Doctors targeted by lawsuits: one in three has received a complaint. Schillaci: 'Criminal shield will become stable'

Doctors are the target of criminal or civil lawsuits, or both, to the extent that one in three white coats has received at least one complaint in his or her professional life. Criminal in 43.6% of cases, civil in 30.8% and even both in 25.6%. But then only in 3% of cases did these cases end in a conviction. Paradoxically, the most affected are the doctors with the most seniority (over 20 years): in particular men over 55 working in hospitals with fewer than 500 beds. And it is surgery that is in the crosshairs of the judiciary with over 82% of cases reported. The data emerged from a report by Anaao Assomed, the hospital doctors' union, which called on the Minister of Health Orazio Schillaci to intervene. "Doctors do not deserve it," said Schillaci. Receiving a warning puts the doctor in crisis and creates feelings of guilt. Within the year we aim to make the criminal shield stable,' warned Schillaci. The instrument first introduced during the Covid years, which limits the criminal liability of doctors to cases of intent and gross negligence, is a temporary measure that expires at the end of 2025. "Andby the end of the year there is my commitment to find a solution to this problem".

The data on medical malpractice emerged from the survey conducted by the Centro Studi dell'Anaao Assomed on a representative sample of white-collar workers equally distributed between men and women aged between 25 and 65 with a length of service ranging from entry to retirement. With regard to the completed legal proceedings, only about 3% were resolved with a conviction. Analysing the numbers in detail, the seriousness of the situation becomes clear. 32.8% of the respondents stated that they had received at least one complaint (civil and/or criminal) in the course of their professional activity. Criminal complaints in 43.6% of cases, civil in 30.8% and even both types in 25.6%. 22.3 % report having received at least one criminal complaint in the course of their career, 35.6 % of them more than one. The distribution of complaints by specialisation sees in the first places Gynaecology: 70%, Cardiac Surgery: 70%, General Surgery 66.2%. This was followed by Orthopaedics: 65.2%, Emergency Room (PS): 53.3%, Cardiology: 44.9%, Internal Medicine: 42%, Radiology: 38.6%, Anaesthesia: 37.3%, Hospital Medical Management: 38.5%, Psychiatry: 16.3%. Distribution by macro-disciplinary area also sees the Surgical Area in first place: 239 out of 393 (60.8%), followed by Medical Area: 296 out of 929 (31.9%) and Service Area: 89 out of 584 (15.2%).

The geographical distribution of lawsuits against doctors shows a prevalence in the South and Islands with a percentage of 39.8%. In second place is Central Italy (38.2%), and in third place the North (27.2%). If we then look at their distribution according to the size of the hospital structure, the primacy goes to hospitals with fewer than 500 beds (37.6%), followed by those with between 500 and 1000 beds 32.2%. Those with more than 1000 beds record the lowest rate (28.4%). It is, as mentioned, in the surgical area that the highest rate of complaints is recorded. In some specialities such as gynaecology, orthopaedics and general surgery, the probability of being reported exceeds 65%, reaching as high as 70% in gynaecology and cardiac surgery. In other words, 7 out of 10 professionals working in these disciplines have had to deal with a lawsuit at least once. From a geographical point of view, an increasing gradient emerges from north to south: it goes from 27.2% in the north to 39.8% in the south and islands, with a peak of 65.9% in the southern surgical area alone. "It is difficult," wonders Anaao Assomed, "not to ask ourselves about the causes of this disparity: structural deficiencies, overloaded services, the socio-economic context, and trust in the health system could all play a role".

Experience does not protect. On the contrary, among professionals with a career of more than 20 years, complaint rates rise sharply, especially in the surgical field. The most impressive figure concerns male surgeons with long seniority: 86.2% have suffered at least one complaint. If men and women are considered together, the percentage drops slightly: more than 8 out of 10 (82.3%). This means that more than 6 out of 7 male surgeons, and 5 out of 6 male surgeons of any gender with at least 20 years of practice, have been the subject of legal proceedings. These are numbers that cannot be considered physiological, but which indicate a structurally critical situation. The size of the hospital also seems to influence the risk of complaints: professionals working in facilities with fewer than 500 beds report a significantly higher frequency of complaints (37.6%) than those working in larger hospitals (28.4% over 1,000 beds). Probably, in smaller settings, the lower availability of resources, staff shortages and the absence of structured teams increase the risk of error and legal vulnerability.

'The issue of complaints,' warns Pierino Di Silverio National Secretary Anaao Assomed, 'is not just an individual problem, but a systemic one. It is necessary to start a deep reflection on doctors' working conditions, professional protection policies, training and dialogue with patients, in order to prevent litigation and restore serenity to those who guarantee care and assistance every day". "After Law 24/2017 Gelli-Bianco, which has certainly marked steps forward, especially in terms of civil liability, we need - in Di Silverio's opinion - new legislative tools, such as the definition of new principles on the formation of the roll of technical consultants; the transition to a no-fault insurance system, on the French and Scandinavian model, freed from the need to prove liability, in order to reduce legal disputes; a different criminal framework of medical liability; a greater role recognised to the GIP". The French so-called 'no-fault' model allows patients to obtain compensation for damages resulting from medical treatment without having to prove fault and allows professionals to work with greater peace of mind. "According to this model," Di Silverio explained, "patients can choose to obtain economic compensation by renouncing to take legal action: in this way they are certain to be compensated (98 per cent of cases are approved by a commission) and at the same time it contributes to streamlining waiting times and queues in the courts.