Commentaires du rapport de la Commission nationale des accidents médicaux pour l'année 2011. Analyse de ses recommandations visant au bon fonctionnement et à l'harmonisation du dispositif d'indemnisation

In her year 2011 annual report, the National Commission of Medical Accident (NCMA) report that the use of Regional Commissions of Conciliation and Compensation of Medical Incidents, recently renamed Commissions of Conciliation and Compensation of Medical Incidents (CCI), is constantly increasing of 10% every year since 2006. Despite a certain degree of consistency at the national level, actions varies according to the medical density and number of medical or chirurgical acts. The most common reason for contacting the commission is dominated by the research of a financial compensation. There is an increase of requests (4733 cases in 2011) that led to the designation of expert in 76%. The files are in majority incomplete due to the lack of medical documents. After examination of the request, the number of negative conclusion without expertise increases compared to 2010, mainly due to a gravity level unreached (25%). The duality of expert is respected (49%) with a permanent reduction in the proportion of professional, who are not inscribed on a list of experts at the court, nominated. Sixty percent of experts nominated are surgeons, obstetrician-gynecologists and anesthesiologist. The others (40%) practice a medical speciality, internal medicine at the top of the list. The average time to obtain final rapport of expertise is 4.8 months. In 2011, 2601 (45%) positive conclusions after expertise have been made, 68% with a complete financial compensation. The main reasons of negative conclusions after expertise are absence of causal link (46%), gravity level unreached (31%), absence of fault or hazard (18%). The average time between request and conclusions after expertise is 1 year (11.8 months). In the interests of harmonization, the NCMA makes a series of seven recommendations in order to homogenize the system and to reduce disparities. Make the NCMA annual report coincide with the National Office for Compensation for Medical Accidents annual report. Facilitating access by NCMA members to CCI decisions protected by medical secret. Maintaining the possibility to integrate on the national list physicians who are not expert but who have a theoretical and practical training on expertise of medical accidents. Imposing the nomination by the CCI of experts only registered on the national list after a serious study of their application files, especially with regard to their quality, their competence and their independence. Encouraging victims to take note of the possibility to benefit of medical and juridical advises provides in their insurance contracts. To expend the NCMA competences on medical expertise, helping the National Office for Compensation for Medical Accidents concerning the choice of the experts in their specific missions.