Minister for Active Ageing Jo Etienne Abela has said that the circumstances which led to Carmelo Fino’s disappearance had nothing to do with the fact that the nurse on duty lacked experience, and the minister refused to entertain the idea that the nurse was being used as a scapegoat.

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 Malta Union of Midwives and Nurses has taken issue with the report.

The Malta Independent on Sunday sat down with Minister Abela to talk about the inquiry and the suspension of the nurse (Rhys Xuereb) as well as other important factors of the case.

Minister Abela said that the inquiry into Fino’s disappearance was led by an independent ex-magistrate who was helped by senior staff not connected to St Vincent de Paul in any way.

Minister Abela said that the inquiry found multiple persons responsible for Fino’s disappearance (one nurse, three carers and four security officers) and not just nurse Xuereb. “The MUMN is saying that the nurse is being used as a scapegoat, when in fact the carers and all those involved had disciplinary action against them.”

Minister Abela said that in the ward in question, the norm was for one nurse to be accompanied by two carers, but that night the nurse had three carers with him and another carer who was on constant watch with a particular resident.

“This means that on shift that night, there was an employee for every eight patients roughly,” Abela said. The MUMN have rebutted this argument by stating that the international standard is for there to be a minimum of two nurses on duty during a night shift for 34 patients.

Minister Abela was questioned about the nurse in question’s lack of experience.

Xuereb was a relieve nurse who had graduated recently. MUMN president Paul Pace had once stated that a number of years have to pass for a nurse to be left in charge of a ward and given the nurse’s lack of experience, Pace said that he should have never been in that position.

In response to this Minister Abela said that “the inquiry’s sole purpose was to identify what went wrong, the moment that happened, and as a minister I gave the findings to the St Vincent De Paul administration. I gave them the freedom to do as they deem fit. I have full faith in the institutions to do what is necessary.”

Pressed on whether the nurse should have been left in charge of the 34-patient ward, Minister Abela said that this was a matter of personal opinion.

“If I was trusted with 34 patients at the beginning of my shift, I have to be accountable for 34 patients when I give my handover at the end of my shift. If the headcount is not the same, irrelevant to my experience, I lost a patient.”

He said that the fact that Fino was reported missing five hours later was an added problem. “We have to be privileged that we are taking care of patients and this responsibility does not change one month into your working experience or 30 years in the service.”

The MUMN has also argued that Fino was misdiagnosed by doctors and placed in an open ward when he should not have been.

When asked about this Minister Abela said that “this was not the aim of the inquiry. Although they were given the freedom to investigate anything and everything related to the case, the problem of Fino being in an open or closed ward was not the aim”.

“The inquiry was only concerned with the fact that the headcount started with 34 patients and ended with 33. It is immaterial if the ward was open or closed. In my opinion, it didn’t make a difference if it was open or closed, Fino left his ward at 3am not at 11 in the morning where people are entering and leaving the ward constantly. We are concerned as to why it happened. People of 80 years of age are not going out and about at 3am.”

The directives put in place by MUMN state that: Nurses are not to phone any relatives for any reason in St Vincent de Paul; All top-up forms are not to be filled, only emergency tablets and injections are to be ordered on the day and nurses will not be signing forms which allow residents to go outside the hospital grounds.

These directives will remain in place until the needs of the union are met. These needs include having two nurses in wards of 30 residents during night shifts and that no replacement nurses are needed in order for other nurses to go on leave.

“I have a lot of respect for all the unions and in the first few months of becoming a minister, I met with them countless times. One has to keep in mind that the inquiry was launched in order to bring a form of closure for the Fino’s family, they rightly want answers.”

Minister Abela stressed that the disappearance of Fino was not a system failure. “If it was the case, things like this would be happening on a weekly basis and not one-offs. We have standard operating procedures and they are in place to prevent cases like this.”

Another procedure, which failed on the day of the disappearance, regards the security gate which was left open throughout the night. “The gates at St Vincent de Paul are meant to be closed from 11 in the evening to the early hours of the morning. This did not happen and it was another case of negligence. Regardless of this, as is stated in the operating procedures, three times a night patients are visited to make sure that they are in bed and this also failed.”

“What the inquiry is suggesting is that these operating procedures in the wards, guard rooms and so on are not the cause, but they could be updated. Therefore, there is no excuse that these procedures have failed, but rather the people going through them neglected them.”

Minister Abela said he also met with the shadow minister from the Nationalist Party and together with Paula Mifsud Bonnici they agreed that the inquiry was transparent and factual. “We needed the inquiry to get the answers and work on the recommendations. As the minister responsible, the findings were instantly forwarded to the administration of St Vincent de Paul and I have full faith in the work they’re going to do to amend the situation.”