Commentary on the Judgment of the Court of Cassation, Civil Section III, Order No. 34516 of 2023: Medical Liability and Guidelines
The judgment No. 34516 of 2023 of the Court of Cassation provides an interesting opportunity for reflection on medical liability and the application of guidelines in complex clinical contexts. In this case, the appellant, A.A., contested a decision of the Court of Appeal of Turin regarding a surgical intervention for endometriosis, highlighting the issue of fault and liability of both the physician and the healthcare facility.
The Context of the Judgment
The appeal originated from a surgical intervention that, although compliant with the guidelines, resulted in significant complications. The Court of Appeal noted an excessive radicality in the surgical choice and the failure to adopt more modern techniques, such as "nerve sparing," whose effectiveness was already documented. This decision led to the physician's conviction for imprudence and lack of skill, raising questions about the adequacy of guidelines in determining medical liability.
The Court reiterated that guidelines are not binding and cannot replace the physician's discretion in choosing the best solution for each patient.
Liability and Fault: A Delicate Balance
The Court clarified that, in this specific case, the physician's liability cannot be excluded simply because the intervention complied with the guidelines. The assessment of fault must take into account the specificity of the clinical situation and the choice of surgical method. Furthermore, it was emphasized that the principle of joint liability between the healthcare facility and the operating physician must be considered, unless it can be demonstrated that the physician's conduct was completely dissonant with the shared plan for health protection.
- Guidelines are a useful parameter for assessing medical fault.
- Joint liability implies an equitable distribution of responsibilities between the physician and the facility.
- The Court limited the recourse of the ASL to 50%, acknowledging shared fault.
Conclusions
The ruling of the Court of Cassation represents an important precedent in the jurisprudence on healthcare liability. It clarifies that adherence to guidelines does not exempt the physician from liability in case of complications, especially when safer therapeutic alternatives exist. The decision emphasizes the need for a thorough analysis of the specific circumstances of each case, promoting greater attention in the choice of operative techniques, for the benefit of patient safety.
