Medical Liability: Overcoming the Principle of Reliance in Team Activities

1. The fact

   As highlighted in legal commentary and Supreme Court case law, the evolution of the reliance principle emerged clearly in two significant judicial cases. In the first case, involving Policlinico di Monza, a gallbladder removal surgery performed between December 2011 and January 2012 led to the patient's death from multiorgan failure. The Supreme Court (Cass. 30626/2019) annulled the doctor's conviction with remand, establishing a favorable outcome that delimits the duty of mutual control with respect to the autonomy of individual functions.

   The second case, concerning Ospedale Santo Bambino in Catania, concluded with a final judgment. A gynecologist was convicted for the 2009 death of a fetus caused by hypoxic distress, while her colleague was definitively acquitted. According to the prosecution, upheld by the Supreme Court (Cass. 40316/2024), the convicted professional should have overcome reliance on standard guidelines and ordered continuous monitoring, evaluating the warning signs of uterine rupture. Defense arguments based on the division of tasks were rejected for her, as the error was deemed detectable through the ordinary knowledge of the specialization, whereas the colleague's acquittal demonstrates that there was no generic negligence by the entire team.

2. 

   The legal framework

   The core of the issue lies in the interplay among several statutory provisions. Article 40 of the Italian Criminal Code governs the causal link, establishing that failing to prevent an event that one has a legal duty to prevent is equivalent to causing it; this is the source of the doctor's so-called guarantor position toward the patient. Article 43 of the Criminal Code defines fault as negligence, imprudence, or unskillfulness, which within a team setting manifests as a failure of mutual oversight.

   Articles 110 and 113 of the Criminal Code regulate culpable cooperation, allowing criminal liability to be extended to those who, despite not physically committing the erroneous technical act, contributed to it through their own inertia. Finally, Article 590-sexies of the Criminal Code, introduced by the Gelli-Bianco Law, excludes punishability for unskillfulness only where guidelines appropriate to the specific case were followed; courts interpret this rule strictly when the concrete clinical situation requires deviating from standard protocols.

3. Case law trends

   The Supreme Court case law has clarified that the principle of reliance does not constitute an absolute shield. Each team member may rely on others' diligence only until circumstances arise that make a colleague's error manifest and macroscopic. In particular, the courts have held that the duty of supervision exists for so-called non-sectoral errors, meaning those that fall within the common knowledge base of an average professional in that field, regardless of the high specialization required for the specific medical act.

   Another fundamental pillar of the case law concerns the so-called duty of dissent. It has been established that, to be exempt from liability, a healthcare professional who observes a risky or erroneous decision by the team leader cannot remain silent, but must explicitly express dissent. Mere compliance with hospital hierarchy does not constitute a ground for excluding fault if the order received is patently dangerous to the patient's health.

5. Analysis drafted and verified with edit.legal

   To verify the provisions cited in this article, we used edit.legal. Test our legal AI on official sources and apply it to your own matters.

   Try edit.legal AI

8. Lessons for professionals

   1. Always record in the surgical report any technical dissent expressed during the operation.
   2. Implement cross-check protocols requiring team members to mutually verify critical steps of the procedure.
   3. Train staff on non-technical skills, particularly assertive communication, to overcome hierarchical barriers that hinder error reporting.
   4. Rigorously evaluate the invocation of the reliance principle in defense strategies, ascertaining whether the colleague's error was genuinely unpredictable and strictly specialized.

References: Cass. 30626/2019Cass. 40316/2024Articolo 40 Codice PenaleArticolo 43 Codice PenaleArticolo 113 Codice PenaleArticolo 590-sexies Codice PenaleLegge 24/2017 (Legge Gelli-Bianco)

Editorial oversight: Avv. Federico Papa·ICAMUpdated 17 September 2026Content drafted with AI support and subject to editorial source checks. Despite these controls, inaccuracies may remain: reports and rectification requests are welcome. Report a correction