Re-Open the Radiotherapy Services in Gueret!

I've just come back from a bike ride through the French countryside. We, a colleague in health services research and his friend, a statistician, set off from Ussel just inside the Départment of the Creuse. By most accounts, the Creuse is the most rural and less developed part of France. It is also a great place to ride a bike and visit small villages. Immediately as we began our ride I saw signs that called for the "Réouverture du service de radiotherapie Gueret!" (Reopen Raditotherapy Service in Geuret). Gueret happens to be the capital of the Creuse and recently, June 30th, the Ministry of Health decided to close the radiotherapy services in its main hospital on the basis of a "low-volume equals low quality" argument.

The region is up in arms. There was not a village I passed through that did not have a banner or sign that called for the re-opening. I was able to pick up a postcard with an appeal to the Minister of Health as I toured the tapestry museum in Aubusson. There had been rallies and letter-writing campaigns and a web site dedicated to the issue. It was the issue of the day for this part of rural France.

Our little group talked about this at length and we discussed the need to assure quality and maintain efficiency; but when I asked about the history of the decision I learned that the policy decisions about services like this were being drive as much by human error and lack of quality control as they were by demand and volume.

France has a record of accidents in radiotherapy that appears to be abnormally poor. There is even an English-language journal article that reports on these. Although the radiotherapy center in Gueret opened as late as October 2006, after there had been several reported incidents, the effects of accidents may have swayed the decision by the Regional Hospital Agency to close the rural service. Accidents with radiotherapy services in Toulouse in that year and again in 2007 heightened concern among policy makers. This came as France was also coping with the very tragic effects of a tainted blood scandal that occurred years earlier (1980s) but was resolved in the mid-90s with very controversial convictions including the former health minister Edmond Herve.

Some involved in the radiotherapy decision feel that closing the service in Gueret is a result of over-caution on the part of the ministry as they wish to avoid another blood-scandal type of outcome. Others see it as a very practical decision given there are only 150 radiotherapy patients who use the service and just one qualified practitioner to operate the service.

What is interesting is the willingness of local general politicians to take up the cause of a medical policy issue and to rally the populace to argue on behalf of access for a largely rural population.