Skip to main content
SpringerLink
Log in

The Judge, the Legislator and … the Mediator. The Long Journey of Medical Malpractice in Italy

  • Chapter
  • First Online:
Compensation Schemes for Damages Caused by Healthcare and Alternatives to Court Proceedings

Part of the book series: Ius Comparatum - Global Studies in Comparative Law ((GSCL,volume 53))

  • 325 Accesses

Abstract

This contribution intends to describe the main features and the evolution of the system to compensate patients for damages caused by healthcare in Italy. In the first part, it outlines the main traits of the regulation developed by the courts on the basis of the general principles established by the civil code, highlighting the gradual shift in favour of patients. Then, it concentrates on the significant legislative measures passed in the last few years in order to tackle the crisis of medical malpractice litigation and reduce the overall costs of the system. The second part focuses on the development of alternative methods of dispute resolution in the field of medical malpractice. The two main ADR processes on which the Italian legislator relies as tools to reduce the number of cases dealt with by the courts are compulsory mediation, established in 2010, and the “pre-action expert report” (accertamento tecnico preventivo—ATP), that, according to the recent Gelli Bianco law is now the main ADR process for all medical malpractice cases.

This contribution is an updated and revised version of the report published under the title Compensation Schemes for Damages Caused by Healthcare and Alternatives to Court Proceedings in Italy in 2018 Annuario di diritto comparato e di studi legislativi. Italian National Reports to the International Academy of Comparative Law XXth International Congress. Special edition 2018: 89–112.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 1.

    In the period immediately following the enactment of the Constitution, when a diffuse system of judicial review was in force in Italy, ordinary courts considered this provision—as many other constitutional provisions—merely “programmatic”, meaning that without implementing legislation it could not be applied by the courts. The approach changed after the establishment of the Constitutional Court, in 1956, and the binding nature to this provision has been fully recognized since the end of the 1970s. Luciani (1991), p. 5.

  2. 2.

    According to an alternative view, the basis for the contractual liability of the institution was the exercise of the potestative right to healthcare access by the patient.

  3. 3.

    The main theoretical criticisms to the traditional approach were two. First, that equating the position of the health professional to that of a tortfeasor ignored the relationship actually existing with the patient. Second, that it was contradictory to subject the two liabilities to different regimes when they were so tightly connected and,  actually, both derived from the same facts. The major practical problem, instead, was the difficulty in satisfying the burden of proof required to ascertain tort liability. In an attempt to establish the contractual nature of the liability of hospital-employed health professionals, different theoretical approaches were adopted by the courts and/or suggested by legal scholars. Di Marzo (2012), pp. 55–60.

  4. 4.

    For this reason, punitive damages have always been deemed inconsistent with our legal system and the award of such damages by foreign judgements has been denied enforcement in Italy. See, most recently, Court of Cassation, decision no. 1781 of February 8, 2012. However, a closer look at national legislation shows several provisions concerning damages that clearly perform a deterrence and/or punitive function and at the doctrinal level the issue is far from settled. For a critique of the traditional Italian conception, see Cappelletti (2015), pp. 821–843.

  5. 5.

    “No obligation of a personal or financial nature may be imposed on any person except by law.”

  6. 6.

    “No one will be punished except by virtue of a law in force at the time the offence was committed.”

  7. 7.

    In order to get an idea of this phenomenon, it could be useful to refer to the 2015–2016 report of the Italian national association of insurers, where it can be read “the number of claims registered by Italian insurance companies in 2014 was estimated at 28,500, 17,000 of them accounted for institutional policies”. In 1994, instead, the total number of claims was around 9500. ANIA (2016), pp. 168–169.

  8. 8.

    Although statistical data are not available, this increase is uncontested. See, e.g., Di Marzo (2012), p. 53 and Ricci et al. (2013), pp. 211–212.

  9. 9.

    Law no. 189 of November 8, 2012, that transposed into law and modified the decree law no. 58 of September 13, 2012, in force since November 11, 2012. It is named after the Minister of Health in office.

  10. 10.

    Law no. 24 of March 8, 2017, in force since April 1, 2017, named after its proponents.

  11. 11.

    Article 2043 of the civil code “Compensation for unlawful acts. Any fraudulent, malicious or negligent act that causes an unjustified injury to another obliges the person who has committed the act to pay damages”. All translations of articles of the Italian civil code come from Beltramo et al. (1969).

  12. 12.

    Court of cassation, no. 8826 of April 13, 2007. Rivista italiana di medicina legale e diritto sanitario 2008: 849.

  13. 13.

    Court of cassation, civil plenary session, no. 13533 of October 30, 2001, in Foro italiano 2002 I: 769.

  14. 14.

    Court of cassation, no. 10297 of May 28, 2004 Foro italiano 2005 I: 2479.

  15. 15.

    See Court of cassation, criminal plenary session, no. 30328 of September 11, 2002 (so called Franzese ruling, after the name of the defendant), which established the “beyond reasonable doubt” standard. This standard requiring near certainty has been subsequently inserted in the criminal code (article 533), by the Law no. 46 of February 20, 2006. Di Marzo (2012), pp. 71–72.

  16. 16.

    Actually, there had been several bills aiming at a reform of this area of law since the early 2000s. All had in common the establishment of a form of compulsory insurance for civil liability.

  17. 17.

    Article 3, paragraph 5, letter e) of the decree law no. 158 of September 13, 2012, transposed into law with modifications by the law no. 148 of September 14, 2011.

  18. 18.

    The decree law contained “urgent provisions to promote the development of the country through a higher level of health protection”.

  19. 19.

    Court of cassation, decision no. 8940 of April 17, 2014. Responsabilità civile e previdenza 2014: 803.

  20. 20.

    Article 27 of the decree law no. 90 of June 24, 2014 as transposed into law and modified by the law no. 114 of August 11, 2014.

  21. 21.

    Other important innovations concerning the determination of the amount due and the alternatives to court proceedings will be dealt with in the following paragraphs.

  22. 22.

    The meaning of this provision and the relationship with the previous regime established by the Balduzzi law were clarified by the judgment of the plenary session of the Court of cassation no. 8770 of 21 December 2017.

  23. 23.

    Legislative decree no. 209 of September 7, 2005 (so called “insurance code”), articles 138 and 139.

  24. 24.

    In fact, article 138, concerning more serious injuries, has just been rewritten by article 1, paragraph 17 of the law no. 124 of August 4, 2017, that modified also article 139.

  25. 25.

    This part of the provision is still in force.

  26. 26.

    The other were condominium, property rights, division of assets, hereditary succession, leases, gratuitous loans, family company agreements, rental companies, damages resulting from vehicle and boat accidents, defamation by the press or other means of advertising, insurance or banking and financial contracts.

  27. 27.

    Foro italiano 2013 I: 1091.

  28. 28.

    According to article 76 of the Italian Constitution “The exercise of the legislative function may not be delegated to the Government unless principles and criteria have been established and then only for a limited time and for specified purposes.”

  29. 29.

    Court of Justice, Third Chamber, 27 June 2013, C-492/11, Ciro Di Donna v. Società imballaggi metallici Salerno srl (SIMSA).

  30. 30.

    Only cases concerning vehicle and boat accidents were excluded. Actually, during the period when out-of-court mediation had been mandatory it had proved to be particularly ineffective in this type of disputes, because insurance companies did not take part in the procedure in a very high percentage of cases. Luiso (2013), p. 138.

  31. 31.

    In 2016, 40% of claimants and 16% of defendants were not assisted by a lawyer. Ministry of Justice (2016), p. 17.

  32. 32.

    Article 3 of the decree law of March 14, 2005, no. 35, transposed into and amended by the law of May 14, 2005, no. 80, in force since March 1st, 2006.

  33. 33.

    The pre-action expert report has significant similarities with the French expertise preventive and the German schriftliche Begutachtung.

  34. 34.

    According to article 696 of the Code of civil procedure, this risk is the condition for admitting the traditional pre-action expert report.

References

  • Aleo S (2014) Introduzione. In: Aleo S, De Matteis R, Vecchio G (eds) La responsabilità in ambito sanitario, vol I. CEDAM, Padua, pp XXI–XXXIX

    Google Scholar 

  • Andò B (2014) On the interpretation of law and legal gaps: a comparative overview of the delicate trade-off between legal rules and judicial creativity in Louisiana and Italy. Tulane Eur Civil Law Forum 29:101–123

    Google Scholar 

  • ANIA Associazione Nazionale tra le Imprese Assicuratrici (2016) Italian Insurance 2015-2016. http://www.ania.it. Accessed 5 Dec 2019

  • ANIA Associazione Nazionale tra le Imprese Assicuratrici (2019) Italian Insurance 2018–2019. http://www.ania.it. Accessed 5 Dec 2019

  • Arianna O (2016) La consulenza tecnica in mediazione. Contratti 2016:193–199

    Google Scholar 

  • Avanza M, Perotti S, Vassalini M (2011) Riflessioni sulla nuova disciplina della mediazione civile (D.Lgs. n. 28, 4 marzo 2010) e sulle possibilità applicative in tema di responsabilità professionale medica. Rivista italiana di medicina legale 2011:655–671

    Google Scholar 

  • Barbarisi A (2017) L’onere della prova nella responsabilità sanitaria. Contratti 2017:217–230

    Google Scholar 

  • Besso C (2010) Pre-action taking of evidence. In: De Cristofaro M, Trocker N (eds) Civil Justice in Italy. Jigakusha, Tokyo, pp 297–306

    Google Scholar 

  • Bona M (2013) La R.C. medica dopo il decreto legge n. 158/2012: indicazione per la corretta interpretazione e per la (dis)applicazione delle nuove disposizioni. In: Martini F, Genovese U (eds) La valutazione della colpa medica e la sua tutela assicurativa. Maggioli, Rimini, pp 27–71

    Google Scholar 

  • Bove M (2008) Evitare il processo? Il giusto processo civile 2008:61–93

    Google Scholar 

  • Bugiolacchi L (2017) Le strutture sanitarie e l’assicurazione per R.C. verso terzi: natura e funzione dell’assicurazione obbligatoria nella legge n. 24/2017 (legge «Gelli/Bianco»). Responsabilità civile e previdenza 2017:1032–1051

    Google Scholar 

  • Camera dei Deputati, Relazione conclusiva della Commissione parlamentare di inchiesta sugli errori in campo sanitario e sulle cause dei disavanzi sanitari regionali. Doc. XXII-bis n. 10, XVI legislature. 22 January 2013. http://leg16.camera.it/494?categoria=022bis. Accessed 05 Dec 2019

  • Cappelletti M (2015) Punitive damages and the public/private distinction: a comparison between the United States and Italy. Ariz J Int Comp Law 32:799–848

    Google Scholar 

  • Carratta A (2010) Special summary proceedings. In: De Cristofaro M, Trocker N (eds) Civil Justice in Italy. Jigakusha, Tokyo, pp 186–225

    Google Scholar 

  • Cecconi F, Cipriani G (2014) Aspetti processuali. In: Cecconi F, Cipriani G (eds) La responsabilità civile medica dopo la legge Balduzzi. Giappichelli, Turin, pp 109–118

    Google Scholar 

  • Comandè G (2010) Dalla responsabilità sanitaria al no-blame regionale fra conciliazione e risarcimento. Danno e responsabilità 2010:977–988

    Google Scholar 

  • Comandé G (2011) La mediazione in responsabilità sanitaria: dal “pacco avvelenato” alla “giustizia alta”. Rivista italiana di medicina legale 2011:309–320

    Google Scholar 

  • Comandé G (2016) La riforma della responsabilità sanitaria al bivio tra conferma, sovversione, confusione e … no-blame. Rivista italiana di medicina legale (e del diritto in campo sanitario) 2016:3–28

    Google Scholar 

  • De Luca A (2015) Mediation in Italy: features and trends. In: Esplugues C, Marquis L (eds) New developments in civil and commercial mediation. Global comparative perspectives. Springer, Berlin, pp 345–365

    Chapter  Google Scholar 

  • De Palo G, D’Urso L (2016) Achieving a balanced relationship between mediation and judicial proceedings. In: Policy Department for Citizens’ Rights and Constitutional Affairs. The Implementation of the Mediation Directive Workshop 29 November 2016 4–30. http://www.europarl.europa.eu/thinktank/en/document.html?reference=IPOL_IDA%282016%29571395. Accessed 5 Dec 2019

  • Di Marzo C (2012) Medical malpractice: the Italian experience. Chicago-Kent Law Rev 87:53–77

    Google Scholar 

  • European Commission (2016) Report from the Commission to the European Parliament, the Council and the European Economic and Social Committee on the Application of Directive 2008/52/EC of the European Parliament and of the Council on certain aspects of mediation in civil and commercial matters. COM(2016) 542 final. http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52016DC0542&from=EN. Accessed 5 Dec 2019

  • Feola A, Marino V, Marsella LT (2015) Medical liability: the current state of Italian legislation. Eur J Health Law 22:347–358

    Article  Google Scholar 

  • Ferrara SD, Viel G, Boscolo-Berto R (2013) Present and future perspectives for medical malpractice, responsibility, and liability. In: Ferrara SD (ed) Malpractice and medical liability. European State of the art and guidelines. Springer, Berlin, pp 3–10

    Chapter  Google Scholar 

  • Franzoni M (2017) Colpa e linee guida nella nuova legge. Danno e responsabilità 2017:271–279

    Google Scholar 

  • Frati P, Gulino M (2013) European legislative and juridical overview. In: Ferrara SD (ed) Malpractice and medical liability. European State of the art and guidelines. Springer, Berlin, pp 69–92

    Chapter  Google Scholar 

  • Gallo P (2017) Quale futuro per il contatto sociale in Italia? Nuova Giurisprudenza Civile Commentata 2017:1759–1767

    Google Scholar 

  • Gattari P (2014) Profili civilistici della legge Balduzzi: il “senso” del richiamo all’art. 2043 c.c. Responsabilità civile e Previdenza 2014:1039–1051

    Google Scholar 

  • Grasso E, Coppola S (2012) Quel che resta della responsabilità medica: riflessioni sul ruolo delle strutture sanitarie. Politica del diritto 2012:643–673

    Google Scholar 

  • Grasso E, Coppola S (2014) La gestione dell’insuccesso medico. Il Mulino, Bologna

    Google Scholar 

  • Luciani M (1991) voce Salute I. Diritto alla salute – Dir. cost. Enciclopedia giuridica XXXII:1–14

    Google Scholar 

  • Luiso FP (2013) Il quadro degli ADR nel biennio 2011–2012. In: ISDACI, Sesto rapporto sulla diffusione della giustizia alternativa in Italia, pp 129–142. http://www.isdaci.it/wp-content/uploads/2016/05/eBook_Sesto_rapporto.pdf. Accessed 5 Jan 2018

  • Martini F (2013) Legge Balduzzi, come cambia (e se cambia) la responsabilità sanitaria. In: Martini F, Genovese U (eds) La valutazione della colpa medica e la sua tutela assicurativa. Maggioli, Rimini, pp 11–20

    Google Scholar 

  • Mastroroberto L, Blandino A (2013) La Legge “Balduzzi”: panacea o placebo per l’assicurabilità del “sistema Sanità” e per il contenimento del contenzioso ad esso relativo? In: Martini F, Genovese U (eds) La valutazione della colpa medica e la sua tutela assicurativa. Maggioli, Rimini, pp 127–139

    Google Scholar 

  • Matteucci G (2015) Mandatory mediation, the Italian experience. Revista Eletrônica de Dereito Processual 16:189–210

    Google Scholar 

  • Ministry of Justice (2016) Civil Mediation Legislative Decree 28/2010. Statistics for the Period January 1st – December 31st 2016. https://webstat.giustizia.it/SitePages/StatisticheGiudiziarie/civile/Mediazione%20Civile.aspx. Accessed 5 Dec 2019

  • Ministry of Justice (2017) Civil Mediation Legislative Decree 28/2010. Statistics for the Period January 1st – December 31st 2017. https://webstat.giustizia.it/SitePages/StatisticheGiudiziarie/civile/Mediazione%20Civile.aspx. Accessed 5 Dec 2019

  • Ministry of Justice (2018) Civil Mediation Legislative Decree 28/2010. Statistics for the Period January 1st – December 31st 2018, https://webstat.giustizia.it/SitePages/StatisticheGiudiziarie/civile/Mediazione%20Civile.aspx. Accessed 5 Dec 2019

  • Napoli GE (2017) La responsabilità sanitaria nel sistema civilistico. Punti fermi e nuove linee di riforma. Responsabilità civile e previdenza 2017:65–93

    Google Scholar 

  • Pagni I (2018) La riforma della responsabilità medica. I profili processuali. Questione Giustizia 1(2018):174–188

    Google Scholar 

  • Ponzanelli G (2017) “Medical malpractice”: la legge Bianco Gelli. Una premessa. Danno e responsabilità 2017:268–270

    Google Scholar 

  • Ricci P, Ausania F, Arbarello P (2013) Medical responsibility and liability in Italy. In: Ferrara SD (ed) Malpractice and medical liability. European state of the art and guidelines. Springer, Berlin, pp 209–226

    Chapter  Google Scholar 

  • The Italian Civil Code (1969) Trans. Mario Beltramo, Giovanni E. Longo, and John Henry Merryman. Oceana, Dobbs Ferry

    Google Scholar 

  • Viciani S (2016) Errore in medicina e modelli di responsabilità. ESI, Napoli

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Legal Sciences, University of Florence, Florence, Italy

    Alessandra De Luca

Authors
  1. Alessandra De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandra De Luca .

Editor information

Editors and Affiliations

  1. Faculty of Law and Administration, University of Warsaw, Warsaw, Poland

    Dobrochna Bach-Golecka

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

De Luca, A. (2021). The Judge, the Legislator and … the Mediator. The Long Journey of Medical Malpractice in Italy. In: Bach-Golecka, D. (eds) Compensation Schemes for Damages Caused by Healthcare and Alternatives to Court Proceedings. Ius Comparatum - Global Studies in Comparative Law, vol 53. Springer, Cham. https://doi.org/10.1007/978-3-030-67000-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-67000-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-66999-7

  • Online ISBN: 978-3-030-67000-9

  • eBook Packages: Law and CriminologyLaw and Criminology (R0)

Publish with us

Policies and ethics

Search

Navigation