Ateneo - UPO

The course addresses professional liability in healthcare from a managerial and organizational perspective, structured into three main areas:
1. Medico-Legal Framework and Legal Obligations: Analysis of the foundations of forensic medicine applied to healthcare management. It examines the legal status of healthcare coordinators and their duties toward the Judicial Authority (medical report vs. official complaint), alongside the protection of privacy, professional secrecy, and official secrecy.
2. Healthcare Liability (Gelli-Bianco Law): In-depth study of the dual nature of medical liability. In civil law, it explores the boundaries between the contractual liability of the facility and the tort liability of the individual practitioner, causation standards ("more likely than not"), and types of damages. In criminal law, manslaughter and negligent injury are analyzed alongside the application of official guidelines (Art. 590-sexies of the Italian Criminal Code). The section also covers administrative-revenue liability (recourse for gross negligence before the Court of Auditors) and structural liability as an essential part of clinical risk management.
3. Deontology, Consent, and Limitations of Liberty: Management of informed consent and Advance Directives (Law 219/2017) as tools of care, integrating the four principles of bioethics (beneficence, non-maleficence, autonomy, justice). Finally, the course examines the legal and organizational aspects of Involuntary Psychiatric Treatment (TSO) and physical/chemical restraint, analyzing their risk profiles and team liability dynamics.

Tagliaro, Bortolotti, Dimonte, Saiani, Raniero, Gibelli, Cittadini: Medicina legale e bioetica (Per i corsi di laurea delle professioni sanitarie) - Piccin editore 2021 - Cicognani, Fallani, Pelotti: Medicina Legale Società editrice Esculapio 2025 - Silingardi, De Leo, Itnrona et al: Medicina legale (per Studenti e Medici di Medicina Generale) Idelson -Gnocchi 2023 - Arnone, Carcarinino, Stornelli, Vicario: Le professioni sanitarie, Società editrice Universo 2024 - GINO S., CAENAZZO L., La Medicina Legale nella protezione dei Diritti Umani, Piccin Nuova Libraria S.p.A., Padova, 2021. - “Narrare la violenza. Cultura, cura e clinica” (a cura di Annamaria Fantauzzi), Giovanni Fioriti Editore s.r.l, Roma, 2020 - Codice civile/codice penale – Laws and materials discussed during the lessons

The course aims to provide future nursing and midwifery coordination, direction, and management figures with the legal, forensic, and ethical skills necessary to govern complex healthcare processes. The goal is to develop the ability to analyze the dynamics of team and structural responsibility, prevent litigation through the application of clinical-assistance best practices, and manage bioethical and deontological dilemmas from an organizational and clinical safety perspective.

No background knowledge is required

Lectures, seminars (including video-recorded sessions), and materials for individual in-depth study. Real-world Case Study Discussion

Students with physical disabilities, Learning Disabilities or Special Education Needs can request specific services and tools via the Staff Sviluppo e Coordinamento Carriere e Servizi alle Studentesse e agli Studenti, consulting the University webpage: https://www.uniupo.it/en/services/services-students-physical-or-learning-disabilities Students with disabilities, learning disabilities or special education needs, once they have contacted the University Staff, can refer to the tutor in charge of the course to define the examination modalities, concerning academic aspects.

Assessment will be integrated with the other course modules, taking the form of an oral or written examination where students may be asked to analyze a case study and apply the knowledge acquired during the course

Introductory Elements and Medico-Legal Framework
• Criminal and Civil Forensic Medicine: definitions and fields of application in healthcare management.
• The legal status of master-level healthcare professionals (Public Official, Person in Charge of a Public Service, Practitioner of a Service of Public Necessity).
• Relations with the Judicial Authority:
o The obligation of the medical report (referto) (for private practitioners) vs. the obligation of official complaint/referral (denuncia/rapporto) (for public officials or persons in charge of a public service).
o Safeguarding confidentiality: Professional secrecy, official secrecy, and privacy in the healthcare sector.

Healthcare Liability in the Light of the Gelli-Bianco Law
• The core relationship between law and medicine, and Law 24/2017.
• Civil Liability:
o Contractual liability of the healthcare facility (due to breach/qualified social contact) vs. extracontrattled (tort) liability (under Art. 2043 of the Italian Civil Code) of the individual practitioner.
o Causation (the causal link) in civil law (the "more likely than not" standard) vs. criminal law ("beyond a reasonable doubt").
o Pecuniary and non-pecuniary damages.
• Criminal Liability:
o Manslaughter (omicidio colposo) and negligent personal injury (lesioni personali colpose) in the healthcare setting.
o The application of Art. 590-sexies of the Italian Criminal Code: the role of guidelines (SNLG - National System for Guidelines) and clinical-assistance best practices.
• Administrative-Revenue Liability and Safety of Care:
o Right of recourse (rivalsa) of the healthcare facility against the employee for gross negligence before the Court of Auditors (Corte dei Conti).
o Organizational and structural liability of the clinic or hospital: the obligation to ensure the safety of care as an integral part of risk management.

Deontology, Consent, Bioethics, and Limitations of Personal Liberty
• Informed Consent: Historical and legislative evolution of consent as an integral "part of the treatment process" (tempo di cura).
• Refusal/withdrawal of treatment and Advance Healthcare Directives (DAT) from an organizational-managerial perspective.
• Elements of Bioethics:
o The four principles of bioethics according to Beauchamp and Childress: beneficence, non-maleficence, autonomy, and equity/justice.
• Involuntary Psychiatric Treatment (TSO): Legal prerequisites, safeguards, and organizational procedures.
• Physical and Chemical Restraint: Ethical, deontological, and legal aspects; restraint as a sentinel event, team responsibility, and profiles of kidnapping (sequestro di persona) or abuse/ill-treatment (maltrattamenti) in cases of unlawful use.

Upon successful completion of this course, the student will be able to:
• Knowledge and understanding: Distinguish between the different liability regimes (civil, criminal, administrative-revenue liability) and understand the reference regulatory framework (Law 24/2017 and Law 219/2017).
• Applying knowledge and understanding: Evaluate the legitimacy of informed consent processes, shared care planning, and the application of extraordinary measures (restraint, involuntary psychiatric treatment - TSO) within organizational units.
• Making judgements (Autonomy of judgment): Analyze complex clinical and organizational cases to identify potential medico-legal risk profiles, as well as systemic or team liabilities.
• Communication skills: Use appropriate legal and medico-legal terminology to interface with healthcare directories, legal advisors, and judicial authorities.