Mariama can't get it out of her mind. The 42-year-old mother tearfully recalls that evening just before the start of summer when her daughter fell ill. She had telephoned the 18 emergency number for the fire service, which in France often deals with medical emergences. What if she had instead dialled 15, the number for the ambulance service SAMU? She also wonders: “What if we weren't black?”
On June 20th Aïcha and her twin brother Ibrahim were celebrating their birthday at the family home in the XIXth arrondissement of Paris. They were not usually allowed to eat burgers but they had permission to do so for this special occasion. “Aïcha and Ibrahim went to the end of the street to buy a takeaway then brought it back to eat. But from the first mouthful my daughter was ill and told me she didn't feel well,” recalled Mariama. Aïcha was squinting, suddenly felt tired and her lips had gone pale. She went to bed and dozed. “She replied to us when we asked her questions but she seemed too sleepy,” said her mother.
Mariama called the emergency services number and then her husband Sambola, who was driving home at the time. A team of three officers from the Paris fire service responded rapidly and arrived at the family's home around 8.15pm. They quickly checked Aïcha's vital signs which were all good. And within barely a few minutes they declared that the 13-year-old girl, who had still not managed to speak, was faking her symptoms. “My wife had left the phone on loudspeaker and me too while I was driving. I felt that something wasn't quite right so I took out my second phone to record the conversation. By some kind of instinct,” said Sambola. The recording, which is more than 30 minutes long, is damning (see the video above, in French).
For 30 minutes the fire crew downplayed the young girl's condition and queried her mother's concerns. At no time did the fire officers call their control room to ask for advice, nor did they contact a specialist medical team. Instead they spent 30 minutes trying to show that the girl was faking her symptoms.
Mariama panicked and explained to the fire crew that she “knew” her daughter and that she would never fake an illness. But they thought that Aïcha was lying, that she was “keeping her eyes closed”, that she was putting on the shaking, and that her mother was refusing to believe them out of “pride”. She did not appear to understand that a child could lie to their mother, they suggested.
Brain haemorrhage
The tone adopted by the fire officers was also quite unusual, as the recording shows. They addressed Aïcha as “Madam” and not “Miss” as one would normally expect with a 13-year-old girl, and kept on blaming her. They explained that they had “other things to do”, that there were “people who had real need” of them and that more serious cases were waiting for them. “Twenty of my colleagues are currently looking after someone who's fallen under an underground train. I don't know if you realise it, but that's serious!” said the team leader, with the girl lying semi-conscious. The comments were also sometimes quite bizarre, such as when they declared that “you can't snore when you're sitting”, that such a thing “didn't happen”.
They also threatened to call in a medical team who would give her “injections”, and warned that her father would arrive home worried and angry over her supposed lie. But the fire officers did not call a medical specialist during their visit and left after more than 30 minutes with Aïcha asleep and still unable to speak. “I'm not worried,” said the team leader as they left the family on their own.
When he came home Sambola said he “trusted” the fire officers and let his daughter sleep, before waking her a few hours later. She was still in the same state “unable to speak and to open her eyes for long”.
At around 3am Aïcha's father took her to the Robert-Debré hospital in the XIX arrondissement. As soon as she arrived the teenager was taken to the emergency room and then put in a coma. “They didn't understand why the fire officers had refused to take care of her,” explained Sambola. Tests showed the teenager had a cerebral haemorrhage and a brain arteriovenous malformation (AVM). Aïcha was quickly taken to Pitié-Salpêtrière hospital where her condition first improved before later worsening again. She died on July 2nd.
The handling of this may have represented a missed opportunity.
So, could Aïcha's life have been saved if the fire officers had taken her to the accident and emergency department immediately? “The handling [of this case] may have represented a missed opportunity,” says one accident and emergency doctor. Several medical staff contacted by Mediapart certainly took a dim view of the fire crew's behaviour. According to Mediapart's information one of the doctors who looked after Aïcha at the Robert-Debré hospital contacted the fire officers involved to say that they did not understand their decision.
“When a patient is unable to speak and is sleeping all that time, you treat them. She could have taken substances that required medical examination,” said one nurse at Robert-Debré hospital, who said the attitude of the fire officers was “incomprehensible”. According to the emergency doctor cited earlier, the emergency services – whether it is ambulance staff from SAMU or the fire brigade – should not take “more than ten minutes to make a decision” when they are on a call-out. “Whether this decision is to ask for a medical team, to carry out treatment or to leave,” they said.
“Even if the vital signs are good, the very fact that the girl was in a groggy state should be taken as a sign. The patient should always get the benefit of the doubt,” added the medical professional, who says it now needs to be established whether the fire officers spoke to the control room, and also who made the decision on this. “Let's suppose she was faking it. It's no big deal, she'd have spent three hours in accident and emergency and we'd have perhaps had a word with a psychologist,” they added.
“We get children every day whose condition looks less serious,” agreed the nurse at Robert-Debré hospital. “Why did the fire officers waste all this time challenging the mother and refusing to take care of this teenager? Perhaps they had a prejudice against this family, perhaps they told themselves that she wouldn't be litigious.”
On December 8th the family lodged a formal complaint with Paris prosecutors for “manslaughter” and “non-assistance of a person in danger” and say they want a judicial investigation to be opened.
“The audio recording … reveals serious dysfunctions in the fire officers' intervention. These serious failings must be looked into fully as well as the potential intellectual bias which underpins them,” said the lawyers acting for Aïcha's family, Elena Sos, Manon Beaucarne and Baptiste Hervieux. Elena Sos added: “The family now intends to determine both the legal and administrative responsibility concerning the death of their daughter, and they trust in the justice system.”
“I don't want to generalise, but what they did wasn't professional,” said the teenager's father Sambola. “I had the impression that I had police officers and not fire officers in my home. They're supposed to save everyone, whether they're French or not.”
Since this tragic case the fire officers have not been back to give the family any explanation or simply to apologise.
Approached by Mediapart, the police authority in Paris, which is responsible for the fire service in the capital, initially refused to give any explanation or make any comment at all. “In line with respect for medical confidentiality, no information relating to the state of health of the victim at the moment of the fire officers' intervention can be communicated. Moreover, in compliance with maintaining professional confidentiality which applies to the entire intervention, no other information can be passed on,” it said.
Pressed again later, the authority said that “a disciplinary inquiry was carried out and that ended in a sanction being issued to the team leader”. In other words, just one of the three fire officers involved was disciplined.
It was in any case a rapid and incomplete disciplinary process which, according to the authority, started on June 21st, though it gave no more details. “This investigation was very fast and the fact that it was carried out without taking note of the full recording and without contacting the family is astonishing,” said one of the family's lawyers Elena Sos.
Questions thus remain as to the nature of the punishment handed out, why the authority did not ask for the full recording (which lasts more than 30 minutes) and why they did not contact the family before the internal inquiry was ended. The police authority for Paris declined to comment on this.
Racial prejudice?
It is not the first time that racialised patients have been claimed to be faking or exaggerating an illness. In particular there was the Naomie Musenga affair, named after the young woman from Strasbourg who was mocked by a phone operator at SAMU and who died from possible poisoning by an over-the-counter painkiller in 2017. At the time there were many accusations that some doctors were downplaying people's suffering because of racial prejudice.
More recently, Mediapart revealed the story of Yolande Gabriel, a 65-year-old woman originally from the French overseas département of Martinique in the Caribbean, who died in August 2020 having waited for the emergency services east of Paris for more than an hour. Here, too, SAMU had not taken her case seriously.
According to reports from within the emeregency services, some doctors think that when a person is of African, Caribbean or North African origins they have a tendency to exaggerate or fake pain; this is sometimes referred to as the 'Mediterranean Syndrome'.
“At SAMU, for example, there is now a checklist of items to keep in mind during an intervention in order to avoid being affected by prejudice or to fight against a certain blinkered approach,” explains the A&E doctor cited above. Indeed, the 13th recommendation in SAMU's rules governing medical interventions reads: “Try to keep on assessing your mood as you deal with the current case. If you perceive a risk of losing your objectivity as a result of your emotions getting in the way, consult the checklist.”
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English version by Michael Streeter