When you hear that a woman lost her uterus, and her newborn is in a coma because two obstetrician gynaecologists went into a fistfight in the delivery room of a university hospital in Sicily, your first thought is, “I can’t believe it.” Then the BMJ calls, and you must try to find a meaningful way to comment on the story, which is multifaceted and complicated like almost everything that happens in Italian healthcare.
At first glance, there are two doctors, a hospital doctor and a younger colleague. The younger doctor is the woman’s private gynaecologist and pushes for a caesarean section, while the older colleague, who is in charge at the Messina Policlinic, thinks it is not appropriate. The result is undoubtedly tragic, but it is unsurprising that the procedure went ahead, considering that the average rate for caesarean sections is 53% for Sicily (for the whole Italy it is around 37%).
The hospital immediately suspended both physicians. The “private” one is working at the hospital too, but in a “precarious” position (a plague of the public sector in Italy). Like many other physicians in Italy, he is being paid for his loyal services in an indirect way, with a scholarship. In theory he shouldn’t take care of patients, but in fact hospitals are full of practising physicians in similar situations. In this case the woman paid the doctor privately because this was the only way for her to be sure of being looked after by the same specialist all through the pregnancy, including the delivery, in the public hospital (when a woman is looked after privately by someone working in the hospital, the colleague in charge on the day of delivery usually doesn’t interfere: it’s standard practice, and it is considered fair play).
When the Minister of Health, Ferruccio Fazio, a physician himself, rushed to Messina to apologise personally to the couple – with a highly significant gesture that hit the news all over the world – he blamed the mixture of private and public assistance. And this adds an ironic note to the story, considering that one of the first decisions taken by the health ministry of the current centre-right government (well, there was officially no health ministry at the time, but that’s another story) was to delay the effects of a new law approved in 2007. The law stated that before the end of 2008, doctors working in public hospitals would have to choose whether they wanted to see their private patients inside the hospital, or they preferred to resign. But the government shifted the term to the end of 2012.
Now several investigations are trying to find out exactly what happened: during the preliminary phases, the doctors denied any physical confrontation, and the hospital authorities officially denied any delay in taking care of the woman in labour. The doctors are still denying they had a fight.
Fabio Turone is a freelance journalist and the president of the newly launched association “Science Writers in Italy.”