Infections nosocomiales : revirement du Conseil d’Etat

Dans un arrêt en date du 10 octobre 2011 ((CE, 10 octobre 2011, n°328500.)), le Conseil d’Etat a renversé sa jurisprudence habituelle en matière d’infections nosocomiales et il s’est aligné sur celle de la Cour de cassation.

Selon l’article L.1142-1 du code de la santé publique, les établissements de santé sont responsables « des dommages résultants d’infections nosocomiales, sauf s’ils rapportent la preuve d’une cause étrangère ».

Jusqu’à cette décision du Conseil d’Etat, les juridictions administratives considéraient qu’une infection, même contractée à l’hôpital, ne relevait pas de la responsabilité de l’établissement, si elle était d’origine endogène. Le patient n’obtenait alors aucune indemnisation.

Dans l’arrêt du 10 octobre 2011, le Conseil d’Etat remet en cause cette jurisprudence. En l’espèce, une patiente contracte, dans les suites d’une exérèse du neurinome de l’acoustique gauche en translabyrinthique,  une méningite à pneumocoques, dont elle décède.

Pour sa défense, le centre hospitalier avait avancé le fait que la patiente, lors de son admission, était porteuse saine du pneumocoque.

La haute juridiction ne retient pas les arguments de l’établissement de santé et décide que :

« cette circonstance, à la supposer établie, n’est pas de nature à faire regarder l’infection comme ne représentant pas un caractère nosocomial, dès lors qu’il ressort de l’expertise que c’est à l’occasion de l’intervention chirurgicale que le germe a pénétré dans les méninges et est devenu pathogène ; que les dispositions précitées du I de l’article L 1142-1 du code de la santé publique font peser sur l’établissement de santé la responsabilité des infections nosocomiales, qu’elles soient exogènes ou endogènes, à moins que la preuve d’une cause étrangère ne soit apportée ».

Pour compléter sa décision, le Conseil d’Etat précise qu’une cause étrangère doit présenter un caractère d’imprévisibilité et un caractère d’irrésistibilité.

Ainsi, désormais, l’origine endogène de l’infection n’est plus considérée comme une cause étrangère et ne dispense donc plus l’établissement de santé de sa responsabilité.

Des solutions de ce type avaient déjà été rendues par les juridictions du fond. A titre d’exemple, la Cour administrative d’Appel de Lyon, dans une décision en date du 26 mai 2009 (n° 06LY00696) avait décidé que :

« pour s’exonérer de sa responsabilité en cas de survenue d’une infection nosocomiale, il incombe à l’hôpital de rapporter la preuve d’une cause étrangère ; qu’en arguant du caractère endogène des germes responsables de l’infection contractée par la requérante, le centre hospitalier de Feurs n’apporte pas la preuve d’une telle cause ; que, par suite, Mme X est fondée à soutenir que c’est à tort que, par le jugement attaqué, le tribunal administratif a rejeté sa demande tendant à ce que la responsabilité du centre hospitalier de Feurs soit engagée à raison des conséquences dommageables résultant de l’infection nosocomiale dont elle a été victime »

Cet arrêt du Conseil d’Etat, en faveur des patients, vient confirmer ces décisions des juges du fond et aligne, par la même occasion la jurisprudence administrative sur la jurisprudence judiciaire.

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