Patients requiring urgent renal dialysis could die if nurses were to follow the directives issued by their union, Mater Dei Hospital superintendent Frank Bartolo warned yesterday.

The Malta Union of Midwives and Nurses (MUMN) on Tuesday directed nurses working at the hospital's Renal Unit to stop being on call as part of a series of actions, which will kick off on Monday.

Although MUMN president Paul Pace said the union's "fight" was not against patients, the action could be disastrous for very sick people. When contacted yesterday he said the union had been approached by two people who offered to act as mediators in the dispute.

"This is playing with human lives. We always have people at the Intensive Therapy Unit and the Cardiac Care Unit who might need urgent renal dialysis," a very concerned Dr Bartolo said.

He explained that nurses working at the Renal Unit were specialised in dialysis and this was not a case of getting a nurse from another unit to perform the procedure.

"If there is a patient whose life is at risk because of lack of treatment, I will inform the police," he stressed.

At a rally on Tuesday night, the union also directed members to stop admitting patients to Zammit Clapp Hospital and St Vincent de Paul Residence for the Elderly.

This action could also have serious repercussions on Malta's only acute hospital, with Dr Bartolo saying it could lead to the cancellation of non-urgent surgery.

"If we cannot send patients needing intermediary care elsewhere, we will not have enough beds and we will have to stop elective admissions and operations."

St Vincent de Paul director Stephanie Xuereb said admissions had already been reduced as a result of an earlier directive and the new actions would make matters worse.

Dr Xuereb said the patients identified for admission were most ly high-priority cases who were very dependent and could no longer live in the community. Many times they were referred from other hospitals.

Nurses have been following industrial action since the end of October when they were directed to stop non-nursing duties and taking blood samples. The dispute revolves around staff shortages, the failure to provide staff meals and the lack of a professional warrant.

Nurses are threatening to walk out of operating theatres if the government goes ahead and employs nursing technicians, whose qualifications are deemed inferior, while district health centres will be shut down until the problem is resolved.

Nurses have also been ordered not to change dressings of patients who were not in their ward and patients will not be allowed to wait in pantries before undergoing surgery when no beds are available. Nurses working at Boffa Hospital have been directed not to give treatment to patients unless two nurses were available.

Hospital medical superintendent Noel Fenech said he will do his utmost to stop the action affecting patients: "If necessary, I will go give patients their medicines myself."

Surprisingly, the actions have also been questioned by former MUMN president Rudolph Cini. He said that, while trade unions had every right to take measures to defend their members, one had to do so responsibly and professional ethics had to be observed.

He expressed concern that the directives were issued even though just 100 nurses and midwives attended the rally - there are more than 2,000 nurses and midwives in Malta.

"During the 11 years I spent as president we issued directives but only when we had a good attendance clearly showing that our members share the union's feelings. If there were only 100 nurses and midwives, one should be cautious what action to take."

Whoever issued the directives was ultimately responsible for the repercussions: "If someone directs nurses not to distribute medicines or not to be on call, they need to be responsible of any negative repercussions these actions could have on patients."

The Health Division yesterday remained mum about the actions, although Social Policy Minister John Dalli, Health Parliamentary Secretary Joe Cassar and the Parliamentary Secretary for the Elderly Mario Galea met last night to discuss the matter.

The General Workers' Union sympathised with the MUMN, adding that while it believed solutions were best sought around a table, no union could wait forever when it found doors closed.