“They underestimated his condition and he died”: a mother's testimony after her son's death in the emergency room at Montpellier University Hospital

Deborah Monaco: “He was screaming in pain and the only treatment he received was a Valium to calm him down, because he was schizophrenic.” Midi Libre – Florence Guilhem

François died after three trips to the emergency room in five days. His mother is speaking out today to raise awareness about the way people with psychological problems are treated.

“He did not have a serious illness. He could have been saved if he had been given the right treatments. That was not the case. He died“, Deborah Monaco immediately states when talking about the death of her son François, who died at the age of 40 at the Montpellier University Hospital in November 2023. Although the mourning is far from over, she has decided to break her silence today to denounce what she describes as “differentiated care between people suffering from psychological disorders and others when they are hospitalized urgently“.

At least that’s how she experienced it when her son was hospitalized in October 2023 following severe abdominal pain, vomiting, diarrhea, and blood in his urine. Symptoms that had already appeared the previous year following the prescription of neuroleptics for his schizophrenia and had caused stomach ulcers. Changing his treatment only relieved him for a while, and the symptoms reappeared. Back to the emergency room a year later.

Chronicle of a tragedy foretold

“During his first visit to the Lapeyronie emergency room, he was treated properly, then hospitalized in Saint-Éloi“, his mother says. Blood tests reveal kidney failure, an alarming lack of potassium and heart rhythm disorders that could lead to death. The next day, François leaves the hospital at his request against medical advice. “They should not have let him go given the risks he was running and the impairment of his judgment inherent in his pathology. At the very least, they should have sought the advice of a psychologist and that of the trusted person“, she explains.

François is not out of the woods yet. His condition deteriorates the very next day. Back to the emergency room. New tests are carried out, confirming the health problems already diagnosed, but also revealing traces of a myocardial infarction. Surprisingly, he is not hospitalized and returns to his mother's house on the morning of November 2. He will return to the emergency room two days later.

The blood tests are still alarming and the abdominal scan reveals an intestinal obstruction. A nasogastric tube is recommended, but will not be placed until many hours later. Until the end of the afternoon, “my son did not see a doctor. He was screaming in pain and the only treatment he received was a Valium to calm him down, because he was schizophrenic. They should have started by giving him antibiotics given the inflammatory syndrome revealed from the first blood test“.

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“For me, they are all responsible”

His transfer to the hospital at 9:30 p.m. in an unmedicalized ambulance, and therefore without oxygen, did not save him. Cyanotic, in a state of septic shock with peritonitis linked to a perforation of the small intestine, he had a heart attack shortly afterwards. Placed in intensive care, he fell into a coma. Several operations were attempted in vain. He died three weeks later.

“What makes me angry is that François had already been treated in this same hospital for an ulcer condition. He had a perforated ulcer, which triggered peritonitis. And no one saw it coming, all because they mistook his cries of pain for cries of psychotic delirium. They underestimated his condition and he died from it even though he did not have a fatal disease when he entered the hospital. For me, they are all responsible.”

“We are nobody in front of them”

So she decided with her daughters, once their state of shock had passed, to contact the Commission for Conciliation and Compensation for Medical Accidents (CCI). A standoff began with the Montpellier University Hospital, as their lawyer struggled to recover all of the hospitalization reports. An expert meeting took place in mid-December. The CCI should not be long in making a decision. But, for now, “the expert report provides us with questionable conclusions on the quality of care provided to François Monaco. We are therefore considering requesting a counter-expert report“, explains Mr. Mouzarine.

Deborah Monaco does not expect much from the procedure, “because we are nobody in front of them“. If her fight is indeed like that of David against Goliath, she will not give up. “We must put an end to racial profiling in the health system against people with psychological disorders. Everyone must be treated equally“, she insists. Bringing the case to criminal court for involuntary manslaughter and failure to assist a person in danger could be the next step.

Montpellier University Hospital: no comment

“The Montpellier University Hospital and its professionals are bound by confidentiality and secrecy obligations to preserve the privacy of its users. As such, we will not comment in the press on the specific situation you describe.

In a policy of continuous improvement of the quality and safety of care, each adverse event is subject to an assessment and identification process for the causes for undertake corrective actions to prevent their recurrence. Patients and/or their relatives may contact the department responsible for user relations for any perceived malfunction in care."

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