Pratica Medica & Aspetti Legali
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La responsabilità dell’ospedale per la somministrazione di farmaci
No full text[Hospital responsibility for drug administration]Malpractice cases may be related to different kinds of errors. Among them, it has been estimated that the poor or incorrect monitoring of adverse events is the leading cause of patients’ injuries in hospitals. Such cases can give rise to litigations where it is difficult to establish responsibilities. The Author discusses the case of a woman who reported a vestibular damage following streptomycin administration. Three sets of proceedings were faced, and different verdicts were returned. The processes focused on the evidence that should be presented by the ASL or by the damaged patient, and on the timing of administration of streptomycin, a known ototoxic antibiotic
La procreazione medicalmente assistita: profili penali e tutela giuridica dell’embrione
No full text[Medically assisted procreation: criminal implications and legal protection of the embryo]Medically assisted procreation is a challenging result in medical research. Since the first baby born after in vitro fecundation in 1978, technology has greatly grown: but at the same time also legal, moral and ethical questions have arisen. Different European countries have established different rules: here we analyse, in particular, the Law 40/04, which in Italy still regulates the matter, with all its implications and consequences. The topic is really complicated, and in Italy the legislator has decided to write restrictive measures, sometimes presenting lacks and contradictions. More recently guidelines and judgements have tried to fill these legislative gaps
Appunti di storia e di etica del consenso informato per la donazione di organi e tessuti da cadavere allo scopo di trapianto
No full text[History and ethics of informed consent for organs and tissues donation from cadavers for transplantation]This is an overview on the main Italian laws about the consent for post mortem organ donation. In 1957 a law established that organ donation could happen only if the subject had made his/her consent clear. In 1975 the presumed consent became a law, but relatives were allowed to present written opposition. Finally in 1999 silence as informed assent was asserted, that is to say that local health service had to notify to the citizens the request about the declaration on their will regard to organ donation. After that, they have to declare their choice: in case of lack of declarations, their will is considered in favour of donation. The problem is that the planned computerised registry office was never set up, thus preventing to be certain that the citizen has been informed, and making “silence as assent” principle inapplicable
“Crisi d’ansia reattiva”: un caso particolare di infortunio sul lavoro
No full text["Anxiety-crisis": a special case of an accident at work]To date, only a few case reports have been published on psychiatric disease due to an accident at work. In this article we describe a case of an employee who entered the emergency room after a verbal altercation with superiors and colleagues, complaining about turmoil. The diagnosis of “anxiety crisis” due to accident at work was made (“bullying”), and therefore the insurer (INAIL) justified the 105-day absence which followed this episode. The case was then submitted to a re-evaluation by INAIL itself, that this time judged only the 30 days following the altercation to be related to the accident at work, considering the remaining days to be due to a common disease, not attributable to the traumatic event. Here we discuss the peculiar features of this case: the nature of the illness diagnosed, the kind of onset, and the management of the injury by the health care authority (INAIL)
La medicina difensiva: una ricerca sul Pronto Soccorso in Italia
No full text[The defensive medicine: an investigation into Emergency Departments in Italy]This article presents the results of a survey focused on the measurement of the extent of defensive behaviours within the Emergency Departments in Italy, and on the comprehension of the related reasons. Defensive medicine takes place when physicians modify their behaviour to reduce the exposure to legal claims by patients. The phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. 90.5% of respondents declared that they had practiced at least one defensive medicine behaviour during the previous working month. This article discusses the factors, such as the blame culture and the increase of medical malpractice litigation, that may lead to defensive behaviours and result in negative effects both in terms of costs and patient safety. A clear need arises to promote a different approach which might cope the problem of medical error – at a cultural, organisational and legal level – just as in other organisations subjected to high-risk conditions. The deterrent of punishment does not increase the reliability of such organisations, nor improves their safety level
Farmaco equivalente, sicurezza del paziente e profili di responsabilità
Full text linkA diabetic patient under oral therapy with a generic drug had a sudden indisposition and hyperglycaemia due to the consumption of a tablet of another equivalent drug product – same active principle – with evident lack of therapeutic effect. The patient herself solved the problem by interrupting the new generic drugs and taking the one normally used. The general practitioner signalled the event to the Pharmacovigilance Centre that, in turns, signalled it to the Agenzia Italiana del Farmaco (AIFA), appointed to execute the controls. The case described is paradigmatic to discuss the responsibilities of the different actors involved (general practitioner, pharmacist, AIFA, and pharmaceutical industry)
Progetto e realizzazione di un sistema di incident reporting per la medicina generale
Full text linkClinical risk management is important in primary care, as most patients and most of their health problems are treated in this setting. The development of incident reporting systems is therefore important to improve patients safety. The Author describes the incident reporting system developed in 2009 by the Italian Society of Primary Care (SIMG – Società Italiana di Medicina Generale), in order to facilitate and organise the uniform reporting of critical incidents among General Practitioners. The system includes: a form for the spontaneous incident reporting, a coding system to identify each report, a classification of all the adverse events reported, and a feedback of the signalled event to the physician. The final aim is the identification of safety risks in healthcare, the creation of a “culture of safety” and the opportunity of learning from errors
Malattie oculari della terza età: quali i rischi e le difficoltà diagnostiche per il medico di famiglia?
Full text linkMedici sentinella: gli 007 dell’ambiente. Una rete di medici impegnati nel territorio a scoprire le cause ambientali delle malattie
No full text[Sentinel doctors: the 007 of the environment