Supreme Court, Patients Are Not Required To Prove Medical Errors

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Patients seeking compensation for medical errors are not required to prove the occurrence of the error.
Italy Litigation, Mediation & Arbitration
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Patients seeking compensation for medical errors are not required to prove the occurrence of the error.

This was established by the Supreme Court in ruling no. 5922/2024, which reiterates the rules on the burden of proof, in response to the appellate court's decision, where this criterion was overturned.

Prior Rulings Before the Supreme Court

The issue began with a lawsuit against a local health authority by a patient seeking compensation for both economic and non-economic damages following a mistake by an anesthetist during a surgical procedure at a hospital under the said health authority.

During the surgery, spinal anesthesia was administered, but the needle deviated, causing pain to the patient and failing to produce the intended effects.

In the following month, the patient had to visit the emergency room twice and undergo several orthopedic and neurological examinations due to the discomfort caused by the anesthesia.

The final diagnosis was "paralysis of the right axillary nerve and the left hemidiaphragm," likely resulting from the anesthesia, despite a pre-existing cervical herniation.

The local court partially upheld the compensation claim, but in the subsequent appeal, the appellate court overturned this decision, siding with the health authority's argument that the plaintiff had not proven the medical negligence.

The Supreme Court's Ruling

The Supreme Court identified a fundamental error in the appellate court's application of the principles regarding the burden of proof.

The appellate court incorrectly assigned the burden of proving the healthcare provider's non-performance to the patient. However, in cases of contractual liability like medical malpractice, this burden does not fall on the harmed party.

The Supreme Court emphasized that it is well-established that the creditor/plaintiff must demonstrate the source of the credit and the causal link, proving that the professional's conduct was more likely than not the cause of the reported damage. Conversely, it is the debtor's responsibility to prove either proper performance or that unforeseen and unavoidable factors caused the non-performance, even with the adoption of ordinary diligence.

For these reasons, the Supreme Court upheld the patient's appeal, quashed the contested decision, and remanded the case to the competent appellate court in a different composition.

Contractual Liability

The liability of the healthcare facility must be classified as contractual liability when the patient claims to have suffered damage as a result of actions performed by medical staff during the service provided, by virtue of the execution of the service forming the subject of the obligatory relationship between the hospital and the patient.

Contractual liability requires that the creditor prove the source of their credit and specify the reasons for being wholly or partially unsatisfied. It is not their duty to prove the debtor's non-performance or incorrect performance. Instead, the debtor must prove proper performance or demonstrate that the non-performance was due to a cause not attributable to them.

Division of Burdens

The rules on the burden of proof, in the presence of a contractual legal relationship, stipulate that it is not the patient's task to prove that the doctors made an error. It is rather the caregiver's duty to demonstrate that they acted in the best possible way.

In summary:

  • The "creditor-plaintiff" who believes they have suffered damage must demonstrate the source of their credit (contract) and the causal link between the non-performance and the damage received.
  • The "debtor" defendant must demonstrate either proper performance or that the non-performance (or incorrect performance) was caused by an unforeseeable and unavoidable impediment despite ordinary diligence (i.e., acting in full compliance with the technical rules of their profession, as per Article 1176, second paragraph of the Civil Code), and thus is objectively not attributable to the agent.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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