Service des urgences : l’urgence n’était pas urgente !!

Élément fondamental de la protection sanitaire de la population, l’organisation des urgences s’inscrit dans le cadre régional et privilégie l’exigence de qualité et de sécurité des soins.Il arrive cependant parfois que le service des urgences ne réponde pas de manière efficiente à sa mission première, c’est-à-dire de prendre en charge toute personne se présentant en situation d’urgence, notamment en cas de détresse et d’urgence vitales.

C’est ainsi qu’un patient, entré au service des urgences d’un centre hospitalier de Dinan en raison de douleurs aux épaules, à la cage thoracique et à la mâchoire, a été invité à patienter en salle d’attente. Durant près d’une heure d’attente et alors qu’il présentait des symptômes alarmants, il a été pris d’un malaise et n’a pu être réanimé. Son épouse a recherché la responsabilité de l’établissement devant le tribunal administratif de Rennes.

L’expertise médicale, ordonnée par jugement avant-dire droit, a indiqué :

« que le service des urgences du centre hospitalier de Dinan, en prenant en charge M. Laigre comme s’il venait dans le cadre d’une simple consultation externe, a privé ce dernier de la possibilité de recevoir un avis médical sur son état et de recevoir en priorité des soins adaptés […] qu’en l’absence de diagnostic de l’état de détresse de M. Laigre lors de son admission au service des urgences, en raison du défaut d’organisation du service des urgences, a privé l’intéressé de chances réelles de récupération, quand bien même ce dernier n’aurait eu que des chances limitées de récupérer, si le diagnostic avait été posé comme il pouvait normalement l’être ; que par suite, il existe un lien de causalité direct entre la faute du service public hospitalier et le décès de la victime »

L’avocat du centre hospitalier a sans doute eu beau jeu, à la lecture de ce passage, de souligner, que l’expert (ou les experts) avait(en)t outrepassé sa (ou leur) mission en se prononçant sur le droit et non pas uniquement sur les faits cependant que, pour l’avocat de la veuve éplorée, c’était du pain bénit, si l’on ose dire.

Le tribunal administratif en a conclu :

« que l’absence de prise en charge médicale de M. Laigre par le service des urgences révèle un défaut de fonctionnement et d’organisation du service médical constitutif d’une perte de chance de survie de nature à engager la responsabilité du centre hospitalier de Dinan » ((TA Rennes, 19 avril 2007, n° 034361, Laigre et Coupeaux, AJDA 2007 p. 1551.)).

Voici donc un jugement qui fait un usage orthodoxe de la théorie de la perte de chance. En effet, la perte de chance se définit comme un préjudice particulier – en ce qu’il n’est pas la situation finale – qui tient à la disparition d’un aléa et qui suppose que soient réunies trois conditions cumulatives : un enjeu aléatoire (la survie du patient), un fait générateur (le retard dans la prise en charge et le délai d’attente, constitutif d’un défaut d’organisation et de fonctionnement) et la non-réalisation de l’enjeu (qui s’est traduite en l’espèce par la mort du patient).

La réparation de la douleur morale de l’épouse a été évaluée à 15.000 euros, une somme qui, sans être mirifique, n’aurait pu être atteinte il y a 30 ans dans des circonstances de fait similaires, preuve s’il en est que les mentalités, y compris celle des juges administratifs, évoluent.

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