French emergency services reach crisis point

BMJ 2002; 325 doi: (Published 07 September 2002) Cite this as: BMJ 2002;325:514
  1. Alexander Dorozynski
  1. Paris

    French hospitals are in a state of crisis, with emergency wards oversaturated in recent weeks because of a shortage of doctors and nurses.

    In Lille and other cities in the north of the country, some emergency patients and babies born prematurely had to be transferred to hospitals in Belgium. Emergency services in Marseilles have been disorganised owing to the resignation of several doctors.

    In the south west, nurses are being imported from Spain, whereas in the east many are being attracted by offers from Switzerland.

    An unexpected increase in the number of births, and particularly multiple and premature births, has placed an additional burden on maternity wards. The number of births, about 740000 a year in the 1990s, rose to 775000 last year; from 1995 to 2001, the number of premature births rose from about 44000 to 56000.

    Throughout the country, neonatal wards and special care baby units are overloaded. Some maternity wards have curbed admissions because of the shortage of doctors and nurses.

    The Port-Royal maternity hospital in Paris, renowned for the treatment of premature babies, has reduced its number of beds from 53 to 43 (and 32 during the summer holidays). In the Paris region as a whole, emergency services have found it difficult to have premature babies admitted rapidly to neonatal wards.

    Dr Nicole Mamelle, epidemiologist with the National Institute of Health and Medical Research (INSERM) in Lyons, warned that France was “entering a phase of regression” in perinatal health care.

    Professor Daniel Loisance, head of cardiology at the Henri Mondor Hospital in Créteil, near Paris, wrote in the daily newspaper Le Figaro (Thursday 22 August): “[Hospitals] face the same problems that have affected their efficiency for years: disintegration of structures, lack of investment… growing discouragement of teams… uncontrolled domination of administrative power.”

    Dr Patrick Pelloux of the St Antoine Hospital in Paris and president of the French association of hospital emergency doctors (AMUHF) said that in France emergency medicine “is sinking slowly, like the Titanic.” He added that many emergency doctors—most of whom are employed full time by public hospitals, with a starting salary of about £;1300 (£833; $1278) a month—are despondent.

    He estimated that the capacity of emergency services has been reduced by up to 30% in some regions. His association has asked to be received by President Jacques Chirac and has invited Prime Minister Jean-Pierre Raffarin to see for himself the working conditions in hospitals.

    “The hospitals, like the schools, are a mirror of the degree of solidarity in a country,” says Dr Pelloux. “Now, they are a mirror of disorganisation.” The transition to the 35 hour working week and the limit on overtime work of 20 hours a month—both measures adopted by the previous Socialist government—are believed to have contributed to the crisis. And the constantly increasing cost of health care in France is a major headache for the new right wing government, which had included a promise to reduce taxes in its electoral campaign.

    In addition, many private and public hospitals face increases in their insurance policies of as much as 500% The insurance companies claim that they cannot take on the increased risk from legislation adopted last year, which allows patients to claim compensation for medical errors and nosocomial infections.

    Embedded Image

    A patient is rushed to the emergency department at Dijon hospital


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