The Order of Physicians has announced that it will sue health professionals who refuse to take the vital card, CMU, CMU-C, ACS and AME.
How did we get here ?
To guarantee access to healthcare for the most disadvantaged, the legislator has provided for various measures such as universal health coverage (CMU), CMU-Complémentaire (CMU-C), assistance in acquiring additional health coverage (ACS) and State Medical Aid (AME).
But contrary to popular belief, it is not so easy to seek treatment when you are poor. Certain doctors (not all, fortunately!) Have succeeded in perverting the system by excluding the most vulnerable populations from the healthcare system.
Health has become a business for many doctors. Between those who refuse to take the vital card and those who, since the generalization of online appointments, show without complex the systematic refusal to receive beneficiaries of social cover, the difficulties encountered by the poor in seeking treatment becomes blatant.
Worse, the followers of these illegal practices systematically refer the most disadvantaged to the Emergency Department who, for lack of serious pathology, will redirect them to a doctor's office which… will refer them to the Emergency Department!
Habits that generate incivility in hospitals and harm the general interest, because they prevent or detect serious illnesses the management of which will cost the health system more.
Until now, the Order of Physicians pretended to ignore this reality by arguing "the absence" of appeals filed with the councils as provided for by law. Article 1110-3 of the public health code provides in its paragraph 2 that " Anyone who values himself victim of an illegitimate refusal of care may grab the director of the local health insurance body or the president of the territorially competent council of the professional order concerned of the facts which allow to presume the existence of it. This referral is equivalent to filing a complaint. It is communicated to the authority which was not addressed to it. The recipient acknowledges receipt to the author, informs the health professional involved and may summon him within one month from the date of registration of the complaint. »
It looks simple! But impossible to implement for a well-known reason! The most disadvantaged do not have recourse: It is the double penalty of precariousness. Lack of access to healthcare goes hand in hand with lack of access to their most basic rights.
Worse, we observe that these marginalized populations simply renounce the benefit of the aid granted, just so as not to have to suffer the shame of discrimination.
For several years, patient associations and the defender of rights have alerted the public authorities and the Order of Physicians to the generalization of “refusal of care”.
And for once, it looks like this call is being taken seriously. The Order of Physicians, singled out for its laxity, (finally?) Announced last February that it wanted to put an end to these illegal and immoral practices by prosecuting doctors who refused to treat the weakest.
The repression of the refusal of treatment
Doctors who post on their websites or announce by telephone the categorical refusal to take care of patients receiving CMU, CMU-C, ACS and AME incur criminal and ordinal prosecution.
Proceedings before the Bar Council
Refusing to provide care to the most disadvantaged goes against all the ethical principles of physicians. Caring for the "poor" is the basic principle of the Hippocratic Oath.
« I will respect all people, their autonomy and their will, without any discrimination according to their state or their convictions (…) I will intervene to protect them if they are weakened, vulnerable or threatened in their integrity or their dignity. I will take care of the needy and whoever asks me for them. I will not let myself be swayed by the thirst for gain or the search for glory… ”
Refusal of care is a ethical misconduct punishable by disciplinary proceedings before the Bar Council including the procedure and the penalties incurred (ranging from reprimand to expungement) are detailed on our site.
Along with ordinal justice, doctors will also be prosecuted in criminal matters as expressly provided for by the legislator.
Article L. 1110-3 of the Public Health Code, bases the illegal nature of these refusals on the prohibition to practice any form of discrimination in access to prevention or treatment.
“No one can be discriminated against in access to prevention or care. A healthcare professional cannot refuse to treat a person for one of the reasons referred to in the first paragraph of article 225-1 or in article 225-1-1 of the penal code (on discrimination) or the family reason that she is a beneficiary of complementary protection (CMU, CMU-C) or the right to assistance provided for in Articles L. 861-1 and L. 863-1 of the Social Security Code (Additional insurance: ACS), or the right to the assistance provided for in Article L. 251-1 of the Code of Social Action and Families (state medical aid: AME) »
Prosecution in criminal courts
These discriminatory practices noted by the High Authority for the Fight against Discrimination in its deliberation n ° 2006-232 of November 6, 2006, have become widespread, as confirmed by the testimonies and “testings” regularly carried out by patient associations.
Criminal proceedings will therefore be initiated on the basis of Articles 225-1 and 225-1-2 of the Criminal Code amended by Law No. 2016-1547 of November 18, 2016, according to which:
« Any distinction made between natural persons on the basis of their origin, their sex, their marital status, their pregnancy, their physical appearance constitutes discrimination. the particular vulnerability resulting from their economic situation, apparent or known to its author, their surname, their place of residence, their state of health, their loss of autonomy, their handicap, their genetic characteristics, their mores, their sexual orientation, their gender identity, their age, their political opinions, their trade union activities, their capacity to express themselves in a language other than French, of their belonging or not belonging, true or supposed, to an ethnic group, a Nation, a so-called race or a specific religion. »
Doctors who refuse to treat the most disadvantaged face sentences of 3 years' imprisonment and 45 euros. When " the discriminatory refusal ... is committed in a place open to the public or for the purpose of preventing access, the penalties are increased to five years' imprisonment and a fine of 75 euros. ”(Article 225-2 of the penal code).
Why should we take the College of Physicians seriously?
These repressive texts have always existed, but have never been applied. So why should we take seriously the College of Physicians' willingness to enforce the law and clean up its own people?
Well because the Order of Physicians had to step up to the plate to restore the image of a profession less and less respected. For many, medicine has become a business and patients a consumer of care.
But the credibility of the Order is based on its stated desire to act not passively, while waiting for cases that will never come, but actively by collaborating directly with the defender of rights and patient associations such as the FNARS. , the Inter-associative Health Collective, and Doctors of the World.
And there, that changes everything! The latter, being in constant contact with these patients ignored by the health system, will be able to act effectively with the Order in the name and on behalf of the victims of these illegal practices.
The files will be transmitted to the ordinal jurisdictions and the future will tell us if it was only a simple effect of announcement or a real desire to "clean up" within the Order.
But doctors (not all!) Are not the only ones to refuse their assistance to the most deprived.
For the record, the law firms (again, not all!) Have done the same thing by refusing to take the files of beneficiaries of Legal Aid. And they got it wrong! Because this small clientele, long ignored, has learned to do without their services to defend themselves in court.
You will find all these details in our next article "Do the poor have access to the law?" ".