“Fanny should never have died”

In June 2016, Fanny Arnoult, a 25-year-old mother, was operated on at the Eure-et-Loir private hospital. Two months later, she died in troubled conditions. France 3 Centre-Val de Loire has immersed itself in this sensitive file and reveals dysfunctions around the care of the patient.

On August 17, 2016, Isabelle Arnoult’s life changed dramatically. His eldest daughter, Fanny, aged 25, died following serious complications that appeared after an operation to treat her morbid obesity, at the Saint-François de Mainvilliers clinic (today the Eure-et-Loir private hospital). She leaves behind two young children, nine months and three years old.

On the dining room table, Isabelle Arnoult opens a large purple suitcase: “I have 70 kilos of papers, we are at 22,000 euros in legal proceedings and 3,490 euros in registered letters, I don’t know what to do anymore“.

For five years, she has been trying to claim the responsibility of the doctors and the clinic in the death of her daughter: “Fanny should never have died. I want to fight for his memory and my grandchildren.“

In December 2022, the Chartres court ordered a dismissal, recognizing a “therapeutic hazard” and relying on the reports of experts medical, who did not reveal “no fault, however simple, attributable to one of the doctors”. A decision which is far from satisfying the family and the lawyer of Fanny Arnoult who decided to seize a civil court in order to obtain compensation.

Same surprise for the former president of the Order of Physicians of Eure-et-Loir, who followed this file closely: “I cannot comment on a court decision. But I am extremely surprised, given the file I had in my hands.”

Independently of the legal aspect, our investigation, which is based on testimonies and documents, reveals a succession of dysfunctions of the medical profession.

Questioned by France 3 Centre-Val de Loire, the Elsan group, owner of the clinic, simply recalls that “The Chartres court issued on November 19, 2020 an order dismissing proceedings against anyone“.

Sterilization agent at the Saint-François clinic, Fanny Arnoult addresses her colleagues to try to treat her morbid obesity. The establishment’s surgeon, Daniel Boudara, was at the time one of the only doctors in the department to offer bariatric operations, medical practices recognized for their effectiveness.

However, these interventions are risky. A strict protocol, published in 2009, is also recommended by the High Authority for Health (HAS).

Indeed, the organization recommends that all operations be carried out after “failure of well-conducted medical, nutritional, dietary and psychotherapeutic treatment“, for six to twelve months.

“Patients must be able to take the measure of this surgical act. It is essential, because it is an operation with irreversible consequences”.

Professor Bouillot, former bariatric surgeon at Ambroise Paré Hospital

Doctor Boudara will choose not to follow the recommendations of the HAS. In less than three months, Fanny Arnoult obtains her appointments with the psychologist, the nutritionist, a cardiologist before going to the block. Too fast a procedure for the family’s Chartrain lawyer, Maître Guillaume Fallourd: “This is one of the most disconcerting points of the file“, he believes. “His consent was not informed enough“.

But for the surgeon’s lawyer, Maître Jean-Claude Boyer, the deadlines recommended by the HAS do not always take into account the specificity of each patient: “Doctors make trade-offs based on the patient’s condition. This is the medical decision, with all the weight of responsibility that doctors have.”

For the clinic too, there is no problem: “I‘surgical indication was posed by the doctor and has never been called into question by the courts.

Medical experts have settled this question, considering that the care upstream of the operation had no “connections“with the complications that arose after the operation.

Three days after her operation, on July 23, 2016, Fanny Arnoult suffered from severe shoulder and stomach pain and went to the emergency room of the Saint-François clinic. That evening, she is welcomed by Doctor A., ​​a doctor on duty. Despite the risk of complications, he sends her home the same day.

An act which infuriates a member of the Council of the Order of Physicians of Eure-et-Loir. As part of the procedure of the national disciplinary commission set up by the Order following the death of the patient, he sent a concise letter, in February 2022, to the Paris headquarters of the Council: “Doctor A. sees a patient in the early postoperative period and does not even examine her!”, he chokes, and adds: “ Doctor A. behaved in a way that dishonors medicine“.

On July 24, the pain becomes unbearable for the young woman. She returns to the Saint-François clinic to be operated on again by Doctor Boudara.

Despite this second intervention, the state of health of Fanny Arnoult does not improve. On August 16, she went again to the clinic’s emergency room. The patient is then placed in a conventional hospital room: “We refused to open the intensive care unit for a single person “, will explain to the council of the College of Physicians, a health professional from the establishment not cited by the council.

However, this specific unit, which allows regular monitoring of vital functions, could have been useful following a major operation such as that suffered by Fanny Arnoult.

“This point has already been raised during the legal proceedings. The clinic has never been sanctioned for such facts”, sweeps away the Elsan group.

The patient’s night will turn out to be excruciating. “I heard shouting: “I’m in pain, I’m in pain,” said his roommate at the College of Physicians on behalf of the disciplinary commission. “An employee came and said: ‘There is blood everywhere, where does it hurt?'”, she recalls.

I can’t take it anymore, let me die, I just ask you to take good care of our children, that they don’t miss anything and that mom will love them all the time, even from up there.

SMS sent by Fanny Arnoult to her companion the night before her death

It was in the early morning of August 17 that she was transferred to Ambroise Paré hospital in Boulogne-Billancourt where she died within a few hours.

In its dismissal order, the justice considers that the death of Fanny Arnoult falls under a “therapeutic hazard” and that’ “there are no more elements allowing […] to impute a failure at the origin of the occurrence of the complications“.

France 3 Centre-Val de Loire is able to reveal documents which testify, despite everything, to a disorganization within the clinic.

Just after having operated on Fanny Arnoult a second time, Daniel Boudara goes on vacation for the whole month of August. A situation which, a priori, is not abnormal, provided that measures are taken so that the operated patients have an attentive follow-up.

Moreover, within the framework of the disciplinary commission, the surgeon presented to the Council of the Order of Physicians an on-call schedule indicating the presence of Doctor S, visceral surgeon, on August 16 and 17. However, it was actually absent.

Doctor S. also wrote a letter to the Order, which France 3 Centre-Val de Loire obtained, indicating that he was on leave between “dates from August 6 to 16, 2016 .”,stating that “Mr. Director [de la clinique] is aware “.

We have obtained the original guard chart of this evening. And there is no doubt: no surgeon was present, in the establishment, the day before the death of Fanny Arnoult.

If Doctor Boudara claims to have ensured that in his absence, his patient would be taken care of by colleagues with the guarantees of required skills […] these allegations are not established by the documents in the file.

Extract from the decision of the Council of the Order of Physicians

Where does this inaccurate chart come from? “The official document of the establishment has been transmitted to justice. If there is an intermediate version, it is a working document of the doctors”,indicates the Elsan group which ensures that “the clinic has organized itself to respond to the continuity of care.”

For his part, Doctor Boudara’s lawyer, assures that he does not know either: “Mr. Boudara was the recipient of this painting, it was not he who made it “.

According to him, the surgeon had anyway “no interest”to make believe that there was another surgeon that night. “Everyone knew that Mr. Boudara was the only bariatric surgeon in the clinic and therefore the only one able to assume the operational consequences of any difficulties that might arise. So he was on call all the time.”

A telephone guard that also criticizes the Council of the Order. The organization accuses the doctor of having “managed all risky situations of his patient by telephone, without personal examination of the patient“, while he was on leave.

In its decision, the Order also indicates that the surgeon did not plan to “medical supervision“before his patient’s next appointment on August 23. This levity led the Council to sentence the surgeon Daniel Boudara on appeal to a one-year ban on practicing his profession in 2019.

If the lawyer does not contest the decision of the College of Physicians, he regrets that the Council “wanted to make a decision at all costs before the criminal investigation ended and without having access to the various expert reports that were in progress“.

No criminal fault held against the surgeon

Because justice considered four years later that if “breaches of the rules of the art have been observed from time to time […] In any case, these did not have any direct or even indirect link with the occurrence of the death of Fanny Arnoult..”

Breaches of the rules of the art which are not so punctual. In the second part of our investigation, we will reveal that Doctor Daniel Boudara was convicted in civil proceedings in 2018 for shortcomings in the care of a patient who died in 2012 at the Saint-François clinic.

Alerted in 2013, the Regional Health Agency did not report to shed light on these events. Worrying signals concerning the practices of his surgeon could have alerted the clinic in April 2016. Elements that we will reveal to you in the next part of our investigation, on March 14.

With Sanaa Hasnaoui