Partial imputability if multifactorial aggravation
Facts and procedure
According to the judgment under appeal (Rennes, 27 May 2020), a judgment dated 20 January 2010 :
- ordered the clinic to pay compensation for the consequences of a nosocomial infection contracted by Mr [U] in 1989 during a knee operation,
- by applying a two-thirds reduction when calculating the damages. Reduction to take account of factors unrelated to the infection that contributed to their occurrence.
Mr [U]'s condition subsequently worsened, necessitating hospitalisations and operations in October 2005 and April 2010.
The latter included the amputation of a leg.
On 29, 31 October and 6 November 2013, after obtaining a summary expert opinion, Mr and Mrs [U] summoned :
- the clinic for compensation for all losses resulting from this aggravation,
- and the Caisse du Régime Social des Indépendants de Bretagne, as well as the Caisse Primaire d'Assurance Maladie du [Locality 4], which requested reimbursement of its expenses.
Examination of the means (partial imputability if multifactorial aggravation) :
Statement of the case
Mr and Mrs [U] then criticised the judgment for deducting two-thirds of the amount in favour of the clinic.
They are contesting thecompensation for damage resulting from the aggravation, then :
1°/
That the purpose of civil liability is to restore, as exactly as possible, the balance destroyed by the damage.
It must put the victim back in the situation he or she would have been in had the harmful act not taken place, without any loss or gain for him or her.
In order to reduce by two thirds the compensation for the damage linked to the worsening of Mr [U]'s condition, the judgment notes that the expert states :
- on the one hand, that the severe septic syndrome was linked to a recurrence of the infection of the left knee directly related to the 1989 osteotomy. This was after an apparent recovery, due to multi-resistant staphylococcus aureus,
- and secondly, that the infection of the left knee prosthesis that led to Mr [U] being admitted to intensive care and then to a life-saving amputation was directly related to that same surgery. A causal link is therefore established between the worsening of Mr [U]'s state of health, the compensation for which is the subject of the present dispute, and thehospital-acquired infection in 1989,
In addition, the judgment states that the existence of this certain causal link does not mean that the clinic is obliged to compensate all of the harmful consequences of the worsening of Mr [U]'s state of health and therefore of the amputation he underwent;
In so ruling, the Court of Appeal violated the principle of full compensation for damages without loss or profit;
2°/
That the right of the victim to obtain compensation for his or her bodily injury cannot be reduced:
- because of a previous medical condition
- when the aggravation for which it seeks compensation was caused solely by the harmful event;
In order to reduce by two-thirds the compensation for the losses related to the worsening of Mr [U]'s condition, the judgment thus held that :
- the existence of a definite causal link between the worsening of the victim's state of health and the accident.hospital-acquired infection in 1989,
- does not mean that the clinic is obliged to compensate for all the harmful consequences of :
this worsening,
and the amputation suffered by the person concerned.
He added that previous medical conditions had contributed to the deterioration in his health,
- the judgment of 20.01.2010 had taken other factors into account. In this case, those that contributed to the damage claimed at the time, thus justifying a reduction of two-thirds of the compensation,
- and that the origin of the reactivation of the infection which necessitated the amputation of Mr [U]'s left lower limb and caused the aggravation for which compensation is sought is the same as that taken into account in this previous decision;
In so ruling :
- taking into account pathologies pre-existing the nosocomial infection
- to limit compensation for the worsening of the victim's state of health,
- However, it noted that it had been caused by the said infection and that compensation for it was therefore the sole subject of the dispute,
the Court of Appeal violated Article 1147 of the Civil Code.
Court's reply (Partial imputability if multifactorial aggravation) :
The Court of Appeal therefore accepted that there was a causal link between the infection and the worsening of Mr [U]'s state of health.
It therefore held that the damage leading to the amputation was multifactorialand supported by :
- the patient's excess weight,
- as well as major osteoarthritis of the right knee, resulting in extra mechanical stress on the left.
The appeal court said that account had to be taken of the important and decisive role played by these factors unrelated to the nosocomial infection.
It was therefore able to deduce, without ignoring the principle of full compensation without loss or gain for the victimthat :
- the infection had only contributed to the aggravation of the damage for which Mr and Mrs [U] were seeking compensation,
- in a proportion that it has thus sovereignly assessed.
The plea is therefore unfounded.
FOR THESE REASONS, the Court dismisses the appeal.
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