Jan
29
MEDICAMENTS : conclusion d'un marché avec un pharmacien et respect du principe de libre choix

Les ESSMS assurant une activité de soins (ex. : FAM, SAMSAH, MAS, EHPAD) sont portés à sélectionner un pharmacien unique pour assurer la fourniture et/ou le conditionnement en piluliers des médicaments utiles aux usagers. Or cette pratique expose le pharmacien à un risque disciplinaire significatif dès lors qu'une telle pratique peut constituer une violation du principe de libre choix du pharmacien.

Sur la plainte de confrères non retenus par un EHPAD, un pharmacien d'officine a fait l'objet d'une suspension disciplinaire de trois semaines pour avoir fourni cet établissement en médicaments préalablement déconditionnés et reconditionnés en blisters. Le Conseil de l'Ordre lui a notamment reproché de ne pas avoir veillé à ce que l'établissement respecte, pour chaque résident, le principe du libre choix du pharmacien. En effet, les articles L. 1110-8 et R. 4235-21 du Code de la santé publique font obligation aux pharmaciens de veiller au respect de ce principe. En l'espèce, les résidents avaient été préalablement informés du recours à une pharmacien fournisseur unique, l'établissement leur ayant fait savoir que ceux d'entre eux qui ne consentiraient pas à cette pratique devraient désormais faire leur affaire personnelle de l'acquisition de leurs médicaments. La juridiction ordinale, considérant qu'en un tel cas le recueil exprès du consentement de chaque résident s'imposait, a jugé qu' "eu égard aux conditions dans lesquelles ce nouveau mode de dispensation des médicaments a été, en définitive, imposé à des patients âgés, en situation de faiblesse et/ou de dépendance, le grief tiré de l'atteinte au libre choix de pharmacien est établi".

Commentaires

Nom: 
Laurent
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Bonjour,

Cette question de la fourniture des médicaments en EHPAD sans PUI occupe nombre de mes journées ! D'où ma question :

Est-ce qu'un appel d'offres auprès de plusieurs pharmacies couplé à un formulaire de libre choix du pharmacien (rempli par les résidents lors de l'admission) respectent-ils la législation ?

Je m'explique :

1) Notre EHPAD est actuellement fourni par plusieurs pharmacies qui possèdent leur propres façons de fonctionner avec l'EHPAD (malgré nos remarques et courriers). Elles ne veulent pas s'impliquer au delà de la simple livraison. (Je vous laisse imaginer le rôle de pharmacien référent !). La prise en charge médicamenteuse des résidents est vraiment minimale pour ne pas dire lacunaire.

2) Ce système ne nous convient pas. Nous souhaitons passer à une étape supérieure en choisissant un prestataire suite à une procédure de marché public. Cette sélection nous permettrait de choisir un prestataire qui s'engagerait sur la livraison, la PDA, le rôle de référent. La contre-partie est l'exclusivité accordée à ce prestataire pour la durée du marché.

3)Or, si nous choisissons un seul pharmacien, nous risquons de contrevenir au libre choix du pharmacien par les résidents. (Droit qui est actuellement symbolique vu l'état de santé des résidents).

4) D'où ma question : est-ce que la procédure d'appel d'offre et l'expression du choix des résidents sont conformes à la législation en vigueur?

Merci de votre aide !

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Nom: 
Laurent

Je me permets de relancer d'événtuelles réponses sur ce sujet posté il y a quelques mois.

 

Tout retour d'expériences sera bienvenu.

 

Bien cordialement,

ci-après extrait du texte de la convention établie entre l'EHPAD et le pharmacien dispensateur. J'ajoute qu'il y a recueil systématique du mandat donné par le résident ou son représentant légal à l'EHPAD.

"Les personnes âgées hébergées par l'EHPAD (ci-après le « Résident » ou les « Résidents») conservent leur droit fondamental au libre choix de leurs professionnels de santé (art. L.1110-8 du Code de la Santé Publique - CSP). Dès lors qu'elles ne peuvent pas ou plus se déplacer, elles peuvent, directement ou par l'intermédiaire de l'EHPAD, demander la dispensation à domicile des médicaments par le pharmacien d'Officine (ci-après « Pharmacien Dispensateur ») de leur choix (art. L. 5125-25 et R. 5125-50 du CSP). L'EHPAD est, à cette fin, réputé être leur domicile légal (art. R. 5126-115 du CSP). En l'absence de choix personnel exprimé par le Résident, l'EHPAD peut exercer ce choix en son nom, au titre d'un mandat exprès donné par le Résident ou son représentant légal, si le Résident ne pouvait exercer ce choix, ni donner de mandat, ou encore se faire représenter à cette fin (art. 1372 du Code Civil). Dès lors que l'EHPAD effectue le choix du Pharmacien Dispensateur au nom de ses Résidents, il s'engage à le faire à leur profit exclusivement selon des critères de pertinence sanitaire,  technique et économique objet de la convention.
Lorsque les prestations sont assurées par plusieurs Pharmaciens Dispensateurs avec lesquels il a passé convention, l'EHPAD, en lien avec le médecin coordonnateur et, lorsqu'il en est désigné un,
le pharmacien référent (ci-après « Pharmacien Référent »), veille à la coordination des prestations. L'EHPAD s'engage à ce que le Pharmacien Référent, lorsqu'il est désigné, et le(s) Pharmacien(s)
Dispensateurs puisse(nt) accomplir sa (leur) mission et préserver la liberté de leur jugement professionnel dans l'exercice de leurs fonctions pharmaceutiques."

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