{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:05:59Z","timestamp":1788300359030,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Over the past two decades, health litigation has followed an exponentially incremental trend. As insurance companies tend to limit their interest because of the high risk of loss, health facilities increasingly need to internalize dispute management. This study was conducted through a retrospective analysis of existing files concerning the civil litigation of the Sant\u2019Andrea Hospital in Rome. All claims from 1 June 2010 to 30 June 2019 were included. Paid claims were further classified according to the areas of health care inappropriateness found. Authors indexed 567 different claims along the study period, with an average number of 59 per year (range 38\u201377). The total litigation involved 47 different units; more than 40% concerned 5 high-incidence wards or services. Concerning the course of disputes, 91 cases were liquidated before a judicial procedure was instituted, while 177 cases landed in a civil court. Globally, 131 different claims hesitated in compensation, for a total of 16 million 625 thousand euros, 41% of which was related to the internal medicine area. Dealing with the inappropriateness analysis, clinical performance alone involved 76 cases, for a total of 10 million 320 thousand euros, while organization defects involved 20 disputes equivalent to 1 million 788 thousand euros. The aim of this study was to enhance the clinical risk management at our facility through a litigation analysis.<\/jats:p>","DOI":"10.3390\/ijerph18073425","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T14:51:12Z","timestamp":1616683872000},"page":"3425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Analysis of Inadequacies in Hospital Care through Medical Liability Litigation"],"prefix":"10.3390","volume":"18","author":[{"given":"Raffaele","family":"La Russa","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy"},{"name":"IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9571-2013","authenticated-orcid":false,"given":"Rocco Valerio","family":"Viola","sequence":"additional","affiliation":[{"name":"Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3689-0001","authenticated-orcid":false,"given":"Stefano","family":"D\u2019Errico","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health, University of Trieste, Strada di Fiume 44, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariarosaria","family":"Aromatario","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniello","family":"Maiese","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Ospedale Santa Chiara, Via Roma 55, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Anibaldi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5775-2276","authenticated-orcid":false,"given":"Christian","family":"Napoli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0358-7965","authenticated-orcid":false,"given":"Paola","family":"Frati","sequence":"additional","affiliation":[{"name":"IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy"},{"name":"Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1686-3236","authenticated-orcid":false,"given":"Vittorio","family":"Fineschi","sequence":"additional","affiliation":[{"name":"IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy"},{"name":"Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"615","DOI":"10.2174\/1389201020666190408094016","article-title":"New Rules on Patient\u2019s Safety and Professional Liability for the Italian Health Service","volume":"20","author":"Albolino","year":"2019","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1136\/bmj.j2277","article-title":"Italy recognises patient safety as a fundamental right","volume":"22","author":"Bellandi","year":"2017","journal-title":"BMJ"},{"key":"ref_3","unstructured":"(2007). The Joint Commission releases improving America\u2019s hospitals: The Joint Commission\u2019s annual report on quality and safety 2007. Jnt. Comm. Perspect., 27, 3."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1258\/hsmr.2009.009011","article-title":"The use of patient complaints to drive quality improvement: An exploratory study in Taiwan","volume":"23","author":"Hsieh","year":"2010","journal-title":"Health Serv. Manag. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.1111\/1475-6773.12623","article-title":"Building a National Surveillance System for Malpractice Claims","volume":"51","author":"Mello","year":"2016","journal-title":"Health Serv. Res."},{"key":"ref_6","first-page":"50","article-title":"Anticipating and controlling rising malpractice insurance costs","volume":"56","author":"Greve","year":"2002","journal-title":"Healthc. FinancManag."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/0025817220926943","article-title":"Is Covid-19 sowing the seeds for future litigation?","volume":"88","author":"Heppinstall","year":"2020","journal-title":"Med. Leg. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/0025817220926925","article-title":"The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?","volume":"88","author":"Bilotta","year":"2020","journal-title":"Med. Leg. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e299","DOI":"10.1097\/PTS.0000000000000793","article-title":"Liability of Health Care Professionals and Institutions During COVID-19 Pandemic in Italy: Symposium Proceedings and Position Statement","volume":"16","author":"Oliva","year":"2020","journal-title":"J. Patient Saf."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pagano, A.M., Maiese, A., Izzo, C., Maiese, A., Ametrano, M., De Matteis, A., Attianese, M.R., Busato, G., Caruso, R., and Cestari, M. (2020). COVID-19 Risk Management and Screening in the Penitentiary Facilities of the Salerno Province in Southern Italy. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17218033"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Piccioni, A., Cicchinelli, S., Saviano, L., Gilardi, E., Zanza, C., Brigida, M., Tullo, G., Volonnino, G., Covino, M., and Franceschi, F. (2020). Risk management in first aid for acute drug intoxication. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17218021"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.2174\/1389201018666170207124835","article-title":"Personalized Medicine and Adverse Drug Reactions: The Experience of an Italian Teaching Hospital","volume":"18","author":"Fineschi","year":"2017","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_13","first-page":"CD000259","article-title":"Audit and feedback: Effects on professional practice and healthcare outcomes","volume":"6","author":"Ivers","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1458938","DOI":"10.1080\/16549716.2018.1458938","article-title":"Key strategies to improve systems for managing patient complaints within health facilities\u2014What can we learn from the existing literature?","volume":"11","author":"Mirzoev","year":"2018","journal-title":"Glob. Health Action"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1108\/09526860810841165","article-title":"Patient claims and complaints data for improving patient safety","volume":"21","author":"Jonsson","year":"2008","journal-title":"Int. J. Health Care Qual. Assur."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1001\/jama.2011.813","article-title":"Paid malpractice claims for adverse events in inpatient and outpatient settings","volume":"305","author":"Bishop","year":"2011","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1108\/02689239610122306","article-title":"Patients\u2019 complaints as a management tool for continuous quality improvement","volume":"10","author":"Javetz","year":"1996","journal-title":"J. Manag. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bonetti, M., Cirillo, P., MusileTanzi, P., and Trinchero, E. (2016). An Analysis of the Number of Medical Malpractice Claims and Their Amounts. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153362"},{"key":"ref_19","unstructured":"National Association of Insurance Companies (ANIA) (2021, January 02). Executive Summary 2015\u20132016. Available online: www.ania.it\/InsuranceInsurance\/2015\u20132016\/ANIA-Italian-Insurance-2015-16.pdf."},{"key":"ref_20","unstructured":"Marsh Risk Consulting (2018). Report Medmal. Annual Report About Medical Malpractice Trends in Private and Public Health Facilities in Italy, Marsh Risk Consulting. [9th ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1056\/NEJMsa054479","article-title":"Claims, errors, and compensation payments in medical malpractice litigation","volume":"354","author":"Studdert","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"74","DOI":"10.4103\/2141-9248.181847","article-title":"Litigations and the Obstetrician in Clinical Practice","volume":"6","author":"Adinma","year":"2016","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2147\/RMHP.S238353","article-title":"Guidelines and Current Assessment of Health Care Responsibility in Italy","volume":"13","author":"Zerbo","year":"2020","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_24","first-page":"484","article-title":"Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation","volume":"40","author":"Levin","year":"2014","journal-title":"Jnt. Comm. J. Qual. Patient Saf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1001\/jama.1994.03520230061039","article-title":"Error in medicine","volume":"272","author":"Leape","year":"1994","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2174\/1389201020666190408095811","article-title":"Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: A Surveillance Study on Extra Hospital Stay and Direct Costs","volume":"20","author":"Giraldi","year":"2019","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_27","first-page":"496","article-title":"Healthcare acquired infections: Malpractice and litigation issues","volume":"31","author":"Siracusa","year":"2019","journal-title":"Ann. Ig."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2174\/1389201020666190408102221","article-title":"Medical Records Quality as Prevention Tool for Healthcare-Associated Infections (HAIs) Related Litigation: A Case Series","volume":"20","author":"Albano","year":"2019","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"D\u2019Errico, S., Pennelli, S., Colasurdo, A.P., Frati, P., Sicuro, L., and Fineschi, V. (2015). The right to be informed and fear of disclosure: Sustainability of a full error disclosure policy at an Italian cancer centre\/clinic. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0794-3"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cartocci, G., Santurro, A., La Russa, R., Guglielmi, G., Frati, P., and Fineschi, V. (2017). The choice of gadolinium-based contrast agents: A radiologist\u2019s responsibility between pharmaceutical equivalence and bioethical issues. Symmetry, 9.","DOI":"10.3390\/sym9110287"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bolcato, M., Fassina, G., Rodriguez, D., Russo, M., and Aprile, A. (2019). The contribution of legal medicine in clinical risk management. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-018-3846-7"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/2277-9531.131891","article-title":"Performance improvement through proactive risk assessment: Using failure modes and effects analysis","volume":"3","author":"Yarmohammadian","year":"2014","journal-title":"J. Educ. Health Promot."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"625","DOI":"10.2174\/1389201020666190408095050","article-title":"Advanced Loss Eventuality Assessment and Technical Estimates: An Integrated Approach for Management of Healthcare-Associated Infections","volume":"20","author":"Gatto","year":"2019","journal-title":"Curr. Pharm. Biotechnol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3425\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:41:11Z","timestamp":1760161271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18073425"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18073425","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]}}}