Clinique, les compétences de tes médecins libéraux tu vérifieras

Quid - La chirurgie esthétique d'Angelika TaschenUne patiente a subi le 26 septembre 2003 une opération de chirurgie esthétique en vue de la mise en place de prothèses mammaires réalisée par un chirurgien généraliste exerçant au sein de la Clinique Anne d’Artois. Insatisfaite du résultat de cette opération, la patiente a recherché la responsabilité de l’opérateur et celle de la clinique, en reprochant à cette dernière un manquement à son obligation générale d’organisation laquelle lui imposait de fournir un personnel qualifié.

La demanderesse s’est adressée à la juridiction de proximité de Béthune, l’enjeu du litige ne devant sans doute pas dépasser 4.000 euros.

Par jugement rendu le 15 mai 2007, ladite juridiction a condamné in solidum la clinique et le médecin à réparer son préjudice. Les parties succombantes se sont alors pourvues en cassation contre la décision de première instance.

Et voici ce que dit la Cour de cassation dans son arrêt du 11 juin 2009 (n°08-10.642) :

« Mais attendu, qu’en vertu du contrat d’hospitalisation et de soins le liant à son patient, l’établissement de santé privé est tenu d’une obligation de renseignements concernant les prestations qu’il est en mesure d’assurer, de procurer au patient des soins qualifiés, et de mettre à sa disposition un personnel compétent ;

Et attendu que le jugement énonce que la clinique qui cherchait un médecin ayant une formation de chirurgien gynécologue, à orientation carcinologue, avait engagé M. Y… en tant que chirurgien généraliste; que celui-ci n’avait obtenu son inscription au conseil de l’ordre qu’en tant que chirurgien généraliste, tout en se présentant comme spécialisé en « chirurgie du cancer du sein et gynécologie » sur les papiers à en-tête de la clinique ; que le tribunal qui a relevé que M. Y… n’avait aucune compétence ni spécialité dans le domaine de la chirurgie plastique, reconstructrice et esthétique, a pu retenir, nonobstant le fait que l’exercice de la chirurgie esthétique n’ait été restreint à une liste déterminée de spécialistes que postérieurement aux faits litigieux, par décret du 11 juillet 2005, que la clinique avait manqué à ses obligations à l’égard de sa patiente, en laissant M. Y…, pratiquer des opérations relevant de la chirurgie esthétique, sans vérifier s’il disposait des compétences requises en ce domaine ;

Que par ces motifs la juridiction a légalement justifié sa décision ; »

Deux types de contrats régissent les relations du patient pris en charge par un médecin exerçant à titre libéral au sein d’un établissement de santé privé : un contrat médical avec le praticien et un contrat d’hospitalisation et de soins avec l’établissement. Ces deux contrats ne se confondent pas.

Si l’indépendance professionnelle s’oppose à ce que la responsabilité de la clinique soit retenue pour des fautes commises par le médecin libéral dans l’exercice de son art, est-ce à dire que ce principe la dispense de tout contrôle sur les compétences du médecin libéral ? Assurément non, dès lors que la délivrance de soins qualifiés, issue précisément du contrat d’hospitalisation et de soins, dépend de la compétence et des qualifications du médecin opérateur.

S’ils ne se confondent pas, les deux contrats, on le voit, sont intimement liés.

En effet, la clinique doit veiller, dans l’organisation des soins, à la réalisation de soins qualifiés par la mise à disposition d’un personnel de santé disponible et d’un matériel opérationnel et suffisant. On imagine mal un établissement observer cette obligation avec des médecins libéraux incompétents qui menaceraient la sécurité de leurs patients.

En l’espèce, le praticien n’avait pas les compétences requises dans les spécialités de « gynécologie, sénologie, carcinologie et esthétique ». Au demeurant, l’arrêté du 16 octobre 1989 portant approbation d’un règlement relatif à la qualification des médecins dans sa version applicable au moment des faits ne mentionne absolument pas la qualification de « chirurgie de cancer du sein ».

Or, la clinique l’avait engagé en tant que chirurgien généraliste.

En le laissant, dès le début de son activité, se présenter sous une qualification non répertoriée et différente de celle pour laquelle il avait été engagé, la clinique a manqué à son obligation d’information sincère à l’égard de sa clientèle concernant les prestations de soins qu’elle était en mesure d’assurer au sein de l’établissement.

Les cliniques sont donc incitées (voire invitées) à vérifier les qualifications de leurs médecins libéraux.

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