Gelli Law: the fight against medical malpractice


Presentation of survey results on the impact of the Gelli-Bianco law in the Court of Rome

Presented this morning in Rome at the Hall of the Nymphaeum Museum was the research entitled: “The Gelli-Bianco law and the preventive technical assessment. A first evaluation on the assessment of healthcare liability in the Court of Rome”. The field survey was carried out by Eurispes in collaboration with the XIII Section of the Court of Rome, Enpam and the Di Maria Pinò Law Firm, and is the first one to be conducted in this particular field in Italy.

The meeting was opened by the President of the Court of Rome, Roberto Reali, the President of Eurispes, Gian Maria Fara, and the President of Enpam, Alberto Oliveti. Discussing the results of the survey were: the President of the XIII Section of the Court of Rome, Alberto Michele Cisterna, Lawyer Franco Di Maria, Prof. Luigi Tonino Marsella, Prof. Lawyer Luca Di Donna, Lawyer Angelo Caliendo, Lawyer Vincenza Pinò, the President of the Eurispes-Enpam Observatory on  Health, Social Security and Legality, Gen. Carlo Ricozzi and the Deputy Director of Eurispes, Raffaella Saso. The work was coordinated by Prof. Lawyer Roberto De Vita.

The XIII Section of the Court of Rome (there is only a similar one at the Court of Milan), is composed of sixteen magistrates who deal exclusively with professional liability; within this liability, healthcare liability accounts for approximately 85%/90% of the total. The Court of Rome is the one that handles the largest number of medical liability and health facility liability cases among all Italian courts (about 35% of the total), the results of the survey are therefore well representative of the national figure.

Consultation of the XIII Section’s archive, starting with approximately 2,000 Preventive Technical Assessments from April 1st 2017 (the date on which the “Gelli-Bianco law” came into force) to December 31st 2021, made it possible to find the Preventive Technical Assessments carried out by 336 forensic doctors. A total of 1,380 technical assessments were considered.

The survey made it possible to make an initial, accurate assessment of the impact of the “Gelli law” with regard to the Preventive Technical Assessments aimed at conciliating disputes (art. 696 bis C.p.c.), which represent the first level of its application.

The Gelli law set itself, among others, a very precise objective: to fight so-called “defensive medicine, i.e. a series of behaviours adopted by the health professional towards the patient with the sole aim of avoiding the risk of civil and criminal litigation against the doctor and/or the medical facility. Defensive medicine, in addition to forcing doctors into the trenches, has an impact on the National Health Service of around 10 billion a year, which is equal to 0.75% of GDP (data updated to 2014).

Five years after the law came into force, despite the fact that some predictions still need implementing decrees in order to be able to unfold their effects, it appears from the results that, at least in part and speculatively for the area of civil liability, the law has achieved some of its objectives. The most significant finding is that in the analysis of the 1,380 cases examined, doctors were not personally involved in 70.3% of the instances, while they were personally involved in 29.7%.

The research shows that the PTAs that end positively for the patient are 65.3%, while the outcome was positive for the structure 31.1% of the time; in two-thirds of the cases, therefore, the professional liability of the healthcare structure and/or the doctor is effective. This is an unexpected data, precisely because the PTA, which represents the true fulcrum and hinge of the proceedings, is essentially nothing more than a judgement that doctors give on the work of other doctors. In 29% of the PTAs, the insurance company was called in.

Looking at the type of defendant, 40.4% of the time it was a public facility, 36.1% it was a private facility and, in 11% of the cases, it was a physical person/insurance doctor.

Analysing the details of the specialised sectors involved, it emerges that the most frequently involved branch is orthopaedics (16.3%), followed by surgery (13.2%) and infectivology (11.7%); overall, therefore, 41.2% of PTAs involve these three sectors.

The data therefore indicate, on one hand, how the majority of the requests for investigation are not pretextual and point to medical and healthcare structures’ responsibilities, and on the other hand, how the medical specialists called upon to evaluate, as technical office consultants, are correct and transparent in ascertaining the responsibilities of their colleagues. It is also shown that in some cases there is a problem with the functioning of the medical and hospital structures rather than a responsibility of the doctors.

The fight against the phenomenon of defensive medicine also and above all requires a systemic social and cultural intervention, centred on the right to adequate information for citizens on the effectiveness of healthcare interventions, built through dialogue between the patient and the doctor. A special effort, therefore, must be made in this direction.

the survey can be viewed after registering on the website at the link


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