While waiting for a return to normal, which the entire hospital community and the inhabitants of Dracénie are calling for, “the subject is taken seriously” by the health authorities, he recalls. A monitoring committee, “bringing together the directors of hospitals and emergency services in Var-Est, CHI Toulon La Seyne, and even part of the Alpes-Maritimes, meets every Tuesday without exception since October 29, (date on which the Dracénoises emergencies closed at night, to make decisions, editor’s note)“. The management of the ARS care offer frequently participates in these meetings. A medical monitoring committee has also been created, led by Dr Garitaine, head of emergencies at the Gassin health center, to work on better fluidity between doctors. “We are not in a disorganization, Mr. Carbuccia points out, but in an organized system where all the partners are looking for a solution to closing the service at night”.
No institution is immune
Among the solutions, the line of emergency physicians within the framework of territorial solidarity, within the territorial hospital group (GHT), led by the boss of CHI Toulon La Seyne, Yann Le Bras. “The emergency workers of the GHT register on a list of time slots, details Mr. Carbuccia. The ARS released on December 17, the solidarity bonus to pay them. There is a solid, close-knit partnership. This made it possible to operate the emergency room during the Christmas period. At the same time, the Dracénie hospital has been actively looking for emergency physicians and it is very difficult”.
Because the origin of this situation, underlines again the departmental delegate of the ARS, “It’s not a budgetary problem. We have funding for 22.5 full-time equivalents. The problem is finding emergency physicians. The numerus clausus does not allow us to have enough doctors. It’s not a problem dracénois, no establishment is safe. Draguignan, it is not a small city, it is an important city. It is not a small hospital, it is an important hospital. He is experiencing a problem cyclical, there is no desire on the part of the ARS to pool this or that”.
A vicious circle from which it is difficult to escape
How does he explain the departure of several emergency doctors in recent months, which led to the decision to close the service at night? “In the private sector, they are better paid, they don’t work weekends. Fewer doctors in a service means more work for those who stay, it’s a vicious circle from which it is difficult to get out”.
But the ARS delegate wants “to hold a speech of reality” and ensures “the objective is to reopen the emergency room at night, even if it is programmed, two to three hours a week more in the evening, in stages. And to consider reopening full time. There is a very strong desire of the ARS and the other hospitals at work. We will get there”.
Several Var hospitals integrated into a monitoring committee
When the decision to close the emergency department of the CHD was taken, it was very quickly necessary to manage the new flow of patients in the surrounding hospitals. “So, we created the medical-caregiver committee to follow up on the closure of emergencies”, says the Dr Philippe Garitaine, head of emergencies at the Saint-Tropez hospital center and responsible for this alliance. “This us(1) made it easier to communicate and make decisions together, rather than each on our own, which would have led to nothing. We keep abreast of the transfers and arrivals of patients, the beds available, the agents who can come as reinforcements.
“There are 39 agents missing in the territory”
Doctors Jean-Marc Minguet, Fadi Rammal, Didier Jammes and Jean-Denis Firoloni ensure today that the operation “Holds the road and continues to strengthen.” Dr Philippe Garitaine continues: “And why have we been effective? Because we are all in the red. All of our emergency services.”
According to him, if the management of the CHD was forced, this time, to take this drastic measure, “which is the equivalent of an earthquake for the territory”, “it could have been any other hospital in the group and we are not immune to this happening at any time. So we are there put all our energy.”
For the emergencies of the Territory Hospital Group to function normally, Dr Jean-Marc Minguet ensures that there is a need for “150 agents.” Dr. Philippe Garitaine regrets “that at present we are short of 39. Imagine the number of hours to compensate that this represents, and look here, in Draguignan, at the consequences.”
Dr Didier Jammes recalls: “However, a group is used precisely to support hospitals that lack staff. But there, there are holes in each workforce. We must stop questioning the management of the CHD, because it is a problem that we cannot can’t solve department-wide. It’s a national pain.”
1. Dr Jean-Marc Minguet, former head of the emergency department of the CHD and president of the establishment medical committee (CME) of the establishment. Dr Fadi Rammal, current medical officer of the service. Dr Didier Jammes, Head of Division and Emergency Department at CHI Fréjus – Saint-Raphaël. Dr Jean-Denis Firoloni, head of the emergency department at CH Hyères and coordinator of the Var emergency department.
Two hires and new projects
“Saving emergencies does not consist in simply making the decision to reopen them. There is substantive work”, underlines Caroline Chassin, director of the establishment. An action plan has been established and is already underway. “As far as the workforce of the service is concerned, a doctor on parental leave took over the blouse. Then, we finalized two new contracts, and others are in negotiation.”
At the same time, an alliance is taking shape with city medicine. “It’s a big project which is a vital reinforcement. The city doctors join our fight and organize a schedule of consultations without an appointment.” Also, the care home Activity of liberal hospital medicine (AMLH) has extended its hours to be open every day from 10 a.m. to midnight.
Be more attractive
Emphasis is also placed on the attractiveness of the hospital. Because the first demand of its teams is to replenish the ranks. To hire. “For that, we have to prove that we want to be ever more present for our patients and that we have ambition!” Projects are already underway. “Like the investment in a second MRI, the modernization of operating rooms, a reinforced service for the benefit of women and children who are victims of domestic violence, or even outpatient services and assistance to the elderly, who are generally disoriented when they join our services.” An attractive dynamic for “propel and promote” the hospital as a whole. New programs will be announced soon.