Temps de travail additionnel des PH, par ici la monnaie

C’est une bonne nouvelle pour les praticiens hospitaliers, une moins bonne pour les établissements qui les emploient. Le Conseil d’Etat a, par deux décisions du même jour ((CE, 25 février 2011, CHU de Dijon c/ Cabrita, n°329733 ; CE, 25 février 2011, CHU de Dijon c/ Boudenia, n°329734.)), considéré qu’un centre hospitalier ne pouvait se fonder sur le manque de moyens budgétaires pour se soustraire à ses obligations réglementaire, s’agissant en particulier de l’indemnisation du temps de travail additionnel des praticiens hospitaliers, dans le cadre de la permanence des soins.

L’article R.6152-23 du code de la santé publique prévoit, dans sa version applicable au moment des faits litigieux, que :

« Les praticiens perçoivent, après service fait : (…) 3° Des indemnités forfaitaires pour tout temps de travail additionnel accompli, sur la base du volontariat, au-delà des obligations de service hebdomadaires ; / 4° (…) / Les indemnités mentionnées aux deux alinéas précédents sont versées, lorsque selon le choix du praticien, le temps de travail, les astreintes et les déplacements ne font pas l’objet d’une récupération. »

Aux termes de l’article 4 de l’arrêté du 30 avril 2003 pris pour l’application de ses dispositions :

« (…) Une période de temps de travail additionnel peut être, au choix du praticien, indemnisée, récupérée ou versée au compte-épargne-temps. Dans ces deux derniers cas, elle est comptée pour deux demi-journées (…).« 

Enfin, l’article 5 du même arrêté dispose :

« Le directeur, avec la commission de l’organisation de la permanence des soins, prépare l’organisation des activités et du temps de présence médicale, pharmaceutique et odontologique, après consultation des chefs de service et de département ou des responsables de structure. / Cette organisation est arrêtée annuellement par le directeur après avis de la commission médicale d’établissement. Elle tient compte de la nature, de l’intensité des activités et du budget alloué aux établissements ; »

A l’époque où l’arrêté du 30 avril 2003 fut rédigé, les établissements publics de santé n’étaient bien évidemment par encore concernés par la nouvelle (nouvelle) gouvernance hospitalière et le mode de financement issu de la tarification à l’activité. L’arrêté n’en conserve pas moins toute sa force normative, même si la rédaction apparaît aujourd’hui par trop décalée avec l’organisation interne actuelle des hôpitaux.

Cet arrêté laisse donc le choix au praticien hospitalier de convertir le temps de travail additionnel en argent, en repos, ou en épargne via le CET.

Pour un praticien hospitalier totalisant beaucoup de temps de travail additionnel, comme les praticiens en l’espèce, qui devaient sans doute être soit anesthésistes-réanimateurs, soit gynécologues-obstétriciens (gardes et astreintes obligent), il sera toujours plus intéressant de demander une indemnisation que de placer le temps de travail additionnel sur un compte-épargne-temps (CET), d’autant plus que ce dispositif ne peut être alimenté que dans la limite de 30 jours par an ((Article R.6152-804 du code de la santé publique.)).

Il s’agit d’une véritable épée de Damoclès qui pèse sur les centres hospitaliers.

En l’espèce, le considérant central gagne à être relevé :

« Considérant qu’il résulte de ces dispositions que, si le directeur est compétent pour organiser la permanence des soins compte tenu, notamment du budget alloué à l’établissement, il doit indemniser le temps de travail additionnel accompli par un praticien hospitalier lorsque celui-ci a opté pour l’indemnisation ; qu’ainsi, c’est sans erreur de droit que, par jugement du 7 mai 2009, le tribunal administratif de Dijon, qui a suffisamment motivé, sans contradiction de motifs, son jugement sur ce point, a jugé que le CENTRE HOSPITALIER UNIVERSITAIRE DE DIJON ne pouvait légalement se fonder sur un motif budgétaire pour limiter la part donnant lieu à indemnisation des périodes de temps de travail additionnel accompli en 2003, 2004 et 2005 par M. A., qui avait opté pour l’indemnisation, et a condamné le centre hospitalier à verser à ce praticien hospitalier les indemnités forfaitaires qui lui étaient dues à ce titre, sans que puissent légalement y faire obstacle les limites du budget alloué à l’établissement ; »

Les établissements qui se trouvent dans la même situation que le centre hospitalier universitaire de Dijon seront contraints soit de négocier avec leurs praticiens hospitaliers afin que la pilule soit la moins douloureuse possible, soit de s’exécuter purement et simplement, une troisième voie demeurant possible : se fonder sur le délai classique d’un procès administratif en pareille occurrence (en l’espèce, 3 ans et demi entre la date de la demande et le prononcé de la décision du Conseil d’Etat en dernier ressort), pour gagner du temps et provisionner la somme prévisible (indemnité en capital, intérêt au taux légal, et intérêts des intérêts) en espérant des jours meilleurs.

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