Doctors: the Chamber of Deputies gives the green light to criminal immunity and the reinstatement of anti-vaxxers. The majority is split

The criminal immunity already introduced during the Covid pandemic and subsequently extended on several occasions is set to become permanent. Thanks to an amendment to the Criminal Code, healthcare professionals who commit offences of causing bodily harm or manslaughter whilst carrying out their duties will only be liable to prosecution for gross negligence, provided they have followed accredited guidelines or best practice. The measure, which comes into force immediately, is contained in the draft enabling bill for the reform of the healthcare professions, which received the Chamber of Deputies’ approval today and which, amongst other things, also provides for the controversial reinstatement of anti-vaccine doctors. This latter provision was approved partly thanks to the votes of Futuro Nazionale, led by Roberto Vannacci, which has split the majority – and in particular Forza Italia – which now promises to amend it when the bill goes to the Senate for its final reading: “When the text reaches the Senate, our group will do its part to amend it because the health of citizens and the credibility of the medical profession come before any ideological agenda,” emphasises Stefania Craxi, chair of the Forza Italia senators.

As soon as the shield comes into force, it will narrow the scope of criminal liability – civil liability remains unchanged – by exempting doctors from conviction in cases such as errors due to minor incompetence, but also in cases of carelessness and negligence, such as might occur when an A&E doctor, having too many patients to see, makes a mistake. In determining fault or its degree, account will also be taken of the conditions in which the doctor works – namely, whether there is a staff shortage, whether treatments are available, or whether an emergency situation is present. One of the measure’s objectives is to try to reduce the phenomenon of defensive medicine: that is, the practice whereby doctors, precisely to avoid litigation, prescribe consultations and tests that are not always necessary, at a cost estimated at between 10 and 15 billion a year. In addition to the criminal immunity provision, the reform contains a delegated power authorising the Government to issue one or more legislative decrees within six months to strengthen measures in favour of staff and to try to stem the exodus of doctors and nurses from the National Health Service. This reform does not allocate new resources and, like any such authorisation, sets out a series of guidelines and general principles to be implemented. Among the measures in the pipeline are the possibility of introducing flexible forms of employment for trainee doctors, cutting red tape for staff, and incentive schemes linked to performance evaluation systems, including those tied to the reduction of waiting lists.

Work is also underway on the overhaul of the regulations governing the professional bodies and federations of the healthcare professions; in particular, changes are envisaged regarding the powers of ordinary and extraordinary bodies and the expiry of terms of office.There are also plans to establish a national system for the certification of skills, to recognise the expertise healthcare professionals have acquired through experience, which will be useful for the allocation of roles and responsibilities and for career progression. As for measures relating to training, the course (currently run at regional level) to become a general practitioner is to be transformed into a university-level programme, as is the case for other medical specialisms, alongside a review of training for certain roles such as chemists, biologists, midwives, psychologists and dentists. To regulate the employment of doctors and nurses arriving from abroad (from outside the EU), there will also be a requirement to register on special registers maintained by the professional bodies, subject to verification of language proficiency. ‘Professionals have never asked us just for money. They have asked us for planning, clear rules and organisation. This is the guiding principle behind the reorganisation of the healthcare professions, which is being pursued on three fronts: attractiveness, so that those trained in Italia choose to stay; skills, updated to meet new healthcare needs and new technologies; and specialisations, for general practice and for all healthcare professions. This is the approach of the right-wing government,” emphasises Marta Schifone, MP and head of professional affairs for Fdi.

The measure was approved, albeit by a margin of just 13 votes, with Forza Italia split over the bill – which has sparked considerable controversy in the past and again during the debate in the Chamber, with the opposition raising objections – and which provides for – in cases where no malicious intent is involved – the reinstatement to the register of doctors and healthcare professionals who were struck off during the Covid emergency, as in the case of anti-vaccine healthcare workers. However, this measure was rejected by Forza Italia, as emphasised by Stefania Craxi, chair of Forza Italia’s senators: “The provision passed in the Chamber of Deputies, which introduces an exceptional procedure to reinstate healthcare professionals struck off the registers during the Covid years, does not convince us and cannot remain as it stands. In the Senate, it is our intention to work towards amending it. I want to be clear, because on issues of this sensitivity, ambiguity serves no one. The right to express opinions, even critical ones, on healthcare decisions is sacrosanct, and no one intends to call it into question. It is a different matter altogether when it comes to the professional and ethical duties of those who wear a white coat. It is not for the legislator to use the law to wipe the slate clean, as if by magic, of decisions that fall within the remit of the professional bodies and concern individual conduct. We must not forget that during the pandemic, thousands of doctors, nurses and healthcare workers kept the country going under extreme conditions, and many of them lost their lives whilst caring for the sick. “When the bill reaches the Senate,” concludes Craxi, “our group will do its part to amend it, because the health of citizens and the credibility of the medical profession come before any ideological agenda.”