Professional liability in healthcare: analysis of the ruling Cass. civ., Sez. III, n. 4400 of 2004

The ruling of the Court of Cassation on March 4, 2004, n. 4400, represents an important reference point in Italian jurisprudence regarding professional liability in the healthcare sector. In this case, the relatives of a patient who died due to a diagnostic error sought justice, but the Court had to address complex issues related to the burden of proof and the causal link between the conduct of the doctors and the lethal event.

The specific case and the judges' decisions

The case originated from the death of A.B., hospitalized in a hospital in Rho for severe abdominal pain. The doctors, after an examination, failed to carry out further tests, and the patient died due to a rupture of the aortic aneurysm. The family then sued the hospital, arguing that the death was attributable to a diagnostic error.

The responsibility of the hospital is directly accountable for the negligence and lack of skill of its employees in the provision of healthcare services to the patient.

The Court of Milan initially accepted the conclusions of a technical consultant, acknowledging the diagnostic error but excluded liability due to a lack of causal link. The Court of Appeal reaffirmed this position, stating that there was insufficient evidence to affirm the fault of the healthcare professionals and that the patient's chances of survival, in the case of a correct diagnosis, were remote.

Legal principles emerged from the ruling

The Court of Cassation accepted the appeal, highlighting that the hospital has the burden of proving that the service was performed correctly. Moreover, the Court stated that, in cases of contractual liability, it is the debtor who must demonstrate the absence of fault, not the creditor who must prove the contrary. This principle is based on Article 1218 of the Civil Code, which establishes liability for non-fulfillment of obligations.

  • The doctor is also liable for slight negligence.
  • Liability is presumed according to Article 1218 of the Civil Code.
  • The causal link can exist even in the case of a probability of success of the intervention.

Conclusions

The ruling n. 4400 of 2004 is fundamental for understanding the delicate balance between patient rights and the responsibilities of healthcare entities. It clarifies that diagnostic errors and lack of assessments can constitute a failure to fulfill obligations, and that the burden of proof of guilt lies with the hospital. This decision has important implications for cases of malpractice, emphasizing the importance of timely and accurate diagnosis in ensuring patient safety.

Bianucci Law Firm