Perte de chance d’une guérison

FlickR - Meningite - Alessandro MartinsPar décision en date du 18 décembre 2009 ((CE, 18 décembre 2009, Centre hospitalier Voiron c/ X, n°311604.)), le Conseil d’État a fait une application directe de la jurisprudence Centre hospitalier de Vienne du 21 décembre 2007 ((CE, 21 déc. 2007, n° 289328)). Jusqu’à cette dernière jurisprudence et depuis un arrêt du 24 avril 1964, Hôpital-Hospice de Voiron (Rec. CE 1964, p. 259.), le juge administratif acceptait, en matière hospitalière, d’engager la responsabilité pour faute de l’administration pour le dommage causé par la perte de chance pour la victime d’être guérie. Cette solution permettait d’éviter la recherche de la preuve d’un lien de causalité entre la faute et la réalisation du dommage corporel indemnisé.

Depuis l’arrêt du 21 décembre 2007, c’est la perte de chance, en elle-même et non le dommage corporel, qui constitue le dommage spécialement indemnisable, même si l’indemnisation doit être calculée sur une part de ce dommage.

En l’espèce, le retard apporté au diagnostic d’une méningite a favorisé l’apparition de séquelles auditives.

La citation de l’essentiel de la décision donnera une idée précise aux lecteurs :

« Considérant, que dans le cas où la faute commise lors de la prise en charge ou du traitement d’un patient dans un établissement public hospitalier a compromis ses chances d’obtenir une amélioration de son état de santé ou d’échapper à son aggravation, le préjudice résultant directement de la faute commise par l’établissement et qui doit être intégralement réparé n’est pas le dommage corporel constaté, mais la perte de chance d’éviter que ce dommage soit advenu ; que la réparation qui incombe à l’hôpital doit alors être évaluée à une fraction du dommage corporel déterminée en fonction de l’ampleur de la chance perdue ; que la cour administrative d’appel a relevé que la faute constituée par le retard apporté au diagnostic et au traitement de la méningite avait privé le patient d’une chance limitée, mais réelle d’éviter les séquelles dont il est atteint ; qu’elle ne pouvait dès lors, sans commettre d’erreur de droit, s’abstenir de rechercher l’ampleur de la chance perdue, le cas échéant en ordonnant une expertise aux fins de la déterminer, ni juger le CENTRE HOSPITALIER DE VOIRON responsable de l’intégralité des conséquences dommageables de la surdité partielle dont souffre le jeune Mathieu X ;

Considérant qu’il résulte de ce qui précède que le CENTRE HOSPITALIER DE VOIRON est fondé à demander l’annulation de l’arrêt attaqué en tant seulement qu’après évocation, il ne limite pas le dommage dont il est responsable aux conséquences de la chance perdue, du fait des fautes commises, d’éviter la surdité partielle ;

Considérant qu’il y a lieu, dans les circonstances de l’espèce, de faire application des dispositions de l’article L. 821-2 du code de justice administrative et de régler l’affaire au fond dans les limites de l’annulation prononcée ;

Considérant qu’il résulte de l’instruction, et notamment du rapport de l’expertise ordonnée en référé par le tribunal administratif, que le retard apporté au diagnostic et au traitement de la méningite dont était atteint le jeune Mathieu X a favorisé le développement de l’infection, elle-même à l’origine des séquelles auditives ; que si l’expert commis par la cour administrative d’appel aux fins de décrire l’étendue du dommage, dont le CENTRE HOSPITALIER DE VOIRON produit le rapport, estime qu’au moment où le traitement de l’enfant aurait normalement dû être engagé, l’infection avait déjà atteint les organes de l’audition, cette circonstance ne suffit pas à établir que les séquelles aient été irréversibles dès cet instant et donc sans lien avec les retards imputables à l’établissement ; qu’il n’est en revanche pas certain qu’un traitement engagé à temps aurait évité leur apparition ; que les fautes commises par le CENTRE HOSPITALIER DE VOIRON ont ainsi fait perdre à l’intéressé une chance d’éviter la surdité partielle dont il est atteint, de sorte que l’établissement est responsable d’une fraction des conséquences dommageables de cette surdité partielle, à déterminer en fonction de l’ampleur de la chance perdue ; qu’il sera fait, en l’espèce, une juste appréciation du préjudice indemnisable en l’évaluant à la moitié de ces conséquences dommageables ; »

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