Health minister to look into Mt Carmel forensic unit allegations

Health Minister Joe Cassar has said he is unaware of an alleged case of abuse at Mount Carmel hospital's forensic unit, and says he has asked the health department to look into the matter.

The minister was twice informed by Robert Abela, the legal advisor to two whistleblowers, of incidents inside the forensic psychiatric unit where nurses were administering non-prescribed drugs to an inmate.

"I have no comment to make - I was abroad this weekend and did not see the newspaper report, but I have asked my head of department to check the matter," Cassar told MaltaToday.

According to letters seen by this newspaper, the whistleblower's legal advisor informed both Mount Carmel chief executive Edward Borg and psychiatry head Joseph Spiteri first in May and later in June of the incidents, and later informed health minister Joe Cassar in October 2011.

Mary Ann Bugeja, a staff nurse, and her partner Patrick Agius, a care worker, told the health authorities back in April 2011 that they witnessed nurses administering medications not prescribed by Mt Carmel doctors, by crushing them into the tea of an inmate who frequently paged nurses during their night shift.

The inmate is a convicted murderer whose insomnia at night often means he pages nurses every other hour for a cup of tea, and this effectively prevents nurses from sleeping on the job when they should be monitoring the CCTV inside the cells.

Since filing their reports, Bugeja and Agius say they have had to resign their part-time posts from the private care provider Health Care Services Ltd, a company that is engaged by the health division to provide nursing services at various stations.

Both Bugeja and Agius were given transfers to other postings: in the case of Bugeja, she was effectively penalised by being paid one euro less per hour.

Agius told MaltaToday he first witnessed the alleged abuse saw a nurse on night-duty at the forensic unit crushing tablets so that she could add them to the tea of an inmate.

"This particular inmate spends the entire day asleep, so at night he cannot really sleep. Every hour or so, he pages the nurse in the nursing station for a cup of tea. The norm is that care workers emerge from their own separate room, collect the inmate's cup from his cell, return to the nursing station for the tea, and take it back to the inmate."

But Agius says he was taken aback when he noticed little mounds of crushed medication - possibly sedatives although Agius cannot be certain about the drugs that were administered - being prepared beforehand, so that they could be added to the inmate's tea. "I knew that the inmate did not have any prescribed medications, because I had been working there since 2009. One evening the nurse asked me to bring the inmate's cup to her so that she could add the medication to it. But I just pretended I forgot to bring the cup back. I wanted no part in this."

On her part, Mary Ann Bugeja, a registered nurse who also works the night-shift at the forensic unit, says she witnessed the nurse in question taking out anti-psychotic drugs from the medication cupboard. "When I asked her what she needed all those medications for, she didn't take notice of me and took the drugs to the guard room and placed them on the desk in front of the CCTV monitor... this practice must have gone on even when I wasn't on duty, because I was once contacted by the nursing officer Alistair Chetcuti, who asked me why so many medication bottles had been left out by the monitor. He instructed me to tell night nurses to be careful that all medications are not left unattended by the CCTV monitor."

According to Bugeja, the medications included the anti-psychotic Largactil, the sedatives Phenergan and Atarax, and other pain relief medications such as Panadol, Ponstan, Voltaren and Zantac.

Bugeja said she later instructed all nurses that insomniac inmates should only be treated after first contacting the duty medical officer for permission to administer medication, and not by adding crushed tablets to their tea.

But the practice continued, with Bugeja chancing upon the crushed substances placed on a white paper on another evening, when she entered the nursing station at 3:30am during a handover.

Bugeja says she handed over the substances to the deputy nursing officer and Major Frank Borg, the senior correctional officer at the forensic unit, and then filed an incident report with Mt Carmel Hospital on 29 April 2011.

The nurse says that after filing the report, her employer Gaetano Bonnici transferred her to another nursing station at the Malta Freeport, a shift which paid her one euro less than her standard €9 hourly rate. In a letter she received on 6 May, Bonnici wrote to her saying since it had transpired that the team of nurses at the forensic unit could not function together, "it was decided that for the smooth running of the unit" she would be transferred to the Freeport clinic.

Soon after, Patrick Agius filed another report with the managing nursing officer at Mt Carmel, claiming the nurses were still administering the tablets without a prescription. Agius says his employer called him and ordered him to start working a morning shift. "I couldn't do this because I already have a full-time job, so I was effectively being made to resign."