Perforation de l’oesophage à l’occasion d’une dilatation endoscopique

Voici encore une triste affaire de responsabilité médicale sur le plan judiciaire, cette fois-ci. En l’espèce, la perforation instrumentale était la conséquence d’un geste maladroit du praticien, de sorte que celui-ci avait ainsi commis une faute, exclusive de la notion de risque inhérent à un aléa médical ((Cass. 1ère civ., 3 avril 2007, n° 06-13.457, Mutuelle d’assurances du corps de santé français (MACSF) et a.)).

L’arrêt mérite une large reproduction :

« Sur le moyen unique :

Attendu que le 15 mai 2000 M. P. a pratiqué une dilatation endoscopique sur Mme B., dont il est résulté une perforation de l’œsophage ; qu’au vu des conclusions d’une expertise ordonnée en référé, Mme B. a assigné le docteur P. et son assureur, la société MACSF, devant le tribunal de grande instance en responsabilité et indemnisation de son préjudice ; que l’arrêt attaqué (Paris, 20 janvier 2006) a déclaré M. P. entièrement responsable du préjudice subi par Mme B. et l’a condamné in solidum avec son assureur à lui payer certaines sommes ainsi qu’à la CPAM des Yvelines ;

Attendu que M. P. fait grief à l’arrêt d’avoir ainsi statué, alors, selon le moyen, que la responsabilité du médecin est subordonnée à la preuve d’une faute commise dans l’accomplissement de l’acte médical et que la réparation des conséquences d’un aléa thérapeutique n’entre pas dans le champ des obligations dont un médecin est contractuellement tenu à l’égard de son patient ; que la faute médicale ne peut se déduire de la seule absence de réussite de l’acte médical et de l’apparition d’un préjudice ; qu’en l’espèce, l’expert a relevé que l’acte endoscopique était justifié par la pathologie présentée par Mme B., que la technique employée et la surveillance avaient été conformes aux règles de l’art ; que la probabilité du risque qui s’est produit est inhérent à cette méthode opératoire, qu’il est rarissime, d’environ 1%, toujours possible mais imprévisible ; que la cour d’appel ne pouvait déduire de la seule survenance d’une perforation, qui est un risque inhérent à l’acte médical en cause, l’existence d’une maladresse fautive à la charge du docteur P. ; qu’elle a violé l’article 1147 du Code civil ;

Mais attendu que c’est dans l’exercice de son pouvoir souverain d’appréciation des éléments de preuve qui lui étaient soumis, que la cour d’appel a relevé que pour réaliser la dilatation endoscopique, M. P. devait, à l’aide de bougies de Savary de 11 à 16 mm, se guider sur la sensation de résistance au passage de la bougie ; que cette résistance devait être vaincue sans brutalité ; que la perforation instrumentale était la conséquence d’un geste maladroit du praticien ; qu’elle a pu en déduire que M. P. avait ainsi commis une faute, exclusive de la notion de risque inhérent à un aléa médical et a, par ces seuls motifs, légalement justifié sa décision ;

Par ces motifs :

Rejette le pourvoi. »

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