Lucas, 25, lost his life to an invasive meningococcal infection. The specialists interviewed believe that he should have benefited from “close monitoring of vital signs”, and that the diagnosis should have been mentioned when his condition deteriorated.
The report from the General Inspectorate of Social Affairs (Igas) on the death of Lucas in October 2023 in the Hyères emergency room points to the delay taken by the service in diagnosing the pathology from which the young man suffered, in a context of activity “particularly ” high that day.
The Igas notes “several dysfunctions” having caused “delays and difficulties in caring for” 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), whereas the data collected by the reception and orientation nurse should have led to an examination by a doctor within two hours maximum, notes Igas in particular in the report made public on Friday December 6.
“At the triage level, not all information is collected”, in particular certain symptoms noted by the Samu teams and “during treatment, the alert signals do not systematically trigger specific action”, also indicates the report, noting that “the transcription” of information in the patient's file “is not systematic”.
Lucas should have benefited from “close supervision”
The triage, carried out in the meantime by two caregivers, “underestimated the seriousness” of his state of health, further notes the Igas. He observed 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 “close monitoring of vital signs”, and that the diagnosis should have been mentioned when his condition deteriorated.
However, they “cannot affirm that earlier implementation” of 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 after the tragedy a “coherent” action plan for the emergency department, such as the reopening of short-stay geriatric beds (their absence had contributed to the congestion of the department on day of the tragedy) or the creation of a nursing assistant position.
But it 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 of the establishment: “Re-examine the possibilities of financing the extension of the premises of the Emergency Department.”
“I complain to everyone that I have trouble breathing, but no one does anything”
Lucas lost his life on the night of September 30 to October 1, 2023. According to testimonies from his family and another patient, the young man had spent long hours in the corridors of the hospital before the medical staff take stock of the situation.
Admitted to the emergency room around 4 p.m., the 25-year-old had communicated by message with his family throughout his agony. “I complain to everyone that I have trouble breathing, but no one does anything,” he wrote to his mother according to Le Parisien.
Another patient, of the same age, noted the lack of reaction from the staff. “A doctor asked him if he had smoked cannabis, probably because he had dreadlocks. Then concluded, in less than thirty seconds, that he had indigestion,” he testified.
During the night, and after receiving an antibiotic injection, the young man suffered two cardiac arrests in front of his parents. The family filed a complaint for “involuntary manslaughter” against the hospital.
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