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AN EMBLEMATICAL CASE OF FIRST ACCESS IN EPILEPSY WHILE DRIVING ACCORDING TO THE ITALIAN LAW N. 41 OF 23 MARCH 2016 AND A REVIEW OF LITERATURE
Full text linkIntroduction: People with epilepsy, all over the world, have many problems in everyday life because of unpredictable seizures
that could hinder every human activity. In particular, they are restricted from driving because of the fear over seizure-related car accidents.
The purpose of this work is to raise some questions about risk of traffic accident, driving restriction and personal liability in
people with and without diagnosis of epilepsy.
Case presentation: We present a case of a 49-year-old woman who accidentally hit a pedestrian with her car, causing him severe
personal injury. After many clinical and instrumental examinations, the physicians diagnosed to her generalized epilepsy and she
started a daily anti-epileptic therapy.
Results: Studies have tried to estimate the real risk of road traffic accident in order to evaluate when a person with epilepsy
reaches an acceptable risk of driving, balancing public traffic safety and personal freedom, without a real success. Therefore, we present
an overview of laws regarding epilepsy-driving restriction and a recent court case related to a car accident during a first seizure,
according to the Italian law n. 41 of 23 march 2016 about personal injuries and murder caused by vehicular accident and a review of
Literature about the first seizure while driving.
Conclusion: We believe that the driver cannot be held liable for any personal injuries or murder caused by vehicular accident,
according to the Italian law n. 41 of 23 march 2016, likewise it happened in the case presented. Indeed, the crisis represent a temporary
reduction of liability (incapacity to understand and want), making the person not imputable for own actions during the time of
the seizure.
Keywords: first seizure, people with epilepsy (PWE), car accident, personal injuries
La nuova legge sulla responsabilità professionale: cosa cambia in punto di linee guida?
Full text linkIl tema della sicurezza delle cure e quello della necessità di affrontare il nodo della
responsabilità professionale sono per la prima volta affrontati in Parlamento nel 2012,
anno in cui è promulgato un primo provvedimento, il cosiddetto “Decreto Balduzzi”,
che introduce la doverosità di attenersi a linee guida quale riferimento
per la valutazione dell’eventuale colpa del medico. Le principali innovazioni che
la legge 24/2017 ha introdotto su questi aspetti sono la regolamentazione dell’esercizio
professionale, basata su linee guida accreditate e buone pratiche, e le ricadute che questo
comporta sul versante della responsabilità per colpa. Nel presente articolo offriamo
una chiave di lettura della nuova legge, con particolare riguardo alle linee guida,
proponendo anche un confronto con i dettami del precedente assetto normativo
sul tema
Shortage of plasma-derived medicinal products: what is next? narrative literature review on its causes and counteracting policies in Italy
Full text link: Introduction: This paper describes the peculiarities of the plasma-derived medicinal product (PDMP) market and illustrates the results of a review of the literature on policies aimed at counteracting the shortage of PDMPs. Characteristics of PDMPs: Plasma is primarily used for the industrial production of blood products (80%). The demand for PDMPs, particularly immunoglobulins (IGs), is increasing. However, the production of PDMPs is complex, long (7-12 months), and expensive, accounting, according to US estimates, for 57% of the total costs of PDMPs compared to 14% for small molecules. PDMP market: Unexpected increases in clinical need cannot be addressed in the short term. Once the demand for some diseases is satisfied, the collection and fractionation of plasma will only be used to supply some specific patients. Hence, the full weight of the marginal costs, which remain constant, are borne by a few products. According to last liter economics, the industry stops producing when the marginal revenue equals the marginal cost, thereby reducing the convenience of producing the most commonly used PDMPs (albumin and IG). The imbalance between the demand and supply of PDMPs was exacerbated by the COVID-19 pandemic, which further increased the cost of plasma collection. Shortage issue and possible solutions: Policies to counteract this imbalance have also been discussed. If the demand is inappropriate, it should be reduced. If the demand is appropriate and supply cannot be increased, the demand should be prioritized for patients for whom PDMPs are the only available treatment. If the shortage depends on insufficient supply and technical and allocative efficiency, both production and supply should be improved, together with incentives for all stakeholders involved in the PDMP market to increase the sustainability of production/supply. The paper is focused on this second issue, that is supply-driven unbalance
Mycobacterium Chimaera: Clinical and medico-legal considerations starting from a case of sudden acoustic damage
Full text linkMycobacterium Chimaera is a microorganism that can cause nosocomial infections particularly in patients undergoing cardiac surgery. The specific case presented herein shows an original clinical presentation of the infection: sudden unilateral deafness as a result of septic embolization. Medico-legal experts appointed by the court in a civil liability dispute analyzed the case and submitted their expert opinion. This article analyzes the peculiar and innovative aspect of professional liability that can be attributed to the healthcare facility and the manufacturer of the equipment used in the operating room from a medical-legal point of view
Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer: A case of medical liability?
No full textINTRODUCTION:
Wernicke's encephalopathy (WE) is a neurological syndrome caused by thiamine deficiency, and clinically characterized by ophthalmoplegia, ataxia and acute confusion. In developed countries, most cases of WE have been seen in alcohol misusers. Other reported causes are gastrointestinal tract surgery, hyperemesis gravidarum, chronic malnutrition, prolonged total parenteral nutrition without thiamine supplementation, and increased nutrient requirements as in trauma or septic shock. WE is a well-known postoperative complication of gastric restrictive surgery for morbid obesity, after which patients often experience protracted nausea and vomiting, leading to malnutrition and massive weight loss.
PRESENTATION OF CASE:
This case report concerns WE occurring in a patient who underwent Roux-en-Y subtotal gastrectomy for gastric cancer, and subsequently experienced neurological symptoms that proved irreversible probably due to the lengthy time elapsing between their clinical presentation and the diagnosis of WE.
DISCUSSION:
There have been some reports of WE occurring after total or subtotal gastrectomy for gastric cancer in non-obese patients with no history of alcoholism, but monitoring for WE has yet to be recommended in the clinical guidelines in this setting (as it has for bariatric surgery). Because of its rarity and variable clinical presentation, WE is often under-diagnosed and under-treated, and confused with other neurological problems.
CONCLUSION:
There is an urgent need for the specific guidelines to take into account not only the neoplastic follow-up of such patients, but also the possible side effects of necessary surgery, since this could help to ensure the timely diagnosis and management of WE in this setting, and to avoid, when possible, claims for medical malpractice that may cause enormous costs both in economical and professional terms
An unusual case of chronic cough: Professional liability in dentistry?
Full text linkForeign body aspiration (FBA) is a serious medical problem, also in dental practice. The case report describes the case of a patient who for 12 years has suffered from chronic cough as a result of the aspiration of a polymeric silicone resin fragment during a dental procedure. In November 2002, the patient was underwent dental care, and she points out that, when performing dental imprint, she had sensed that something "went down in the throat" but she was immediately reassured by the dentist. After lung CT was performed, the foreign body was identified and removed with benefit to the patient. The knowledge of this case report could be useful for dentists who perform dental impressions, to be aware of the fact that the material used is radiolucent e.g. cannot be seen on plan radiographs and it can be accidentally inhaled by the patient. The knowledge of the case is also important for doctors who come in contact with patients who previously underwent dental treatment, suffering from persistent cough, in the absence of positive radiological signs
Seventeen-Year Medical Professional Liability Experience in a Level III University Hospital
No full textIntroduction: In recent decades, the number of medical professional liability disputes has grown exponentially, becoming a well-studied aspect of public healthcare. Legal medicine is an essential tool in managing this phenomenon. Methods: This article reports the results of the analysis of disputes for medical professional liability in a Level III University Hospital in Italy. The study covers the time period from 01.01.2003 to 31.12.2019. Results: About 33% of claims have been compensated. Those claims fall within the following categories: 37% in the surgical field, 17% in the field of internal medicine, and 35% in the emergency care field. As for the types of a medical mistake, compensation was awarded in 30% of diagnostic error cases, 26% of therapeutic error cases, 47% of execution error cases, and 55% of organizational deficiency cases. Discussion: The difference in the rate of compensation between the various medical fields or types of error depends on specific medico-legal characteristics. The aim of advanced healthcare systems is to prevent medical liability disputes by analyzing this phenomenon and improving clinical risk management programs. In particular, according to our study, events related to organizational deficiencies are the most preventable. In addition, through the use of a dedicated reporting procedure, medico-legal analysis of malpractice cases may be the key to risk reduction. Conclusion: Every major hospital should set up a medico-legal watchdog responsible for collecting and analyzing information on professional medical liability disputes in order to prevent and manage such events
Organizational liability: new frontier of medical malpractice? Seventeen-year experience as a medico-legal observer
No full textBACKGROUND: The study of claims for medical malpractice can be a useful tool to understand Clinical Risk. Indeed, the identification of the events that cause or foresee damage to the patient allows the proposal of new strategies to prevent the recurrence of the same event. This ensures better medical case security and health maintenance of individuals and overall society. In particular, this study focuses on the cases regarding secondary errors due to organizational deficit in order to understand the origins of such organizational deficit and to start specific prevention measures.METHODS: The claims for medical damage were analyzed in the period between 1st January 2003 and 31st December 2019 and divided in specific sub-categories.RESULTS: The claims due to deficiencies in organizational responsibility covers 10% of the total cases. The distribution according to the macro-areas shows that the surgical field is the most represented area (68%). The classification of these deficiencies shows the preponderance of "sentinel events" (30%) compared to "diagnostic/therapeutic delay" (27%) and "infections" (23%).CONCLUSIONS: From the present research, it was possible to identify the main cause of errors and propose specific risk mitigating measures to prevent such errors due to system deficiencies
Editorial: Medico-legal aspects of clinical risk management and patient safety
Full text linkFrom the 1990s to date, clinical risk management has become an increasingly important issue in healthcare systems. Since the publication of “To err is human” in 2000, scientific evidence has shown the need for a new approach to handling adverse events in health systems. As a result, a new “no blame” culture has developed, and Clinical Risk Management has assumed a crucial role in healthcare systems because of the inherent repercussions on patient safety, optimization of clinical outcomes for patients, and reallocation of resources. [...
AMMINISTRAZIONE DI SOSTEGNO E DIRETTIVE ANTICIPATE DI TRATTAMENTO
No full textThe Italian institution of Support Administration allows a designated person to make
healthcare decisions on behalf of somebody incapable of clearly expressing their wishes.
In fact, the Support Administrator is in charge of looking after the personal interests of
the beneficiary.
The designation of the Support Administrator as a tool for someone to make effective
their advance directives in case of an accident or of a serious illness is controversial in the
Italian case law and literature. Italy currently lacks a legislation on advance directives
and living will, even if we can find some principles in the Convention on Human Rights
and Biomedicine, signed in Oviedo, and in the Italian Code of Medical Ethics and in the
Code of Conduct for Italian Nurses.
Due to this lack of regulation, guardianship judges have been asked from persons without
any health problem to appoint the Support Administrator in order to ensure compliance
with their healthcare advance directives. An established jurisprudence upholds this kind
of appeal, on the basis of article 408 of Italian Civil Code which reads as follow: « the
Support Administrator can be appointed in anticipation of an hypothetical future
incompetence ». With judgment No. 23707/2012 of 20 December 2012, Italian
Supreme Court has given preference to the opposite case law trend and has ruled that the
incompetence of the beneficiary must be simultaneous with the designation of the
Support Administrator.
This article considers the case law, both preceding and following judgment No. 23707/
2012 of the Supreme Court, and aims at a review of the concept of advance directive. In
the literature and in the case law the idea of advance directive is used even to describe a
present choice. We believe, though, that in these situations the person expresses wishes about a therapeutic project shared with the healthcare professionals and not to a single
medical treatment
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