Revue de jurisprudence judiciaire

Responsabilité pénale

1/ Un médecin généraliste, réquisitionné par le préfet pour assurer une garde de nuit, qui ne prend pas les dispositions nécessaires pour être joint, commet une faute caractérisée exposant autrui à un risque d’une particulière gravité qu’il ne peut ignorer (Cass. Crim., 13 février 2007, n°06-81.089, Bull. info 1er juin 2007, n°1195, p. 50).

2/ Faute pour un anesthésiste de donner aux infirmières des instructions suffisantes pour surveiller l’évolution de l’état d’un enfant ayant présenté des saignements importants à la suite d’une amygdalectomie, la Cour de cassation a retenu l’existence d’une faute caractérisée qui a conduit à sous-évaluer l’ampleur de l’hémorragie et contribué au décès du patient par arrêt cardiaque lors de l’anesthésie préalable à la tentative d’hémostase ((Cass. Crim., 13 février 2007, n°06-82-202, Ibid. n°1196, p. 50.)).

3/ La Cour de cassation a censuré l’arrêt de la Cour d’appel de Poitiers pour violation des articles 111-4 et 222-23 du code pénal dès lors que cette dernière a renvoyé devant la cour d’assises, sous l’accusation de viols aggravés, un médecin qui, agissant dans un contexte sexuel et animé par la volonté d’accomplir un acte sexuel, a contraint trois jeunes patientes à introduire dans leur bouche puis à sucer un objet de forme phallique alors que, pour être constitutive d’un viol, la fellation implique une pénétration par l’organe sexuel masculin de l’auteur de l’infraction et non par un objet le représentant ((Cass. Crim., 21 février 2007, n°06-89.543. – C.A. Poitiers, 24 février 2006.)).


Responsabilité civile contractuelle

1/ Il résulte de la combinaison des articles 1135 et 1147 du code civil que se forme entre le médecin et son patient un véritable contrat comportant, pour la praticien, l’engagement de donner des soins attentifs, consciencieux et, sous réserve faite de circonstances exceptionnelles, conformes aux données acquises de la science.

La violation, fût-elle involontaire, de cette obligation contractuelle est sanctionnée par la mise en jeu d’une responsabilité de même nature. Ainsi, en cas de manquement aux règles de sécurité, la mise en œuvre de la responsabilité du médecin exige, outre la preuve d’un préjudice réparable, comme condition préalable que soit reconnue une faute commise par lui, observation étant faite que la charge de la preuve incombe au malade ou à ses ayants droit.

En l’espèce, compte tenu des circonstances exceptionnelles de l’intervention et de la faiblesse des moyens disponibles, la responsabilité résultant de la maladresse dans le geste médical est écartée dans le cas où le dommage était inévitable en raison d’une anomalie physique du patient. Les anomalies physiques du patient, ignorées du médecin, affectant le trajet du larynx et donc de la sonde comme ses réactions, rendaient inévitable l’erreur de trajet dans la mise en place d’une sonde naso-gastrique en cabinet par un médecin généraliste qui n’était pas le médecin traitant du malade ((CA Nîmes, 1ère ch., sect. A, 16 janvier 2007 – R.G. n° 04/03318.)).

2/ Un médecin, lié à son patient par un contrat comportant, pour le premier, l’obligation de donner des soins attentifs, consciencieux et conformes aux données acquises de la science, est tenu de délivrer à son patient une information loyale, claire et appropriée sur les risques graves afférents aux investigations et soins proposés et n’est pas dispensé de cette information par le seul fait que ces risques ne se réalisent qu’exceptionnellement.

En l’espèce, il ressort des divers rapports d’expertise qu’à l’époque des faits, il était possible de prescrire de la tétracaïne pour une brève période sans limitation, ce médicament étant inscrit au tableau A en 1983 et ne figurant plus dans le dictionnaire Vidal depuis 1997. Il est indiqué comme anesthésique local pour l’examen ou l’extraction d’un corps étranger et il ne doit pas faire l’objet d’un usage répété en tant qu’antalgique. Cet usage prolongé, en association avec un autre médicament prescrit par l’appelant (le médecin interjetant appel, en l’occurrence), le Scarlene, a été néfaste.

En fournissant à son patient un médicament dont le médecin connaissait ou devait connaître tant sa limitation dans le temps que les dangers de l’association avec l’autre médicament prescrit sans informer son patient de ces risques et sans mentionner expressément dans son ordonnance du 17 avril 1982 la posologie et la durée du traitement, l’appelant a commis une faute en relation directe avec le préjudice subi par son patient ((CA Agen, 1ère ch. Civ., 5 juillet 2006 – R.G. n° 05/00226.)).

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