2024-10-30 19:31:00
A patient waits in a bed in the emergency department of Lariboisière hospital, an establishment of Assistance publique-Hôpitaux de Paris, in Paris, October 14, 2020. LUCAS BARIOULET / AFP
L’Public Assistance-Paris Hospitals (AP-HP) will be tried before the criminal court for manslaughter, after the death in 2018 of a 55-year-old patient, admitted to the emergency room and left for several hours without “no one cares”.
This patient, born in Martinique in 1963, suffering from headaches and calf pain, was dropped off at the Lariboisière emergency room by the firefighters on December 17, 2018 at the end of the afternoon, then received and directed to an emergency room. waiting.
Called around midnight under a wrong identity (“Myatil” instead of “Myrtle”), the patient never responded, then was considered to have left. She was actually on a stretcher, “unsupervised” between 1 a.m. and 6 a.m., when she was found dead, without having seen a doctor. A first autopsy report established that the patient was dead. “acute respiratory failure secondary to pulmonary edema”.
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Left overnight on her stretcher
According to the investigating judge, the “gross negligence obviously lies in the fact of having medically taken care of Ms. Myrtil in the emergency department around 7 p.m. and of not having been concerned about the evolution of her condition for more than five hours”.
« Avant »he continues, “to call her in vain to the hospital under an incorrect identity on two occasions, without further trying to locate her when she was necessarily on her stretcher in the corner of the short circuit where he had been positioned, with her bracelet on her wrist , and to have left it there all night, without anyone worrying about it. »
According to him, “the fault of gross negligence excluded any possibility of survival” from Mrs. Myrtil, advancing “the lethal nature of an invasive meningococcal infection in the absence of medical treatment”.
If the Paris prosecutor’s office had initially requested a trial for manslaughter at the end of 2022, it finally requested a dismissal on July 3, considering that “the causal link between possible deficiencies in hospital care” et “death was not established”.
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Lack of staff and resources
During the investigation, the AP-HP defense argued that the protocol at the time “was consistent with professional recommendations”and that the situation that day was “exceptional, both in the number of people admitted to the emergency room and in the fact that a doctor was exceptionally absent due to sick leave occurring at the last minute”. Neither the AP-HP nor one of its lawyers, Me Mario Stasi, wanted to react.
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According to an expert opinion rendered in December 2023, the placement of the patient “in a “short circuit” zone did not seem recommended given its initial state” more “had been validated by the referring doctor due to a lack of space”.
After this death, Lariboisière announced increased control measures for patients in the emergency room. The regional health agency (ARS) had also issued various recommendations, including an increase in staff numbers. During the investigation, hospital practitioners collectively blamed a lack of staff and resources, which had long been denounced.
During the hearing, the emergency doctor who should have treated Ms. Myrtil on the night of her death described an emergency system overwhelmed by the influx of patients and drew attention to insufficient resources and premises complicating care. . “I didn’t even know this patient existed before I learned of her death”he will concede tragically.
The five main unions of the AP-HP (CGT, Sud, FO, CFDT, CFTC) had deplored “that it took this tragedy for management to finally commit to the responses to the crisis situations suffered and denounced”. The case of Micheline Myrtil had more widely fueled the chronic and still current debate on the crisis in the hospital world, even before the earthquake of the health crisis linked to the Covid-19 epidemic.
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**Interview: Discussion on the Manslaughter Trial of Assistance Publique-Hôpitaux de Paris (AP-HP)**
**Host:** Welcome to our program. Today, we have with us Dr. Sarah Martin, a healthcare policy expert, to discuss the upcoming trial concerning the Assistance Publique-Hôpitaux de Paris (AP-HP) due to the tragic case of a patient left unattended in the emergency room. Dr. Martin, thank you for joining us.
**Dr. Martin:** Thank you for having me.
**Host:** Let’s start with the facts. In 2018, a 55-year-old patient died after being left unattended in a stretcher for several hours in the emergency department. What do you think this case reveals about the current state of emergency healthcare in Paris?
**Dr. Martin:** This case is indeed alarming and reflects serious systemic issues within emergency healthcare. The negligence described, where a patient was not monitored for hours, underscores the dire consequences of understaffing and resource limitations in hospitals. When hospitals face overwhelming demand, patients can tragically fall through the cracks.
**Host:** The investigation noted that the patient was misidentified and never saw a doctor before her death. How significant is accurate patient identification in emergency settings?
**Dr. Martin:** Patient identification is critical in any healthcare setting, especially in emergencies where time is essential. Misidentification can lead to the wrong treatments or, as we saw here, a complete lack of care. It can lead to catastrophic outcomes, which is exactly what happened in this case.
**Host:** The defense argues that the situation was exceptional due to high patient volume and a doctor’s unexpected sick leave. How do you interpret this justification?
**Dr. Martin:** While it’s understandable that emergency departments can be overwhelmed, this situation cannot be dismissed as merely an exception. High demand should always be anticipated in emergency healthcare planning. Institutions must have protocols, staff contingencies, and resources to ensure patient safety even in peak times.
**Host:** The Paris prosecutor’s office had initially sought a trial for manslaughter but later requested a dismissal. What are the implications of such a decision on public trust in healthcare?
**Dr. Martin:** Confidence in healthcare can be severely impacted by cases like this. When accountability is questioned, public trust erodes. The dismissal could signal to the public that there are no real consequences for systemic failures, which could affect how they view the safety and reliability of healthcare services.
**Host:** Lastly, as a policy expert, what recommendations would you make to prevent similar tragedies in the future?
**Dr. Martin:** We need a multi-faceted approach. First, increasing staffing levels and ensuring adequate training on protocols related to patient monitoring is essential. Secondly, implementing robust patient tracking systems can prevent misidentifications. Lastly, regular audits of emergency departments can ensure compliance with best practices and highlight areas needing improvement. The ultimate goal is to ensure that patient safety is paramount, regardless of circumstances.
**Host:** Thank you, Dr. Martin, for your insights on this critical issue. We hope this trial brings about necessary changes to improve patient care in emergency departments.
**Dr. Martin:** Thank you for having me. Let’s hope for positive outcomes in both this case and for healthcare systems moving forward.
