Pratica Medica & Aspetti Legali
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Aspetti medico-legali della teleradiologia. Che cosa ci hanno insegnato i casi di Marlia e Barga
No full textTelemedicine is the use of information and telecommunications technology to provide, support and supplement traditional health care services at a distance, thus overcome the presence of physical, geographical, social and cultural barriers, and ensure effective and equitable availability of access to healthcare. However, in spite of the opportunities granted by the Telemedicine, its spread in the country is still affected by the presence of medico-legal problems.Teleradiology, the sector with the most large application e-Health service, uses integrated systems capable of transferring multimedia remote radiographs, ultrasound and computerized axial tomography and magnetic resonance imaging, for their interpretation, to ask for a second opinion in particularly complex cases, for a collegial review of a case and, finally, for a diagnosis in cases of emergency.In 2013, doctors and medical technicians of Radiology, working in two hospitals posted of AUSL 2 Lucca (“Marlia” and “S. Francesco di Barga”), were indicted for the crime of the unauthorised practice of the medical profession and for the violation of legal obligations relating to radiation protection. During the trials it was found that in the two hospitals were provided, after prescription, radiological basic building blocks, and the images were interpreted by a radiologist not present in the place, but using computer technology (RIS-PACS System).Criminal trials under review, in which all defendants were acquitted as requested by the prosecution, suggest that if the evidence and the law had been further enhanced, already under preliminary investigation, criminal prosecution would not have even started.In addition, the changes introduced by the Telemedicine services – among them the reorganization of the mode of service delivery, and the revolution of the doctor-patient relationship – impose a reflection on how to evaluate the responsibility of the professionals involved
L’infortunio lavorativo e la malattia professionale in un mondo del lavoro che cambia. Trattazione e obblighi del medico di base
No full text[The workplace injury and work-related illness in the changing world of work. Legal obligations of the family doctor]This article describes functions and tasks of INAIL (the Italian insurance institutefor workplace injury and work related illness), given the changes in the world ofwork with its relevant legislation. In addition, the article explains the mission ofINAIL, in the prevention, insurance and rehabilitation.The main concepts that characterize the work injury and occupational disease aredefined. Then the legal obligations of family doctors in the treatment of injuriesand work related illnesses are highlighted
Il regolamento generale sulla protezione dei dati e le principali innovazioni in materia di sanità elettronica
No full text[The General Data Protection Regulation and the main innovations in the field of e-health] At a distance of twenty years from the adoption of Directive 95/46/EC, the scenario has been changed. In particular, the use of Information and Communications Technologies has, among others, given: a) the definition of new business organizational models; b) new methods of collecting and usability of the data; c) the spread of digital forms for the storage of sensitive data; d) the increased transfer of personal data across national borders, internal and external.In light of these changes, the European Union has set new goals in terms of protection of personal data in order to establish an atmosphere of trust among consumers.The proposal for a General Data Protection Regulation was officially presented by the European Commission on January 25th 2012 and is pending approval.With the entry into force of the new regulatory text, also the national health system and the hospitals will be called upon to review methods of organization and internal processes. It is desirable to define new organizational policies that transpose three key elements of the proposed regulation: Privacy by Design, the Data Protection Office, the Privacy Impact Assessment
La valutazione medico-legale dell’impairment in età pediatrica ed evolutiva: linee di indirizzo
No full text[The medico-legal assessment of impairment in children and youth: an operative proposal] Medico-legal evaluation of the impairment (or permanent functional impairment) in disabled people not in working age is an underestimated issue in the Italian jurisprudential literature. This is due to several factors including the difficulty of grasping the many deviations observed in clinical practice compared to the theoretical trajectory that expresses the regularity of the physical and mental development of the human person, the difficulty of giving them a weight in terms of functional severity and the lack of multiaxial tools for this specific purpose.The authors reflect on this theme and, after taking into consideration the Italian laws and have shown the (many) unsolved problems, develop their operative proposal to be presented to the scientific community.This proposal, based on the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) approved by the World Health Organization, is intended to indicate the threshold levels needed to assess the severity of the progressive impairment. The proposal aims to give a clear path for the evaluation, to standardize the criteria for the granting of the expected economic benefits and to standardize levels of access, to ensure social equity
La Risonanza Magnetica Nucleare nei pazienti portatori di Dispositivi Impiantabili attivi: implicazioni legali
No full text[Nuclear Magnetic Resonance in patients with Active Implantable Medical Devices: legal implications]The Italian Ministerial Decree 02.08.1991 prohibits to perform Nuclear Magnetic Resonance (NMR) in patients with Active Implantable Medical Devices. This Decree is still in force despite the commercialization of new devices that, according to manufacturer, are compatible with NMR. The lacking of Decree updating generates a variety of behaviors, since physicians themselves are not in agreement concerning the decisions to take, especially in those cases in which there is uncertainty about the compatibility of the device. In these cases, the decision is left to the physician.This article provides a broad overview on the evolution of jurisprudence concerning the role and the responsibilities of physicians. Starting from the right to selfdetermination and the right to health guaranteed by Italian laws to the patients, informed consent was rendered compulsory, hypothesizing a different relationship between patients and doctors, more patient- than doctor-centered. However, rather than creating a more mature relationship among the two players, jurisprudence has evolved in the sense of growing responsibilities given to physicians, who are now harassed by several lawsuits. We hope that the still evolving healthcare jurisprudence will create a more serene atmosphere for healthcare professionals
La tecnica di analisi proattiva FMEA/FMECA per la gestione del rischio clinico in diagnostica di laboratorio
No full text[FMEA/FMECA proactive analysis technique for clinical risk management in laboratory diagnostics]At the IRCCS Rizzoli Orthopaedic Institute of Bologna the FMEA/FMECA technique has been used for several years in the laboratory diagnostics setting for the analysis of processes, the proactive identification of possible mistakes and the implementation of improvement actions. In five laboratories of the Institute, current critical processes have been mapped to identify priority risks. Therefore, the intervention priorities have been defined, the improvement plans implemented and the efficacy in reducing the risks evaluated. The results were assessed by calculating the index of improvement (IM), as the ratio between the value of the Risk Priority Number (RPN) obtained by an evaluation before (ex-ante) and after (ex-post) the improvement actions. In all analyzed diagnostic processes initial values RPN were reduced and all IM showed values > 1. In addition, as result of risk analysis, 75 improvement actions were implemented, divided into: training/information (18,7%), organizational changes (53,3%), acquisition/maintenance of equipment and technologies (10,7%), revision and elaboration of procedures/protocols (16%), structural adjustments (1,3%).The technique FMEA/FMECA has proven to be useful to identify critical and high-risk processes proactively and to implement improvement actions according to priorities
Il medico non incorre in responsabilità penale a fronte del ragionevole dubbio sul nesso di causalità. Commento a Corte di Cassazione - Quarta Sezione Penale, Sentenza 28 novembre 2014, n. 49654
No full text[Physicians don’t incur criminal responsibility if there is reasonable doubt about the causal link. Comment to: judgment of the Court of Cassation (28 November 2014, n. 49654)]Abstract non presente. Si riporta l\u27inizio dell\u27editorialeNell’ambito delle decisioni giudiziali afferenti la responsabilità medica, si ritengono ormai consolidati e pacifici gli orientamenti giurisprudenziali che assumono quale caposaldo delle proprie argomentazioni il portato della nota sentenza “Franzese” della Corte di Cassazione a Sezioni Unite [1], secondo cui, sostanzialmente, allineandosi al principio di diritto della “dimostrazione di colpevolezza al di là di ogni ragionevole dubbio”, di cui all’art. 533 comma 1, del codice di procedura penale: «La condotta del medico che si configuri come colposa, in presenza di probabilità solamente causali, non rappresenta più la condicio sine qua non, senza la quale cioè, nel giudizio controfattuale, si può affermare che l’evento lesivo non si sarebbe verificato ma, al contrario, che anche senza quella condotta colposa (o meglio, in presenza di una condotta medica non colposa), si può dire che quel particolare evento si sarebbe potuto verificare ugualmente» [2]
Alla ricerca della sicurezza e della qualità: il modello di miglioramento dell\u27Oncologia Medica nel Policlinico Universitario di Palermo
No full text[In search of safety and quality: the improvement model proposed by the Oncology Department of the Palermo University] Over the past 20 years the field of oncology has product therapeutic innovations that have radically changed the prognosis of the most prevalent malignancies, since introduction of so-called targeted molecular agents. As a result of these changes, also the management of cancer patients has become more complex requiring technologies and skills that involve many professionals (medical oncologists, biologists, molecular geneticists, surgeons, pathologists, radiologists, nurses and psychologists), each engaged in a different stage of the disease, with the common goal of ensuring the patient the best treatment available today.So as well as have the chemotherapy changed, have also changed the needs of patients during the execution of the chemotherapeutic program. These changes have affected several areas of therapeutic sphere and in particular the aspect of safety during prescription, preparation, distribution and administration of chemotherapy, and the psychological aspect of the cancer disease, which focused on the acceptance of the disease by using tools such as music, sports, painting and initiatives for the care of the physical appearance (make-up). Not only. The patient wants to be treated today with the guarantee that the proposed protocols are adhering to the most authoritative international guidelines and that staff are highly qualified in the management of all stages of the disease and possible toxicity observed during treatment.Here’s the experience of the Oncology Unit of the University Hospital of Palermo that proposes itself as a leader of a movement to improve the quality of care to offer today to cancer patients in Italy. * Altri coautori: Giuseppe Badalamenti 1, Giuseppe Cicero 1, Fabio Fulfaro 1, Gaetana Rinaldi 1, Sergio Rizzo 1, Antonio Galvano 1, Francesca Lo Vullo 1, Andrea Pasquale 2, Erminia Taormina 2, Dario Piazza 1, Rossella De Luca
I conflitti in ambito sanitario e l’istituto dell’ospitalità. La ragione/regione dell’etica
No full text[The conflicts in healthcare organizations and the principles of hospitality. The reason/region of ethics]In this work the author proposes the basis of a global ethical theory trying to understand and solve conflicts in healthcare organizations. The principles of hospitality, which since antiquity has a central place in social rules system, may be useful in analyzing the origins and in limiting the effects of this conflicts. Starting from the idea that the hospitality is the most realistic phenomenological expression of ethics, the conflicts ethical management in healthcare organizations should involve improving hospitality rules knowledge by healthcare professionals towards patients and colleagues, regarding medicine as a place of hospitality, where everybody is the guest of everybody, and setting hospitality above every other requirements in healthcare organizations
Gli aspetti medico legali nell’ambito della medicina specialistica ambulatoriale con attenzione alla branca di oculistica
No full text[Medico-legal issues of outpatient care, with a focus on ophthalmology]Over the centuries cultural and social changes have led to a substantial change in the rules of the medical profession and in the rules governing medical liability, with profound changes in the way we think about the medicine, the figure of the doctor, the patient and their relationship. Initially the focus of medicine has been the disease, then the doctor and, finally, the patient. This article will briefly summarize the main aspects of this change, focusing especially on the informed consent, the physician\u27s professional responsibility and the burden of proof