Obligation d’information du patient après sa sortie

FlickR - A doctor from the Leakey, Texas - The US National ArchivesOn s’imagine souvent, et les manuels de droit hospitalier ne le démentent pas, que l’obligation d’information du patient trouve matière à s’appliquer uniquement en amont de sa prise en charge, qu’il s’agisse d’une hospitalisation conventionnelle, ambulatoire, ou bien d’une consultation externe. Voici une preuve, s’il en était encore besoin, que cette obligation d’information ne s’éteint pas à la sortie du patient de l’hôpital mais que, au contraire, elle perdure.

En l’espèce, le service des urgences d’un centre hospitalier a constaté, au vu des radiographies effectuées, que le patient souffrait d’une entorse à la cheville. Celui-ci, rentré chez lui avec une attelle provisoire et une ordonnance lui prescrivant un plâtre, n’a ensuite ressenti aucune amélioration. Un erreur fautive de diagnostic a été commise lors de son passage au service des urgences. En effet, le centre hospitalier a effectué un nouvel examen des radiographies le lendemain du départ du patient et les résultats différaient manifestement de ceux qui lui avaient été communiqués lors de son passage aux urgences. L’hôpital ne lui a pas communiqué spontanément les nouveaux résultats.

Le patient n’en a pris connaissance que lors de sa demande de communication de son dossier médical. L’établissement de santé aurait donc dû prendre l’initiative de communiquer ce complément d’information, ce dont il s’est abstenu.

Cette omission constitue une faute de nature à engager la responsabilité du service public hospitalier. Le patient a en effet perdu une chance de recevoir des soins adaptés qui lui auraient permis une guérison sans séquelles ((CE, 2 septembre 2009, n°292783)).

Aucun critère temporel ne limite en somme l’obligation d’information à délivrer au patient, laquelle s’applique aussi bien avant qu’après sa sortie de l’hôpital.

Cette solution de bon sens doit être mise en corrélation avec le critère 11c du manuel de certification V2010 de la Haute Autorité de santé, intitulé Information du patient en cas de dommage lié aux soins qui indique notamment :

« Toute personne victime ou s’estimant victime d’un dommage imputable à une activité de prévention, de diagnostic ou de soins ou ses ayants droit, si la personne est décédée, ou, le cas échéant, son représentant légal, doit être informée par le professionnel, l’établissement de santé, les services de santé ou l’organisme concerné sur les circonstances et les causes de ce dommage. Cette information lui est délivrée au plus tard dans les quinze jours suivant la découverte du dommage ou à sa demande expresse, lors d’un entretien au cours duquel la personne peut se faire assister par un médecin ou une autre personne de son choix (art. L. 1142-4 du code de la santé publique). »

La jurisprudence se montre, on le voit dans le cas présent, plus exigente que le manuel de qualité dès lors qu’il ne s’agit pas d’un entier préjudice mais d’une perte de chance pour le patient de guérir sans séquelles, laquelle est financièrement sanctionnée.

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