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    Interview to Gabriele Chiarini of Studio Legale Chiarini


    In Italy there are no up-to-date and credible data on errors in health care, not even reliable estimates. The statistics showing a decrease in claims do not include the increasing practice of self-recovery of health risk, i.e. the fund to compensate patients, which facilities set aside so as not to have to have recourse to insurance companies.

    Gabriele Chiarini, of Studio Legale Chiarini, is an expert in the field of health liability and compensation for personal injury caused by medical error. Chiarini and his staff have created a report – in italian language - on medical errors, which can be read for free at this link:

    https://www.chiarini.com/fenomenologia-errore-in-sanita/

    We met him to ask some questions

    The "medical errors" are a growing phenomenon in the U.S., but in Italy you can not have really reliable data, why?

    Currently, available estimates of health errors only include cases where there has been a complaint or claim by the patient or his relatives. All other events remain in the background, as health workers tend not to report adverse events spontaneously, very often for fear of repercussions. The main reason why it is very difficult to have exact data on medical errors, therefore, is that the errors reported in the statistics are significantly lower than those that actually occurred. Even in the U.S. the numbers of medical errors are rather controversial.

    For example, some studies speak of 100,000 deaths per year caused by errors in the United States (*), while others say that it is 251,000 deaths per year, so that medical errors would be the third leading cause of death in the country (*).

    These are hypothetical estimates and not actual data, also because the studies themselves show that less than 10% of medical errors are reported voluntarily (**).

    However, it would seem that error rates are significantly higher in the US than in other developed countries (such as Canada, Australia, Germany and the UK) (**).

    The latter figure could mean, in practice, only that in the U.S.A. there is a growing awareness of the extent of the phenomenon, and not that US doctors are worse than their Canadian, Australian, German or English colleagues.

    In your experience, can medical errors occur more frequently in public or private facilities?

    Insolvability is a cross-cutting phenomenon, so mistakes occur in both public and private structures. It is true, however, that some surgical procedures, especially on fragile patients or patients with important diseases, can lead to complications that are difficult to manage in a private facility. This means, from our professional experience, that private facilities may be more exposed to adverse health events.

    The report states that the responsibility for medical error, more than the individual, is often the responsibility of structure and organizational problems. So it's about lack of management in health care facilities? How can the problem be addressed?

    When we say that medical error is (almost) always due to an organizational failure, we want to emphasize that - except in exceptional cases of macroscopic individual responsibilities - even the errors of the individual have their roots in so-called "latent" systemic causes. The latter include, for example, outdated structural environments or machinery, lack of adequate clinical standards, low staff density, and poor organisation of workspaces or shifts.

    These are causes that arise very far from the patient (mostly from management decisions), and may remain unknown for a long time. Nevertheless, they provide fertile ground for individual error, which can have an immediate impact, even a very serious one, on the patients' health.

    Awareness of the possible causes of errors is a fundamental prerequisite for establishing appropriate countermeasures. Therefore, policies must be adopted to encourage the spontaneous reporting of adverse events, overcoming the traditional reluctance of health workers, often resistant to reporting mistakes for fear of punishment, disciplinary action, or even just damage to their reputation.

    In addition, the prevention strategy should include actions that directly affect the causes of the error, such as the spread of checklists and standard operating procedures, the creation of critical event reporting systems, the use of advanced computer systems for prescribing and managing the drug, trying to involve in this direction not only the management but all operational staff.

    Whenever a citizen feels that he or she has been the victim of medical error, what should he or she do to protect himself or herself as well as possible?

    The first thing to do is to try to understand whether what actually happened to the patient is a medical error. Then it is necessary to verify if this error is relevant for the law, that is if a damage has occurred for the patient and if this damage is causally connected to the error.

    When such preliminary investigations are successful, then we are dealing with a hypothesis of "medical malpractice", which can be managed from a legal point of view, favouring the path of claiming damages in civil proceedings, rather than the - much more difficult - one of complaint or complaint in criminal proceedings.

    It is therefore necessary to quantify the exact damage, identify the legal entity that is required to compensate it, open the accident with the responsible Structure and with the Insurance Company, if any, and then manage it out of court and - if necessary - before the competent judicial authority.

    For all these activities, you should seek advice from a health liability attorney, who should be supported by a legal practitioner and a specialist in the discipline involved.

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    (*) Rodziewicz TL, Hipskind JE, Medical Error Prevention, StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018-2018 Mar 30.

    (**) Anderson JG, Abrahamson K, Your Health Care May Kill You: Medical Errors, Stud Health Technol Inform. 2017;234:13-17.
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