L’important, c’est la santé l’important

FlickR - Bonne année 2010 ! - pfalaPuisque l’année 2010 nous tend les bras, il convient de conjuguer 2009 au passé… simple si possible.

Et pourtant, on ne peut oublier les drames qui ont inauguré le tout début de l’année 2009 dans les hôpitaux franciliens, s’agissant d’abord d’une erreur mortelle dans l’administration d’un médicament à un petit enfant, s’agissant ensuite d’un prétendu manque de lit en service de réanimation à l’origine du décès d’un patient, s’agissant également d’une erreur de dosage en substituts nutritionnels administré à un nouveau-né.

On ne peut passer sous silence le feuilleton tarifaire opposant l’hospitalisation privée au ministère de la Santé notamment, et dont le dernier épisode s’est matérialisé en particulier par une offensive médiatique portant sur la revendication d’un tarif unique, au bénéfice (prétendu ou avéré) de l’assurance maladie.

Souvenons-nous également de la parution du Livre noir des hôpitaux, qui certes ne trônera pas dans ma bibliothèque aux côtés des ouvrages de La Pléiade, mais qui plus modestement côtoiera les De Closets, Frémont, Sedel et consorts, bouquin dont le mérite – au-delà du titre accrocheur – est d’interroger nos institutions sur l’utilisation des deniers publics par les hôpitaux, la pratique contemporaire de la médecine libérale (dépassements d’honoraires en sus), ou encore la sécurité des soins.

N’oublions pas la révolution silencieuse qui s’opère dans la fonction publique en général et la fonction publique hospitalière en particulier, en premier lieu à travers l’utilisation d’une sémantique propre au secteur privé (intéressement, parcours professionnels, prime au mérite, contractuels, etc.), dénotant par là même une déconstruction progressive du bras armé de l’Etat et du service public ; en second lieu, par le biais de l’effondrement progressif du tabou de la masse salariale dans la recherche de l’équilibre budgétaire des établissements publics de santé, la presse ayant évoqué le retrait de plus d’un millier de postes à l’AP-HP.

Comment ne pas se souvenir du douloureux et médiatique accouchement de la titanesque loi portant réforme de l’hôpital et relative aux patients, à la santé et aux territoires du 21 juillet 2009 ? La préparation des décrets d’application subséquents s’avère visiblement tout aussi mouvementée.

Comment ne pas se souvenir de l’avortement dans la préparation d’une grande loi sur la psychiatrie, avec la discrète inhumation du rapport Couty ?

Que dire encore de la gestion menée jusqu’à présent par les pouvoirs publics dans le cadre de la préparation à la pandémie grippale et l’organisation de la campagne de vaccination de l’Hexagone, avec les prétendus ou avérés dommages collatéraux au nombre desquels figure notamment le grand malentendu persistant entre la médecine libérale et les pouvoirs publics ?

Indépendance de l’expertise médico-légale, désamour entre radiologie libérale et assurance maladie, hausse du forfait hospitalier, fin agitée du cycle conventionnel dans les rapports assurance maladie/médecins libéraux, bourgeonnement incessant de palmarès des hôpitaux et cliniques dans les quotidiens et hebdomadaires en quête désespérée d’audience, (dés)Ordre national des infirmiers : tels sont les quelques sujets (juridiques ou non), parmi d’autres, que l’année 2009 a pu mettre en lumière.

Loin de tout ce brouhaha, nous serions bien inspirés de relire, au calme, le Discours préliminaire de Portalis :

« Les lois ne sont pas de purs actes de puissance ; ce sont des actes de sagesse, de justice et de raison. Le législateur exerce moins une autorité qu’un sacerdoce. Il ne doit point perdre de vue que les lois sont faites pour les hommes et non les hommes pour les lois (…) ; il faut être sobre de nouveautés en matière de législation (…). Il faut changer, quand la plus funeste de toutes les innovations serait, pour ainsi dire, de ne pas innover. L’essentiel est d’imprimer aux institutions nouvelles ce caractère de permanence et de stabilité qui puisse leur garantir le droit de devenir anciennes »

A bon législateur, salut ! Et surtout, bonne santé.

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