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The Centre Hospitalier François Dunan in Saint-Pierre-et-Miquelon faces a critical financial crisis, accumulating a global deficit of nearly 18.5 million euros between 2019 and 2025, according to a report by the regional audit chamber, the Chambre régionale des comptes d’Île-de-France.
In Plain English: The Clinical Takeaway
- Budgetary Insolvency: The hospital drained 12.1 million euros from its reserves, pushing its working capital into a negative balance by December 31, 2025.
- Aged Care Pressures: Expenses tied to medico-social services, including nursing home beds at Maison Églantine and long-term care units, drove the deficit higher.
- Structural Overstaffing: Auditors identified a high headcount relative to the local population, alongside reliance on traveling locum physicians.
Financial Irregularities and the 18.5 Million Euro Deficit
An audit released by the Chambre régionale des comptes d’Île-de-France reveals deep systemic accounting flaws at the sole public health institution in the French archipelago. The report documents a cumulative deficit of 18.5 million euros amassed over a period ending in 2025, with 7.5 million euros accumulating in 2025 alone. Auditors noted that irregularities in bookkeeping practices prior to 2025 obscured the true financial trajectory of the hospital. “In conclusion, the importance of the anomalies recorded in the keeping of accounts prevented, until 2024, having a true and fair view of the result of the hospital’s management and its financial situation,” the document states.
The visibility of these figures in 2025 stems from corrective accounting adjustments that brought hidden losses to light. Beyond the headline deficit numbers, the hospital depleted 12.1 million euros from its reserves. Consequently, the institution’s working capital plunged into negative territory by the close of 2025. Auditors explicitly criticized the cash management practices, noting that available credit lines and loans were diverted to cover basic operational expenses rather than sustainable capital equipment.
Medico-Social Services and Elderly Care Pressures
A primary driver of the fiscal strain is the institution's medico-social sector. This financial pressure occurs against a backdrop of an aging population and a scarcity of medical specialists on the islands.
| Financial Metric | Recorded Figure / Status |
|---|---|
| Global Deficit (2019–2025) | Nearly €18.5 million |
| Single-Year Deficit (2025) | €7.5 million |
| Reserves Depleted (2019–2025) | €12.1 million |
| Working Capital (As of Dec 31, 2025) | Negative balance |
Staff Count Exceeds Patient Capacity and Local Population
The report asserts that the Centre Hospitalier François Dunan maintains a staff count that remains large relative to the small population it serves and its patient capacity. While acknowledging the unique geographic isolation of the archipelago, auditors emphasized that the facility's resource allocation surpasses that of other overseas health establishments. To maintain operations, the facility has relied on mission-based visiting physicians, alongside expenditures on service vehicles and real estate upkeep.
Restructuring the Governance and Funding Framework
References
- Chambre régionale des comptes d’Île-de-France. Public Audit Report on the Management of the Centre Hospitalier François Dunan (2019–2025).
- Agence territoriale de santé (ATS) Saint-Pierre-et-Miquelon. Regional Health Infrastructure Directives.
