Kurt Sansone
Doctors blame waiting lists on staff and bed shortages
The long waiting lists for operations at Mater Dei are not caused by the current system but by staff and bed shortages, the Medical Association said yesterday, defending its members against a damning report by the Ombudsman released on Wednesday.
In a stern attack on the current system, the Ombudsman said hospital waiting lists remain "shrouded by a thick veil of unaccountable criteria," and pointed his finger at consultants who maintain a stranglehold on the way operations are scheduled.
In particular, he criticised the fact that consultants have their own individual appointment diary rather than a more accountable, centralised system of appointments, pointing out that this should be of more concern where specialists are allowed to carry on with their private practice while working for the State hospital.
But according to MAM secretary general Gordon Caruana Dingli, surgeons are frustrated that almost half the operating theatres are not used because of a shortage of support staff and hospital beds, which prevents them from performing more operations.
He defended the system, saying that it affords consultants the flexibility to prioritise patients on clinical grounds.
"These decisions are best made by the clinician taking care of the patient. It is obvious that emergency and cancer cases deserve priority over less serious cases. The current system also ensures that patients remain under the care of an individual consultant with the advantage of continuity of care," the secretary general said.
According to the MAM, the current system allows maximisation of theatre time because the consultant can plan his own list and fill in slots caused by patients who do not attend.
Reacting to the Ombudsman's findings that hospital management did not administer waiting lists, MAM insisted that the authorities have "full access" to an information system recording all outpatient visits, ward attendances and individual operations.
"It is this same system which shows that there is a sustained year on year increase of operations by about five per cent," the association said.The Ombudsman had investigated a complaint made by a foreign prison inmate who stood in line for a knee replacement operation for six whole years.
Moreover, the lack of a centralised appointment system prevented the Ombudsman from determining the reasons for the delay.
In his report he lambasted the hospital authorities and consultants because patient waiting lists were "inadequately documented and marked by lack of transparency and accountability".
In his conclusions he said that a working group had been set up to submit recommendations to the Ministry for Social Policy on the best way forward.
When asked about the progress achieved by the working group, no reply was forthcoming from the ministry by the time of going to print.
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A Cauchi
Jan 17th 2009, 12:45
@ Andrew Cassar
its true they dont work on saturday's but still on saturday's there's a good roster and the service remains intact both sundays and saturdays. I ahve also seen oepartations being done at 3am and 6am in the morning.
Well if local specialists go and open their clinics after midday and keep on working till midnite to meet their private clients, how on earth can they manage to provide a good days work the following day, moreso when this happens every single day of the week.
James Sultana
Jan 17th 2009, 08:31
Oh .... so now we are going to blame MAM for speaking out? We are going to blame MAM members because they don`t give their full commitment at Mater Dei ? OF COURSE !! NOW WE CAN! NOW GONZIPN DOESN`T NEED THEIR VOTE! HAVE WE ALREADY FORGOTTEN THE HEFTY PAYRISE THEY GOT TWO WEEKS BEFORE THE ELECTION WHEN THE PUBLIC WAS TOLD THAT WITH THESE PAY RISE THEY CAN NOW WORK FULLTIME AT MATER DEI?
Now that they are claiming that the problem is LACK OF BED SPACE - something which was OBVIOUS with Mater Dei since day 1 because the number of beds is smaller than St.Lukes, we are saying that the problem is MAM! Didn`t the various Dr. Deguara and Dr. Gonzi use to tell us that the problem with bed space at St.Lukes was due to these being taken by social cases and that is why less beds are needed at Mater Dei ??
WELL- now the bubble is starting to burst: either there aren`t enough beds or else MAM`s members are STILL not giving full commitment even though they got an election wage rise to compensate for their vote. WHO IS TO BLAME?
Andrew Cassar
Jan 17th 2009, 08:10
I'm afraid that it really seems that you are unaware of the situation. It seems that you are mixing up a bad experience that you had with the waiting list problem. I can totally imagine that sometimes courtesy and politeness might be an issue, during a busy outpatient session.....but does that have anything to do with waiting lists?
The minister rightly described MDH as a part-time hospital because doctors work 7:45 to 2:30, including Saturday. That works out to 40hrs a week, like everyone else. Is 40 hrs a week part-time? In the UK they work 9 till 5, but not including saturdays. The minister wants the hospital to be running in the afternoon too. How? More staff and doctors!
And if you read the ombudsman's objections, they were not about some irregularities going on in the waiting lists, but the lack of transperency! And he is right! He also complained of the arrogance of the consultant towards the ombudsman, and probably he was right there as well!
a.dalli
Jan 16th 2009, 20:02
Lack of staff where????????????
Most nursing staff working at private hospitals worl also at Mater Dei on par time bases. Why is this? Is it because private hospitals pay better? Is it a way of tax evation on the part of these part timers. If we are professing lack of staff why do we you all allow this?
lgalea
Jan 16th 2009, 19:06
David Grech
We have been paying for hospital services through our Taxes so stop saying that the health service is free.
Besides, how convenient for you to forget that Gonzipn increased VAT from 15% to 18% supposedly to cater for Mater Dejn and all health related expenses!
Di you forget that it was no problem for Gionzipn to find enough money for him, his Ministers and Parliamentary Secretaries to have an INCREASE of €290 per week €15080 per year in their salaries?
If they had no problem finding money for their salaries increase, why should Gonzipn have a problem in finding money for our health services?
V Fenech
Jan 16th 2009, 19:02
This is what really bothers our elderly and not all the other trivial words about how intelligent Gonzi is in electing Cikku or Peppi as President!
Minister Dalli, considered as the last hope of the Nationalists' party, should see that precautions are taken a.s.a.p!
eric saliba
Jan 16th 2009, 14:39
@ david grech. since when does money come before the welfare of the citizen??
i never heard anyone from the govt benches complain whenever we overshoot the allocated budget for some project...... roads and the mgarr terminal and the building of the mater dei itself immediately spring to mind.
or maybe it suits the powers that be the let private care flourish at the expense of the patient !!!
David Grech
Jan 16th 2009, 12:33
It all boils down to money...the only reason why the government doesn't introduce any fees (e.g. for medicines) is because of the political fallout which would follow such a decision. There is a limited budget and the government needs to stick to it, even in healthcare.
Joe Vassallo
Jan 16th 2009, 12:23
@ Andrew Cassar
Do not talk to me about being unaware – God forbid you go through the hell that I and my wife had to go through, then you would have earned the right to judge me.
All I want is to be treated as a human being, and to know that for these mighty “gods” my pain and suffering is not just a good opportunity or them to make a quick buck.
These are the same people who when they talk to you at Mater Dei (probably after months of waiting for an appointment) hardly bother to look at you, and yet are the epitome of politeness when you fork out your hard earned Euros and go to see them privately.
If you think I am wrong, all you have to do is to see the reaction of the people who have commented on this blog – or are we all “unaware”?
Is the ombudsman too unaware?
Was the Minister unaware when he described Mater Dei as a part time.
Hospital? Yet as far as I know no staff member at Mater Dei takes home a part time salary.
Hallina sur Cassar!!
E. Grech
Jan 16th 2009, 11:22
MAM should start talking some ethics to its members and remind them that theirs is a caring profession, not a business. It is well known that in order to speed up one's chances on an operation waiting list it is adviseable to visit one's specialist (with some names being notoriously common) privately regularly and to "thank" the doctor profusely for seeing you.
Urgent cases are not only determined by the condition suffered but also by the personal and social circumstances of the patient. The European Court of Justice has found that a waiting time of one year for a hip-replacement operation in the UK was too long a waiting period and asked the British authorities to reimburse the patient for having had to seek treatment abroad. But doctors in Malta are loathe to sign the appropriate E112 authorisation forms for Maltese patients to seek treatment in another EU member state, because every patient who goes abroad is one less private patient in their clinics/private hospitals. What a mentality!
Andrew Cassar
Jan 16th 2009, 11:21
@ Joe Vassallo
It seems that you are totally not aware of the situation.
Let's say an orthopaedic surgeon has 2 opertion lists a week, and the government supplies 1 knee prosthesis for every list. How exactly can a surgeon do his 400 patients awaiting a knee replacement in 1 year? If you think that a foreign doctor can do 20 patients in 1 morning using only 1 prosthesis you must be living in fantasy land!!!
Do you by any chance know the number of operations that each surgeon carries out every year, before you lay the blame squarely on the surgeons?
s camilleri
Jan 16th 2009, 11:20
The problem is as Dr Caruana Dingli said, lack of staff. This is because the building itself cost so much to build and costs so much to run, that the Health Department is deliberately not employing people so as to save money. The sad fact is that the planning and support of this hospital stopped at the ribbon cutting ceremony.
eric saliba
Jan 16th 2009, 11:10
the solution is simple. the govt should get foreign specialists/surgeons on a short term contract and ensure these carry out operations in the afternoons and during weekends when minister dalli said operating theatres are not being used.
according to the minister the waiting list problem is scandalous and we have a state of the art part time hospital!!
roger Flett
Jan 16th 2009, 10:51
Is the real problem that there is no centralised integrated computer system available yet in the hospital system? The argument that consultants want to keep continuity and control of the order of operations is not a limiting factor since this can all easily be built into a centralised system. However the efficiency advantages of integrated scheduling of staff and facilities, plus the ability to analise usage, waiting lists etc., as a management tool through a computerised system far outweighs clinging on to disparate islands of data held in consultants hands. Why is it difficult to implement? Don't the consultants also rely on the availability of public facilities to carry out some of their private work?
A Cauchi
Jan 16th 2009, 10:41
Tell it to the marines MAM. Try to fool us any more. Where are all the specialists and consultants after midday? I ve been in UK hospital and the way they work is very different and i suiggest MA should pay a visit and see how they operate. They work as a team and notwithstanding you never meet all the speciailist all of them would know your story, and the decision is taken together not one speciailist trying to hoard his clients. They are available from 8 till 5 and even on mobile if its late. They do not look down on you and think their secision is the best , but i manage to discuss the situation (even though me not being a medical authority) and if they see your point they dont hesitate to change the decision. Thats what i call efficiency . We still have much more to learn if we remove our pride, stubborness and greed
Silvio Abela
Jan 16th 2009, 10:31
MAM can say what they want. They know the truth but will not admit it. The consultants are the ones that prioritise the appointments. They can put whoever they want at the head of the queue. Someone in my family has been waiting for OVER 6 years for the 2nd knee replacement. The first was done OVER 3 years ago. So the Ombudsman should look into that as well. The risk that the "new" knee will fail is becoming greater as time passes. The usual wait between ops for knee replacement is around 6 months.
We are all for a centralised system. Some MAM members like to slot their ops so they can maximise their "private" practices. The patient should always come first, especially those who cannot afford to pay for a "tomorrow treatment" in a private clinic.
And if there is a shortage of staff, its not the MAM's members or the staff's fault, but of who should have seen to it that 25 operating theatres are well staffed before the hospital opened with all the glitz that came with it.
lgalea
Jan 16th 2009, 10:21
Probably the problems are the result of putting friends and friends of friends in positions which they should not be occupying. But then we have to scratch the back of those that scratch ours, haven't we?
Joe Vassallo
Jan 16th 2009, 10:15
Does MAM expect the long-suffering victims of this immoral system to believe them, rather than the Ombudsman? MAM should read the comments on yesterday’s Times..
It would be very interesting to see how many operations are being carried out at private hospitals, and why are the patients opting for private hospitals.
Is it true that one goes private only because he/she is insured?
Most of them know that although private hospitals in Malta are of a high standard, they are still not as equipped as Mater Dei - if anything really goes wrong, they will have to be transferred to Mater Dei in any case.
Yet they are still willing to take the risk.
Why? Is it because they like to take a gamble or because they are not being given much option?
I would say the blame lies squarely the on the medical staff, especially the consultants and the surgeons, and the obviously incompetent hospital authorities. Indeed the latter should resign with immediate effect – they seem to have given up long ago.
The only solution is or Government to bring over foreign doctor who are willing to work hard for the benefit of the Maltese population.
Michael Neville Cassar
Jan 16th 2009, 10:14
MAM has every right to defend her system but too much is too much.Are we saying that it is someone else fault? If it is so then what and who is responsible to fix these ? Is it money ? At the end what about the suffering ? Who cares we are just a number.
Charles Micallef
Jan 16th 2009, 10:07
I am one of those people who cannot believe why, a year or so after this state of the art hospital opened (which incidentally has become the envy of many Nationalities who visit this hospital) the Hospital Management still cannot get their act together and organize the day to day hospital general operations systems. No one can now blame the facilities they work from, as what use to happen at St Luke’s.
Having a good guess, I think that internal politics plays the major part in this disorganization and hence this hospital is “shrouded by a thick veil of unaccountable criteria," again at all levels.
How about, if we all start to put the patients interests really firsts, instead of what is good for us as individuals, there are enough intelligent people at all levels to act and make this a really state of the art operation and the envy of many.
Egoism by some seems to be the order of the day!