Commentary on Judgment Cass. civ., Section III, Ord. no. 34516 of 2023: Medical Liability and Guidelines

Judgment no. 34516 of 2023 by the Court of Cassation offers an interesting opportunity for reflection on medical liability and the application of guidelines in complex clinical contexts. In this case, the appellant, A.A., challenged a decision by the Court of Appeal of Turin concerning surgery for endometriosis, highlighting the issue of fault and liability for both the physician and the healthcare facility.

The Context of the Judgment

The appeal originated from a surgical procedure that, despite being compliant with guidelines, resulted in significant complications. The Court of Appeal found 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 override the physician's discretion in choosing the best solution for each patient.

Liability and Fault: A Delicate Balance

The Court clarified that, in the specific case, the physician's liability cannot be excluded simply because the procedure complied with guidelines. The assessment of fault must consider the specificity of the clinical situation and the choice of surgical method. Furthermore, it was highlighted that the principle of joint and several liability between the healthcare facility and the operating physician must be considered, unless the physician's conduct is shown to be completely inconsistent with the shared plan for health protection.

• Guidelines are a useful benchmark for assessing medical fault.
• Joint and several liability implies a fair distribution of responsibilities between the physician and the facility.
• The Court limited the ASL's recourse to 50%, recognizing shared fault.

Conclusions

The Cassation judgment represents an important precedent in healthcare liability jurisprudence. 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.