Ombudsman lambasts authorities, consultants

Hospital waiting lists remain "shrouded by a thick veil of unaccountable criteria" according to the Ombudsman.

The system used by the public health service to draw up patient waiting lists for operations is "inadequately documented and marked by lack of transparency and accountability," he said in a document that refers to a complaint he investigated.

His strong words may not be of solace to people who have been waiting for ages to undergo an operation but they spell out the facts clearly and unashamedly.

The investigation refers to a complaint lodged by a foreign prison inmate who was put on a waiting list in 2002 and six years later was still waiting to be operated upon. The hospital authorities admitted with the Ombudsman that they have no control on the way waiting lists for operations at the hospital are established and could not manage the admission of patients on these lists.

The Ombudsman found that waiting lists are kept on the appointments diary of individual consultants and only in ophthalmic and cardiac cases are the lists of pending operations recorded in a centralised system.

The hospital authorities admitted it was difficult to find a solution to this "festering situation" and efforts to introduce a system that would verify the way in which waiting lists were administered and managed had "drawn a blank".

The Times revealed last June that despite the new infrastructure the hospital had no centralised statistics for waiting lists and the Social Policy Ministry said it was working on the problem. When asked again last month it admitted that the system was still not in place.

The Ombudsman said it appears that this state of affairs is attributable to lack of control over consultants who keep a stranglehold on current waiting lists in their departments and which does not allow an independent check on how these active lists are compiled and managed.

He insisted that lack of control and verification "invariably gives rise to suspicion and doubt" even if it may not necessarily be well founded. The Ombudsman said that in a situation where specialists have full rein to exercise their own discretion, the hospital management should disseminate good practice and ensure the existence of a fair and equitable verification process.

"These safeguards are even more necessary when consultants who determine the order of patients to undergo interventions in state hospitals and perform these operations themselves are also allowed the private practice of their profession," the Ombudsman remarked, pointing out that these arrangements are likely to constitute a conflict of interest. He concluded that, since he could not extract a plausible explanation from the current system as to why the complainant's operation took six years to materialise, he would say that the patient suffered discrimination because of maladministration. He also said that the consultant had to bear "the full brunt of responsibility" while the hospital management too was responsible in an indirect manner.

The Ombudsman observed that after the submission of his final report, the consultant involved was admonished by the health authorities and a working group was set up to submit recommendations to the Ministry for Social Policy.

Timeline of a patient's ordeal

November 21, 2002 - The detainee is referred to an orthopaedic surgeon at St Luke's Hospital who decided that he needed an operation and placed him on the waiting list.

June 2003 - Detainee writes to Ombudsman complaining of the delay.

September 2003 - The Ombudsman closes the file after being informed by the consultant that a tentative date was set for February 2004 for the operation to be held.

February 2004 - The operation is not held as scheduled.

March 2008 - The Ombudsman receives a second complaint that surgery had not yet taken place and asked the hospital authorities for an explanation.

June 2008 - The hospital authorities inform the Ombudsman that the surgeon involved would perform the operation within a couple of weeks. The surgeon objects to what he terms "outside pressure" by the Ombudsman, which, in his view, would result in complainant "jumping the surgery queue of about 400 Maltese citizens".