Medical Liability: Quantifying Damage in the Presence of Pre-existing Conditions

With judgment no. 2776 dated January 30, 2024, the Italian Court of Cassation once again ruled on medical malpractice liability. In the case under review, a patient died due to an intestinal perforation during a colonoscopy, which was followed by a septic infection.

According to the Court of Cassation, while the patient’s pre-existing medical condition may have contributed to the death, this circumstance alone is not sufficient to automatically exclude the healthcare professional’s liability. Instead, it may influence the calculation of compensation.

In the lower court ruling, the Court of Appeal of Florence found that the patient’s pre-existing conditions were not significant enough to exclude medical liability or affect the assessment of damages. The healthcare facility, however, appealed to the Court of Cassation, arguing that the pre-existing condition was sufficient to break the chain of causality, thereby excluding medical liability.

Nonetheless, the Court of Cassation upheld its prior position, ruling that when a harmful event is caused by both human conduct and a natural cause, the perpetrator of the wrongful act is liable for all the damages, even if they were partially caused by natural events. These natural events will only influence the quantification of damages.

In conclusion, the Court recognized that the patient’s pre-existing condition may result in a reduction in the amount of compensation awarded. However, it also reaffirmed that this condition does not automatically exclude the healthcare provider’s liability for the error committed.