Professor Christophe Barrat. A title, a first name, a name. He is the only one whose identity is declining and his personality is embodied throughout the hundred pages devoted to psychosocial risks within the merger of two departments of the Avicenne hospital, in Bobigny and Jean-Verdier, in Bondy.
"It seemed important to humanize the drafting of this expert report", write the authors of the document produced by the CEDAET cabinet and presented last week at the CHSCT in Avicenne. The AP-HP on which the establishment depends was contacted several times on the subject but it did not answer us.
The shock wave triggers an audit in the services
Dressed in his block uniform, Professor Barrat, 57, commits suicide by defenesting himself from his office, on the fifth floor of the Avicenne hospital, on Sunday, February 3, 2019. He leaves no letters but the violence of the gesture of this specialist recognized in France for bariatric surgery (which notably includes the placement of gastric rings) and obesity creates a shock wave among healthcare teams but also his patients.
The next day, the CHSCT appointed a cabinet whose experts took the pulse of the services and places where the victim practiced: the operating room, digestive surgery of Avicenna and the consultation of the Jean-Verdier hospital. At the same time, the AP-HP greets in a press release a professional who "embodied the excellence of his specialty" while referring to "the serious illness" from which he suffered. Professor Barrat had cancer.
A humanly failed merger
CEDAET met with 40 team members, including nine surgeons and four supervising paramedics. There are striking and sometimes poignant testimonies, revealing of suffering at work. In addition, there were institutional interviews and half-days of on-site observations.
On the other hand, the analysis of documents was made complicated, because "only a small requested part was received", indicate the authors of the report.
The expertise highlights the conditions in which the bariatric surgery departments of Jean-Verdier (of Professor Barrat) and digestive surgery of Avicenne merged in 2015. The merger accompanies the construction of a new operating theater in Avicenne.
"Avicenne's colleagues called us with broken arms"
Three years later, the atmosphere is "deleterious" sums up the report, with avoidance behaviors between the teams, boycotts of medical meetings by some. The working methods are different: bariatric surgery works on protocols, the digestive (often cancer patients) is based on adaptation and adjustment.
The testimonies collected tell a lot about the preparation for the merger and the lack of understanding. “After a few weeks, I left, says a caregiver from Jean-Verdier. I fled. I felt depressed and cried every night when I got home. I didn't want to stay anymore. I was on sick leave for three months and then I left. "
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Another details: “As soon as there was a problem, it was Jean-Verdier's that we came to look for to deal with it. We were not considered in the same way. The nursing assistant colleagues from Avicenne called us with broken arms . A nurse from Bondy's hospital further summarizes: "There was a rivalry: they (Editor's note: Avicenne's agents) were at home and we were intruders. "
Departures and "exfiltrations" should have alerted
In 2020, the grouping took a particular turn. "The merger of services went so badly that, apart from the hospital secretary, today there is no one left from the former bariatric surgery department of Jean-Verdier in the digestive surgery department of Avicenna ”, specifies the report.
In view of the interviews, the experts note that "Professor Barrat seems to have taken part in the flight of his own medical personnel. […] This work to “exfiltrate” its personnel reflects the seriousness of the situation, where there is the conviction that things cannot improve over time, and that it is more dangerous for one's health to remain working at the breast. of service than leaving it. "
Example with the story of a nurse: "It was Professor Barrat who asked me to leave because I was destroying myself," she says. I suffered a lot and I don't know how I held on. […] When I got up in the morning, I felt like I was already late. I felt exhausted, empty inside of me. "
The victim herself expressed the wish to leave Avicenne while retaining his teachings at the Paris 13 faculty of medicine. Experts' statement: "Once again, a particularly renowned surgeon, at the peak of his career, who wishes to leave a university establishment to join a hospital group which is not, without seeking to exercise there as head of service, this bundle of elements should have strongly challenged the management of the hospital and the medical department of Paris 13. "
We must "reweave the link between certain employees"
"Any reorganization is likely to generate professional risks", recall the experts who underline the need to better involve staff and communicate on projects.
Regarding psychosocial disorders, they suggest the use of external support "to get out of situations of unhappiness at work and to re-establish the bond between certain employees". The report recommends monitoring warning indicators such as absenteeism and accidents… as well as specific training.
The firm recommends the establishment of a "plan for the prevention of occupational risks, particularly psychosocial risks" focusing on prevention but also compensation, by supporting the return of people who are victims of a health problem at work.
Experts finally propose the creation of a body responsible for regulating conflicts with the entire medical profession, like what exists in some hospitals.
"There are no bad guys on one side and good guys on the other" nuances Professor Philippe Wind
"A charge report. This is in essence the impression that certain management representatives would have expressed at the presentation of the expertise to the CHSCT. "There are no bad guys on the one hand and the good guys on the other," said Professor Philippe Wind, one of the pillars of digestive surgery at Avicenne Hospital. He was head of department at the time of the suicide of Professor Christophe Barrat, with whom he worked.
“He did not leave an explanation […] Nothing suggested what was going to happen. I had seen him on the Friday just before. It was a complete surprise, ”he continues, admitting to having been shaken. A few months later, in April 2019, he left his duties as head of service. "There was a loss of meaning, I was fed up," sums up Philippe Wind. I don't think I would have resigned if he hadn't committed suicide. "
"His blocks have never been canceled," repeats the surgeon about the activities of Christophe Barrat. He is surprised by the statements that circulate in this direction. “There was no competition. Until the start of 2018, Professor Barrat is also the head of the cluster, that is to say, he is in charge of organizing his medical sector. A mission that put him in a position to negotiate around the restructuring, according to Professor Wind.
"He led discussions with management and had control over the steering," he says. There was no animosity between us. In January 2018, Christophe Barrat nevertheless resigned from his position as department head.
"We cannot say that the merger was made by force, we collaborated," explains Philippe Wind. The surgeon, however, asks himself questions more generally: "Can we do mass mergers, with complete teams that will regroup behind their frames, at the risk that this will end in a rugby match?" I am not sure. "
