De la faute dans un transfert de patient inter-établissements

Présentant une violente douleur thoracique accompagnée de malaises, un patient a été transporté au service des urgences du centre hospitalier de Pertuis par les pompiers vers 22h30. Un infarctus du myocarde associé à une pneumopathie a été diagnostiqué et un traitement initial lui a été administré. Ce diagnostic a conduit les médecins du centre hospitalier à prendre contact avec le service de cardiologie de garde du centre hospitalier d’Aix-en-Provence, de trasnférer le patient dans ce dernier afin qu’y soient effectuées une coronarographie et, éventuellement, une angioplastie.

Le CH de Pertuis a demandé à 00h15 à un S.M.U.R. ((Service mobile d’urgence et de réanimation.)) le transfert du patient. En pareille hypothèse, chaque heure, chaque minute, chaque seconde comptent.

Las, l’ambulance envoyée par le S.M.U.R. n’est arrivée qu’à 2h40 du matin et le patient n’a été admis au centre hospitalier d’Aix qu’à 3h15. Alors qu’une angioplastie était effectuée en urgence dans l’établissement destinataire, une aggravation progressive d’un tableau infectieux respiratoire et de l’état cardiaque du patient ont conduit à son décès le jour suivant.

Les ayant-droits de la victime ont formé une requête dirigée contre le centre hospitalier d’origine. Le Tribunal administratif de Marseille a rejeté cette dernière. La Cour administrative d’appel de Marseille a également rejeté leur requête d’appel. Saisi d’un pourvoi contre l’arrêt d’appel, le Conseil d’Etat ((CE, 18 février 2010, Consorts A., n°318891.)) a jugé que :

« eu égard à la collaboration étroite que [les dispositions des articles R.712-63, R.712-72 et R.712-71-1 du code de la santé publique, dans leur rédaction alors en vigueur] organisent entre le SAMU, les [SMUR] et les services d’accueil et de traitement des urgences, la victime d’une faute commise à l’occasion du transfert d’un patient d’un établissement de santévers un autre peut, lorsque les services impliqués dépendent d’établissements de santé différents, rechercher la responsabilité de l’un seulement de ces établissements ou leur responsabilité solidaire, dans préjudice des appels en garantie que peuvent former l’un contre l’autre les établissements ayant participé à la prise en charge du patient ».

La haute juridiction a ainsi estimé « qu’en se fondant sur la circonstance que le délai qui s’est écoulé entre le moment où le service d’accueil et de traitement des urgences du [CH] de Pertuis a fait appel à un SMUR […] et celui où le patient […] est arrivé à destination, n’aurait pas été imputable au [CH] de Pertuis pour en déduire que ce délai n’était pas susceptible d’engager la responsabilité de ce dernier à l’égard des requérants, la cour administrative d’appel de Marseille a entaché son arrêt d’une erreur de droit ».

Au plan pratique, les patients victimes – lorsqu’elles sont encore vivantes – ou leurs ayant-droits auront, pour des raisons évidentes de solvabilité, davantage intérêt à rechercher la responsabilité solidaire des établissements en pareille hypothèse.

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