Between legal causes, defensive medicine and structural deficiencies, the Italian health system risks collapse. Every year 35 thousand new complaints against the white cans and a billionaire business that enriches only lawyers, while hospitals lose professionals.
A shield that does not protect against poisonous darts that for years have undermined the work and serenity of the doctors And the holding of the health service: a shield that now risks being further weakened. Every year, in fact, they are intended against the white cans, due to alleged damage caused to patients, about 35 thousand new legal actions, while more than 300 thousand slopes lie in the courts. A enormousness. And these are underestimated data, because in recent years they have not been updated by any independent body. In addition, although one in three doctor in Italy has been the subject of a complaint, only 3 percent of the causes end with a sentence. And in the meantime, after years of expenses, lawyers, media pillory and moral damage, when several of those professionals have already abandoned hospitals at the end of the nightmare.
The law and the criminal shield
The health liability, regulated by the Balduzzi decree of 2012, then by the Gelli-Bianco law of 2017, from the emergency criminal shield of 2021 to the last Milleproroghe, divides politics and health professionals. On August 4, the bill presented by the Minister of Health Orazio Schillaci, who should have made the criminal shield for the doctors structural, raised himself to the Council of Ministers: everything postponed to after the holidays.
The measure, designed to protect doctors and stem the escape from hospital lanes, provided for a reformulation of article 590-sexies of the penal code-in order to make doctors punishable only in the event of “gross fault”-and the addition of 590-septies, where it is established that in ascertaining the fault it is also necessary to take into account the scarcity of human resources and materials available and organizational deficiencies. But the square was not found, probably also for reasons of political opportunity: the concept that health professionals enjoy privileges that protect them in case of errors is indigestible for citizens.
The weight of defensive medicine
Except that these are not privileges, and those who have more to “get lost”, from conflicts in court, are precisely citizens. “The sword of Damocles of judicial uncertainty pushes the doctors to act no longer in the primary interest of the patient, but to protect himself from the judge”, explains to Panorama Filippo Anelli, president of Fnomceo (National Federation of orders of surgeons and dentists). “A doctor knows that, if something goes wrong, he will find himself in front of a magistrate who will ask him why he has not made that examination, prescribed that drug or arranged that hospitalization. To protect yourself, it will tend to do everything: longer or useless shelters, superfluous exams, redundant prescriptions. In this way resources are wasted, the waiting lists are stretched and opportunities for care are subtracted from those who need it ».
Even prolonged hospitalizations can prove to be counterproductive: the more you remain in lane, the more you are at risk of hospital infections, disorientation, risky exams and falls that irreparably compromise the clinical picture. “The sick and family members, when they induce the white cans to make defensive medicine, risk collapse the very concept of” courage “, both diagnostic and action”, explains Paolo Groff, the first aid primary of the Perugia hospital. «This way of thinking governs our mind in front of each patient, pushing us to think to defend us. Medicine is a non -exact science, and when we make a diagnosis we proceed in probability, trying to frame the patient in a Gaussian curve. But at the end of that curve the error is inevitable. We do not ask for a shield that makes us untouchable, we contest that the diagnostic or therapeutic error, the result of clinical reasoning, is treated as a crime. If I choose a logical and rear road, it proves to be wrong, it does not mean that I have committed a crime ».
The structural deficiencies and the shadow of the AI
To all this must be added the lack of organic and the insufficiency of territorial medicine, which downloads all health problems on hospitals, in addition to the problems that a near future will come from the diagnoses suggested by artificial intelligence, with which doctors will have to agree or to whom they will have to oppose, finding themselves in a situation of even greater “legal uncertainty”.
The expectation of patients and public perception
In this situation of poor clarity and discrepancy between supply and demands, the disputes are born. “The sick and their families come out furious from hospitals, convinced that medicine can always give an answer”, explains Dr. Franco Marozzi, vice president of Simla, Italian company of forensic medicine and insurance. “But this is not the case, because in the history of humanity the life expectancy has been so high, and this is an extraordinary result, the son of scientific progress: all this has meant that people live a sort of absolute pretense of health and survival. They do not contemplate the possibility that the medical ARS can be fallacious. When things go badly they feel betrayed and the search for the culprit is triggered ».
To worsen things you also put public opinion: the individual case of alleged malpractice is magnified, as if it were the rule, ignoring that in terms of statistics it is infinitesimal fractions. In Italy every day millions of health services are paid, all with a percentage of risk, but the complaints are “only” 35 thousand per year. “Politics, for its part, often starts only in search of the individual scapegoat,” says a primary of surgery that prefers to remain anonymous. “Never admit the limits of the system, better to speak of individual negligence and invoke exemplary punishments, perhaps for a doctor who made a mistake by working under staff and in stress conditions”.
The pain of family members and the business of the causes
Then there is the other part of the barricade. That of those in the lane, in the emergency room, on an ambulance, have lost a loved one: it is blinded by pain, convinced that she is the victim of a medical error. How to blame him? “And understandable behavior,” continues Rings. «Nobody wants to prevent citizens from having justice in case of errors. But let’s clarify a key concept: if I shoot someone, I do a voluntary act, I choose to hurt. In medicine it is not so: you can have followed the guidelines, but statistically an adverse event can occur. It is not the will of the doctor: that’s why 97-98 percent of the procedures closes without faults. What is the point of opening investigations, spending public money, making professionals live years of unnecessary processes, and then always return to the starting point? ».
Behind the despair of patients and family members there is also a huge business: on the economic level, an ecosystem revolves around healthcare responsibility that does not only concern the policies of the hospital facilities but also parcels, consultations and appraisals. The insurance market of civil liability is very popular: in 2023 the prizes of the general and health liability branches amounted to about 706 million euros, for an economic basin that feeds the induced of the dispute (lawyers, CTU, experts, mediators).
For law firms there is talk of a turnover that is worth 2 billion a year and that – given the data of archives and acquittals – turns out to be a good deal only for lawyers who, of course, must be paid anyway: such a path therefore risks “ruining” the patient or his family.
No solution on the horizon
Solutions? At the moment none and it is not even obvious that the “criminal shield” soon returns to the attention of the Council of Ministers and is approved, given the problems of Minister Orazio Schillaci. And also given the lack of clarity on the discrimination between gross negligence and activities of special difficulty. “The heart of a possible resolution of the dispute is precisely the definition of gross negligence,” concludes Marozzi. «To establish it is very complicated: the Cassation has already developed various definitions, but they are all difficult to applicable. Today medicine is so evolved that being able to write in a law what is gross negligence and what would not be a company from the great legislator, at the level of Napoleon. Joints aside: we have not seen this political stature in recent decades ».
In Marta, however, it no longer interests: valid for a specializing in an Italian emergency room, a couple of months ago has resigned. He did not hold up to the intental legal action for a death due to the breakdown of an aneurysm: months of anxiety, diagnosis of exhaustion and that point the escape in search of a less risky job. Then came the storage, but Marta at that point was already one of the many less doctors, those that we will not find when we get to the hospital in search of help.
