By Christina White
To Christiane Dodier, it looked like a four-star hotel. Last October, when she took her husband to the brand-new hospital on the west side of Paris, they seemed to step into an ultramodern world of privilege: Patients ate off Limoges china. The private rooms, each with its own bathroom, allowed for visiting families and friends. The sparkling glass exterior gave an aura of transparency and natural light. "I was flabbergasted," says Dodier.
Of course, this wasn't just any hospital. It was the $278 million Hôpital Européen Georges Pompidou. The French government constructed this showcase to prove that a society with heart could deliver top-notch services to ordinary folk. To drive home the message, it built the new unit in Paris' economically diverse 15th Arrondissement, just down the Seine from the Eiffel Tower.
But for Dodier's husband, Christian, who went to the hospital for prostate cancer treatment, the Pompidou's glitz was all for naught. Troubles first surfaced when a building inspector, who had come to take a look at the broken shower in Christian's room, was horrified to find sediment resembling fine grains of sand flowing into the wash basin. Christian, his immune system already weakened, was inhaling minuscule particles that had dissolved into the steam. Within two days, he was being treated for a high fever. He died less than four months later of cancer complicated by Legionnaire's disease.
Christian Dodier was the first of 12 Pompidou patients who fell victim to the illness, six of whom have died, during two outbreaks over an eight-month period. Government reports have identified bacteria festering in substandard pipes as the likely cause. Other problems, such as a digital-imaging network without enough cable to bring a picture to the screen, are crippling France's 21st century hospital.
Nearly one and one-half years after its opening, the Pompidou is living up to its role as a showcase. But instead of displaying the virtues of France's state-run hospitals and universal health-care system, it's highlighting the shortcomings. "The Pompidou Hospital project is evidence of the administration's incapacity to complete a reasonable project with a reasonable budget within a reasonable time frame," says Professor Philippe Even, a former member of the hospital's board and author of The Scandals of Paris Hospitals and of the Pompidou Hospital, published on Oct. 18.
The hospital's woes have spread through the health-care system. Public Assistance-Paris Hospitals (PA-PH), the body in charge, was too bogged down overseeing 40 other hospitals to focus on problems at the Pompidou. Five different directors have led the project during its 26-year history. Two of the contracted construction companies went bankrupt during building. Some of the exterior was so shoddily built that it had to be redone. The Pompidou's construction was justified by shuttering three other area hospitals. But the closing of two was pushed back by months as building dragged on, and the PA-PH has been forced to keep one of them, Broussais, partially open because the Pompidou can't absorb the load of emergencies. Meanwhile, Louis Omnès, the director since 1990, and his crew charged ahead with their futuristic vision.
Omnès' troubled project stands in glaring contrast to the reputation of the French health system. The World Health Organization ranked it as the best in the world last year. But France also spends 9.8% of gross domestic product on health care, compared with Britain's 5.8%, and the French have a knack for building pricey grands projects such as the Pompidou. Each year, the white elephant consumes $169 million of the PA-PH's $4.14 billion hospital budget. Its per-bed cost is on a par with other hospitals, but that's before repair costs, at this point unknown, are taken into account.
And calamities such as recurring Legionnaire's keep the hospital's costs high. Two months after Dodier fell ill, Omnès finally acknowledged the disease's existence at the hospital. For the next six months, everything seemed under control. Then, Legionnaire's invaded the cold-water pipes--a mystery, since the disease is known to incubate only in lukewarm water. In July, the government called in its experts. Their report claimed that six different brands of pipes made of low-quality galvanized steel, subject to corrosion, were installed at a third of the cost of the stainless steel plumbing required by law. Omnès, who is legally responsible for the gaffe, lays the blame on Sogelerg Dolbeau, the company in charge of building the water system. Nonetheless, Omnès maintains that the pipes are of sufficient quality and that they are not the cause of the disease. "The water system is still in good condition even if the pipes do not meet French regulation," he says.
UNDER WRAPS. Whatever the cause of the cold-water breakout, an inspection team saw early on that trouble was brewing in the hot-water system. In July, 2000, just days before the hospital opened, they detected concentrations of bacteria 75 times higher than normal. The reports were kept under wraps, and hospital officials took protective measures such as removing tanks in which the bacteria were developing. Six months later, after the stories of diseased patients hit the newspapers, Omnès presented the problem to the public and to hospital employees.
Now, it's clear that the hospital suffered from careless planning. Carried away by the beauty of the glass structure, architect Aymeric Zublena opted for a hot-water network whose pipes were too long and upright, and without enough heating platforms to keep the water at a minimum of 55C on every level. Patients such as Dodier, treated in the third-floor cancer unit, were at the highest risk, but doctors could not protect them from a disease they didn't know was present. "It shows a serious lack of conscience that the hospital could act this way about an issue of health safety," says Marie-Jose Payot-Rieu de Bat, vice-president of the Legionnaire's Disease Victims Assn.
The government is keeping a closer eye on the Pompidou now. In March, Laurent Dominati, a member of the National Assembly, called for an investigation into the hospital's "dysfunctions and their consequences in terms of public health and cost." His resolution has been rejected, and partisan politics will probably sideline any follow-up until after next year's elections. But the PA-PH is now aware that other branches of the government are watching.
That means increased pressure on Omnès, who has embarked on a salvage mission, putting filters on all faucets and analyzing the water at a cost of $1.39 million a year. A new heating platform has been added so hot water can circulate better. Omnès insists there is no need to tear down the walls and replace the entire water system. But Professor Even is sure that if the disease recurs--and there's no guarantee it won't--the press and politicians will force the hospital to close for repairs.
That wouldn't be a bad time to address its other problems. Its information system has proved a disaster, which is an embarrassment for a high-tech hospital. The network, designed by Syseca-Thomson, was not intended for so many simultaneous users. It takes 15 minutes for computers to download an image--if the screen doesn't freeze up first. To make the system function at an acceptable speed, the number of cables hidden behind the walls needs to be multiplied. That repair, though not as widely publicized as a plumbing overhaul, could cost even more. "We must invest in it for it to be effective," says Omnès.
TIGHT LEASH. The director's job may well be on the line as his superiors' patience wears thin. And the Pompidou has alerted the public to the incompetence of the PA-PH, a financially autonomous organization overseen by four ministries and Paris' city hall. In 1995, when a court injunction forced the PA-PH to consult with a group of doctors on the building plan, the physicians cried out that the architecture was poorly adapted to medical needs. But it was too late. The design had already been approved. Critics of the Pompidou argue it would have made more sense to renovate the three older hospitals.
The PA-PH is now keeping Omnès on a tight leash. He has held to his budget by cutting 1,000 jobs, freeing up nurses who are in short supply in France. Eighteen months after the hospital's opening, he is working out quirks he thought would take only three months. Consolidating three hospitals into one is a bit like any company merger, he contends: "There is always the shock of the move."
That's nothing compared with the shock of patients who contracted Legionnaire's. Christiane Dodier now wishes the most modern hospital in France had never been built. Her husband was taken to the 350-year-old Laennec Hospital to be treated for the disease he caught at Pompidou. Shortly after, Laennec, a well-worn but secure health center, was one of the three hospitals closed down as part of the grand Pompidou plan.
White is a correspondent in the Paris bureau.
Edited by Harry Maurer