Chronique sur le défaut de surveillance

Responsabilité du médecin psychiatre pour prescription d’une surveillance insuffisante

Il appartient au médecin psychiatre, chargé au sein de l’établissement de santé de suivre le patient, de prescrire les mesures de soins et de surveillance appropriées à son état.

Une cour d’appel qui, à la suite du suicide d’un patient dans un établissement de santé, a relevé qu’un médecin psychiatre ayant connaissance des risques élevés de suicide de son patient, n’avait donné aucune information de nature à mettre en œuvre une surveillance rigoureuse et que le personnel de l’établissement de santé n’avait pas connaissance de ces risques et avait effectué une surveillance régulière du patient, a pu en déduire que la responsabilité du médecin psychiatre était engagée et que l’établissement de santé, dont le personnel ne pouvait légalement accéder à l’ensemble du dossier médical du patient pour déterminer lui-même les mesures de surveillance à envisager, n’avait pas, en l’absence d’information, commis de faute ((Cass., Civ. 1ère, 21 juin 2005, n° 03-18779, Bulletin 2005 I N° 274 p. 228.)).

Suicide d’un détenu suivi par un psychiatre

Placé en quartier disciplinaire, un détenu s’est suicidé au centre de détention de Salon-de-Provence, en se pendant à des lanières de drap accrochées à la grille d’aération de la cellule.

Le tribunal administratif avait rejeté la responsabilité de l’État, et la Cour administrative d’appel annule ce jugement. Pour ce faire, la Cour souligne les nombreux éléments qui sont de nature à établir le défaut de surveillance, et accorde une importance particulière à l’absence de réactivité aux signaux d’alerte qui accompagnaient immédiatement le geste du détenu.

La juridiction fait le lien entre la prescription du psychiatre d’une surveillance particulière et les carences du personnel non soignant. L’obligation de surveillance ne relève pas du seul fait du personnel infirmier ((CAA Marseille, 6 mars 2006, n° 04MA01337.)).

Suicide d’une jeune patiente : absence d’erreur de diagnostic et absence de faute de surveillance

A la suite du suicide d’une patiente, un recours est engagé contre deux structures hospitalières qui estiment chacune que la responsabilité relève de l’autre.

La patiente souffrait d’une pathologie du caractère avec débilité psycho-affective aggravée par un accident neurologique. Elle avait bénéficié d’une prise en charge au sein du centre hospitalier de Thuir. Les praticiens du centre hospitalier, compte tenu de leurs observations et de celles issues de précédents séjours dans d’autres établissements, concluent à une admission à titre dérogatoire à une maison de retraite à compter du 6 décembre 1994, l’objectif étant une réinsertion progressive. Le 5 février 1995, la patiente se défenestre et meurt.

La Cour administrative d’appel met hors de cause les deux établissements de santé.

Les psychiatres du centre hospitalier spécialisé n’ont pas commis d’erreur de diagnostic, ni de thérapeutique en décidant de l’hébergement en dehors d’une structure psychiatrique, notamment parce que le risque suicidaire était inconnu.

S’agissant de la maison de retraite, le dossier ne laissait pas apparaître de troubles du comportement ou d’inadaptation dans la structure. Ainsi cette jeune patiente ne justifiait pas d’une surveillance particulière ((CAA Marseille, 24 mars 2005, n° 01MA02430.)).

Suicide d’un patient en chambre d’isolement : absence de responsabilité du fait de la qualité de la surveillance qui ne saurait être sans faille

Le tribunal administratif a reconnu la responsabilité de l’unité psychiatrique du centre hospitalier général et la Cour administrative d’appel réforme le jugement.

Il est certain que ce patient exigeait une surveillance particulière. Il était connu pour des passages à l’acte violents, contre autrui ou contre lui-même. Admis sous le régime de l’hospitalisation d’office, il était placé en chambre d’isolement. Alors qu’il demandait avec insistance la levée du placement pour reprendre le travail, il venait de lui être annoncé que l’hospitalisation était renouvelée.

Cela étant, la Cour détaille ce qu’a été la surveillance, en examinant tant la configuration des lieux que la présence des médecins et de l’équipe infirmière. Plus particulièrement, le dossier laisse apparaître que le décès a eu lieu à 19h15, et a été découvert à 19h20, ce qui témoigne d’une surveillance attentive par le personnel : il aura donc suffi de 5 minutes pour que se réalise le drame.

Le placement dans une chambre d’isolement crée une obligation de sécurité renforcée, mais non absolue ((CAA Marseille, 2 février 2006, n° 04MA00882.)).

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