Supreme Court: this is how heavy shifts in hospitals cause damage to health

Once the causal link between work-related stress and health damage has been proved, the onus is on the health authority to prove that it took the necessary measures to avoid the harmful event. A different solution would be contrary to Article 2087 of the Civil Code, which requires the employer to 'protect the physical integrity and moral personality of employees'. In these terms, the Supreme Court of Cassation (Order No. 26923 of 2025) held a hospital company liable for the death of an anaesthetist, who suffered a 'myocardial infarction' during a work shift that lasted almost sixteen hours.

Following the acknowledgement of the doctor's death due to "service-related causes", the heirs had asked the court of first instance and, subsequently, the Court of Appeal to ascertain the hospital's failure to adopt measures aimed at safeguarding the employee's psycho-physical integrity. The territorial Court had rejected the appeal, pointing out that the anaesthetist had enjoyed "twenty-three days of compensatory rest" a few weeks earlier and that "he had not worked in the four days preceding the event, except for one hour and 43 minutes for on-call duty".

In their appeal in cassation, the heirs had argued that the Court of Appeal had failed to take into account that a few days before the heart attack, the doctor had been employed on shifts beyond the "maximum of twelve continuous hours" without the hospital taking any measures to prevent the recurrence of the incident. This thesis hit the nail on the head.

The Court of Cassation referred to the orientation according to which "With regard to compensation for damage to health consequent to work activity, the causal link relevant to the recognition of fair compensation for the cause of service is identical to that to be proven for the purposes of sentencing the employer to compensation for damages, when reference is made to the same work performance and the same harmful event" (Court of Cassation, no. 6008/2023); so that it is up to the employer to prove that the damage, although attributable to the work performance, was caused by a cause not attributable to him (Court of Cassation, no. 34968/2023). Hence the order in narrative that annulled the sentence of the Court of Appeal for having linked "the lethal event to the doctor's last shift only" and for not having taken into account the "impact of the entire working relationship characterised on the one hand by highly stressful shifts and on the other [by] the recognition of fair compensation".