Court orders health authorities to reimburse costs of woman's life-saving treatment

 The court awarded the couple over €35,600 after a government entity refused to reimburse the costs of a life-saving operation in the UK

A court has awarded an elderly couple over €35,600 in damages from the health authorities after a government entity’s refusal to reimburse the costs of a life-saving operation in the UK, which the couple had been forced to pay for because of an administrative error.

This emerged in a judgement handed down on Thursday by Mr Justice Francesco Depasquale, presiding the First Hall of the Civil Court in a case against the Minister for Health, the Superintendent of Public Health and the government’s Chief Medical Officer.

The case deals with a series of events which began in 2015 when, at just over 60 years of age, Concetta Montalto was diagnosed with aortic stenosis, a narrowing of one of the heart’s valves, commonly caused by calcium buildup over several years. 

Montalto’s health had started to deteriorate, requiring that she be operated on immediately, so cardiac surgeon Alex Manche had made an urgent referral to St. Bartholomew’s Hospital in London, as the surgical operation she required could not be performed in Malta.

Arrangements were made by Mater Dei’s Treatment Abroad Unit for the woman to be operated upon in London within the space of a month.

But in London, the day before the operation, while the woman was being prepared for surgery, the woman and her husband were informed that a problem had arisen. They learned that the hospital was requesting a guarantee for payment from the Maltese authorities, who, in turn, were pointing out that the patient was number 175 of an agreed quota of patients that the hospital would handle. The couple were subsequently informed that the two-month application process relating to obtaining treatment abroad would have to be restarted.

As a result of the dispute between the Maltese authorities and St. Barts, the Saturday morning operation was cancelled and Montalto had to leave the hospital. However attempts to contact the Maltese authorities were unsuccessful because it was a weekend. With no instructions as to what to do next was available until the next Monday, despite the efforts of the now very concerned patient, her husband and Manche, the woman was admitted to a private London hospital, the Wellington Hospital. She was operated on by the same surgeon who would have performed the operation at St. Barts, but as the hospital was a private one, which was not part of the UK’s National Health Service, Montalto and her husband were then handed a €35,644 medical bill.

The Montaltos subsequently took the Maltese authorities to court in order to recoup the huge cost of the operation.

The Minister for Health and the Superintendent of Public Health had requested the court to non-suit them, arguing that they had no part in the decisions referred to by the plaintiffs. This was dismissed by the judge, who observed that they had proffered no evidence to support this claim.

The court had also noted the testimony given by Professor Manche, who emphasised the critical condition of the patient at the time. A CT scan showed that her aorta had swollen, reaching a diameter of 60mm, which required immediate intervention to substitute the swollen blood vessel and avoid her death, he said. Manche had contacted Stephen Edmondson, a leading expert in the field who was based at St. Barts hospital in London. Edmondson had recommended that the patient be brought to him urgently, informing his Maltese colleague that he was “ready and prepared” to operate on her.

Mr. Justice Depasquale also observed that the medical issue was a “life or death” one and that the couple were aware of the administrative procedure required in Malta before treatment abroad at the government’s expense could be approved.

This approval had already been granted but the woman’s surgery had not taken place because of a non-payment of a guarantee by the government, noted the judge.

Depasquale pointed out that the woman had not decided to go to seek treatment in the UK on a whim, but had only travelled after receiving assurances that she would benefit from assistance by the Maltese authorities. “Therefore the defendants’ argument that the plaintiffs had not given them any time to take action, because they had immediately resorted to private medical care, does not hold water.”

After a detailed inspection of the acts, the court also made further, more alarming observations. Amongst them was the fact that the Chairman of the Treatment Abroad Unit had testified to not knowing the reason behind the couple’s decision to go private. “Therefore, it appears that the Chairman of the Board had not been informed of the fact that when Barts hospital had requested a guarantee for payment, they were sent Concetta Montalto’s quota number instead.” 

From the Chairman’s testimony, it emerged that neither had he been aware that the couple had been told to resubmit their application from scratch.

The defendants had an obligation to explain and give reasons as to why, a few days after the operation was supposed to take place, the plaintiffs were informed that the application process would have to start again, said the court, going to to add that an analysis of the testimony of the witnesses showed a clear lack of communication between the Board, the Maltese authorities and St. Barts.

Having established a causal link between the lack of communication on the Maltese side, the negligence of the defendants, and the damages suffered by the plaintiffs, the court upheld the couple’s claim for the damages incurred and ordered the defendants to pay the Montaltos €35,644.59, together with the costs of the case and legal interest incurred on that sum in the time since the case was filed.

Lawyers Roberto Montalto and Jonathan Thompson appeared for the couple.