort of thing happens all the time. Even now, as we speak: though five years have passed, since that particular incident, it is still an ongoing issue, today. Inevitably, some of those Lev- el-1 patients do end up without receiving Level-1 care… And it was also inevitable that the nurses themselves would take all the blame for it, in the end. Like we always do. And in this particular case: unfortu- nately, the blame had to fall on Joe Pace, of all people… Nonetheless, there still remains the question of who SHOULD really take the blame, in such cases. From the perspective of the victim's family members, for instance: if one's relative dies, while supposedly under 24-7 hospital observation… isn't it only natural that they might hold the hospital staff re- sponsible? Look, let me put it to you this way: Joe Pace's main respon- sibility, as manager of Mount Carmel Hospital, was first and foremost to cover what we call the 'complement': basically, the minimum number of nurses to be assigned to each and every single ward. In both Mount Carmel and Mater Dei, that number is sup- posed to be six. In practice, however, we'd be lucky to have three. So Joe Pace's first head- ache is always going to be to 'try to get the complement right': which is never even possible, to begin with. When it comes to the Level 1s, however: usually, there is no staff at all. And everybody involved in the entire health- care administration – from top to bottom: all the way up to the minister himself – knows this perfectly well. They know, as well as I do, that those cases are simply not being covered at all. So it is pointless for doctors to keep issuing Level-1 supervision orders: when we all know (in- cluding the doctors themselves) that there simply aren't enough nurses to actually carry them out. In fact, after the Joe Pace case, government itself entered into an agreement, to start supplying nurses through a private con- tractor. Unfortunately, however, the private contractor has failed to actually deliver, to this day. It seems that he, too, couldn't cope with the sheer number of cases: despite being bound by a contract to do so. So much so, that he ended up sending carers, instead of expe- rienced nurses … and even that failed. Which incidentally also means that there even aren't enough carers – let alone nurses - to cover the case-load, either. But basically, what it all means is that the system itself is still failing, to this day. And this is why I hold the ministry re- sponsible, for what happened at Mount Carmel. Because, just like us… they knew. And I know that they knew: because we raised this issue with them dur- ing countless meetings, over the years. And yet, they did nothing to actually address the problem: beyond, as I said, hiring a private contractor… which, in any case, didn't even work… How, then, can you possibly blame the nurses? Or Joe Pace, in particular? Earlier you mentioned that 'everyone' – including the doc- tors – knows about this prob- lem. Am I right in interpreting that to mean that you expect more co-operation, from your colleagues in the medical pro- fession, than you are actually receiving? No, no, I wouldn't say it's a question of 'co-operation', or anything like that. And just in case I gave you the wrong impression: I certainly don't 'blame the doctors', either. For one thing: they're the ex- perts, at the end of the day. And if a doctor decides that a certain patient requires a certain type of treatment… who I am, a nurse, to argue? Besides, the reality is that doc- tors have just about as much control over the situation, as nurses do: or as Joe Pace himself did, for that matter… At the same time, however: it is an issue that affects them, too. In Malta, for instance, there is a law which ultimately holds doc- tors responsible, for the well-be- ing of their patients. So we do inform them, on a routine basis, that… "Listen: that 'Level-1 you ordered? Sor- ry, but it couldn't be done. No nurses available…" So while the doctors them- selves are not to blame: then again, this is also why I com- pared the situation to 'out of stock' medicines, earlier. What happens when a certain medication is 'out of stock', any- way? We inform the doctors, of course; and usually, the doctor will try to order something that is similar to that medication. When it comes to nurses, how- ever; when we likewise inform doctors that it is now 'nurses' – not 'pills', or 'tablets' – that are 'out of stock'… what they usual- ly say is: 'Not my problem. Call top management; call the minis- ter; call whoever you like; but it's not my problem…' And in a sense… they're right, too. It is, after all, what we've been saying, all along: i.e., that the responsibility to provide more nurses all along lies with the government – and the health ministry, in particular – and certainly not the doctors; or, even less, the nurses. But then… it's a lot easier to just 'blame the nurses', isn't it? We are, after all, at a much lower level in the medical hierarchy…