« Jumeau évanescent », le « non, mais » du juge administratif

Selon les Saintes Écritures, Dieu aurait dit à Ève : « tu accoucheras dans la douleur ». Grâce aux récentes évolutions techniques, la péridurale (pour les accouchements par voie basse) et la rachi-anesthésie (pour les césariennes) ont quelque peu tempéré la sentence divine, il faut bien le reconnaître, et elles ont permis de repousser l’âge limite auquel les parturientes peuvent accoucher. Il n’est donc pas rare de voir des quarantenaires primipares.

C’est le cas de la présente espèce dans laquelle une patiente, âgée de 41 ans et quoique traumatisée par une fausse couche quelques mois plus tôt, est tombée enceinte de jumeaux. Cette grossesse gémellaire, révélée par échographie, ne s’est pas très bien déroulée dès lors qu’elle s’est caractérisée par un décollement du pôle inférieur de l’œuf, puis par des saignements à répétitions et enfin des douleurs de la fosse iliaque droite.

On comprend, dans ces conditions, l’état de stress dans lequel la patiente peut avoir été plongée, ce d’autant que les médecins ne sont pas tombés d’accord sur le principe d’une hospitalisation. Alors que son médecin de ville lui a proposé une hospitalisation, cette dernière lui a été refusée par l’interne de garde qui l’a examinée aux urgences du centre hospitalier André Grégoire de Montreuil, refus confirmé par le chef de service, aucun traitement médical n’ayant été préconisé de surcroît. A la suite de son retour au cabinet de son médecin, elle a été hospitalisée durant 17 jours à la clinique du Bois d’Amour, où elle a été placée sous perfusion de Spasfon, ce qui a permis la disparition de la douleur. Lors de ce séjour, un contrôle de sa grossesse a permis de découvrir que l’un des deux embryons n’avait plus d’activité cardiaque, le second embryon poursuivant toutefois une évolution favorable, lequel aboutira à la naissance d’un petit garçon.

Une fois passé l’heureux évènement, la jeune mère a introduit un recours à l’encontre du centre hospitalier qu’elle a tenu pour responsable de sa fausse couche, le premier embryon n’ayant pas survécu. En substance, elle lui a reproché :

  • un refus d’hospitalisation alors qu’elle était, selon elle, sur le point d’être victime d’une fausse couche, lequel refus serait à l’origine du décès d’un des deux enfants,
  • un refus de lui administrer un médicament pour soulager ses douleurs.

Le tribunal administratif de Cergy-Pontoise a, par jugement du 3 avril 2008 ((TA Cergy-Pontoise, 3 avril 2008, Mme Anna F, n° 0506992, AJDA 2008, p. 1791.)), exprimé un balancement circonspect si cher aux énarques : le « non, mais ».

Non, le centre hospitalier n’est pas responsable du décès d’un des jumeaux

Pour tenter de démontrer la responsabilité du centre hospitalier, la requérante a soutenu que les refus d’hospitalisation et de traitement de nature à la soulager qui lui ont été opposés – faute dans l’organisation et le fonctionnement du service public hospitalier – ont été à l’origine du décès d’un des embryons, au même titre que la faute médicale consistant dans le fait de ne pas avoir diagnostiqué l’imminence d’une fausse couche et de ne pas lui avoir, par voie de conséquence, dispensé de traitement approprié.

Des griefs de cette nature nécessitent naturellement que le juge administratif s’appuie sur le rapport d’expertise, pièce maîtresse dans les contentieux techniques. Il ressort précisément du rapport que dans le cas de la requérante présentant des douleurs, aucun traitement médical ne peut être recommandé. Les médecins hospitaliers n’ont donc pas commis de faute en préconisant le repos à domicile et l’abstention thérapeutique, l’administration de Spasfon ne constituant qu’un traitement adjuvant et symptomatique. Le raisonnement consiste à dire ici que si l’administration dudit traitement par les médecins hospitaliers aurait pu supprimer les douleurs ressenties, il n’aurait pu éliminer la menace de fausse couche.

En conclusion, le centre hospitalier n’a commis aucune faute et, en particulier, n’a fait perdre aucune chance d’éviter la fausse couche.

Mais le centre hospitalier est responsable du défaut de prise en charge de la douleur de la parturiente

C’est là que réside à mon sens l’apport original de la décision qui expose notamment :

 » Considérant cependant, qu’il ressort du rapport du Docteur Chemla que la douleur et la souffrance psychologique de Mme […] auraient dû être mieux prises en charge compte tenu du contexte de panique et de douleur qui a accompagné cette menace de fausse-couche, dont Mme […] avait déjà été victime, quelques mois plus tôt ; qu’à ce titre, Mme […] aurait dû bénéficier, outre d’une prise en charge de sa douleur morale, d’un traitement tendant à atténuer les douleurs dont elle souffrait ; que, dès lors, compte tenu des symptômes présentés par Mme […], du diagnostic déjà établi de grossesse à risques, de l’inquiétude et de l’insistance qu’elle a manifesté auprès des médecins, l’absence totale de prise en charge médicale de Mme […] aux urgences du centre hospitalier André Grégoire de Montreuil le 11 octobre 2004 est constitutive d’une faute de nature à engager la responsabilité du centre hospitalier ; « 

En effet, l’article L.1110-5 du code de la santé publique dispose que toute personne a le droit de recevoir des soins visant à soulager sa douleur et que celle-ci doit être en toute circonstance prévenue, évaluée, prise en compte et traitée.

De mémoire, très peu de décisions de justice condamnent un établissement de santé, quel que soit son statut, pour défaut de prise en charge de la douleur, si ce n’est à titre subsidiaire. Or, en l’espèce, le défaut de prise en charge de la douleur figurait parmi les moyens principaux de la requête en plein contentieux.

Si on adopte une lecture politique de la décision, le juge explique grosso modo que l’établissement public aurait pu la soulager, sans qu’il soit besoin qu’elle se rende dans une clinique privée.

Le défaut de prise en charge de la douleur vaut 2.000 euros

Exprimée de cette façon, l’affirmation peut paraître choquante, car il n’existe pas de barème proprement dit. Tout est affaire de circonstances. Il n’en demeure pas moins que les magistrats ont accordé la somme de 2.000 euros en réparation du pretium doloris ((Expression latine signifiant le prix de la douleur.)) et du préjudice moral.

Pour expliquer cette évaluation souverainement fixée, le tribunal relève dans son dernier considérant que le comportement du centre hospitalier a été à l’origine, pour la demanderesse, d’un état d’angoisse particulièrement important lié à la crainte de faire une fausse couche et de perdre ses jumeaux alors même qu’elle avait récemment vécu une telle expérience. Le refus opposé à sa demande d’hospitalisation ainsi qu’à sa demande de se voir administrer un traitement contre la douleur ont accentué et aggravé son angoisse initiale.

Le tribunal relève enfin que la patiente a enduré des douleurs durant plusieurs heures avant d’être prise en charge à la clinique du Bois d’Amour.

Dans l’évaluation des dommages et intérêts, le juge judiciaire se montre généralement plus prodigue avec les demandeurs, ce qui est parfaitement compréhensible dès lors que ce ne sont pas les deniers publics qui sont en jeu mais le budget d’une entreprise privée.

Au plan médical, on apprend enfin que le décès d’un des jumeaux était lié au phénomène dit de « jumeau évanescent », lié vraisemblablement à des anomalies concernant le nombre de chromosomes ou à des malfromations embryonnaires, lequel phénomène tient aux imperfections de la reproduction de la nature humaine.

Omar YAHIA

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