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Erreurs, dossiers \u00ab\u00a0nettoy\u00e9s\u00a0\u00bb, \u00ab\u00a0sous-estimations notables\u00a0\u00bb, \u00ab\u00a0absence d\u2019information et m\u00eame d\u00e9sinformation\u00a0\u00bb sur fond \u00ab\u00a0d\u2019usage d\u00e9viant du secteur priv\u00e9\u00a0\u00bb \u00e0 l\u2019h\u00f4pital: une enqu\u00eatrice a dress\u00e9 jeudi un tableau accablant du pire accident de radioth\u00e9rapie enregistr\u00e9 en France au proc\u00e8s des surirradi\u00e9s d\u2019Epinal.<\/strong><\/p>\n Jean-Francois Sztermer et son avocat Herv\u00e9 Temime \u00e0 leur arriv\u00e9e le 24 septembre 2012 au palais de justice de Paris (Photo Mehdi Fedouach. AFP)\n

Fran\u00e7oise Lalande, de l\u2019Inspection g\u00e9n\u00e9rale des affaires sociales (Igas), a enqu\u00eat\u00e9 sur le premier accident enregistr\u00e9, qui a affect\u00e9 24 patients, les plus gravement touch\u00e9s. Avec un deuxi\u00e8me dysfonctionnement s\u00e9par\u00e9 d\u00e9couvert ensuite, le nombre de victimes approche les 450. Douze sont mortes.<\/p>\n

Devant la cour d\u2019appel qui rejuge Joshua Anah, 57 ans, radiophysicien, et deux m\u00e9decins radioth\u00e9rapeutes, Jean-Fran\u00e7ois Sztermer, 66 ans, et Michel Aubertel, 64 ans, condamn\u00e9s en premi\u00e8re instance \u00e0 18 mois de prison, le docteur Lalande retrace ses d\u00e9couvertes apr\u00e8s que des patients trait\u00e9s pour des cancers de la prostate eurent d\u00e9velopp\u00e9 de graves s\u00e9quelles li\u00e9es \u00e0 des surdosages de radioth\u00e9rapie.<\/p>\n

Tout d\u2019abord, il y a ces \u00ab\u00a0dossiers qui semblaient avoir \u00e9t\u00e9 nettoy\u00e9s\u00a0\u00bb et l\u2019ont oblig\u00e9e \u00e0 \u00ab\u00a0tirer la pelote\u00a0\u00bb en contactant elle-m\u00eame les patients.<\/p>\n

Puis la d\u00e9couverte qu\u2019une proc\u00e9dure de soins avait \u00e9t\u00e9 modifi\u00e9e par M. Anah, en l\u2019absence des chefs du service. Et que sur sept manipulateurs, qui administrent les traitements, quatre avaient \u00e9t\u00e9 mal form\u00e9s et reproduisaient une m\u00eame erreur conduisant \u00e0 des surdosages massifs (20% au dessus du maximum), de mai 2004 \u00e0 ao\u00fbt 2005.<\/p>\n

Or la zone est ultra-sensible, \u00ab\u00a0il faut \u00e9viter la vessie et le rectum et la fronti\u00e8re entre dose th\u00e9rapeutique et dose toxique est tr\u00e8s t\u00e9nue\u00a0\u00bb. Enfin, l\u2019enqu\u00eatrice d\u00e9couvre \u00ab\u00a0un usage excessif des images de contr\u00f4le, sans tenir compte de la dose de rayonnements suppl\u00e9mentaire\u00a0\u00bb (c\u2019est le deuxi\u00e8me dysfonctionnement).<\/p>\n

A ces erreurs techniques, s\u2019ajoute un suivi de l\u2019accident \u00ab\u00a0d\u00e9ficient\u00a0\u00bb. Alors que \u00ab\u00a0les sympt\u00f4mes sont apparus assez vite\u00a0\u00bb chez plusieurs patients, on ne les rappelle pas tous, les m\u00e9decins traitants ne sont pas alert\u00e9s.<\/p>\n

\u00ab\u00a0Une absence d\u2019information, ou m\u00eame une d\u00e9sinformation, qui a emp\u00each\u00e9 la prise en charge\u00a0\u00bb, pire, qui a parfois conduit \u00e0 des erreurs de diagnostic aux cons\u00e9quences dramatiques. Plusieurs m\u00e9decins traitants ont ainsi prescrit des biopsies \u00e0 des surirradi\u00e9s, examen alors totalement contre-indiqu\u00e9 car pouvant causer des fistules.<\/p>\n

\u00ab\u00a0Des comportements fautifs qui ont entra\u00een\u00e9 retards et errements\u00a0\u00bb, r\u00e9sume s\u00e8chement l\u2019enqu\u00eatrice. Et pourquoi? \u00ab\u00a0La peur pour leur r\u00e9putation et surtout la crainte d\u2019une perte de revenus\u00a0\u00bb.<\/p>\n

Et de d\u00e9crire un \u00ab\u00a0usage d\u00e9viant du secteur priv\u00e9\u00a0\u00bb au sein d\u2019un h\u00f4pital public o\u00f9 les praticiens peuvent exercer en lib\u00e9ral, mais \u00ab\u00a0pas plus de 20% de leur temps de travail\u00a0\u00bb et sans s\u00e9lectionner les malades.<\/p>\n

Elle d\u00e9roule les statistiques implacables du service de radioth\u00e9rapie d\u2019Epinal. 13% du temps en lib\u00e9ral pour le docteur Aubertel et 15% pour le docteur Sztermer. Ils sont dans les clous\u2026 en dur\u00e9e. Mais en valeur, c\u2019est 32% de leurs actes, traduction d\u2019un \u00ab\u00a0\u00e9cr\u00e9mage\u00a0\u00bb des patients. Et sur 250 trait\u00e9s pour cancer de la prostate de 2004 \u00e0 2006, 75% sont en secteur priv\u00e9.<\/p>\n

Les \u00ab\u00a0cotations\u00a0\u00bb de la S\u00e9cu, particuli\u00e8rement avantageuses, \u00ab\u00a0permettaient de doubler le prix des traitements. Malgr\u00e9 la redevance de 60% revers\u00e9e \u00e0 l\u2019h\u00f4pital, cela pouvait repr\u00e9senter un suppl\u00e9ment de revenu de 160.000 euros par an\u00a0\u00bb.<\/p>\n

Face \u00e0 la charge, la d\u00e9fense joue chacun pour soi. Pour le radiophysicien, son avocat invoque des probl\u00e8mes d’\u00a0\u00bbassurance qualit\u00e9\u00a0\u00bb, comme dans 75% des services de radioth\u00e9rapie en France. La d\u00e9fense d\u2019Aubertel charge au contraire le radiophysicien. Celle de son coll\u00e8gue, qui a moins de patients dans ce groupe, juge que \u00ab\u00a0la gravit\u00e9 des faits n\u2019est pas la m\u00eame\u00a0\u00bb pour les deux m\u00e9decins.<\/p>\n

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Source\u00a0 AFP. 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