Astreinte et déplacements, ne pas satisfaire mais rembourser (quand même)

FlickR - L'Aare, Jean, n'a pas d'eau d'heure - 1suisseLe fait pour un praticien hospitalier (PH) d’avoir manqué de rigueur dans les formalités à accomplir lors de ses périodes d’astreinte ne peut justifier le refus d’un centre hospitalier de lui rembourser les frais de déplacements. Telle est la leçon que le directeur du centre hospitalier de Bourg-en-Bresse a tiré d’une décision du Conseil d’État du 25 septembre dernier ((CE, 25 septembre 2009, M. Rondepierre c/ Centre hospitalier de Bourg-en-Bresse, n°313463.)).

En l’espèce, conformément aux dispositions de l’arrêté du 30 avril 2003 relatif à l’organisation et à l’indemnisation de la continuité des soins et de la permanence pharmaceutique dans les établissements de santé, le directeur de l’établissement avait édicté des règles d’organisation de la permanence des soins. Par une note du 3 novembre 2003, il avait demandé  » à chaque praticien qui se déplacera durant l’astreinte de noter les déplacements chronologiquement sur un registre unique  » et d’y consigner l’heure d’arrivée, le nom du patient pour lequel il a été appelé puis, une fois le déplacement terminé, l’heure de départ de l’hôpital et les actes médicaux effectués.

On comprend que le praticien hospitalier ait pu considérer cette obligation comme une contrainte, mais on ne peut blâmer le directeur de vouloir introduire un peu de discipline dans la traçabilité des déplacements, par souci de préservation des deniers publics et de sécurité des soins.

Ce pouvoir général d’organisation dévolu au représentant légal de l’établissement est parfaitement reconnu par les juges en l’espèce, quel que soit le degré de juridiction au demeurant. Mais là n’est pas le débat.

En effet, faute pour le praticien d’avoir scrupuleusement et systématiquement noté les informations demandées, le centre hospitalier a purement et simplement refusé de payer les interventions non « tracées ».

Saisi par le PH, le tribunal administratif de Lyon, plus royaliste que le roi, a rejeté la requête au motif que le refus de paiement était légal dès lors que le PH n’avait pas déféré aux règles d’organisation édictées par le directeur d’établissement.

Le Conseil d’État récuse ce raisonnement en relevant deux erreurs de droit commises par les magistrats de Lyon.

En premier lieu, le tribunal, en jugeant que le fait pour le praticien de n’avoir pas systématiquement de manière chronologique ses heures d’arrivée à l’hôpital sur le registre prévu à cet effet et de n’avoir pas toujours inscrit sur ce registre tous les renseignements requis, était de nature à justifier légalement le refus de l’hôpital de lui rembourser les déplacements correspondants, alors qu’il était d’astreinte et que l’établissement ne constestait pas la réalité de ceux-ci et du temps de travail effectif auquel ils avaient donné lieu, a entaché son jugement d’erreur de droit.

En second lieu, l’indemnité forfaitaire de déplacement a pour objet d’assurer la rémunération du temps de travail effectif accompli par un praticien lors d’une période d’astreinte. Par suite, en excluant la rémunération des interventions effectuées, alors qu’il était d’astreinte, par le PH les 2 décembre 2003, 27 mai 2004, 5, 8, 26 et 29 juillet 2004, 2, 9, 16, 19, 26 et 30 août 2004, 2, 7, 13, 16, 20, 24 et 28 septembre 2004 et 18 novembre 2004 au motif que celui-ci se trouvait à l’hôpital lorsqu’il avait été appelé et n’avait effectué aucun déplacement physique depuis un lieu extérieur à l’hôpital, le tribunal administratif de Lyon a également entaché son jugement d’erreur de droit.

Ce faisant, le tribunal a clairement ajouté des conditions que l’arrêté de 2003 susvisé ne prévoyait pas.

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