Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 2/2009

01-02-2009 | Symposium: Clinical Risk and Judicial Reasoning

Medical Malpractice: The Experience in Italy

Author: Francesco Traina, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2009

Login to get access

Abstract

At the present time, legal actions against physicians in Italy number about 15,000 per year, and hospitals spend over €10 billion (~US$15.5 billion) to compensate patients injured from therapeutic and diagnostic errors. In a survey summary issued by the Italian Court for the Rights of the Patient, between 1996 and 2000 orthopaedic surgery was the highest-ranked specialty for the number of complaints alleging medical malpractice. Today among European countries, Italy has the highest number of physicians subject to criminal proceedings related to medical malpractice, a fact that is profoundly changing physicians’ approach to medical practice. The national health system has paid increasingly higher insurance premiums and is having difficulty finding insurance companies willing to bear the risk of monetary claims alleging medical malpractice. Healthcare costs will likely worsen as Italian physicians increasingly practice defensive medicine, thereby overutilizing resources with the goal of documenting diligence, prudence, and skill as defenses against potential litigation, rather than aimed at any patient benefit. To reduce the practice of defensive medicine and healthcare costs, a possible solution could be the introduction of an extrajudicial litigation resolution, as in other civil law countries, and a reform of the Italian judicial system on matters of medical malpractice litigation.
Literature
1.
go back to reference Adelman SH, Westerlund L. The Swedish Patient Compensation System: a viable alternative to the U.S. tort system? Bull Am Coll Surg. 2004;89:25–30. PubMed Adelman SH, Westerlund L. The Swedish Patient Compensation System: a viable alternative to the U.S. tort system? Bull Am Coll Surg. 2004;89:25–30. PubMed
2.
go back to reference Basile G, Passeri A, Monteleone F, Bellero R, Della Croce G. L’articolo 20 del nuovo codice di deontologia medica: “rispetto dei diritti della persona”. Ital J Orthop Traumatol. 2007;33:143–146. Basile G, Passeri A, Monteleone F, Bellero R, Della Croce G. L’articolo 20 del nuovo codice di deontologia medica: “rispetto dei diritti della persona”. Ital J Orthop Traumatol. 2007;33:143–146.
3.
go back to reference Cardona J, Cordier AL, Malicier D. Medicolegal responsibility. Rev Prat. 2005;55:933–938.PubMed Cardona J, Cordier AL, Malicier D. Medicolegal responsibility. Rev Prat. 2005;55:933–938.PubMed
4.
go back to reference Casson FF. Dignity of the medical profession. Feder Med. 1984;37:936. Casson FF. Dignity of the medical profession. Feder Med. 1984;37:936.
5.
go back to reference Chawla A, Gunderman RB. Defensive medicine prevalence, implications, and recommendations. Acad Radiol. 2008;15:948–949.PubMedCrossRef Chawla A, Gunderman RB. Defensive medicine prevalence, implications, and recommendations. Acad Radiol. 2008;15:948–949.PubMedCrossRef
6.
go back to reference Clinton HR, Obama B. Making patient safety the centerpiece of medical liability reform. N Engl J Med. 2006;354:2205–2208.PubMedCrossRef Clinton HR, Obama B. Making patient safety the centerpiece of medical liability reform. N Engl J Med. 2006;354:2205–2208.PubMedCrossRef
7.
go back to reference Comandè G, Turchetti G. Responsabilità sanitaria: valutazione del rischio e assicurazione. Padova, Italy: CEDAM; 2004. Comandè G, Turchetti G. Responsabilità sanitaria: valutazione del rischio e assicurazione. Padova, Italy: CEDAM; 2004.
8.
go back to reference de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:23–27. de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:23–27.
9.
go back to reference de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:104. de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:104.
10.
go back to reference de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:786. de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:786.
11.
go back to reference de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:76. de Franchis F. Dizionario giuridico = Law dictionary. Vol. I. Milano: Giuffrè; 1984:76.
12.
go back to reference Del Sasso L. Malpractice: un business da milioni di Euro. SIOTnews. 2007;09:1. Del Sasso L. Malpractice: un business da milioni di Euro. SIOTnews. 2007;09:1.
13.
go back to reference Deutsch E. Revision of the medical malpractice law? Malpractice in an international Comparison. Z Arztl Fortbild Qualitatssich. 1998;92:574–578.PubMed Deutsch E. Revision of the medical malpractice law? Malpractice in an international Comparison. Z Arztl Fortbild Qualitatssich. 1998;92:574–578.PubMed
14.
go back to reference Di Nunno N, Dell’Erba A, Viola L, Vimercati L, Cina S, Vimercati F. Medical malpractice: a study of case histories by the Forensic Medicine Section of Bari. Am J Forensic Med Pathol. 2004;25:141–144.PubMedCrossRef Di Nunno N, Dell’Erba A, Viola L, Vimercati L, Cina S, Vimercati F. Medical malpractice: a study of case histories by the Forensic Medicine Section of Bari. Am J Forensic Med Pathol. 2004;25:141–144.PubMedCrossRef
15.
go back to reference Di Nunno N, Luigi V, Viola L, Francesco V. Epidemiological case survey of medical malpractice in some medical and surgical specialties. Forensic Sci Int. 2005;149:139–142.PubMedCrossRef Di Nunno N, Luigi V, Viola L, Francesco V. Epidemiological case survey of medical malpractice in some medical and surgical specialties. Forensic Sci Int. 2005;149:139–142.PubMedCrossRef
16.
go back to reference Di Pentima GM. Il consenso. L’onere della prova nella responsabilità medica. Milano; Giuffrè, 2007:71. Di Pentima GM. Il consenso. L’onere della prova nella responsabilità medica. Milano; Giuffrè, 2007:71.
17.
go back to reference Faldini A. Una professione diventata un rischio. SIOTnews. 2005;04:1. Faldini A. Una professione diventata un rischio. SIOTnews. 2005;04:1.
19.
go back to reference Fiori A. Il nesso causale e la medicina legale: un chiarimento indifferibile. Rivista Italiana di Medicina Legale. 2002;24:247–265. Fiori A. Il nesso causale e la medicina legale: un chiarimento indifferibile. Rivista Italiana di Medicina Legale. 2002;24:247–265.
20.
go back to reference Fortuni G. The forensic medical aspects of thromboembolic risk in orthopaedic surgery. Chir Organi Mov. 2005;90:317–322.PubMed Fortuni G. The forensic medical aspects of thromboembolic risk in orthopaedic surgery. Chir Organi Mov. 2005;90:317–322.PubMed
21.
go back to reference Fusciani M. Rischio tecnologico e responsabilità legale in sanità. At Convegno ANIA, Milano, 2004. Fusciani M. Rischio tecnologico e responsabilità legale in sanità. At Convegno ANIA, Milano, 2004.
23.
go back to reference Gasparini D. The role of medical examiner and Conciliation Courts in the disputes between surgeon and patient. G Chir. 2008;29:110–114.PubMed Gasparini D. The role of medical examiner and Conciliation Courts in the disputes between surgeon and patient. G Chir. 2008;29:110–114.PubMed
24.
go back to reference Hoffmann B, Beyer M, Rohe J, Gensichen J, Gerlach FM. “Every error counts”: a web-based incident reporting and learning system for general practice. Qual Saf Health Care. 2008;17:307–312.PubMedCrossRef Hoffmann B, Beyer M, Rohe J, Gensichen J, Gerlach FM. “Every error counts”: a web-based incident reporting and learning system for general practice. Qual Saf Health Care. 2008;17:307–312.PubMedCrossRef
25.
go back to reference Italian Chamber of Deputies ruling of 25th July 2007 Istituzione di una Commissione parlamentare di inchiesta sugli errori in campo sanitario e sulle cause dei disavanzi sanitari regionali. Gazzetta Ufficiale. 28 July 2007;174:3. Italian Chamber of Deputies ruling of 25th July 2007 Istituzione di una Commissione parlamentare di inchiesta sugli errori in campo sanitario e sulle cause dei disavanzi sanitari regionali. Gazzetta Ufficiale. 28 July 2007;174:3.
26.
go back to reference Italian Constitution, Article 28, 27 December 1947. Italian Constitution, Article 28, 27 December 1947.
27.
go back to reference Italian Court of Cassation, United Sections, Judgment n. 30328, 11 September 2002. Italian Court of Cassation, United Sections, Judgment n. 30328, 11 September 2002.
28.
go back to reference Italian Court of Cassation, United Sections, Judgment n.577, 11 January 2008. Italian Court of Cassation, United Sections, Judgment n.577, 11 January 2008.
29.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n. 6464, 8 July 1994. Italian Court of Cassation, Third Civil Section. Judgment n. 6464, 8 July 1994.
30.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n. 8470, 18 October 1994. Italian Court of Cassation, Third Civil Section. Judgment n. 8470, 18 October 1994.
31.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.10014, 25 November 1994. Italian Court of Cassation, Third Civil Section. Judgment n.10014, 25 November 1994.
32.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.2466, 3 March 1995. Italian Court of Cassation, Third Civil Section. Judgment n.2466, 3 March 1995.
33.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.8845, 12 August 1995. Italian Court of Cassation, Third Civil Section. Judgment n.8845, 12 August 1995.
34.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.11440, 18 November 1997. Italian Court of Cassation, Third Civil Section. Judgment n.11440, 18 November 1997.
35.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.2698, 11 March 1998. Italian Court of Cassation, Third Civil Section. Judgment n.2698, 11 March 1998.
36.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.12233, 2 December 1998. Italian Court of Cassation, Third Civil Section. Judgment n.12233, 2 December 1998.
37.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.103, 8 January 1999. Italian Court of Cassation, Third Civil Section. Judgment n.103, 8 January 1999.
38.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.589, 22 January 1999. Italian Court of Cassation, Third Civil Section. Judgment n.589, 22 January 1999.
39.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.9198, 1 September 1999. Italian Court of Cassation, Third Civil Section. Judgment n.9198, 1 September 1999.
40.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.5945, 10 May 2000. Italian Court of Cassation, Third Civil Section. Judgment n.5945, 10 May 2000.
41.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.2335, 16 February 2001. Italian Court of Cassation, Third Civil Section. Judgment n.2335, 16 February 2001.
42.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.7027, 23 May 2001. Italian Court of Cassation, Third Civil Section. Judgment n.7027, 23 May 2001.
43.
go back to reference Italian Court of Cassation, Third Civil Section, Judgment n. 9471, 19 May 2004. Italian Court of Cassation, Third Civil Section, Judgment n. 9471, 19 May 2004.
44.
go back to reference Italian Court of Cassation, Third Civil Section. Judgment n.10297, 28 May 2004. Italian Court of Cassation, Third Civil Section. Judgment n.10297, 28 May 2004.
45.
go back to reference Italian law N° 833, art. 33, 34 and 35, 23rd of December 1978. Gazzetta Ufficiale. 28 December 1978;360 (Ordinary Suppl). Italian law N° 833, art. 33, 34 and 35, 23rd of December 1978. Gazzetta Ufficiale. 28 December 1978;360 (Ordinary Suppl).
47.
go back to reference Jourdan S, Rossi ML, Goulding J. Italy: medical negligence as a crime. Lancet. 2000;356:1267–1268.PubMedCrossRef Jourdan S, Rossi ML, Goulding J. Italy: medical negligence as a crime. Lancet. 2000;356:1267–1268.PubMedCrossRef
48.
go back to reference Kachalia AB, Mello MM, Brennan TA, Studdert DM. Beyond negligence: avoidability and medical injury compensation. Soc Sci Med. 2008;66:387–402.PubMedCrossRef Kachalia AB, Mello MM, Brennan TA, Studdert DM. Beyond negligence: avoidability and medical injury compensation. Soc Sci Med. 2008;66:387–402.PubMedCrossRef
49.
go back to reference Kessler D, McClellan M. Malpractice law and health care reform: optimal liability policy in an era of managed care. J Publ Econ. 2002;84:175–197.CrossRef Kessler D, McClellan M. Malpractice law and health care reform: optimal liability policy in an era of managed care. J Publ Econ. 2002;84:175–197.CrossRef
50.
go back to reference Kessler DP, Sage WM, Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA. 2005;293:2618–2625.PubMedCrossRef Kessler DP, Sage WM, Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA. 2005;293:2618–2625.PubMedCrossRef
51.
go back to reference Kessler DP, Summerton N, Graham JR. Effects of the medical liability system in Australia, the UK, and the USA. Lancet. 2006;368:240–246.PubMedCrossRef Kessler DP, Summerton N, Graham JR. Effects of the medical liability system in Australia, the UK, and the USA. Lancet. 2006;368:240–246.PubMedCrossRef
52.
go back to reference Klimo GF, Daum WJ, Brinker MR, McGuire E, Elliott MN. Orthopedic medical malpractice: an attorney’s perspective. Am J Orthop. 2000;29:93–97.PubMed Klimo GF, Daum WJ, Brinker MR, McGuire E, Elliott MN. Orthopedic medical malpractice: an attorney’s perspective. Am J Orthop. 2000;29:93–97.PubMed
53.
go back to reference Litvin SG. An overview of medical malpractice litigation and the perceived crisis. Clin Orthop Relat Res. 2005;433:8–14.PubMedCrossRef Litvin SG. An overview of medical malpractice litigation and the perceived crisis. Clin Orthop Relat Res. 2005;433:8–14.PubMedCrossRef
54.
go back to reference Mallardi V. The origin of informed consent. Acta Otorhinolaryngol Ital. 2005;25:312–327.PubMed Mallardi V. The origin of informed consent. Acta Otorhinolaryngol Ital. 2005;25:312–327.PubMed
55.
go back to reference Martelli A, Mastroroberto L. Implicazioni assicurative della responsabilità professionale del medico nell’ambito del Servizio Sanitario Nazionale. La Responsabilità Medica in ambito civile, Ed. CEDAM 193–225, 1989. Martelli A, Mastroroberto L. Implicazioni assicurative della responsabilità professionale del medico nell’ambito del Servizio Sanitario Nazionale. La Responsabilità Medica in ambito civile, Ed. CEDAM 193–225, 1989.
56.
go back to reference Martini G. Studio di epidemiologia giudiziaria. Ital J Orthop Traumatol. 2000;26:16–18. Martini G. Studio di epidemiologia giudiziaria. Ital J Orthop Traumatol. 2000;26:16–18.
57.
go back to reference Martini G, Perugia D. La descrizione dell’intervento chirurgico: un dovere ed un diritto. Ital J Orthop Traumatol. 2000;26:244–248. Martini G, Perugia D. La descrizione dell’intervento chirurgico: un dovere ed un diritto. Ital J Orthop Traumatol. 2000;26:244–248.
58.
go back to reference Martini G, Perugia L. Medicina Legale. Ital J Orthop Traumatol. 2003;29:11–13. Martini G, Perugia L. Medicina Legale. Ital J Orthop Traumatol. 2003;29:11–13.
59.
go back to reference Mommo G. Responsabilita’ professionale del medico il consenso informato: origine etica e fondamento giuridico sua evoluzione giurisprudenziale. Altalex quotidiano di informazione giuridica. 2005;1746. Mommo G. Responsabilita’ professionale del medico il consenso informato: origine etica e fondamento giuridico sua evoluzione giurisprudenziale. Altalex quotidiano di informazione giuridica. 2005;1746.
60.
go back to reference Montisci M, Snenghi R, Pasquali A, Prandoni P, Ferrara SD. Profiles of medical malpractice in the prophylaxis of pulmonary thromboembolism. Ital Heart J Suppl. 2003;4:217–225.PubMed Montisci M, Snenghi R, Pasquali A, Prandoni P, Ferrara SD. Profiles of medical malpractice in the prophylaxis of pulmonary thromboembolism. Ital Heart J Suppl. 2003;4:217–225.PubMed
61.
go back to reference Mora P. Le Professioni Sanitarie Come Rischio Sociale. At Convegno ADIMED, Torino, 2004. Mora P. Le Professioni Sanitarie Come Rischio Sociale. At Convegno ADIMED, Torino, 2004.
63.
go back to reference Neu J, Scheppokat KD, Vinz H. Medical risk and iatrogenic injury “accident reports” from the North German Schlichtungsstelle (expert panel for extrajudicial claims resolution). Z Arztl Fortbild Qualitatssich. 2004;98:567–574.PubMed Neu J, Scheppokat KD, Vinz H. Medical risk and iatrogenic injury “accident reports” from the North German Schlichtungsstelle (expert panel for extrajudicial claims resolution). Z Arztl Fortbild Qualitatssich. 2004;98:567–574.PubMed
64.
go back to reference Neu J, Scheppokat KD. Increasing patient safety by utilising datapools of medical arbitration boards, at Patient Safety Research Conference, Porto, 2007. Neu J, Scheppokat KD. Increasing patient safety by utilising datapools of medical arbitration boards, at Patient Safety Research Conference, Porto, 2007.
66.
go back to reference Olivetti L, Fileni A, De Stefano F, Cazzulani A, Battaglia G, Pescarini L. The legal implications of error in radiology. Radiol Med (Torino). 2008;113:599–608.CrossRef Olivetti L, Fileni A, De Stefano F, Cazzulani A, Battaglia G, Pescarini L. The legal implications of error in radiology. Radiol Med (Torino). 2008;113:599–608.CrossRef
67.
go back to reference Ricciardi L, Ricciardi A. Etica in ortopedia: i fattori di rischio. Ital J Orthop Traumatol. 2007;33:13–16. Ricciardi L, Ricciardi A. Etica in ortopedia: i fattori di rischio. Ital J Orthop Traumatol. 2007;33:13–16.
68.
go back to reference Rodríguez-Vázquez V. Doctors in Spanish criminal law: medical criminal responsibility for deaths and injuries caused by negligence in present-day Spain. Med Law. 2006;25:411–425.PubMed Rodríguez-Vázquez V. Doctors in Spanish criminal law: medical criminal responsibility for deaths and injuries caused by negligence in present-day Spain. Med Law. 2006;25:411–425.PubMed
69.
go back to reference Santovito D, Iorio M, Mastro F, Conforti M, Rispoli P. Symptomatic carotid stenosis. Diagnosis and treatment guidelines. Juridical and medico-legal approach. Minerva Cardioangiol. 2007;55:167–198.PubMed Santovito D, Iorio M, Mastro F, Conforti M, Rispoli P. Symptomatic carotid stenosis. Diagnosis and treatment guidelines. Juridical and medico-legal approach. Minerva Cardioangiol. 2007;55:167–198.PubMed
70.
go back to reference Sawicki PT. Quality of health care in Germany. A six-country comparison. Med Klin (Munich). 2005;100:755–768.CrossRef Sawicki PT. Quality of health care in Germany. A six-country comparison. Med Klin (Munich). 2005;100:755–768.CrossRef
71.
go back to reference Scheppokat KD. Learning from the experiences of an arbitration unit for medical liability Questions. Ther Umsch. 2005;62:185–190.PubMedCrossRef Scheppokat KD. Learning from the experiences of an arbitration unit for medical liability Questions. Ther Umsch. 2005;62:185–190.PubMedCrossRef
72.
go back to reference Stella F. Leggi scientifiche e spiegazione causale in diritto penale. Milano; Giuffrè, 1990:125. Stella F. Leggi scientifiche e spiegazione causale in diritto penale. Milano; Giuffrè, 1990:125.
73.
go back to reference Studdert DM, Thomas EJ, Zbar BI, Newhouse JP, Weiler PC, Brennan TA. Can the United States afford a “no-fault” system of compensation for medical injury? Law Contemp Probl. 1997;60:1–34.CrossRef Studdert DM, Thomas EJ, Zbar BI, Newhouse JP, Weiler PC, Brennan TA. Can the United States afford a “no-fault” system of compensation for medical injury? Law Contemp Probl. 1997;60:1–34.CrossRef
74.
go back to reference Studdert DM, Brennan TA. No-fault compensation for medical injuries: the prospect for error prevention. JAMA. 2001;286:217–223.PubMedCrossRef Studdert DM, Brennan TA. No-fault compensation for medical injuries: the prospect for error prevention. JAMA. 2001;286:217–223.PubMedCrossRef
75.
go back to reference Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, Brennan TA. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609–2617.PubMedCrossRef Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, Brennan TA. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609–2617.PubMedCrossRef
76.
go back to reference Suk M, Udale AM, Helfet DL. Orthopaedics and the low. J Am Acad Orthop Surg. 2005;13:397–406.PubMed Suk M, Udale AM, Helfet DL. Orthopaedics and the low. J Am Acad Orthop Surg. 2005;13:397–406.PubMed
77.
go back to reference Thorpe KE. The medical malpractice ‘crisis’: recent trends and the impact of state tort reforms. Health Aff (Millwood). 2004;Suppl. web exclusive:W4-20–30. Thorpe KE. The medical malpractice ‘crisis’: recent trends and the impact of state tort reforms. Health Aff (Millwood). 2004;Suppl. web exclusive:W4-20–30.
78.
go back to reference Williams CW. Guide to hospital incident reports. Health Care Manage Rev. 1985;10:19–25.PubMed Williams CW. Guide to hospital incident reports. Health Care Manage Rev. 1985;10:19–25.PubMed
79.
go back to reference World Health Organization. World Health Report 2000—Health systems: improving performance. Geneva, Switzerland: World Health Organization; 2000:200. World Health Organization. World Health Report 2000—Health systems: improving performance. Geneva, Switzerland: World Health Organization; 2000:200.
Metadata
Title
Medical Malpractice: The Experience in Italy
Author
Francesco Traina, MD
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 2/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0582-z

Other articles of this Issue 2/2009

Clinical Orthopaedics and Related Research® 2/2009 Go to the issue

Symposium: Clinical Risk and Judicial Reasoning

An Introduction to Medical Malpractice in the United States

Symposium: Clinical Risk and Judicial Reasoning

The Regulation of Medical Malpractice in Japan