Défaut de surveillance d’un interne et décès d’une patiente

Clinique NDM - BlocChirurgicalWebUne patiente est décédée lors d’une coelioscopie réalisée en vue de rechercher l’origine des douleurs pelviennes dont elle se plaignait. Cet acte médical a été effectué par un gynécologue de l’hôpital de Pontoise (Val d’Oise), assisté d’une interne. L’information judiciaire ouverte dans cette affaire a notamment permis d’établir que le décès de la patiente était dû à une hémorragie interne résultant d’une incision trop profonde de l’aorte. Il a également été admis que ladite incision cutanée avait été pratiquée par l’interne, dès le début de la coelioscopie.

L’interne et le gynécologue ont été renvoyés devant le tribunal correctionnel du chef d’homicide involontaire, la première pour avoir directement causé la mort de la patiente, le second pour y avoir indirectement contribué, en commettant une faute caractérisée.

Le tribunal correctionnel a relaxé l’interne mais a déclaré coupable le gynécologue qui a dès lors interjeté appel de la décision. En appel, la décision de première instance a été infirmée et la relaxe du praticien a été prononcée.

Indignées, les parties civiles se sont pourvues en cassation contre la décision des juges du fond. Ces dernières ont fait valoir notamment que le caractère défaillant de la surveillance du gynécologue à l’égard de l’étudiante et son retard dans le diagnostic avaient directement causé le décès de la patiente. Dès lors, les demandeurs au pourvoi ont estimé que la juridiction d’appel n’avait pas à rechercher l’existence d’une faute caractérisée, la preuve d’une faute simple étant suffisante pour entrer en voie de condamnation.

Ils soutenaient, à cet égard, qu’il incombait à la cour d’appel de requalifier les faits de la prévention. Dans son arrêt du 10 février 2009 ((Cass. Crim., 10 février 2009, n°08-80.679.)), la Cour de cassation a accueilli ces arguments et a cassé, pour manque de base légale, la décision de la Cour d’appel de Versailles.

Le tort des juges de la Cour d’appel de Versailles a été, aux yeux de la Cour de cassation, de s’être focalisés sur le diagnostic tardif et erroné du médecin, aucune faute qualifiée ne pouvant être caractérisée à son encontre. Les juges de cassation infirment cette décision en ce que les juges d’appel n’ont pas recherché si les agissements du médecin étaient constitutifs d’une « faute entretenant un lien direct de causalité avec la mort de la patiente ».

Au-delà de la solution elle-même, c’est le raisonnement et, partant, la motivation qui sont sanctionnés par la Cour régulatrice, ainsi qu’en atteste le visa de l’article 593 du code de procédure pénale propre aux motivations défaillantes.

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