The court has ordered that a minor who was being kept in an adult psychiatric ward at Mount Carmel Hospital be transferred back to the Young Persons Unit, following a dispute in which a union directive overrode medical advice and forced the hospital to move underage patients out of the specialised ward.The decision follows revelations made on Monday by Campus FM broadcaster Andrew Azzopardi, who reported that the minor had been placed in an adult psychiatric ward as a result of a directive by the Malta Union of Midwives and Nurses (MUMN). While not all details are yet known, it would appear that nurses assigned to the Young Persons Unit were refusing to care for the minor — who has been admitted to Mount Carmel in the past — within that ward.One can understand that caring for patients in the midst of acute mental health crises can be difficult and emotionally taxing. But a functioning state must have the capacity to provide such care. What should never happen is for the health authorities to act in direct contradiction of medical advice, simply because of a union directive.According to Azzopardi, the court application filed by the Foundation for Social Welfare Services (FSWS) and the Directorate for Alternative Care was signed by two psychiatrists who are directly responsible for the minor’s care. Both doctors stated that keeping the patient in the adult ward went against medical advice and risked causing psychological harm.However, Azzopardi also said that he had spoken with the Commissioner for Children, who told him that she had spoken with both the CEO of Mount Carmel Hospital and the doctors treating the minor — and that both had assured her the patient would be better off in the adult ward.It is not clear whether those doctors initially held that view and later changed their minds, whether they were misrepresented, or whether someone was not being truthful. What is clear is that this case — as it has been made known so far — raises serious concerns about how decisions affecting vulnerable patients are being made within the system.Based on the information currently available, the case points to possible insubordination, dereliction of duty of care, and a breakdown in clinical governance — potentially even civil liability or criminal negligence.Lovin Malta reached out to the Health Ministry, which said it was “cognizant of a court decree in relation to the situation in question” while confirming that the minor had been returned to the YPU.“In order to safeguard the sole and supreme interest of patients in its care, named patient-specific union directives and any other union directives that counter clinical guidelines and/or specialist recommendations shall not be tolerated,” said a ministry spokesperson. “The Ministry has always acted and will continue to act in line with the direction and decisions which emanate from the Law Courts.”The assertion that such directives shall not be tolerated begs the question of why they have been tolerated thus far, and who, if anyone, will take responsibility for what happened. The spokesperson did not respond to further questions in this regard.If there is no responsibility to be taken, now that the case has come to light there should at least be a frank and sensitive explanation of how this situation arose — how a state agency ended up having to go to court to compel a government hospital to follow psychiatrists’ advice.Both the MUMN and the FSWS have remained silent despite repeated requests for comment.•