Visible from the main entrance to Fresnes prison, the prison hospital (officially called the Fresnes National Public Health Establishment – EPSNF), contrasts with the divisions of the remand center. Here, there are no inmates shouting at windows or strings or ropes to move objects from cell to cell. The atmosphere is also less oppressive.
In a room dedicated to rehabilitation, several inmates complete their exercise session, accompanied by physiotherapists, occupational therapists or an adapted physical activity teacher. “We have around forty physical medicine and rehabilitation (MRP) beds. These are sometimes detainees who tried to escape from the window, or people who were injured while trying to escape during an arrest.“, explains Sylvie Paul. Entering the prison administration as a supervisor in 1999, she became the first woman to direct this hospital at the beginning of the year.
In this room, detainees can follow rehabilitation sessions
Around twenty beds provide follow-up care. To visit a patient alone in a room, the presence of a caregiver and a supervisor is required. Each has a key to unlock a double lock.
In total, the establishment can accommodate nearly 80 patients. But on this day in mid-September, 65 beds are occupied. “We receive the vast majority of men. The average age is 44 years old and 80% of them come from Île-de-France.“, assesses the director. The hospital, on the other hand, was full during the health crisis, welcoming covid inmates who presented with severe disorders.
Medical center by day
The prison hospital also offers medical or surgical consultations in several specialties such as cardiology, dentistry, neurology, pulmonology, infectious diseases and even diabetology. This in partnership with external establishments such as the Antony private hospital, the Bicêtre University Hospital, the Merle d’Aubigné Institute in Valenton, the Paul-Guiraud hospital in Villejuif, etc.
The hospital has two walking courtyards. To diversify the rehabilitation and physical maintenance workshops offered to prisoners, fitness trails and equipment line this green space which also hosts therapeutic gardens.
A hybrid status
Both a prison and health establishment, the EPSNF employs 132 hospital staff and 109 prison administration staff. “Having worked in many departments, I see great stability in the staff here. Some have been here since the start of their career“, notes Sylvie Paul. Among caregivers, the comparison with the public hospital is attractive. “For care, we offer the same thing as outside. On the other hand, there is no fee-for-service pricing. We have a global annual envelope. It offers us a little more flexibility in the management of our projects“, explains Samia Lemtaï, head of hospital administrative services. The annual budget is approximately 12 million euros, mainly contributed by the Ministry of Health.
Apart from the bars on the windows and the secure access points like in this long corridor, it is difficult to differentiate this hospital from those outside.
A mini nursing home project for aging inmates
Due to its dual status, as a hospital and prison, the establishment is also on the front line facing the aging of the prison population. A national issue a little under the radar but very real. While it is already complicated to find places in nursing homes for the general population, the placement of prisoners with a full CV is a matter of squaring the circle. Even though the latter are in a state which is no longer compatible with the conditions of detention in a prison. Furthermore, elderly people who are already somewhat fragile age more quickly in prison. “The state of health deteriorates more quickly in detention and a prisoner is considered senior once he is 65 years old.“, indicates Sylvie Paul.
Released in early 2023, a documentary, shot in part at the Fresnes prison hospital, commissioned by the Ministries of Justice and Solidarity, illustrates this problem. “As soon as a dependent elderly person comes home, we wonder when and how they will be able to get out”testifies Anne Dulioust, representative of the establishment’s Medical Commission.
Documentary to watch below:
By transforming part of the security detention center into a long-term care unit
It is in this context that the establishment plans to transform one of its services to accommodate these people over the long term, while some patients, in fact, already stay for several years. “We have a socio-medical-judicial security center with around ten places which has welcomed fourteen people since its opening fifteen years ago. These are profiles who have completed their sentence but who are retained by the magistrates. Most often, these premises are unoccupied and there is currently a project with the Regional Health Agency and the administration to transform part of this center into a long-term care unit.“, explains the director.
Article updated at 3:50 p.m.
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