Professional Liability and Damages: Commentary on Judgment No. 6386 of 2023

Judgment No. 6386 of March 3, 2023, by the Court of Cassation, falls within a complex legal framework concerning professional liability in the healthcare sector. In this case, the Court upheld the appeal filed by A.A. and others, who had reported the death of their relative, F.F., attributing it to negligence on the part of the healthcare professionals at Fondazione Monte Tabor. The Court's decision offers interesting insights into the causal link and the burden of proof in such disputes.

The Context of the Judicial Matter

The case originates from the death of F.F., who was hospitalized for an ophthalmological procedure at San Raffaele. Following an accidental fall, she developed a nosocomial infection of Staphylococcus aureus. Despite evidence of negligence, the Court of Milan and subsequently the Court of Appeal had excluded a causal link between the conduct of the healthcare professionals and the patient's death, deeming the proof provided by the family insufficient. However, the Court of Cassation overturned this assessment.

The Court of Cassation emphasizes that the causal link must be assessed based on logical probability, not absolute certainty.

The Principle of the Causal Link

The Court affirmed that, in cases of medical liability, it is incumbent upon the plaintiffs to provide proof of the causal link between the healthcare facility's breach of duty and the damage suffered. However, the Court also clarified that such proof need not be provided in terms of certainty, but rather according to a criterion of probability. This point is crucial, as it is often difficult in the healthcare setting to prove with certainty that different conduct by the healthcare professionals could have prevented the patient's death.

Burden of Proof and Extracontractual Liability

Another relevant aspect of the judgment concerns the burden of proof in relation to extracontractual liability. The Court clarified that, although the patient may not have the opportunity to provide all necessary evidence, the healthcare facility has the obligation to demonstrate that it has complied with the standards of care. Otherwise, liability may be attributed even in the presence of a nosocomial infection contracted during hospitalization.

• The liability of the healthcare facility is based on various factors, including:
• Infection prevention protocols.
• Procedures for managing hygiene.
• The conduct of healthcare personnel during the hospital stay.

Conclusions

Judgment No. 6386 of 2023 by the Court of Cassation represents a significant step forward in jurisprudence on medical liability. It highlights the need to consider probability as a fundamental criterion for establishing the causal link and the burden of proof resting on the healthcare facility. Furthermore, this decision could have significant repercussions on future professional liability cases, emphasizing the importance of ensuring high standards of care and safety in hospital settings.