Ouverture et exploitation sans autorisation d’un établissement de santé privé

Si les médecins, toutes spécialités confondues, ne s’intéressent pas spontanément à la réglementation sanitaire, ils ne peuvent pour autant s’en affranchir impunément. Les Tutelles veillent : qui pourrait en douter ? Un exemple récent nous le rappelle avec force.

À la suite d’un courrier adressé au procureur de la République par un médecin inspecteur départemental de la santé dénonçant l’activité d’un médecin ophtalmologiste, qui pratiquait sans autorisation des greffes de cornée dans une clinique ophtalmologique, des investigations ont établi que ce médecin avait exercé dans les locaux d’un établissement, dont il était le dirigeant effectif, avec le concours de deux confrères, un anesthésiste et un spécialiste de la greffe de cornée qui fournissait les greffons. Pour le déclarer coupable d’ouverture et exploitation sans autorisation d’un établissement de santé privé, délit prévu et réprimé par l’article L. 715-3, alors applicable, (devenu l’article L. 6125-1 du code de la santé publique), l’arrêt relève que l’établissement géré par le prévenu, en raison de la nature et de la technicité des actes qui y étaient pratiqués ainsi que du niveau de ses équipements et installations, constituait un établissement de santé privé et précisément une structure de soins alternative à l’hospitalisation permettant l’exercice de la chirurgie ambulatoire.

Les juges constatent qu’un tel établissement était soumis, lors de sa création, à l’autorisation du ministre chargé de la santé ou de l’ARH, conformément aux prescriptions de l’article L. 712-8 du CSP.

Dès lors que l’établissement ouvert et géré par le prévenu, qui avait pour objet de dispenser, sans hébergement, des soins de courte durée en chirurgie, répondait à la définition des établissements de santé fournie par les articles L. 711-1 et L. 712-2 (devenus les articles L. 6111-1 et L. 6111-2 du CSP), la cour d’appel, qui a retenu une incrimination exprimée par la loi de manière claire et précise, a caractérisé sans insuffisance l’élément matériel de l’infraction. Par ailleurs, la seule constatation de la violation, en connaissance de cause, d’une prescription légale ou réglementaire implique de la part de son auteur l’intention coupable exigée par l’article 121-3, alinéa 1er du code pénal.

En revanche, méconnaît les dispositions de l’article 2 du code de procédure pénale, la cour d’appel qui condamne le prévenu à payer des dommages-intérêts à la CPAM alors que le préjudice allégué ne résulte pas directement de l’infraction ((Cass. crim., 9 mai 2007, n° 06-85.021.))

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