“Given the needs of this area, we need to develop the hospital”, the action plan of Christian Cataldo, new director of the Alès hospital center

Christian Cataldo : “Le recrutement est la solution pour améliorer la partie financière. Pas l’inverse.” Midi Libre – ALEXIS BETHUNE

Recrutement de médecins, rénovation des urgences, situation financière… Le nouveau directeur de l’hôpital alésien fait le point sur l’avenir et les projets de la structure.

You have been the director of the Alès hospital since last May. What was the state of the hospital, according to your analysis, at the time of your arrival ?

First, there is the financial aspect. I had asked for a report as soon as I arrived. The hospital has a deficit of between 10 and 12 million euros, including nursing homes. We are continuing the financial report. We want to produce a report by the end of the year on the investments to be made in the establishments. In Ponteils, for example, we have launched a major discussion paper on the future of the buildings. In Génolhac too. In Alès, the hospital is new, but the nursing homes are still 15 years old, as is the psychiatry department. The laundry too: the machines have not moved in 20 years! From this assessment, we will establish a strategic plan to have clarity on what we need to do. At the same time, relations with union organizations are also rather healthy and normal.

Some unions were previously criticizing communication problems with management, indeed…

Whether here or at Mas Careiron (Uzès branch), there are no problems with the unions. We don't agree on everything. That's normal, that's the game. But communication, exchanges, are fluid. We have also reconnected with the medical community, with whom it had been complicated. We created a project commission where we discuss with doctors. This allows us to take stock of professional projects.

In terms of investment, you have already launched numerous recruitments in several departments, where are you at ?

Today, there are sectors where we have a consolidation of staff: intensive care, anesthesia, maternity… We are recruiting one more orthopedist and two visceral surgeons. In gastroenterology, we have a great team that has arrived. We are increasing to three doctors in urology. We are strengthening oncology, with two additional positions, perhaps, at the end of the year. We are increasing from one to two in psychiatry in October. We managed to recruit operating room nurses, even though it was not a given.

The sector that remains the most difficult is internal medicine, where we are struggling despite prospects. In dermatology, we are also actively looking. And the emergency room, despite the efforts made, will experience two retirements. This will cause some tension for two months before the planned arrivals at the end of the year.

But we have rather good momentum. We have obtained more interns than before. We will also receive, for the first time, externs (4th year medical students, Editor's note)who will come to us. And we have four territorial clinic heads arriving in November, who will be part-time in the services and the rest of the time on research. The CH d’Alès is part of the regional research system supported by Montpellier. We will be able to launch research here, which will also make it attractive.

How can we recruit, and therefore invest, when the hospital is in deficit ?

It's linked ! A doctor costs us money, but brings us a lot. The fewer doctors I have, the less revenue I have. When a doctor arrives, it costs us between 120,000 and 150,000 euros if we include on-call duty. But he brings us at least three or four times what he costs us! In all the services, we know that the new doctors will have activity. One of our new gastroenterologists is already overwhelmed. So there will be financial results, and the service to the population will be better treated.

We should therefore not oppose recruitment and financial difficulty. Recruitment is the solution to improve the financial part. Not the other way around. I have applied this method in the other hospitals I have worked in that were in deficit. We are managing to reorganize. This will not happen in a year. But I think that in two or three years, the hospital will have sustainable operations and a better response to the population.

This shows a change in the decisions taken by the former management ?

I am not judging the policy that we wanted to pursue. But given the needs of this area, we need to develop the hospital. What's more, we are not even in competition with the Bonnefon clinic, since between the two of us, we cannot absorb all the demand.

Unlike in 2023, the emergency services were not forced to regulate patients this summer due to lack of resources. Should this fact be interpreted as an improvement in service??

There was no regulation because we were able to recruit 2-3 doctors in May to strengthen our team. We also had the signing of the territorial team with Nîmes, which means that Nîmes is trying to help us if necessary. Now, we are going to have some small difficulties with planned retirements. We are anticipating this problem to find short-term solutions, either with temporary work or with Nîmes. For the future, we have validated applications that should arrive at the end of the year. The objective is to increase the emergency staff from 19 to 22-23 by this summer. Either directly or with part-time work shared with Nîmes. We will therefore be able to put the second SMUR into service more regularly.

Refurbished rather than expanded emergency services

Although on track since at least 2017, the project to expand the emergency services in Alès, which had been imagined until then, will ultimately not be carried out. “I stopped it, specifies Christian Cataldo, not considering it financially acceptable. It was initially estimated at 3.5 million euros. A year later, 5 million euros. A year later, 7 million euros. Then at the end 11 million euros. At 3.5 million euros, we were supported enough not to borrow. At 11 million euros, we have 9 million euros to borrow. So it's impossible. There were also aspects of the project that bothered me. So we took everything back and found solutions by redeveloping the existing premises. There, the cost is divided by three. It was also planned to make hard surfaces for NRBC protection (nuclear, radiological, biological and chemical threats, editor's note). However, this need is exceptional. We therefore decided with the emergency doctors not to make specific surfaces and to set up a mobile device in the emergency airlock. We are therefore using the current surfaces to reorganize them in the event of a crisis."

A new call for tenders was launched for the project on September 13, with work expected to begin in early 2025. According to the latest statistics, the Alès emergency room has exceeded the 52,000 admissions mark in one year.

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