She doesn't get upset.
One morning in May, a general practitioner saw two police officers tumble into her office in Nogent-sur-Marne (Val-de-Marne), and interrupt her appointment.
"It happened in front of my patients in the waiting room, they told me that I was requisitioned to declare a death and they said loudly that if I did not come I would have a fine", s' strangles this doctor who has been living in the city for many years.
On her agenda that day, twelve patients plus three emergencies that she managed to stall by cutting back on her meridian break.
"I knew it would be a big day ..." continues the doctor.
The police station had asked her the day before about the death of a former legionary living in a social hotel.
But the practitioner had declined.
“The police were called on Thursday morning to find a death, reports the Créteil prosecutor's office.
They were there at 10 a.m., but were unable to find a doctor available during the day to establish this certificate allowing the body to be lifted.
"
"They told me they could take me under duress"
By email, the Samu is requisitioned at 6:20 p.m. In vain, despite the offense of refusing to respond to this summons, punishable by a fine of… 3750 euros. "But it is especially for the form, they never have to pay", recognizes a judicial source.
At 11:15 a.m. the next day, the police arrived at the office. “They told me they could take me under duress, plague the doctor. They went on to tell me that I was not honoring my Hippocratic Oath. The general practitioner therefore cancels her first four afternoon appointments and then leaves to examine the body to conclude ... "a natural death". "Already that we are less and less numerous, that we are recovering from emergencies because of the pandemic and new patients who cannot find a doctor… We cannot add more tasks to us indefinitely", launches t -it.
Without a death certificate, no body transport is possible.
The doctor may conclude that there is a natural death or that there is a medico-legal obstacle which will then trigger a judicial investigation to understand the causes of death.
But without a doctor, it's impossible to decide.
It doesn't matter if the family is waiting there.
"It is rare, but we sometimes needlessly go to court to
find the causes of death, in
order to be able to send a person to the Paris medico-legal institute, in order to retrieve a death certificate," we plague at the Créteil prosecutor's office.
“My biggest scare was to send someone who was not dead to the cold room,” says another magistrate from the small crown.
"It's not a question of money, each general practitioner does the best"
In Seine-Saint-Denis, the prosecutor of the Republic Fabienne Klein-Donati, recalled in an internal note that in the event of absence of doubt on the origin of the death, it is up to the mayor to organize and d '' appeal to the prefect if necessary.
"The sticking point is the absence of voluntary doctors to travel and a council of the Order which does not move on the subject, while the death certificate is now paid," said the prosecutor.
Since 2017, this has been a flat rate of 100 euros.
If the area is considered "fragile" with regard to the medical offer, that is to say a medical desert, the package is due regardless of the time.
In Ile-de-France, this is the case for 76% of the territory.
"It is not a question of money, each general practitioner does the best", we assure the Council of the Order of Physicians.
It is even "a major public health problem which will only worsen because of medical desertification", fears Ludovic Toro, general practitioner and mayor of Coubron (Seine-Saint-Denis).
“If you don't treat the dead well, you can't treat the living well,” he adds.
These certificates are a help to the living, to the family.
"
In the meantime, the various Parisian public prosecutors continue to "struggle" with their dead, according to the expression of some magistrates.
Given the increase in deaths at home (+ 16% in the first half of 2021 compared to 2019), the subject is not trivial.
"We encounter great difficulties in bringing in a general practitioner or SOS doctor to ascertain a death, the intervention times can reach 6 to 12 hours," said the prosecutor of Pontoise (Val-d'Oise).
Students and retirees authorized to make the report
With in the viewfinder, the role of Samu:
"If the person is already dead on their arrival or dies during their intervention, the doctors of the Samu conclude each time that there is a medico-legal obstacle, this generates an investigation which does not need to be and unnecessarily mobilizes a new doctor, we told the prosecution this Créteil, joined in this observation by several other jurisdictions in Ile-de-France.
Nine times out of ten there is absolutely nothing suspicious, and it happens every day.
"
Dr Braun, president of Samu, recognizes a problem: “There are too many medico-legal barriers awarded.
We kick in touch so as not to immobilize one of our teams for too long.
But I am fighting to have the death certified on plain paper simply.
We do not necessarily know the exact cause.
But there is not always a suspicious origin that would require an autopsy.
"
Who is to blame, then?
"The registration of death, like that of births, comes back to civil status," said Dr. Bernard Marc, head of the medico-judicial unit in Seine-et-Marne.
There should be a list of civil status doctors open to volunteers, with local operations and paid on-call duty.
"
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In 2020, a decree authorized certain medical students, foreign doctors or retirees, to make these observations. Thus, Jacques Hook, 74, a retired gynecologist in the Loiret, is called if no other doctor is available. “I take this as a service of humanity for the family,” says Dr. Hoock, who is called on average “three or four times a month”. If there is no doctor, justice opens an investigation to search for the causes of death. "This is the case a hundred times a year", explains Loic Abrial, prosecutor in Montargis, 200,000 inhabitants on the resort.
The mobilization of retired doctors, by word of mouth, goes to the funeral directors Caton. A quarter of the deceased she takes care of died at home. "Everyone felt really bad about this impasse, imagine a person hanged, we cannot let the family wait five hours at the door for a doctor to arrive", illustrates Gauthier Caton, head of the company, who hopes develop the system, particularly in Paris, on the occasion of the opening of a new agency in September.