Professional Liability in Healthcare: Analysis of Judgment Cass. civ., Section III, no. 4400 of 2004

The judgment of the Court of Cassation of March 4, 2004, no. 4400, represents an important reference point in Italian jurisprudence concerning 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 doctors' conduct and the fatal event.

The Specific Case and the Judges' Decisions

The case originated from the death of A.B., who was admitted to a hospital in Rho for severe abdominal pain. The doctors, after an examination, failed to perform further tests, and the patient died due to a ruptured aortic aneurysm. The relatives then sued the hospital entity, claiming that the death was attributable to a diagnostic error.

The hospital entity is directly liable for the negligence and lack of skill of its employees in the context of healthcare services provided to the patient.

The Court of Milan initially accepted the conclusions of a technical consultant, recognizing the diagnostic error, but excluded liability due to a lack of causal link. The Court of Appeal reiterated this position, stating that there were no sufficient elements to affirm the fault of the healthcare professionals and that the patient's chances of survival, in case of a correct diagnosis, were remote.

Legal Principles Emerging from the Judgment

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

• The doctor is liable even for slight negligence.
• Liability is presumed according to art. 1218 of the Civil Code.
• A causal link may exist even in cases of probable success of the intervention.

Conclusions

Judgment no. 4400 of 2004 is fundamental for understanding the delicate balance between patients' rights and the liability of healthcare entities. It clarifies that diagnostic errors and a lack of investigations can constitute a breach of contract, and that the burden of proof of fault lies with the hospital entity. This decision has important implications for cases of medical malpractice, emphasizing the importance of timely and correct diagnosis in ensuring patient safety.