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Original Research

Open Access Special Issue

Fear of the COVID-19 and medical liability. Insights from a series of 130 consecutives medico-legal claims evaluated in a single institution during SARS-CoV-2-related pandemic

  • Matteo Nioi1,†
  • Pietro Emanuele Napoli2,†
  • Gabriele Finco3
  • Roberto Demontis1
  • Maurizio Fossarello2
  • Ernesto d'Aloja1

1Department of Clinical Sciences and Public Health, University of Cagliari, Forensic Medicine Unit, 09124 Cagliari, Italy

2Department of Surgical Science, University of Cagliari, Eye Clinic, 09124 Cagliari, Italy

3Department of Clinical Sciences and Public Health, University of Cagliari, Anesthesiology Unit, 09124 Cagliari, Italy

DOI: 10.22514/sv.2021.098 Vol.17,Issue 4,July 2021 pp.79-85

Submitted: 28 March 2021 Accepted: 14 May 2021

Published: 08 July 2021

*Corresponding Author(s): Matteo Nioi E-mail:

† These authors contributed equally.


Objectives: The aim of the current work was to evaluate the frequency and the type of cases of medical liability from a single center in the first ten months of the pandemic as well as to identify critical issues associated with the organization of public health during the coronavirus disease 2019 pandemic.

Methods: We compared 130 cases evaluated for medical liability from March 2020 to January 2021 and compared with 159 cases from March 2019 to January 2020. The cases were divided in four pre-established groups: surgical error, diagnostic/therapeutic errors and nosocomial diseases, delays, and problems related to assistance.

Results: Analysis showed a significant increase in cases due to delay in treat-ment/hospitalization and shortages in health care of non-autonomous patients [χ2 (1, N = 289) = 5.6746, p = 0.02].

Conclusions: The work showed an increase in medical/legal cases regarding non-COVID-19 emergencies in which the outcome is related to the time of treatment and/or arrival at the hospital. There was also a rise in complaints of deficits in supervision and care for non-autonomous patients. Despite the persistence of preventive measures for the current pandemic, measures should be taken to improve health care in these categories of patients.


COVID-19; COVID-19 and medical liability; Medico-legal claims; COVID-19 and forensic pathology; COVID-19 penal shield; COVID-19 risk management; COVID-19 and triage; COVID-19 delay; Surgical error; medical error; Lockdown effects; COVID-19 fragile patients; COVID-19 mental health; COVID-19 childbirth; SARS-Cov-2

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Matteo Nioi,Pietro Emanuele Napoli,Gabriele Finco,Roberto Demontis,Maurizio Fossarello,Ernesto d'Aloja. Fear of the COVID-19 and medical liability. Insights from a series of 130 consecutives medico-legal claims evaluated in a single institution during SARS-CoV-2-related pandemic. Signa Vitae. 2021. 17(4);79-85.


[1] Hickson GB. Patient Complaints and Malpractice Risk. Journal of the American Medical Association. 2002; 287: 2951–2957.

[2] Napoli PE, Nioi M. Global spread of coronavirus disease 2019 and malaria: an epidemiological paradox in the early stage of a pandemic. Journal of Clinical Medicine. 2020; 9: 1138.

[3] Napoli PE, Nioi M, d’Aloja E, Fossarello M. The ocular surface and the coronavirus disease 2019: does a dual ‘ocular route’ exist? Journal of Clinical Medicine. 2020; 9: 1269.

[4] Akhmerov A, Marbán E. COVID-19 and the heart. Circulation Research. 2020; 126: 1443–1455.

[5] Puelles VG, Lütgehetmann M, Lindenmeyer MT, Sperhake JP, Wong MN, Allweiss L, et al. Multiorgan and renal tropism of SARS-CoV-2. New England Journal of Medicine. 2020; 383: 590–592.

[6] Wright A, Salazar A, Mirica M, Volk LA, Schiff GD. The invisible epidemic: neglected chronic disease management during COVID-19. Journal of General Internal Medicine. 2020; 35: 2816–2817.

[7] Napoli PE, Nioi M, Fossarello M. The “quarantine dry eye”: the lockdown for coronavirus disease 2019 and its implications for ocular surface health. Risk Management and Healthcare Policy. 2021; 14: 1629–1636.

[8] Nouri S, Khoong EC, Lyles CR, Karliner L. Addressing equity in telemedicine for chronic disease management during the Covid-19 pandemic. NEJM Catalyst Innovations in Care Delivery 2020; 1.3.

[9] Louvardi M, Pelekasis P, Chrousos GP, Darviri C. Mental health in chronic disease patients during the COVID-19 quarantine in Greece. Palliative and Supportive Care. 2020; 18: 394–399.

[10] DeJong C, Katz MH, Covinsky K. Deferral of care for serious non–COVID-19 conditions. JAMA Internal Medicine. 2021; 181: 274.

[11] Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: a global survey of views from healthcare professionals. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020; 14: 965-967.

[12] Mauro V, Lorenzo M, Paolo C, Sergio H. Treat all COVID 19-positive patients, but do not forget those negative with chronic diseases. Internal and Emergency Medicine. 2020; 15: 787–790.

[13] Nioi M, Napoli PE, Fossarello M, d’Aloja E. Autopsies and asymptomatic patients during the COVID-19 pandemic: balancing risk and reward. Frontiers in Public Health. 2020; 8: 595405.

[14] Bogdanović M, Atanasijević T, Popović V, Mihailović Z, Radnić B, Durmić T. Is the role of forensic medicine in the covid-19 pandemic underestimated? Forensic Science, Medicine and Pathology. 2021; 17: 136-–138.

[15] Gualniera P, Mondello C, Scurria S, Oliva A, Grassi S, Pizzicannella J, et al. Experience of an italian hospital claims management committee: a tool for extrajudicial litigations resolution. Legal Medicine. 2020; 42: 101657.

[16] MARSH. Report MEDMAL -SINTESI Studio sull’andamento del rischio da medical malpractice nella sanità italiana pubblica e privata. 9th Ed. 2018 Available at: (Accessed: 1 May 2021).

[17] MARSH. Report MEDMAL -SINTESI Studio sull’andamento del rischio da medical malpractice nella sanità italiana pubblica e privata. 10th Ed. 2019 Available at: (Accessed: 1 May 2021).

[18] MARSH. Report MEDMAL -SINTESI Studio sull’andamento del rischio da medical malpractice nella sanità italiana pubblica e privata- EXECUTIVE SUMMARY 11th Ed. 2020 Available at: (Accessed: 1 May 2021).

[19] Blecker S, Jones SA, Petrilli CM, Admon AJ, Weerahandi H, Francois F, et al. Hospitalizations for chronic disease and acute conditions in the time of COVID-19. JAMA Internal Medicine. 2021; 181: 269–271.

[20] Secco GG, Zocchi C, Parisi R, Roveta A, Mirabella F, Vercellino M, et al. Decrease and delay in hospitalization for acute coronary syndromes during the 2020 SARS-CoV-2 pandemic. Canadian Journal of Cardiology. 2020; 36: 1152–1155.

[21] Findling MG, Blendon RJ, Benson JM. Delayed care with harmful health consequences—reported experiences from national surveys during coronavirus disease 2019. JAMA Health Forum. 2020; 1: e201463.

[22] De Filippo O, D’Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, et al. Reduced rate of hospital admissions for ACS during Covid-19 outbreak in Northern Italy. New England Journal of Medicine. 2020; 383: 88-89.

[23] d’Aloja E, Finco G, Demontis R, Napoli PE, Fossarello M, Nioi M. COVID-19 and medical liability: Italy denies the shield to its heroes. EClinicalMedicine. 2020; 25: 100470.

[24] Nioi M, Napoli PE, Lobina J, Fossarello M, d’Aloja E. COVID-19 and Italian healthcare workers from the initial sacrifice to the mRNA vaccine: pandemic chrono-history, epidemiological data, ethical dilemmas, and future challenges. Frontiers in Public Health. 2020; 8: 591900.

[25] Solomon MZ, Wynia MK, Gostin LO. Covid-19 crisis triage—optimizing health outcomes and disability rights. New England Journal of Medicine. 2020; 383: e27.

[26] Napoli PE, Nioi M, d’Aloja E, Fossarello M. Safety recommendations and medical liability in ocular surgery during the COVID-19 pandemic: an unsolved dilemma. Journal of Clinical Medicine. 2020; 9: 1403.

[27] Nioi M, Napoli PE, Ferreli F. Fatal iatrogenic pituitary apoplexy after surgery for neuroophthalmological disorder. Anesthesiology. 2019; 130: 822.

[28] Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID‐19 during pregnancy and childbirth. International Journal of Gynecology & Obstetrics. 2020; 150: 47–52.

[29] Ahlers-Schmidt CR, Hervey AM, Neil T, Kuhlmann S, Kuhlmann Z. Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic. Patient Education and Counseling. 2020; 103: 2578–2582.

[30] Souto SPA, Albuquerque RS, Prata AP. Fear of childbirth in time of the new coronavirus pandemic. Revista Brasileira de Enfermagem. 2020; 73: e20200551.

[31] Arbaje A. Coronavirus and COVID-19: caregiving for the Elderly. 2020 Avaialble at: (Accessed: 1 May 2021).

[32] Araújo MPD, Nunes VMA, Costa LA, Souza TA, Torres GV, Nobre TTX. Health conditions of potential risk for severe Covid-19 in institutionalized elderly people. PLoS ONE 2021; 16:e0245432.

[33] Banerjee D. ‘Age and ageism in COVID-19’: elderly mental health-care vulnerabilities and needs. Asian Journal of Psychiatry. 2020; 51: 102154.

[34] Araújo PO, Freitas MYGS, Carvalho ESS, Peixoto TM, Servo MLS, Santana LDS, et al. Institutionalized elderly: vulnerabilities and strategies to cope with Covid-19 in Brazil. Investigación y Educación en Enfermería. 2021; 39: e07.

[35] Bojdani E, Rajagopalan A, Chen A, Gearin P, Olcott W, Shankar V, et al. COVID-19 pandemic: impact on psychiatric care in the United States. Psychiatry Research. 2020; 289: 113069.

[36] Steardo L, Steardo L, Verkhratsky A. Psychiatric face of COVID-19. Translational Psychiatry. 2020; 10: 261.

[37] Li LZ, Wang S. Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom. Psychiatry Research. 2020; 291: 113267.

[38] Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020; 7: 468–471.

[39] Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine. 2020; 113: 707–712.

[40] Klomek AB. Suicide prevention during the COVID-19 outbreak. The Lancet Psychiatry. 2020; 7: 390.

[41] Bambi S, Ruggeri M, Sansolino S, Gabellieri M, Tellini S, Giusti M, et al. Emergency department triage performance timing. a regional multicenter descriptive study in Italy. International Emergency Nursing. 2017; 29: 32–37.

[42] Weston V, Jain SK, Gottlieb M, Aldeen A, Gravenor S, Schmidt MJ, et al. Effectiveness of resident physicians as triage liaison providers in an academic emergency department. Western Journal of Emergency Medicine. 2017; 18: 577.

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