The Malta Union of Midwives and Nurses has taken exception to the conclusions of an inquiry into the disappearance of a patient from St Vincent de Paul home, and has issued directives to nurses in protest.

In a statement, the MUMN referred to the conclusions reached by Mr. Justice Emeritus G. Valenzia relative to the disappearance of resident Mr. Carmelo Fino from SVP and to the immediate reactions thereto by the Ministry for Active Ageing and Community Care and this insofar as the said report indirectly refers to one of its members, namely, the nurse who was on duty at the ward where Mr Fino resided.

At this stage MUMN said it has only been provided with the conclusions of the said report and is not privy to the entire report, with media outlets reporting that there were enough nurses present at the time of the disappearance..  

"If the Report truly states that there was ‘sufficient staff’ on the night of the incident, this would be a completely erroneous assertion resulting, one would imagine, from a lack of knowledge about nursing protocols and procedures on the part of the inquiring judge," the union said..

MUMN said that its officials have not been interviewed by the judge in the course of this inquiry, as otherwise it would have certainly drawn his attention to the fact that, according to a protocol agreed between MUMN and Government, the ward in question should have (during night shift) two nurses, not one. The fact that only onenurse was on duty on the night in question is clearly a system failure for which responsibility falls totally on the shoulders of the Ministry / Administration. To make matters worse, this one nurse was a reliever and most relievers will not know the residents of the wards. This one nurse had graduated only a few months ago with 34 patients and so the Ministry / Administration has left this open ward with ONE nurse reliever with no experience at all, the union said.

The MUMN has been clamouring for a long time that the shortage of nurses has become a ticking timebomb for all nurses working in SVP, MDH, KGH, Homes for the Elderly and GGH. Whenever incidents occur the government resorts to its favourite ploy to put the blame on personnel rather than on its abject failure to ensure the necessary staffing levels according to protocol, agreements and international standards, the union added.

Furthermore, the conclusions of the said report, places a collective blame for this occurrence on the “night shift” without distinguishing between the various personnel and categories of personnel constituting the said ‘night shift’. There was no distinction between the different duties and responsibilities of the personnel on the said night shift and certainly it was not the nurse’s duty to ensure that each and every one of the residents is in their place during every minute of every hour of the night shift.

Indeed it is incredible how one could reach such conclusions in such a superficial manner especially in view of the consequences which such conclusions can have on the nurse. Clearly the shortcomings which the retired judge points out do not fall within the parameters of the nurse’s duties but the report places a collective blame on the entire ‘night shift’, the union said.

In its reactions, the Ministry pats itself on the back and takes especial satisfaction from the retired judge’s conclusions that the incident in question was not a result of system failures, and yet, at the same time, it refers to a whole list of measures which were taken after this incident occurred in order to avoid any future repetition of such an incident. This is a "veritable contradiction in terms if ever there was one", the union said.

If there were no system failures, as the Ministry is saying, why was there the need to take all these measures in order to change the system? Contrary to the Ministry’s utterances of self-praise, the extensive measures implemented after this incident occurred point out to the inevitable conclusion that the systems which were in place at the time were poor, insufficient and inadequate. Responsibility for such a state of affairs certainly does not lie with the personnel and certainly not with the MUMN’s member.

MUMN said it is determined to resist all attempts which may be made to turn the nurse who was on duty at the ward during the night when Mr. Fino disappeared into the proverbial sacrificial lamb, as has happened in the past on too many occasions. It is for this reason that the MUMN has resorted to industrial action in order to safeguard its members, actions which event the Court has decreed to be proportional and within its rights to take.  

It has also been reported in the media that one of the considerations made in the inquiry was that Mr. Fino was not suffering from dementia. Whilst the MUMN would not like to dwell too long on this issue and respects the privacy of Mr. Fino and his family, one must perforce refer to what was reported on the Times of Malta on 2^nd July 2002 in the sense that Mr. Fino’s family expressed their concern that “he is unable to communicate verbally because of the dementia”. 

The main consideration which arises from this fact, from a system and administration point of view, is that SVP residents suffering from dementia, if the system is truly in place and is truly working, should be placed in a Closed Ward specifically designed for residents suffering from dementia, where more stringent measures are in place to avoid wandering from such patients. In this case, Mr. Fino was accommodated in an open ward which ward allows patients to enter and leave the ward as the resident pleases, which ward does not have any locked doors and which was offers no restrictions for patients to leave the ward as they please.

Was the ‘night shift’ also to blame for this deficiency, as the judge would appear to conclude? Why did the medical team of Mr. Fino never transfer such patient to the closed ward? Why was this omitted from the report of the retired judge? The truth is that this incident could easily have been avoided had Mr. Fino been placed in a closed ward; this is a decision which clearly does not fall within the remit of the nursing staff to make, the MUMN said.

In its conclusions, the report also states that “the night shift” purposely misled the investigation which was triggered once Mr. Fino’s disappearance became known. This was possible in reference to a statement given by a carer to the effect that Mr. Fino had been given tea at 5am. The nurse on duty made no such assertions, the union said.

In view of the above, MUMN expressed its complete condemnation for the conclusions of the report which includes the nurse in an exercise of collective blaming when in reality there were absolutely no shortcomings from the part of the nurse, and hence it is, as of now, making it clear that should any measures be taken against its member in an effort to put on his shoulder blame which should be put elsewhere, it will be taking all and any necessary measures to defend its member’s interests.  

Directives in SVP and all elderly Homes

The MUMN issued directives that SVP and the elderly homes are not to admitt additional patients until all wards in SVP can supply two nurses in all open wards during the night shift.

Also all big open wards are not to exceed the 30 patients limit and all wards are to have at least three nurses during the day and two nurses during the night. 

If criminal charges are submitted to the nurse involved, MUMN would issue further industrial actions it deems fit. Such directives are with immediate effect.