6. Action taken following the emergency recommendations dated
8 February 2016 on the Ain psychotherapy centre (CPA).
The hospitalisation units of the Ain psychotherapy centre (CPA) are situated in the outskirts of
Bourg-en-Bresse, within spacious grounds, and has a full-time hospitalisation capacity of 412 beds.
The good condition of most of its accommodation and working premises, the construction and
renovation plans undertaken for the rest and the good level of hotel-style services are all evidence, at
first glance, of a concern for quality, both where the staff and the hospitalised patients are concerned.
And yet, on observing the patients' care provision conditions in practice during this
inspection, individual situations entailing serious violations of patients' fundamental rights came to
light which had prompted the Chief Inspector of places of deprivation of liberty to set in motion the
emergency procedure provided for in Article 9 of the Act of 30 October 2007; she referred her
observations and recommendations to the competent authorities and asked them to respond.
Following the response obtained, the observations, recommendations and responses supplied were
published in the 16 March 2016 edition of the Journal officiel (Official Gazette).
The published observations refer to:
-
a practice of control and monitoring of patients' actions and movements, all the more
striking because it is applied excessively strictly;
-
solitary confinement and restraint which are practised in proportions never before
encountered - at stark odds with the rules that are commonly applied;
-
an abnormally strict management of the patients detained (systematic solitary
confinement and restraint upon arrival, security frisking including inspection of the
genital parts, systematic confinement for the duration of the hospital stay, etc.);
-
general restrictions imposed upon patients with no bearing on their clinical condition,
even when the institution's means would allow for them to be managed in an entirely
different way.
This persisting situation has met with apathy from most of the administrative managers,
physicians and nursing staff, owing to the lack of any consideration of prevailing practices and
operating conditions in the institution, a system which does not involve patients' families, low level of
responsiveness to any reports families' make and extensive submission to medical authority.
The findings reported by the CGLPL prompted the Minister of Health and the
Regional Health Agency to issue instructions to the institution to implement the
recommendations made; their implementation is checked by a monitoring
committee which has met twice a month over the year following the inspection.
The measures taken bear on free movement as appropriate for each unit,
prohibition to confine within an ordinary bedroom and reduction in solitary
confinement and restraint practices (which fell from 13,000 days in 2015 to 4,000
in 2016). They provide for a doubling in medical on-call services at the weekend.
At the same time, the National Authority for Health (HAS) had expressed reservations about
patients' rights, casting doubt over the institution's certification, and these gave rise to an
improvement strategy monitored by the HAS. The CGLPL has recently been informed that this
procedure has now ended, as the objectives set by the HAS were achieved. The institution's strategic
plan for 2018-2022 has incorporated the recommendations of the two independent government
agencies, the healthcare block "dedicated to solitary confinement" has been closed, users'
representatives have been involved in the strategic plan's definition, organisation has been set up to
coordinate the transition, risks to patients' rights have been mapped out, documentary management
has been reorganised, teams have been mobilised to ensure operational roll-out and the necessary
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