Doctors deliver strike ultimatum over ambulance nurse agreement

Doctors' union president Dr Martin Balzan has delivered an ultimatum of impending strike action by medical professionals, unless legal amendments take place to allow ambulance nurses to administer certain medication.

Balzan said that while the MAM was not against allowing paramedics to administer medication to ambulance patients, the assoiciation was registering a dispute with the Ministry of Health because it had not been consulted over the agreemnet hammered out with the Malta Nurses and Midwives' Union.

He said that unless the union is involved in discussions and consultations over the agreement, industrial action would start as from 14 October.

"This agreement is a verbal once, according to out information, and this exposes both MAM and MUMN members to considerable risk. We know that this agreement was wrested from government under threat of further industrial action."

Balzan referred to how once-regular statements and union warnings regarding the working conditions of ambulance workers, as well as the state of the ambulances themselves, seemed to have ceased since the agreement was announced. "It is not acceptable that the government endangers the welfare of patients simply in a bid to buy the silence of a union," Balzan said.

Balzan said the agreement does not confirm to the Health Care Professions Act and the Medicines Act, two acts which regulate who may diagnose patients and prescribe medication respectively. "Of course, the ministry will say that they spoke to emergency consultants, and we do not deny that. But they are government employees. They cannot register their disagreement as openly as we can," Balzan said.

Balzan said that the MAM's intention is to "stimulate the discussion that failed to take place before the announcement of the agreement", and insisted that the union "remains open for discussion."

Asked about what industrial actions are being contemplated by the union, Balzan was evasive, saying only that the union did not wish to alarm the public.

Asked about whether the MAM's point of contention is whether it feels that a decision to allow nurses to administer medication would be intruding into doctors' professional territory, Balzan was dismissive. "We have no issue with nurses administering certain types of medication," Balzan insisted, "as long as this happens within the proper legal and training context."

But he pointed out that nurses still lack the necessary training to administer medication in emergency situations. By way of example, Balzan supplied a course breakdown for Paramedic Practitioner, a three-year course which trains a medical practitioner to work as an ambulance paramedic. "To our knowledge, there are no nurses with such training in Malta," he said.

Balzan also explained that locally, nurses who accompany ambulances possess general nurse training, and doctors accompany ambulances only in exceptional circumstances. He also reiterated that the current legal framework regulating the medical profession prohibits anyone who is not a doctor from diagnosing patients and prescribing medication.

"Any changes would need to go through parliament," Balzan said, insisting that "a mere verbal agreement" between the MUMN and Government exposes practitioners to legal liability.

Balzan also said that the "verbal agreement" covered the use of six types of medication. Among these, Balzan said, are three drip medications, oxygen, and insulin, "which the MAM has no issue with allowing properly-trained nurses to administer."

He however said that the list included also adrenaline, which he described as an "aggressive medication which can result in heart failure or even death if misused."

Balzan said the MAM is also objecting to the manner in which government has "created" the position of "Specialist Nurse" despite how no such qualification exists. "Not only is the qualification meaningless, but there are no courses through which one can obtain such a qualification, no examination that establishes a benchmark of quality in health care training."

Balzan also said nurses had no specialist register, and called on government to call off further recruitment of specialist nurses and establish the necessary framework for the qualification, arguing that "specialist status of medical practitioners is undermined."