MPs call for a commission of inquiry

MPs call for a commission of inquiry

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Hyères, NantesToulouse… After “unexpected” deaths in overwhelmed emergency services, deputies and organizations are calling for a parliamentary commission of inquiry.

Last Wednesday, in Toulouse, a patient committed suicide after several days on a stretcher, in a psychiatric emergency waiting area. “It was “stored” in an office, due to lack of space,” denounces Olivier Varnet, FO hospital representative, who sees in this tragedy an illustration of “the cataclysmic situation of the hospital”.

Traveling to Toulouse on Tuesday, the Minister for Health Frédéric Valletoux pointed out “unacceptable dysfunctions” linked, in part, to poor cooperation “between public and private” locally. He promised to work to better “distribute the load”.

Last October, Lucas, 25, died in EMERGENCIES from Hyères (Var), of septic shock, according to his parents, after hours of agony. Other complaints from families were publicized in early 2024, such as in Nantes or Eaubonne (Val-d’Oise).

“No census is taken”

Are “avoidable” tragedies on the increase? “Difficult to say, because no census has been done,” notes Marc Noizet, president of Samu-Urgences de France (SUdF). “But there is increased sensitivity. Everyone understands that the health system, which is extremely fragile, is not functioning as it should.”

The only data available, the number of “serious adverse events associated with care” – namely dysfunctions involving a vital prognosis or functional deficit, declared anonymously by professionals – remains “largely under-declared”, according to the High Authority of Health. Between January 2022 and March 2023, 136 “events” of this type, linked to emergency services, led to a death.

On Wednesday, deputies, unions and associations demanded from the President of the National Assembly the rapid creation of a commission of inquiry into the emergency crisis and the “loss of vital opportunities”.

In the summer of 2023, the number of nighttime closures due to lack of staff will reach an unprecedented scale. In certain territories, the authorities have systematized the obligation to call 15 to be supported.
The SAS (access to care service), an improved Samu which redirects “lighter” cases to community medicine, is present today in 63 departments, according to the Ministry of Health. Which promises to deploy “everywhere” by the summer this system, relieving certain teams.

More and more patients on stretchers

But a problem is getting worse: patients remain on stretchers, sometimes for several days, awaiting hospitalization due to a lack of beds available in specialized departments. “Danger zones”, because they are impossible to monitor correctly, underlines Marc Noizet.

The emergency physician denounces an “infernal spiral”, born from an “activity-based” financing method introduced in 2004: it led establishments to “occupy 100% of their beds” out of “concern for profitability”, causing bed closures further amplified by an “ambulatory shift” strategy and shortages of caregivers.

Nearly 40,000 full hospitalization beds were deleted between the end of 2013 and the end of 2022, according to the statistical services of the social ministries (Drees).

“A new nosocomial disease”

A study carried out at the end of 2022 in France, notably by AP-HP and Inserm, showed that for a patient aged 75 and over, spending a night on a stretcher increases the risk of hospital mortality by 40%.
“This is what makes caregivers resign: no longer working in conditions allowing the quality and safety of care,” underlines Agnès Ricard-Hibon, spokesperson for Sudf and emergency doctor in Val d’Oise.

“We need to reopen beds, concentrate recruitment on multi-purpose medicine,” continues Marc Noizet.
The government must also “have the political courage” to measure and publish a new indicator: “the number each morning, in each hospital, of patients who have not found a place”, to include it among the criteria giving rise to “virtuous results-based financing”.

This congestion “is a new nosocomial disease”, points out the emergency physician. “It must become a national cause.”

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