Healthcare Liability and Causation: Commentary on Judgment Cass. civ., Section III, No. 21530 of 2021

Judgment No. 21530 of July 27, 2021, by the Court of Cassation represents an important in-depth analysis of healthcare liability and causation in civil matters. In the specific case, the Court examined an appeal concerning the death of a patient due to Lyell's syndrome, diagnosed late by healthcare professionals.

The Case and Previous Decisions

The case originated from the conviction of local healthcare authorities for compensation of damages suffered by the patient's family members. The Court of Oristano had granted the claim, but the Court of Appeal of Cagliari, on appeal, held that the liability was to be attributed exclusively to the doctors at the Oristano hospital. Specifically, the Court argued that the incorrect diagnosis and the failure to suspend a medication contributed to the patient's death.

The Court of Cassation confirmed the importance of the 'more probable than not' criterion in establishing causation.

The Principle of 'More Probable Than Not'

A crucial point of the judgment is the principle of 'more probable than not,' applied to verify the causal link between the conduct of healthcare professionals and the harmful event. This criterion implies an evaluation that is not only statistical but also logical, meaning the necessity of considering the confirming and excluding elements available in the specific case. The Court referred to previous case law that had outlined a stable orientation on the proof of causation, highlighting how the assessment cannot be based on mere quantitative probability.

Implications of the Judgment

The judgment of the Court of Cassation is significant for several reasons:

• It reiterates that the burden of proof rests on the injured party, but the judge must rely on coherent and well-founded evidentiary reasoning.
• It establishes that, in cases of omission, a counterfactual judgment is necessary to assess whether the due conduct could have prevented the harmful event.
• It highlights that healthcare liability is not limited to cases of gross negligence but also extends to negligence or imprudence, as emerged from the doctors' conduct in the examined case.

Conclusions

In conclusion, judgment No. 21530 of 2021 offers an important reflection on civil liability in healthcare, clarifying the criteria for evaluating causation. This approach emphasizes the need for a concrete and detailed analysis of medical acts and decisions made, in order to ensure fair protection for patients and their families.