Medical Malpractice In Italy: Who To Contact. Complete Guide On Complaints, Compensation And Legal Protections

Who to contact in cases of medical malpractice, meaning errors or omissions by healthcare personnel.

If a patient has suffered significant harm, it is advisable to contact a lawyer to assert their rights.

Medical malpractice includes incorrect diagnoses, inadequate treatments, negligence, organisational shortcomings within the healthcare facility, and any situation in which the applicable standard of care has been breached.

Not all adverse medical events are considered malpractice, only those that could have been avoided through proper professional conduct.

If medical error is suspected, it is essential to involve professionals with both legal and medical expertise.

Medical malpractice: who to contact to report a doctor or hospital

Depending on the objective (simple report, protection of rights or an actual legal action), one may contact:

• A medical malpractice lawyer
  This is the key professional for initiating legal proceedings and requesting potential compensation. They protect the patient's rights and guide them through the litigation process.
• A forensic medical doctor
  This specialist evaluates whether there is a causal link between the alleged medical error and the harm suffered by the patient.

Through an expert evaluation, they assess whether negligence occurred and the extent of the biological damage, providing a scientific basis for potential legal action.

• Medical specialists
  In addition to the forensic medical expert, other specialist doctors may be involved as technical consultants to analyse the medical records and confirm the error within their field of expertise.
• URP office (Public Relations Office)
  Located within hospitals, this office is the first formal point of contact for lodging complaints or reporting issues, although it does not provide legal assessment or compensation.
• Provincial Medical Council
  To request disciplinary sanctions against a doctor.
• Patient advocacy organisations
  Organisations offering initial guidance and support, often directing patients to qualified professionals or offering initial assistance.
• Judicial authority (Public Prosecutor's Office)
  If it is believed that a crime has been committed (serious negligent bodily harm or manslaughter), a criminal complaint may be filed with law enforcement or the Public Prosecutor. Legal assistance is highly recommended to follow the investigation.

Turning to an integrated team of lawyers and forensic medical experts is often the best solution for effectively managing suspected medical malpractice, transforming a suspicion into a concrete and well-documented action.

How to report a case of medical malpractice

If you suspect you have been the victim of a medical error or negligence, it is essential to follow a structured process in order to file a report.

Whether you are directly involved or seeking justice for a loved one, you should:

1. Request the medical records

This is the patient's right. The patient, a family member or a lawyer may request the records.

2. Gather all medical documentation

Tests, subsequent reports, photos of the injury (if useful), and witness statements. Without accurate documentation, proving the error is nearly impossible.

3. Analysis of the documentation

To determine the seriousness of the event and the potential liability of the doctor, nurse or healthcare facility, the review may be entrusted to a lawyer, who will assess the facts from a legal standpoint and have the medical records reviewed by a trusted forensic medical expert.

Alternatively, one may consult a forensic medical doctor directly to assess the error and determine whether there are grounds for legal action.

The forensic medical expert is the specialist responsible for assessing the biological consequences of medical malpractice.

After this overall assessment, once the legal and medical elements have been analysed, the appropriate course of action can be chosen.

If represented by a lawyer, they may decide to submit a formal compensation claim (letter of demand) or commence legal proceedings (civil or criminal) before the competent authorities.

Reporting medical malpractice: civil or criminal proceedings?

The choice between civil and criminal proceedings in cases of suspected medical malpractice depends on the desired outcome: compensation for damages or establishing criminal liability.

One does not exclude the other, but only in the most serious cases involving clear wrongdoing will a lawyer typically recommend pursuing both avenues.

Who to sue: the doctor or the healthcare facility?

In suspected medical malpractice, claims are more often filed against the healthcare facility (hospital, clinic, local health authority).

Under Italian law, the healthcare facility is liable for its own negligence and for the negligence of the doctors working within it (contractual liability).

Advantages:

• Ten-year limitation period
• Lower burden of proof: the patient must prove the damage and the causal link, not the specific fault

If acting against the doctor directly (non-contractual liability), the statute of limitations is five years, and the claimant must prove fault, damage and causation.

Criminal liability

Criminal proceedings apply when the conduct constitutes a crime. The injured party may join the proceedings as a civil claimant to seek damages.

Important: the limitation period begins when the patient becomes aware of both the harm and its cause.

Mandatory mediation and Preventive Technical Assessment (ATP) in medical malpractice

Mandatory mediation and the Preventive Technical Assessment (ATP) are out-of-court procedures that serve as conditions of admissibility for filing a civil lawsuit in medical malpractice cases.

Mediation cannot be bypassed if one intends to go to court.

Mediation:

1. Filing of application
2. Maximum duration: 3 months
3. Possible agreement with enforceable effect

ATP (Preventive Technical Assessment) under the Gelli Law (Law 24/2017):

1. Application to the court
2. Appointment of a court-appointed expert (CTU)
3. Expert assessment in adversarial proceedings
4. Attempt at settlement
5. High evidentiary value in subsequent legal proceedings

Healthcare insurers always participate, as they are responsible for paying compensation.

The role of the Judge in medical malpractice cases

The judge's role varies depending on the stage:

• Before the lawsuit (ATP stage):
  The judge appointed for precautionary proceedings appoints one or more court-appointed experts (CTUs).
  They oversee the expert procedure, ensure adversarial participation, and actively encourage settlement based on the expert's findings.
• During the lawsuit (mediation stage):
  If a case is filed without mandatory mediation or ATP, the judge declares the claim inadmissible and instructs the parties to initiate mediation or ATP.
  The judge may order delegated mediation at any point if the dispute appears suitable for settlement.
• Acquisition of results:
  The expert report produced during ATP is admitted into the subsequent civil proceedings without requiring a new assessment, except in exceptional circumstances.

Statute of limitations for seeking compensation in cases of medical malpractice

The limitation period is 10 years for actions against the healthcare facility (contractual liability) and 5 years for actions against the individual employed doctor (non-contractual liability).

The clock starts when the damage becomes apparent and when the causal link between the medical conduct and the harm is known or could have been known with ordinary diligence.

Limitation periods in medical malpractice cases

In detail:

• 10 years:
  For legal actions against the healthcare facility (contractual liability).
• 5 years:
  For legal actions against the hospital doctor (non-contractual liability under Article 2043 of the Civil Code).

Commencement:
The limitation period begins when the victim becomes aware of the damage and of the causal link between the medical error and the harm suffered.
It does not automatically begin at the moment of the event but when the damage becomes perceptible.

Criminal complaint:
For filing a criminal complaint, the time limit is 3 months from when the potential offence is discovered.

Medical records: their importance in medical malpractice cases

Medical records are crucial in malpractice cases because they officially document the entire course of treatment, providing essential data to reconstruct the events, assess potential medical errors and support a compensation claim.

They are vital for forensic medical assessments and represent the primary source for proving negligence or omissions, containing detailed information on diagnoses, therapies, medications administered and the patient's response to treatment.

Role of medical records in malpractice cases

Medical records are essential for:

• Reconstructing events:
  If properly compiled, they reconstruct all medical procedures, treatments and observations chronologically and accurately.
• Evidence of facts:
  They are the key evidence for demonstrating medical error. Their contents, analysed by forensic experts, can reveal inconsistencies, omissions or negligent conduct.
• Forensic medical assessment:
  They form the basis for medico-legal evaluations to determine whether the patient suffered harm due to medical error.
• Completeness:
  Failure to record vital data such as vital signs, test results, administered medications or allergies may compromise care and disadvantage the patient during litigation.

Medical records are public documents, and altering or tampering with them constitutes the crime of falsifying a public document, rendering the documentation unusable and increasing liability.

The patient has the right to obtain a copy of their medical records. The law requires transparency and does not allow facilities to delay or withhold them without valid reasons.

Protocols for the prevention of nosocomial infections

Prevention protocols include hand hygiene, the use of personal protective equipment (gloves, masks, gowns, goggles), sterilisation and disinfection of instruments and environments, safe management of invasive devices such as catheters and ventilators, proper disinfection and waste management, and adequate environmental hygiene and sanitation of systems.

Continuous staff training and appropriate use of antibiotics according to international guidelines, including those of WHO, are also essential.

Failure to follow prevention protocols for nosocomial infections (HAIs) has serious negative consequences for patients, healthcare personnel and the system as a whole, and may give rise to healthcare liability.

Duration of a medical malpractice case

A medical malpractice case may last:

• 1 to 3 years if resolved during mediation or ATP
• 3 to 7 years if it proceeds to judgment

Timeframes depend on clinical complexity and insurer participation.

Cost of a medical malpractice case

Fees for lawyers and medical experts vary based on:

• Case complexity
• Need for forensic medical expertise
• Out-of-court or in-court phase