The situation at the Mater Dei Emergency Department is "dire" with overworked medical professionals having to decide which patient in need of urgent medical attention is treated first due to massive understaffing issues in a thankless job, a medical professional told The Malta Independent on Sunday.

"Mental health-wise, we're not okay at all. I can speak for the majority of my colleagues. I've been messaging colleagues and we've been messaging each other trying to offer words of support to one another because of what happened on Tuesday and the verbal abuse and physical threats we're seeing online as well. You can't help but read the comments, you know? It's a safety concern at the end of the day and I think we're the scapegoats of a system failure."

The medical professional agreed to speak to the newspaper on condition of anonymity following the death of Stephen Mangion in the waiting room of the emergency department last Tuesday while he was complaining of chest pains. An independent inquiry has been launched into the procedures adopted in the department, to run in parallel with a magisterial inquiry into the man's death.

The medical professional said that the situation at the hospital "has become a matter of putting one emergency over another, which is a very dangerous situation to be in. We're not gods, we can't make the choice of who deserves to live over another. Everyone should be seen to with the same level of care and attention".

The medical professional said that things at the Emergency Department, as they stand, are "volatile" due to the large influx of patients being seen to by a handful of overwhelmed doctors "on the edge of their seats. [The doctors] are always wondering, are they missing something? Should they see that patient immediately? That patient seems to be in pain, but that other patient is also in pain. How are we going to prioritise seeing one over the other?"

The best measures are taken to try to avoid such situations by bringing in as many patients as possible into the highest priority areas of the triage, "just in case something happens, so that they can attend to them almost immediately".

The medical professional said that they see between 300 and 400 cases a day, over a 24-hour period. "Seeing to all the population of Malta, including all road traffic collisions that happen during the night, requires a large number of staff to help in a 'risk of death' situation. Not to mention other, lower-priority, cases since we don't want people waiting for a long time."

Further complicating the situation, the medical professional said that following the Vitals scandal, the Gozo General Hospital, including its Emergency Department, has now become the responsibility of Mater Dei Hospital. "As a result, our senior staff is being stretched to cover both the Gozo General Hospital and Mater Dei, as required by the administration. If Vitals didn't happen, more senior staff would have been working a shift in the Emergency of Mater Dei, and bolstering our forces, so to speak. Obviously, this stretched them out thin as well, as if they weren't already stretched out enough."

Going to the root of this high demand at the Emergency Department, the medical professional said that the influx of foreigners, both those who reside in Malta, as well as tourists, aren't aware of the other options for public healthcare such as the health centres, or believe that they can cut the queues at the healthcare centre by going straight to Emergency. They said: "This is a multifaceted problem, which I think that the relevant authorities are not tackling in a direct manner."

"We had a lot of public health involvement in the Covid-19 pandemic, and they did a very good job at it. But I think we're coming on to a new 'pandemic', which is a health crisis where the Emergency department is unable to keep up with the amount of people who are coming through its doors every day. I think it is a public health crisis and it should be tackled appropriately by them."

When asked if this demand was due to the population growth, a failure to plan for the population growth or both, the medical professional said: "So, the rising population was an inevitability, we all saw it coming. It's happening all over the world, not just in Malta. But while all of the Emergency departments in the world are in a crisis, it is particularly acute in Malta since Mater Dei has the only Emergency department on the island that offers free public healthcare. The horrible influx of patients is not just a phenomenon and we're seeing it more often."

"I think there was most certainly a lack of forward planning. While we're trying to make ends meet in the Emergency department since we lack the resources to deal with this rising population, the government is trying to solve the problem now. I think we're just adding band-aids to a situation that should have been addressed at least 10 to 20 years ago."

The medical professional said that the government's proposals to solve the problem now are sounding hollow. "They're telling us that the Paola Hub was going to relieve the load but nothing has happened yet. They were also saying that they would take workers from the Mater Dei Emergency Department to work at the Paola Hub. I don't see how it would ever work out since they're understaffed at Mater Dei already."

When asked about their opinion on the Health Minister's promise to outsource emergency services to the private sector via a tender, the medical professional said: "Honestly, this wasn't discussed with our department. We don't know what the minister means by this outsourcing, and it was never explained to us directly." When pressed if the Emergency department was even informed if the promised outsourcing meant the bringing in of nurses or doctors from the private sector, they answered: "We know nothing; we haven't even received an email about it yet. We saw it in the papers and that's it. So, I'm not sure when it will come out. A lot of decisions we feel are being made behind closed doors without involving the staff directly."

The medical professional said: "There was going to be a circumstance where certain staff were going to be forced to go to Gozo to cover certain hours with a week's notice. We didn't know what our working hours were going to be like, our working conditions, our support or any other information." They said: "We already cover the Gozo General Hospital to a large extent, so this was an addition to it, and it wasn't discussed with any of us."

"This all contributes to us being overworked, burnt out and at times admittedly jaded about the amount of people we're seeing in a night shift or during the day." They said that the Emergency department personnel are currently facing "insubordinately" long shifts with no breaks, having staff "sneak out for two minutes for a bathroom break. The situation is out of control and we don't feel that we're being supported at all by the hospital administration or the government".

They asked if one would rather work in a calmer environment, allowing one time to think before taking a medical decision, with good hours and breaks, as well as administrative support or "a very hectic environment where one sees patient after patient with a lot of backlash, complaints all around, and people sometimes being verbally or physically abusive towards us". They added that in both environments, the same pay is received so, "what would you go for? It's a simple answer".

As a consequence of, and adding to, the poor work conditions, in the Emergency department staff over-fatigue is rife, the medical professional said. "People get so burnt out and overloaded that they can't cope with it anymore. There are staff that end up spending many hours away from family at a time when they're trying to cope with every aspect of their life. I don't blame them for leaving. We end up losing senior staff every year; the crucial staff that we're meant to be safeguarding in our department."

The medical professional said: "We, as healthcare professionals, are trying our best not to comment on the situation, because we know it's futile, it's pointless and people are just suffering. Obviously, it takes a huge toll on mental health, because you feel like you're giving your 110% and people are not appreciating that."

They added: "There's never any reason to attack another individual who's trying to do their job. There's no justification for all the attacks on a personal level. They can attack the system, yes, the system needs attacking and overhauling, fully, but not those who are just trying their best to keep the ship afloat."

For the medical professional, some solutions are simple and can be implemented immediately. "I would suggest raising more awareness on what should be defined as an emergency; what would justify you coming to the Emergency department or to call an ambulance."

"More awareness should be raised on the services that are given and provided in the health centres, even just a simple pamphlet handed out at airports, for example, would do a world of difference for emergency staff. This way you'd avoid tourists coming into the Emergency department for very minor complaints."

The medical professional said: "If we give the public a pamphlet with appropriate information on where to go and which health centres are open 24/7 it would do a mile of good. It would make a huge difference to the demand we face in the Emergency department. Public health education needs to happen and the people need to realise that they too have a responsibility to help us. They have a hand in helping us help them."