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Doctors complain of shortages at emergency department
Hospital doctors yesterday flanked Medical Association of Malta officials who complained about a shortage of staff at St Luke's Hospital's accident and emergency department.
The bone of contention lies in the fact that instead of getting off duty doctors to work at the casualty section, the authorities were taking doctors from wards to fill the gaps at the accident and emergency department, MAM president Stephen Fava said.
Dr Fava and MAM general secretary Martin Balzan stressed that this was not the answer and could actually put patients' lives at risk.
Dr Balzan told The Times last week that the doctors in question were not sufficiently experienced, the level of supervision at casualty was inadequate and the other departments also had staff shortage problems.
"Emergencies happen not only at the emergency department but even in wards. Taking doctors from wards would put patients' lives at risk," Dr Fava said.
Dr Balzan said the government preferred to let patients suffer instead of paying a few hundred liri to get extra doctors from other sections to work at the accident and emergency department when they are off duty.
Dr Fava explained that doctors were leaving because working conditions in Malta were not attractive, causing a brain drain.
Dr Balzan said that as soon as doctors gained enough experience to be able to work on their own, they were being lost to hospitals abroad. While the number of patients was increasing, the number of doctors was on the whole decreasing. The situation had long been deteriorating and had now reached a point where patients were suffering.
Dr Fava said even though the emergency department operated on a triage system, there were still times when people waited for a long time.
Contacted yesterday a spokesman for St Luke's, Boffa and Mater Dei hospitals said waiting times at the department were the result of "erratic patterns of demand on the services".
"The demand is not constant, so while shifts are structured to mirror the demand pattern, it is not always possible to have a perfect fit," he said.
Dr Fava said the health authorities accepted the fact that there was a shortage of doctors at casualty and also accepted that the full complement should be 40 but there were only 30 doctors currently working.
The hospitals' spokesman said it was acknowledged that over the years the demand for the accident and emergency department services had increased and that was why the hospital management proposed to increase the number of doctors at the section at specific times, using both doctors on duty and those who were not.
He said this was the subject of talks with the MAM but despite its initial agreement the association had decided to withdraw this agreement and issue directives to doctors not to move from the department they work in to the accident and emergency unit "even if for just a short period of time (four hours)".
"These four hours were precisely the period when the backlog at the accident and emergency department accumulated, resulting in long waiting times," he explained.
The spokesman said the complement of 40, mentioned by the MAM, was still being evaluated by the management.
"One must keep in mind that the possibility of deploying 10 additional doctors is dependant on having more house officers (graduating doctors)," he said.
Asked whether doctors could be taken from health centres, Dr Balzan said these were more understaffed than hospital, having only half the complement.
The MAM has directed doctors to work to rule and not to accept to be moved from a ward to the casualty department. Dr Fava said there were no plans at present to step up the action.
minn John Pisani
L-Assocjazzjoni Medika Maltija (MAM) akkuzat lid-Dipartiment tas-Sahha li biex ma johrogx ftit mijiet ta’ liri qed jipperikola sahhet il-pazjenti li jaghmlu uzu mid-Dipartiment ta’ l-Emergenza fl-Isptar San Luqa.
F’konferenza ta’ l-ahbarijiet li saret il-bierah quddiem l-istess sptar, it-Tobba Stephen Fava u Martin Balzan qalu li ghalkemm hemm nuqqas kbir ta’ tobba fl-Emergenza, id-Dipartiment tas-Sahha ma jridx idahhal tobba li ma jkunux xoghol. Kull darba li l-MAM talbet spjegazzjoni ghaliex qed isir dan, qatt ma nghatat risposta, izda r-raguni hija li d-dipartiment ma jridx li jhallas ghat-tobba li jkunu ‘off’.
“L-awtoritajiet tas-sahha kkonfermaw li m’humiex lesti li jdahhlu tobba fl-Emergenza li jkunu ‘off duty’. L-uniku rimedju li qeghdin joffru huwa li jittiehdu tobba li jkunu fi swali ohrajn,” qalu r-rapprezentanti tal-MAM.
“Kif jaf kulhadd digà hemm nuqqas ta’ tobba f’dipartimenti ohrajn u ghaldaqstant jekk jittiehdu tobba minn swali ohrajn, se jbatu l-pazjenti ta’ dawk is-swali minn fejn se jitnaqqsu t-tobba. Din ma ssolvix il-problema”, qal Dr Fava.
“Anzi tkompli tiggrava s-sitwazzjoni ghax kull ma jkun qieghed jigri huwa li jnaqqas minn post biex jimla post iehor. Fi kliem iehor l-awtoritajiet qeghdin izarmaw knisja biex jibnu ohra,” qal it-tabib.
Dr Fava u Dr Balzan spjegaw li n-numru ta’ tobba qed ikompli jonqos minhabba li l-kundizzjonijiet tax-xoghol m’humiex attreanti ghalihom. B’tobba b’esperjenza jitilqu u jfittxu impjieg ahjar, specjalment barra minn Malta u mal-privat, is-sitwazzjoni f’San Luqa qieghda tiggrava l-aktar fl-Emergenza fejn il-pazjenti qeghdin jispiccaw jistennew ghal sieghat twal. Id-dewmien ta’ spiss johloq mumenti ta’ tensjoni u rabja mill-pazjenti u qrabathom.
Dr Fava qal li tobba li jkunu hadu l-edukazzjoni f’Malta, inghataw stipendju fl-istudji u anke l-ewwel esperjenza, issa l-frott ta’ dan kollu qeghdin jaghtuh lil pajjizi barranin.
Huwa ta ezempju fejn minn 50 tabib li ggradwaw fl-1999, inqas minn ghaxra baqghu hawn Malta.
Dr Fava qal li s-sitwazzjoni se tkompli tiggrava fl-isptar fil-jiem tac-CHOGM peress li l-awtoritajiet iridu jiehdu bejn tmienja u ghaxar tobba mid-Dipartiment ta’ l-Emergenza biex ghal dawk l-erbat ijiem ikunu f’postijiet ohrajn bil-lest ghal dak li jista’ jinqala’.
Hu qal li l-pazjenti fl-isptar fl-istess erbat ijiem m’humiex se jonqsu u l-attakki tal-qalb u kull emergenza ohra xorta se jinqalghu, anke waqt il-laqgha tac-CHOGM. Huwa qal li l-unika haga logika hija li dan ix-xoghol isir minn tobba li ma jkunux xoghol u mhux jitnaqqsu mill-Emergenza.
Min-naha tieghu, Dr Balzan qal li hemm tobba li ma jahdmux fl-Emergenza, li izda jridu jahdmu hemm meta jkunu ‘off duty’. Huwa ghamilha cara li dawk it-tobba li lesti li jahdmu fl-‘off duty’ taghhom, m’humiex l-istess tobba li jahdmu fl-Emergenza peress li dawn digà qeghdin jahdmu sieghat twal. Huma dawk it-tobba li jahdmu f’dipartimenti ohrajn li lesti jahdmu meta ma jkunux xoghol.
“Izda l-awtoritajiet qeghdin jghidu le lill-pazjent. Qeghdin jghidulu stenna fl-Emergenza, bati ghax m’ghandniex flus izjed ghad-Dipartiment ta’ l-Emergenza”, qal Dr Balzan.
Hu kompla jghid li biex id-Dipartiment tas-Sahha jiffranka ftit flus u l-Emergenza tkompli tahdem b’madwar ghaxar tobba neqsin, qieghda tinholoq sitwazzjoni kerha b’detriment ghall-pazjent. Din l-istess sitwazzjoni la jridha l-pazjent u wisq inqas iriduha t-tobba. L-Assocjazzjoni Medika Maltija tat direttiva biex it-tobba kollha jahdmu biss fid-dipartimenti taghhom.
Doctors’ complement at 75 per cent of requirements
by Gerald Fenech
The situation at the Emergency Department in St Luke’s Hospital had gone from bad to worse with the current complement of doctors at only 75 per cent of what was required to man the unit, Medical Association of Malta president Dr Stephen Fava said yesterday.
The MAM yesterday called a press conference in front of St Luke’s Hospital to complain about the shortage of staff.
Dr Fava said the situation was leading to increased waiting times for patients, in turn creating unnecessary tension and stress for all at the department.
“To function properly, the Emergency Department requires 40 doctors; at the moment the staff complement is 30. The health authorities have at least acknowledged that a shortage exists but nothing is being done about it,” Dr Fava said.
The “brain drain” which was affecting the health sector in general, he said, was acute in this department and a large number of experienced doctors had gone overseas to pursue better career opportunities.
The MAM has ordered that no doctor in another department within the hospital who is off duty to report at the Emergency Department to plug the shortage.
“It is not acceptable that an off-duty doctor is brought in to work at the department because this is only being done to save money and it is not in the best interests of the patient,” he added.
Dr Fava said there was general agreement that the number of doctors would be boosted over the long-term but no medium-term solution existed.
He said that CHOGM requirements will further reduce the number of doctors available at the department because the government was proposing that around 8-10 doctors would have to be taken from emergency.
“We have heard that around 10 doctors will be required for the upcoming CHOGM summit. At this stage, all we have heard are numbers,” MAM Secretary General Dr Martin Balzan said.
MAM was highlighting the situation, he said, because the public was not getting a good service at the hospital.
“The situation has been deteriorating for a long time and nothing is being done to address the ‘brain drain’ at the department because the more experienced doctors are leaving on a regular basis,” he added.
Dr Balzan said that of the 55 doctors who graduated in 1999, only a handful remained. He said the situation in health centres was even worse.