The Igas report on the death of Lucas in October 2023 in the Hyères emergency room highlights the delay by the service in diagnosing the pathology from which the young man suffered, in a context of activity “particularly” high that day.
The General Inspectorate of Social Affairs (Igas) is responsible for “several malfunctions” having generated “delays and difficulties in providing care” of the patient, aged 25, victim of an invasive meningococcal infection.
“The first medical examination takes place almost four hours after the initial triage” (the initial examination by a nurse), while the data collected by the reception and orientation nurse should have led to an examination by a doctor within two hours at most, notes in particular the Igas in the report released Friday.
“At the triage level not all information is collected”in particular certain symptoms noted by the Samu teams and “during treatment, warning signals do not systematically trigger specific action”the report also says, noting that “transcription” information in the patient’s file “is not systematic”.
The triage, carried out in the meantime by two caregivers, “underestimated the severity” of his state of health, further notes the Igas. He still observes a delay in sending biological analyzes to the laboratory located in Toulon, compared to the planned procedures.
The specialists interviewed by the mission believe, in view of the file, that Lucas should have benefited from a “close monitoring of vital signs”and that the diagnosis should have been mentioned when his condition deteriorated.
However, they do not “can say that earlier implementation” resuscitation maneuvers would have avoided a fatal outcome.
The report also specifies that the Hyères emergency rooms received 114 patients that day, compared to an annual average of 96 per day, during an intense summer period when other emergency services in the Var were under pressure.
Igas notes that the hospital put in place an action plan after the tragedy ” consistent “ for the emergency department, such as the reopening of geriatric short-stay beds (their absence had contributed to the congestion of the department on the day of the tragedy) or the creation of a nursing assistant position.
But he makes additional recommendations for the organization of the service – “entrust the referring doctor with the mission of supervising the allocation of patients to nursing and medical staff in compliance with treatment deadlines” for example – or the establishment: “re-study the possibilities of financing the extension of the premises of the Emergency department”.