La continuité du service public excuse-t-elle de graves irrégularités comptables ?

Entrée de la Cour des comptes à Paris - Ier arrondissement - Rue Cambon.La Cour de discipline budgétaire et financière a rendu un arrêt qui risque de donner du grain à moudre à l’hospitalisation privée, laquelle ne se prive pas de dénoncer – à tort ou à raison – la qualité de la gestion par l’hospitalisation publique des deniers publics qu’elle considère comme défaillante. Il s’agit de l’arrêt Centre hospitalier de Fougères rendu le 16 avril 2009.

La juridiction financière a en effet relaxé un directeur de centre hospitalier qui avait pourtant commis des irrégularités, dont certaines étaient pourtant qualifiées de graves par la juridiction, dans la rémunération de certains personnels médicaux contractuels. Entre la continuité du service public et d’accès aux soins et le respect des textes, la juridiction a choisi. La Cour a également relaxé sa tutelle (le directeur départemental des affaires sanitaires et sociales), qui avait pourtant été au courant des irrégularités et qui ne s’y était pas opposée.

La Fédération hospitalière de France a beau se féliciter du verdict de la Cour dans son communiqué du 15 mai dernier, au regard de « circonstances locales particulières », cette solution laisse un goût amer d’inachevé, pour ne pas dire plus.

Il serait par trop simpliste d’accabler le directeur d’établissement et la directrice départementale des affaires sanitaires et sociales mis en cause et relaxés in fine. Force est toutefois de relever que la solution adoptée ne fait pas l’unanimité de la doctrine et invite à s’interroger sur le caractère inadapté d’une réglementation budgétaire vieillissante.

Ainsi des analystes autorisés ((N. Groper et C. Michaut, Relaxe d’un directeur d’hôpital et de sa tutelle en dépit de faits gravement irréguliers, AJDA 2009, p. 1194.)) relèvent-ils dans leur commentaire :

« […] la Cour elle-même a affaibli son raisonnement aboutissant à la relaxe en insistant à deux reprises, dans la partie « responsabilité » de l’arrêt, sur la particulière gravité des irrégularités. Car une partie des faits doit être considérée comme grave en l’espèce : la certification de fausses gardes et astreintes, comme dit précédemment, va au-delà de la seule liberté prise avec une réglementation, qui certes était sans doute inadaptée à la réalité des contraintes des hôpitaux ; il y a dans un tel comportement une charge fautive plus lourde, pas loin de l’intention frauduleuse, donc moins facilement excusable. En prononçant en l’espèce la relaxe, la Cour a non seulement pris quelques libertés avec sa jurisprudence habituelle (les trois critères précités), mais a également fermé les yeux sur des agissements quasi-frauduleux, qui eussent mérité au moins une sanction de principe, comme dans l’affaire Centre hospitalier d’Ambert ».

Les chroniqueurs s’interrogent – à juste titre – sur deux points essentiels dépassant le cadre de la présente affaire.

1/ Si la tutelle, également renvoyée devant la Cour en l’espèce, ce qui est rarissime, était au courant des montages irréguliers, pourquoi ne pas engager la responsabilité de cette dernière, puisque le fait d’avoir été transparent vis-à-vis d’elle constitue précisément l’un des critères de la relaxe du directeur d’hôpital ?

2/ Pourquoi l’État laisse-t-il en vigueur pendant des années des réglementations qui sur le terrain se révèlent inapplicables, incitant par là même les gestionnaires publics à commettre des irrégularités ?

Le lecteur se reportera avec profit à la chronique mise en exergue ainsi qu’au commentaire présent dans l’excellente revue Finances hospitalières. ((M. Trémeur, Quand les circonstances de l’affaire excusent l’illégalité financière…, Finances hospitalières, juillet 2009, p. 24.))

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