Bini, Giulia

Bolcato, Vittorio

Braga, Paola

Carelli, Claudia

Quaiotti, Jessica

Radogna, Alessandra

Tronconi, Livio Pietro

English

PubMed

Journal of Preventive Medicine and Hygiene (JPMH)

E4J PREV MED HYG 2022; 63: E4-E5https://doi.org/10.15167/2421-4248/jpmh2022.63.1.1858 OPEN ACCESS Dear Editor,After lots of reforms the Italian healthcare system has changed on many levels from the inspirational idea of National Healthcare System (NHS) and its universality  [1‑3]. At the same time, recent Italian Legislation has expanded the perimeter of citizen’s right of health, beyond psycho‑physical well‑being, but better as an extension of self‑determination right. The aforementioned principle was also emphasized by a recent Italian Supreme Court pronunciation, that stated the right of compensation for injuries of the self‑determination principle, putting the right of health within the sphere of the rights of freedom  [4,  5]. Moreover, the Legislator with Laws no. 24/2017 and no. 219/2017 has strengthen the role of doctor in society, doctor‑patient fiduciary relationship and citizens’ accountability [6, 7]. In this legislative framework, COVID‑19 emergency displayed the great strengths, but also the weaknesses of Italian NHS, always considered as one of the best in the world [8]. As professionals in healthcare, with a forma mentis more prone for the juridical aspects of medical art, and from these considerations, we draft emerging implications on the holding of our NHS after COVID emergency, mainly in a risk management way, proposing some solutions, especially as the state of emergency continues.First of all, on the model of clinical risk prevention, Authors emphasize a deflationary approach, already well organized in many hospitals, but to be extended to the whole health sector, especially to protect general practitioners, who were unable in this emergency to handle all requests and are potentially exposed to litigation. In this horizon, the medico‑legal causal assessment of any improper conduct and their eventual health consequences becomes pivotal, in order to quickly and effectively filter patients’ claims, already growing, rose by COVID‑19 patients but also by non‑COVID‑19 patients. For this purpose, medico‑legal support is advocated for a better overall evaluation, in order to reduce judicial issues between costumers and professionals. Secondly, and logically after the causal assessment of the health damage, it is to contemplate the introduction of an indemnity system opposed to current compensation method, considering both the contingent state of force majeure, subsequent to national emergency declaration by the Council of Ministers [9], and the impossibility of granting same health rights to people as in peace‑time, given the sudden revolution of Healthcare Service. In this sense, looking at European Legislation, there is already a tradition of indemnity‑compensation, both in France and in Germany, for example regarding nosocomial infections, where liability system is characterized by the formula of no‑fault or objective liability. In a healthcare system such as the French one, with the prevalence of a Bismarck mutualistic funding, the interest in better control of the health damage outlay was certainly greater. This would allow to plan ahead and better the disbursement from health damage, first of all by the structures. As for years and as stated by the Gelli‑Bianco Law no. 24/2017, with this approach hospitals could have better knowledge of their budgets and consequently of their self‑retention fund. The most important implication of this methodological approach, the no‑fault liability, is not to blame medical conduct, since there is no purpose of offense repression in the medical activity as a whole, in particular during this extraordinary emergency. The French principle is so simple on the procedural front that effective on the deflationary and economical level: if the error could be attributed to the frailty of the Institutions, responsible for the public service, who failed to guarantee the right to health because unprepared to manage a irresistible situation ‑here pandemic‑, health‑workers’ responsibility, but also healthcare managers’ responsibility, must be excluded  [10‑14]. The patient then, such as in hospital infections or compulsory vaccination, has any onus probandi and receives an indemnity, financed by mutual insurance funds for illness. In this special condition of emergency and exception to the natural rule, in view of factum principis, planning an adverse event management method, prior to the lawsuit, could be fundamental. Fair compensation for damage is granted, with the incomparable advantage of knowing previously the relative value. The question of liability in the COVID‑19‑era arose urgently. Authors do not consider possible and disagree to undo responsibility at all: responsibility is the fundamental element that guarantees the professional diligence in particular, and the care of mankind in general. Nor do Authors agreed, as professionals, on the amendments, withdrawn, of deleting d’emblée the liability of the structures towards damages to operators. The insurance companies, called into question already by the Gelli‑Bianco Law, will also have to commit themselves to the protection of the health professionals and health system  [7]. We conclude by discussing the very foundations of the current financing Letter to the editorItalian National Health Service immunized by COVID-19?ALESSANDRA RADOGNA1, VITTORIO BOLCATO1, CLAUDIA CARELLI1, GIULIA BINI1, PAOLA BRAGA1, JESSICA QUAIOTTI1, LIVIO PIETRO TRONCONI1,21 Department of Public Health, Experimental and Forensic Medicine, Forensic Medicine Section “Antonio Fornari”,  University of Pavia, Pavia, Italy; 2 IRCCS Fondazione Casimiro Mondino, Pavia, ItalyKey wordsCOVID‑19 • Italian national healthcare system • Litigation • Indemnity reparationMEDICO-LEGAL ISSUES ON ITALIAN NHS WITH COVID-19E5and organization system of healthcare. The pure Beveridge model works with a general taxation system and with the instruction on the correct use of such a precious and expensive system, therefore Authors appeal to collective commitment, without forgetting that this model alone is no more sustainable. Rethinking healthcare architecture and taking the lesson from the emergency, we should clarify relations among stakeholders (State, Regions, Local Authorities) and strengthen the Regional primary care system. On this perspective, the synergic participation of all health players is needed in order to build a mechanism in which the State intervenes not only to compensate deficits, but also to encourage a more efficient Regional health organization, integrating both the territorial medicine and the hospital management. The pandemic forced all the players – stakeholders, clinicians and citizens – to rethink our precious healthcare system, particularly its resilience, to still ensure health right for all in the future.Acknowledgments We dedicate this study to the memory of our Professor Antonio Osculati, our greatest instrument, rethinking to Quintilian, “that without which the matter cannot be shaped to achieve its purpose”.Ethical approvalNot applicable.Conflict of interest statementAuthors state no conflict of interest.Funding sourcesThis article did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors.Authors’ contributionsAR: conception or design of the work and drafting. VB:  conception or design of the work and drafting. CC: drafting and final version approval. GB: drafting and final version approval. PB: drafting and final version approval. JQ: drafting and final version approval. LPT:  supervision and final editing.References[1] Bottari C. Profili innovativi del sistema sanitario. Giappichelli Editore 2018. https://www.giappichelli.it/profili‑innovativi‑del‑sistema‑sanitario[2] Ferré F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: health system review. Health Syst Transit 2014;16:1‑168. [3] Pavolini E, Kuhlmann E, Agartan TI, Burau V, Mannion R, Speed E. Healthcare governance, professions and populism: Is there a relationship? An explorative comparison of five European coun‑tries. Health Policy (New York) 2018;122:1140‑8. https://doi.org/10.1016/j.healthpol.2018.08.020[4] Corte di Cassazione Civile, Sezione III, Sentenza no. 28989, 11 novembre 2019 (2019).[5] Corte di Cassazione Civile, Sezioni Unite. Sentenza n° 26972, 11 novembre 2008. (2008).[6] Gazzetta Ufficiale della Repubblica. Disposizioni in materia di sicurezza delle cure e della persona assistita, nonché in materia di responsabilità professionale degli esercenti le professioni sanita‑rie. Legge 24, 8 marzo 2017 (2017). https://www.gazzettaufficia‑le.it/eli/id/2017/03/17/17G00041/sg[7] Gazzetta Ufficiale della Repubblica. Norme in materia di con‑senso informato e di disposizioni anticipate di trattamento. Legge 219, 22 dicembre 2017 (2017). https://www.gazzettaufficiale.it/eli/id/2018/1/16/18G00006/sg[8] Rosenbaum L. Facing COVID‑19 in Italy ‑ Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. N Engl J Med Published Online First: 18 March 2020. https://doi.org/10.1056/NEJMp2005492[9] Gazzetta Ufficiale della Repubblica. Decreto Legge “Misure urgenti connesse con la proroga della dichiarazione dello stato di emergenza epidemiologica da COVID‑19 e per la continuità operativa del sistema di allerta COVID, nonché per l’attuazione della direttiva (UE) 2020/739 del 3 giugno 20. Decreto Legge 7 ottobre 2020 (2020). https://www.trovanorme.salute.gov.it/nor‑me/dettaglioAtto?id=76574[10] De Rada D. Infezioni da COVID‑19 e responsabilità or‑ganizzativa della struttura sanitaria. Altalex 2020. https://www.altalex.com/documents/news/2020/05/13/infezio‑ni‑da‑covid‑19‑e‑responsabilita‑organizzativa‑struttura‑sanitaria?utm_medium=email&utm_source=WKIT_NSL_Altalex‑00019605&utm_campaign=WKIT_NSL_Alta‑lexFree17.05.2020_LFM&utm_source_system=Eloqua&utm_e (Accessed on: 19 May 2020)[11] Iorio C. Responsabilità medica e tutela del paziente ai tempi del Coronavirus. Judicium 2020;12.06.2020. http://www.judicium.it/responsabilita‑medica‑tutela‑del‑paziente‑ai‑tempi‑del‑coronavirus/[12] Cioffi A, Rinaldi R. COVID‑19 and medical liability: A deli‑cate balance. Med Leg J 2020;002581722093587. https://doi.org/10.1177/0025817220935879[13] Parisi SG, Viel G, Cecchi R, Montisci M. COVID‑19: the wrong target for healthcare liability claims. Leg Med 2020;46:101718. https://doi.org/10.1016/j.legalmed.2020.101718[14] Martin‑Fumadó C, Gómez‑Durán EL, Benet‑Travé J, Bar‑bería‑Marcalain E, Arimany‑Manso J. Liability claims in Spain post‑COVID‑19: A predictable scenario, Leg Med 2020;47:101745. https://doi.org/10.1016/j.legalmed.2020.101745Received on November 10, 2020. Accepted on February 28, 2022.Correspondence: Vittorio Bolcato, Department of Public Health, Experimental and Forensic Medicine, Forensic Medicine Section “Antonio For‑nari”, University of Pavia, Via C. Forlanini 12, 27100, Pavia, Italy – E‑mail:bolcatovittorio@yahoo.it ‑ vittorio.bolcato01@universitadipavia.itHow to cite this article: Radogna A, Bolcato V, Carelli C, Bini G, Braga P, Quaiotti J, Tronconi LP. Italian National Health Service immunized by COVID‑19? Medico‑legal considerations. J Prev Med Hyg 2022;63:E4‑ E5. https://doi.org/10.15167/2421‑4248/jpmh2022.63.1.1858© Copyright by Pacini Editore Srl, Pisa, ItalyThis is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further infor-mation: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

Italian National Health Service immunized by Covid-19?

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