After giving an initial assessment of the Louis Constant Fleming Hospital Center in our previous edition—one marked, according to him, by years of instability, financial difficulties, and a lack of methodology—Patrick Lambruschini continues this interview by revealing his roadmap. Building on his experience in France's overseas territories, the hospital director presents his plans to strengthen care services, modernize infrastructure, and develop partnerships.

Faxinfo: Some specialties remain difficult to access. Are there plans to strengthen care services?

P.L.: Yes. Our role is not to do everything, but to do everything that can reasonably be done in Saint-Martin, and to guarantee fast, organized access to the rest.

Where the referral leakage rate is massive is in higher-level care activities that fall under a university hospital (CHU). No 85-bed facility on a territory of 30,000 residents performs cardiac surgery or neurosurgery.

However, several avenues are being explored: developing sub-specialties tied to pathologies present on the island—diabetes and its complications, hypertension, nephrology, sickle cell disease, tropical infectious diseases, mental health, ophthalmology, and gastroenterology—as well as expanding surgical activity.

We must also consolidate oncology. The development of chemotherapy sessions here is the facility's greatest recent success. It needs to be secured and integrated into a formalized partnership with reference centers.

Finally, telemedicine and tele-expertise must be reactivated and expanded. On a double-island territory, it is the fastest and least expensive way to provide access to specialist opinions.

Faxinfo: Can cooperation with Sint Maarten be strengthened?

P.L.: We believe so. Foundations are already in place: ambulances can cross the border in both directions, a French-Dutch administrative agreement has organized a care pathway for Saba and Sint Eustatius since 2012, and we use Juliana Airport for certain medical evacuations.

This could take the form of a written protocol between both emergency services in the event of a major disaster, hurricane, or other emergency. We can view the opening of our neighbors' new hospital as competition, or we can build complementarity around certain specialties, pathology, or shared consultations. We also need to clarify patient billing rules.

Our billing system is heavily complicated by the island's dual nationality. Non-resident patient files, often high in value, go uncollected due to missing documentation. This is obviously not about refusing care to anyone—we provide care, that is our mission and the law. It is about seriously organizing the collection of outstanding fees through clear agreements.

Faxinfo: What investments do you see as priorities today?

P.L.: Our priority is the building itself, specifically its technical installations. The air handling units in the surgical block are extremely dilapidated, and the primary plumbing systems are outdated, featuring condensation on chilled water networks and damaged drop ceilings.

We cannot talk about medical attractiveness, surgical expansion, or quality of care if the technical platform is not secured and reliable. An audit of the facilities has been launched, and the first contractors have already visited the site. We have the financial resources to do this: it is not optional.

Psychiatric facilities must also be renovated. Additionally, we need to relocate the Child and Adolescent Medico-Psychological Center (CMP)—currently housed above McDonald's alongside the Adult CMP—to more suitable premises.

Faxinfo: Drawing from your experience in overseas territories, what lessons would you like to apply to Saint-Martin?

P.L.: You cannot manage an overseas hospital the same way you manage a facility in mainland France surrounded by ten competitors. Isolation is counterbalanced by networks, not self-sufficiency. An island hospital that tries to do everything alone ends up doing many things poorly. (…)

In Saint-Pierre and Miquelon, telemedicine and cooperation agreements were not gimmicks: they were our survival condition. Finally, I learned how much management rigor is a form of social policy. When a hospital bills poorly, it loses cash flow; when it loses cash flow, it fails to replace equipment and hire staff. Restoring structure and internal controls isn't bureaucracy: it's what funds positions, renovations, and training.

Faxinfo: A final word?

P.L.: I would simply like to say that this is a hospital with a lot of good in it. I have talked about many issues, and I wouldn't want people to conclude that everything is bad. There is room for improvement, and above all, it is doable. Together as a team, it is doable.

Retrouvez la première partie de l’entretien : https://www.faxinfo.fr/entretien-patrick-lambruschini-directeur-du-chlcf/