Commentary on Order No. 10901 of 2024: Changes in the Claim for Compensation in Medical Malpractice

The recent Order No. 10901 of April 23, 2024, from the Court of Cassation serves as an important reference point for issues related to compensation for damages resulting from medical malpractice. In particular, the ruling clarifies that changes to the claim for compensation should not be considered inadmissible, even when different errors are highlighted compared to those initially presented.

The Legal Context

In the case at hand, the plaintiff initially alleged a medical error related to the improper execution of a surgical procedure, only to later modify their position during the conclusions, asserting that the error was due to inadequate postoperative care. The Court held that this modification did not constitute an inadmissible change to the claim, emphasizing that the constitutive fact must be considered in its material essence.

The Implications of the Ruling

The principle stated in the ruling offers several important reflections:

  • Flexibility in the Claim for Compensation: The Court acknowledges the need for a certain degree of flexibility in formulating the claim, which must be able to evolve based on the outcomes of the investigation and the technical consultancy (c.t.u.).
  • Material Essence of the Constitutive Fact: It is essential that the constitutive fact is considered in its substance, rather than in the specific modalities of execution initially indicated by the plaintiff.
  • Relevance of Technical Evidence: The impossibility of identifying specific technical-scientific elements ex ante highlights the importance of technical consultancy in determining medical responsibility.
Generally. In the judgment for compensation for damages resulting from medical malpractice, the circumstance that the plaintiff, after alleging in the introductory act that the healthcare provider's error consisted of the improper execution of a surgical procedure, concludes by alleging instead that the error consisted of inadequate postoperative care does not constitute an inadmissible change of the claim, as the constitutive fact, suitable for delimiting the scope of the investigation, must be considered in its material essence, without the specifications of conduct initially indicated by the plaintiff having a preclusive effect, given the impossibility of identifying specific technical-scientific elements ex ante, which are usually only attainable at the outcome of the investigation and the execution of a c.t.u. (In application of the principle, the S.C., in a case of a patient's death due to septic shock following an intestinal injury, rejected the grounds for appeal that criticized the appellate ruling for basing the judgment of responsibility on a different fact, both compared to that which formed the basis for the first instance conviction - differently identifying the execution error of the procedure, despite the lack of incidental appeal on the point - and regarding that deduced in the summons, identifying further aspects of responsibility in the failure to apply drains, alleged by the plaintiff only in the concluding appearance, and in the lack of postoperative supervision, noted only with the incidental appeal).

Conclusions

In conclusion, Order No. 10901 of 2024 represents a significant step forward in Italian jurisprudence concerning medical responsibility. It underscores the importance of considering the constitutive fact in its essence, rather than in its specific modalities initially indicated. This flexible approach allows for greater protection of patients' rights, enabling them to have their claims for compensation recognized even in the presence of changes in the formulation of the claim.

Bianucci Law Firm