Risque banal : pas d’indemnisation ?

Voici une bien curieuse motivation que celle des magistrats de la Cour administrative d’appel de Paris, dans leur arrêt du 26 novembre 2007, lequel a été déféré à la censure du Conseil d’État.

Les faits sont dramatiques. Un patient, atteint d’un cancer des amygdales diagnostiqué en 1997, a fait l’objet d’une radiothérapie qui a entraîné une ostéoradionécrose, nécessitant une reconstruction de la mandibule. Une première opération, comportant la greffe sur la mâchoire d’un lambeau pédiculé, a été réalisée le 31 août 1998 à l’hôpital Henri Mondor de Créteil.

Il a du être procédé le 9 septembre 1998 à une reprise du geste chirurgical. Au cours de cette seconde intervention, pendant la phase postopératoire, le patient a développé une hémiplégie droite massive, attribuée à un accident vasculaire cérébral (AVC) consécutif à une occlusion de la carotide interne gauche.

Il a formé un recours indemnitaire dirigé contre l’Assistance Publique Hôpitaux de Paris, dont relève l’hôpital Henri Mondor de Créteil, mais le Tribunal administratif de Melun, comme la Cour administrative d’appel de Paris l’ont débouté.

Dans sa décision ((CE, 19 mars 2010, Cts. A., n°313457, Rec. 2010, tables.)), le Conseil d’État commence par rappeler la définition de la responsabilité sans faute, issue de la jurisprudence Bianchi, que l’on enseigne aux étudiants en droit de 2ème année :

« Considérant que, lorsqu’un acte médical nécessaire au diagnostic ou au traitement du malade présente un risque dont l’existence est connue mais dont la réalisation est exceptionnelle et dont aucune raison ne permet de penser que le patient y soit particulièrement exposé, la responsabilité du service public hospitalier est engagée si l’exécution de cet acte est la cause directe de dommages sans rapport avec l’état initial du patient comme avec l’évolution prévisible de cet état, best android blackjack app, et présentant un caractère d’extrême gravité. »

A l’espèce, la Haute juridiction applique ledit principe :

« Considérant que, pour écarter l’application de ce régime de responsabilité, la cour administrative d’appel de Paris a relevé que l’accident dont a été victime M. A. « n’est pas lié au choix des thérapies mises en œuvre et que par ailleurs il peut se produire à l’occasion de toute intervention » ; qu’en excluant ainsi que la responsabilité de l’Assistance publique-Hôpitaux de Paris puisse être engagée à raison de la réalisation d’un risque commun à une large catégorie d’actes médicaux, alors qu’une telle circonstance n’est pas une condition de l’engagement de la responsabilité sans faute du service public hospitalier, la cour a commis une erreur de droit ; que son arrêt doit, dès lors, être annulé ; »

En d’autres termes, les juges d’appel ont considéré que le risque (un AVC, en l’espèce), parce qu’il était commun à une large catégorie d’actes médicaux, excluait par là même toute indemnisation du patient. Au-delà du caractère dérangeant de l’affirmation, la Haute juridiction invite les juges du fond à ne pas ignorer, durcir ou même alléger les conditions posées par la jurisprudence Bianchi.

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