Limitation de l’accès au dossier médical pour un patient soigné en psychiatrie

Humour et psychiatrie pour le CH de Valvert - avec l'aimable autorisation de M. SEILERNon, le patient psychiatrique n’est décidément pas un patient comme les autres, s’agissant en particulier de son droit d’accès direct aux éléments d’ordre médical le concernant.

A la suite du refus de communication directe d’une copie de l’intégralité de son dossier médical par le directeur d’un centre hospitalier où un patient avait été hospitalisé à trois reprises sur demande d’un tiers, ce dernier a saisi le juge administratif afin d’obtenir l’annulation de cette décision et la possibilité de disposer directement de son dossier. Le tribunal administratif puis le Conseil d’État ont rejeté sa requête.

Par application de l’article L. 1111-7 du code de la santé publique, on sait que l’accès du patient aux informations concernant sa santé recueillies dans le cadre d’une hospitalisation sur demande d’un tiers peut être limité « en cas de risques d’une gravité particulière. »

Ainsi la consultation du dossier médical peut être subordonnée à la présence d’un médecin désigné par le demandeur au regard de la gravité des pathologies psychiatriques. En cas de refus de désignation par le demandeur, la commission départementale des hospitalisations psychiatriques (CDHP) est saisie. Elle rend un avis qui doit être suivi.

En l’espèce, la consultation du dossier a été autorisée par l’intermédiaire d’un médecin désigné par le demandeur. Mais le praticien choisi par le patient ne l’ayant pas tenu informé, le centre hospitalier a demandé au patient de désigner un nouveau médecin, ce que le requérant a refusé. La CDHP a été alors saisie par le centre hospitalier qui a confirmé la nécessité de la présence d’un médecin nommé par le patient aux fins de consulter le dossier compte tenu des risques d’une particulière gravité liés à sa maladie.

En prenant la décision de refuser de lui communiquer directement une copie de son dossier médical, la Haute juridiction a considéré que le directeur du centre hospitalier avait fait une exacte application des dispositions du code de la santé publique, nonobstant l’existence d’un doute sur l’état psychique réel du patient. Le Conseil d’État précise par ailleurs que cette décision n’appartient pas au nombre de celles qui nécessitent une motivation en vertu de l’article 1er de la loi n°79-587 du 11 juillet 1979.

CE, 10 avril 2009, M. R., n° 289794.


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