Judgment

Medical negligence: the Court of Cassation rules out the ‘excuse’ of excessive workload

Doctor convicted of misdiagnosis: working conditions did not affect the correct interpretation of an electrocardiogram

by Pietro Verna

15 June 2026

2' min read

Translated by AI

Versione italiana

Key points

The thesis that missed the mark

2' min read

Translated by AI

Versione italiana

Work overload cannot be cited as an “excuse” to rule out a doctor’s liability. This was established by the Court of Cassation in judgment no. 17569 of 2026.

The Supreme Court upheld the ruling by which the Naples Court of Appeal had found an A&E doctor liable for the death of a patient caused by a misdiagnosis (having confused “acute coronary syndrome” with ‘diffuse dorsal myalgia’ despite the electrocardiogram having shown ‘signs typical of critical stenosis of the coronary arteries’) and by failing to take measures that would have prevented the fatal outcome: testing for cardiac enzymes and transferring the woman to the cardiology ward or the catheterisation laboratory, where the patient could have undergone coronary angiography and angioplasty, with the possible insertion of a stent.

The Supreme Court’s ruling

In his appeal to the Court of Cassation, the doctor had argued that:

- on the day of the incident, “he had just completed a shift that had lasted for two consecutive days, without any support staff to assist him in the emergency department”, so that the “criminal immunity” introduced by Article 3-bis of Decree-Law No. 44 of 2021 (Urgent measures to contain the Covid-19 epidemic) would have been applicable;

- The patient’s husband reportedly failed to disclose her previous medical conditions, including a heart condition, which is why her medical history is incomplete.

The thesis that missed the mark

The Court of Cassation dismissed the appeal (“[The doctor] does not explain how the conditions of service would have prevented him from reading an electrocardiogram that showed signs clearly consistent with an acute myocardial infarction in progress”), pointing out that:

- the clinical findings from the electrocardiogram necessitated “the immediate activation of the protocol for acute myocardial infarction, regardless of the clinical history reported by the patient or their family members”;

- Article 3-bis of Decree-Law No. 41 of 2021 limits criminal liability for the offences of manslaughter and causing bodily harm through negligence, committed by healthcare personnel, “to cases of gross negligence only, but within a strictly defined scope: the events must have taken place during the state of epidemiological emergency [and] have a causal link with the extraordinary conditions caused [by] the pandemic”;

- there is no evidence to suggest that the failure to read the electrocardiogram and the consequent failure to initiate the patient’s care pathway “to emergency conditions comparable to those under anti-Covid regulations, which presuppose a causal link between the adverse event and extraordinary circumstances (limited scientific knowledge regarding the pandemic, deployment of non-specialist staff), and not merely individual fatigue or the ordinary workload of the shift”.

Hence the Supreme Court’s ruling: the appeal amounts to a “vague complaint” because it fails to set out the grounds that would have rendered unenforceable “tasks that are not complex and, above all, are required by the defendant’s role in the emergency department”.

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