The white blouse, Gwenaël Frassa has been wearing it for fifteen years. Head of emergency in a Toulouse hospital, he decided in November to resign, death in his soul. "I have always been very attached to public service but too many elements made me lose my illusions," he says.
His credo: to offer the patient quality care. "Today, I can't offer this anymore, so I'm going to stop."
As in many hospitals in France, its emergency department has to face a saturation of activity. "People who no longer have access to care in the city, or who are in a catastrophic social situation, are turning more and more to emergencies," he explains. According to the Ministry of Health, attendance at hospital emergencies has almost doubled in twenty years, with 21 million passages recorded in 2016 against 10 million in 1996.
"You walk on a wire, but without a safety net and at an increasingly higher height"
In its department, the attendance has doubled in ten years to reach today 80 patients per day, who follow each other on five beds. And, at the same time, the means are getting poorer: in two years, the continuing care unit has been closed and the laboratory has been outsourced. "We are now forced to call a courier who must deliver the blood test, he said, which can lengthen the waiting time for results from one to two hours." The only alternative to save time, nurses can improvise laboratory assistants, in addition to their workload.
Added to this is a shortage of radiologists, who leave the public for the private sector. The hospital where Gwenaël Frassa works has lost four of the five posts planned. Result: the waiting time for a scanner is getting dangerously long. "It is difficult to accept when you entered this profession to treat, he admits. You roll up your sleeves, you are involved but you are forced to play a balancing act. As if you walked on a wire, but without a safety net and at an increasing height. "
Faced with these departures, management offers alternative telemedicine solutions for remote scanners. "But this can lead to a deterioration in the technical quality of the image which can lead to a misinterpretation, therefore a diagnostic error," he underlines.
The service also has to cope with a glaring shortage of staff. "The night nurse can manage up to 35 patients on their twelve-hour period, while ensuring the functions of nursing assistant, stretcher bearer, secretary and maintenance agent," continues the emergency room doctor. .
"In the corridors, privacy and modesty no longer exist"
For several months, Gwenaël Frassa has seen patient waiting times lengthen, some even leaving the emergency room without having been seen. "In the corridors, privacy and modesty no longer exist. And the consequences are sometimes serious," he adds. "Since the spring, we have had the first verbal and physical attacks on doctors and nurses, which has resulted in sick leave."
The head of service said he was witnessing "the bankruptcy of the public health system". "Emergency staff in France are on burn-out and this extends to the entire public hospital," he said.
Faced with this "overpressure", the head of service requested, in September, additional staff. "A crumb when you know that the emergency of the neighboring CHU required 80 additional positions," he said. Management provided only two additional hours of nursing time per day and four hours of nursing assistant time. A blow for the emergency service which can boast for two years as being the first in terms of activities, according to the Occitanie Regional Emergency Observatory which reports its findings to the Regional Health Agency, the local arm of the ministry.
The management response sparked a public outcry, which was followed eight days later by strike notice. But the hierarchy has given up nothing. "When the resources allocated jeopardize the quality of care and staff, you have to know how to say stop and leave," he said. Result: the service has experienced nine resignations from the eleven current positions, which raises fears of a possible closure for the benefit of other activities deemed more profitable by the hospital.
"Intermediate emergency centers to relieve CHU congestion"
The observation that the emergency physician draws up on his service reflects what is happening nationwide in hospitals. "The public service is sliding towards a degradation of care for very clearly economic reasons," he believes. Who are the decision makers? Management, boards of directors and the Regional Health Agency (ARS). "Today, they are no longer very sensitive to information coming back from care units. The priority in 2019 in France is to balance budgets," he notes.
According to the doctor, the will of the public authorities is to close certain emergencies in France and to "liberalize intermediate medical centers". These new emergency centers, which have already existed in France for several years, are in the private sector but will provide ARS funding for development aid.
They offer access to emergency care with agreed rates. "They should make it possible to do bobology and to orient light traumas, as well as unscheduled urgent care except vital distress. And thus decongest the CHU, which will remain dedicated to vital emergencies", decrypts Gwenaël Frassa, who was asked to work in one of them. He will start his new position in early 2020 with the idea of reconnecting with quality care.
>> Read also: "I experienced my resignation from National Education as a 'coming out'"
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