Accès au dossier médical et délais de transmission : des écarts de 1 à 50 !

« Comme la Conférence nationale de santé a déjà eu l’occasion de le dire dans son précédent rapport, le droit d’accès au dossier n’a pas généré dans les établissements de santé l’afflux de demandes qui pouvait être craint.

Pour autant, le nombre de demandes est inégal selon les établissements et il est indispensable que les moyens dédiés au service de l’accès au dossier médical soient adaptés au niveau de la demande, de façon à ce que, notamment, le délai moyen de transmission des informations ne soit pas trop élevé. Des écarts de 1 à 50 ne sont pas tolérables ».

Ainsi s’exprime le rapport 2009 de la Conférence nationale de santé.

Sur la question des délais, l’arrêté du 5 mars 2004 énonce :

« Il est rappelé les contraintes de délais imposées pour les réponses aux demandes d’accès aux informations : la personne peut accéder aux informations directement ou par l’intermédiaire d’un médecin qu’elle désigne et en obtenir communication au plus tard dans les 8 jours suivant sa demande et au plutôt après qu’un délai de réflexion de 48 heures aura été observé. Ce délai de communication est porté à 2 mois lorsque les informations médicales datent de plus de 5 ans à compter de la date à laquelle l’information a été constituée. Ce délai peut également être de 2 mois dans le cas particulier de la saisine de la commission départementale des hospitalisations psychiatriques ».

A la vérité, l’arrêté est, sur ce point, fort mal rédigé en ce que, d’une part, il ne précise pas avec exactitude le point de départ du délai de communication du dossier médical et en ce que, d’autre part, il fixe un délai difficilement réaliste selon le point de départ qui serait retenu.

S’agissant de l’ambiguïté du point de départ, il est permis de se demander si l’expression « suivant sa demande » désigne la date d’émission du courrier de demande ou sa date de réception. Cette dernière option offrirait assurément l’intérêt de faire courir le délai à partir du moment où la demande a été portée à la connaissance de l’autorité responsable, ce qui représente à tout le moins un minimum auquel les établissements peuvent s’attendre pour prendre en considération l’exercice par les usagers du droit à l’information médicale les concernant.

A supposer même que la date de réception prévale sur tout autre point de départ, la difficulté n’est pas résolue pour autant. Le courrier de demande peut en effet supposer la communication d’informations complémentaires auquel le patient n’aurait pas songé de prime abord, telles que son état-civil, le motif de sa demande, la copie de sa pièce d’identité, la copie du livret de famille dans le cas des ayants-droit. Autrement dit, une autre interrogation se fait jour : la délai commence-t-il à courir à compter d’une demande parcellaire ou d’une demande parfaitement renseignée et complétée avec les pièces justificatives idoines ?

Dossiers 5 couleursS’agissant du délai proprement dit, soit huit jours, ce qui représente un peu plus d’une semaine, pour communiquer la copie du dossier médical, cela peut représenter selon le profil, la taille, l’activité, et le degré d’organisation des établissements, un défi insurmontable, faute de moyens, de temps ou parfois même – il faut le reconnaître – de volonté politique clairement affichée.

Si, dans son manuel de certification V2010, la Haute autorité de santé (HAS) a érigé « l’accès au dossier du patient » au rang de pratique exigible prioritaire (PEP) ((Critère 14b de la PEP n°9.)), ce dont il faut se féliciter, force est toutefois de déplorer qu’à l’ambiguïté ci-avant relevée, elle ajoute de la confusion à travers la rédaction d’un de ses éléments d’appréciation.

En effet, le critère 14b indique que le dossier médical est communiqué dans des délais compatibles avec ses besoins, ce qui ne manque d’étonner le praticien dès lors que les délais de communication sont déjà réglementés, comprenant un délai minimum et un délai maximum, sans qu’il soit utile de faire référence aux besoins du patient.

Ce faisant, la HAS n’ajouterait-elle pas à la réglementation une condition qu’elle ne pose pas ?

Cette interrogation existentielle étant précisée, devant l’inobservation manifeste et répétée par les établissements de santé des prescriptions réglementaires, le médiateur de la République, lequel a récemment créé un pôle dédié spécifiquement aux patients, a été saisi à plusieurs reprises de cas relatifs au non-respect des délais.

Ces saisines ont conduit le ministère de la Santé à édicter une circulaire en date du 3 juillet dernier aux fins de rappeler les directeurs d’établissements à leurs obligations légales et réglementaires et exposant les voies de recours offertes aux patients en cas de violation des dites dispositions.

Dans une dynamique constructive, la Conférence nationale de santé a proposé que le délai de remise du dossier médical soit porté à 15 jours, d’une part, et qu’une procédure d’urgence, dans un délai maximum de 48 heures, soit mise en œuvre dans les hypothèses où la demande du dossier serait motivée par la recherche d’un deuxième avis, d’autre part.

Au délai de 15 jours, je souscris pleinement. Le délai d’urgence de 48 heures me laisse en revanche sceptique pour les raisons précédemment évoquées.

En définitive, l’exercice des droits individuels fondamentaux des patients ne saurait se satisfaire de la simple inscription d’un délai au fronton de la démocratie sanitaire, encore faut-il qu’il soit dépourvu de toute ambiguïté dans sa formulation et que son effectivité fasse l’objet d’une inlassable vigilance.

Omar YAHIA

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