Paul Pace, the president of the Malta Union of Midwives and Nurse (MUMN), said that the newly-appointed Minister for Active Ageing, Jo Etienne Abela, used nurse Rhys Xuereb as a scapegoat because the minister was only interested in “saving his political career”.

Pace said that the suspension of Xuereb displays the lack of appreciation that the ministry has for the work nurses perform.

Carmelo Fino, an 83-year-old St Vincent de Paul resident with dementia, went missing from the residence on 28 June. An internal inquiry had found that the disappearance of Fino from St Vincent de Paul was the result of shortcomings in the standard of care provided by employees, rather than a failure of the system. The MUMN has taken issue with the report and with the suspension of the nurse over the incident. 

“He (Jo Etienne Abela) is not a minister we can rely on,” Pace told this newsroom.

In a press conference earlier in the week, the MUMN announced that it had issued a number of directives, including that nurses should not admit new patients to St Vincent de Paul and all government homes for the elderly until their demands are met. The union is demanding that all wards have no more than 30 residents, that every nursing shift in every roster in St Vincent de Paul have four nurses during the day, that every ward would have two nurses during the night shift. This, as the MUMN had said that on the night of Fino’s disappearance, Xuereb was the only nurse on duty in a ward taking care of 34 patients, when according to agreed protocols there should have been two nurses.

Pace believes that government elderly homes will remain closed for a long time, because the ministry will not take their demands seriously.

Regardless of everything taking place, Pace made it clear that the MUMN is set on maintaining the ratio of one nurse for every eight patients in residential homes during the day, and two nurses per ward of 30 at night, which will ensure the safety and health of everyone.

The Malta Independent on Sunday sat down with Pace on Friday to question him about the inquiry which led to the suspension of the nurse, as well as about the MUMN’s directives.

He was asked to elaborate as to why the MUMN is stating that the nurse was being used as a scapegoat by the Ministry for Active Ageing.

Pace said that the nurse who was suspended “wasn't even called or asked to make a statement. I was told by my own lawyer that this is actually illegal; not being called in when your name is part of the investigation”.

He said that the nurse was suspended without ever having the chance to defend himself and without ever being summoned to court. “This never happened before, when a suspension used to take place it was always after that person would be taken up to court, in this case, the nurse was never accused, neither by the police nor by the PSC (Public Service Commission).” He further stated that the nurse was condemned before actually being accused of anything.

Moreover, “there were other things which didn’t actually make sense”. He said that one of the regulations states that if a person is suspended they have a five-day window period to reply to the suspension and defend themselves. However, when the MUMN’s lawyer asked for the suspension report, they were denied access to the report, so Xuereb did not have the chance to defend himself.

Also, Pace said that the doctors got off “scot free” when, he says, they were also to blame because they were not supposed to admit Fino, a dementia patient, into an open ward.

“He (Jo Etienne Abela) safeguarded his friends, the doctors, which is clear,” Pace added.

Subsequently, he was asked about the nurse and his colleagues reportedly seeing Fino in bed at 5.30am, when CCTV cameras showed him leaving St Vincent de Paul at around 3am.

The impression the MUMN got was that “what happened was that these four young people made a mistake,” he replied.

Pace added that on the day of the incident, the nurse was being asked to give a report of the event and he submitted one which stated that he spotted Fino at 5.30 am. But the MUMN always suggests that nurses should not write an instant report before they notify the union, to check things out. He said that the union had sent an email recalling that report.

When asked whether the nurses should have noticed that Fino was a dementia patient and notified the doctors, he replied by noting that “Xuereb, the nurse involved, doesn’t work in that ward, he has never been in that ward before.”

He followed by saying that Xuereb was only a reliever; he was only there to replace staff who were on sick leave, so he could not have been aware of the patient’s condition.

Additionally, because of the reports of there having been no handover between the night shift and day shift, he was asked whether there was a level of negligence that took place on the night Fino went missing.

“There was a handover! Judge Valenzia never called for the nurse, so his conclusions are totally erroneous,” Pace said.

He said that because the retired judge heading the inquiry never summoned the nurse, then the “report is misleading to everyone”. He added that a handover was given, but Judge Valenzia never called for the nurse and so concluded that there was no handover.

In addition, Pace pointed out that the carers, security and nurse on the night shift were all suspended (four security officers, two carers and a nurse). However, he brought up that the doctors “were not penalised for their misdiagnosis”. They allowed a dementia patient to be in an open ward when they should be in closed wards, Pace said.

“St Vincent de Paul is divided in two, there are the closed wards for the dementia patients and the open wards. This is a residence, it's not even a hospital. Imagine, the ward where Carmelo Fino was doesn't even have a main door, it's just a corridor,” he said.

Pace added that one of Judge Valenzia’s recommendations was for the doctors to revisit all the patients again. As a result, they assigned 60 new constant watches, which meant that there were 60 cases, just like Fino, who needed a carer to be on constant watch.

He said that it is not a criminal offence to let a patient who is assigned to an open ward to leave.

“They can leave, especially if it's a residence. So really there's nothing criminal with just him leaving. He was never under constant watch, he was never told to be supervised by the doctors, so really there's no criminal case against him,” he said.

“We are not wardens, nurses are not wardens,” Pace added.

Pace referred to the state of St Vincent de Paul as being worse than Mount Carmel. The minister “took such an extreme measure out of political panic”, he said.

Moreover, the MUMN stressed that their directives do not harm any patients. Having said that, Pace was asked how the union could justify closing elderly homes when there are elderly people and families who are in desperate need of this service.

He said: “If you don't keep to those health and safety ratios, ratios which are recognised worldwide, mistakes are going to happen.”

The nurse-to-patient ratio for elderly residents is one nurse for every eight patients, while in Mater Dei, it is one nurse for every six patients, he said.

Pace observed that understaffing was not reported by judge Valenzia.

He said that the union was still not harming patients through its directives, because it is appealing to a ratio which caters for the best health and safety practices for staff and patients. He further expressed that the MUMN could have implemented much harsher directives which would have potentially harmed patients, but chose not to.

He continued that “unfortunately, the staffing levels are so bad that it's going to take a very long time for the directives to be lifted”.

“We already lost 400 beds in St Vincent de Paul due to the lack of nurses, and more beds will be lost, not out of spite, but because we intend to keep the ratios for the health and safety of both the patient and staff,” he said.