A new ruling from the Italian Supreme Court establishes a revolutionary principle: healthcare authorities must compensate patients even when medical errors combine with pre-existing natural conditions. Patient vulnerability is no longer an excuse.
Court
Supreme Court - Third Civil Section
Ruling No.
Order 760/2026
Date
01/14/2026
Key Provisions
Art. 41 Cr.C., Art. 1226 C.C.
The causal relationship between conduct and a harmful event does not cease simply because pre-existing, simultaneous, or subsequent factors, independent of human action, also contributed.
— Art. 41 Italian Criminal Code - Concurrence of Causes
When a patient suffers health damage, the causes are often multiple: on one hand, there may be errors by medical staff; on the other, pre-existing pathological conditions already present in the patient's body.
Until now, many hospitals have attempted to reduce or eliminate compensation, arguing that the patient was already compromised and that the negative outcome would have occurred anyway.
With Order No. 760 of January 14, 2026, the Supreme Court established that if a doctor or local healthcare authority commits an error that worsens an already delicate situation, they cannot escape liability by invoking nature or bad luck.
The Italian legal system adopts the criterion of equivalence of causes: every element that contributed to creating the damage is considered a cause of it. Consequently, the healthcare facility must answer for the entire event on the level of so-called material causation, meaning the historical and factual reconstruction of what occurred.
The case examined by the judges of the Third Civil Section of the Supreme Court involved a baby girl born prematurely, hospitalized immediately after birth.
During her stay in the facility, the infant contracted two serious infections, requiring highly aggressive antibiotic therapy.
The child suffered permanent disability of approximately 30%, primarily due to severe hearing problems that compromised her quality of life from the earliest days.
The judge deemed the natural factor of auditory nerve immaturity to be prevalent.
The appellate judges, based on the Court-appointed Expert's conclusions, denied any compensation to the family.
The Supreme Court completely reversed the approach of the lower courts.
Because medical science could not establish with absolute certainty whether the child would have lost her hearing anyway, even without the hospital-acquired infection, the judges concluded that the natural factor was prevalent and absorbing, thereby denying all compensation. This decision proved to be contrary to the general principles of civil liability.
The Supreme Court completely overturned the lower courts' approach, introducing a fundamental distinction between two phases of evaluation:
Serves to establish whether human conduct actually contributed to the harmful event.
"If the hospital-acquired infection played a role, even minimal, in determining the child's hearing loss, then the causal link exists and is complete."
Intervenes at a second stage, once liability has been established.
"It serves to select which harmful consequences are actually attributable to the medical error and which would have occurred independently."
The Court clarified that the fact that an impairment was partly already "written" in the patient's natural condition does not automatically cancel the hospital's liability.
The judge cannot simply declare an inability to quantify the error's impact and then deny the right to compensation. On the contrary, the court must proceed with a proportional estimate of the damage, separating what derives from nature from what derives from human conduct.
One of the most delicate issues addressed by the ruling concerns precisely how to calculate compensation when medical science offers no absolute certainties.
If the technical consultant declares it impossible to mathematically separate the portion of damage caused by nature from that caused by human error, the judge cannot surrender to this uncertainty. The court must resort to the equitable assessment power provided by Art. 1226 of the Civil Code.
Determine the patient's overall disability percentage. In this case: 30%
Subtract the portion of damage that would have been present anyway due to natural pathology or pre-existing condition.
Example: Auditory nerve immaturity linked to prematurity.
The result represents the actually compensable damage, i.e., the portion attributable to the healthcare facility's error. This is the compensation amount.
When this subtraction cannot be quantified with scientific precision, the judge must examine all elements of the specific case to arrive at a figure that is fair: neither too generous toward the patient nor unjustly favorable to the healthcare authority.
The important thing is that the judge accurately explains the reasoning, clarifying how they arrived at that particular sum and on what concrete elements the assessment was based.
This Supreme Court decision has profound implications for the entire national healthcare system.
Hospitals and healthcare authorities can no longer rely on scientific uncertainty or the presence of natural factors to avoid the consequences of their errors.
Natural concurrence of causes no longer represents a legal shield to hide behind to avoid compensation.
Vulnerable patients — such as premature newborns, elderly patients with multiple conditions, or those suffering from chronic diseases — receive enhanced protection: their vulnerability does not diminish the duty of care.
For healthcare authorities, this translates into the need to constantly improve protocols for preventing infections and complications.
Any minimal deviation from good practices could result in a significant compensation obligation. Patient vulnerability does not diminish the healthcare facility's duty of care — it increases it.
If you believe you have suffered harm due to a medical error or healthcare negligence, this Supreme Court ruling could represent an important precedent for protecting your rights. Don't let the complexity of the matter discourage you.
Thorough evaluation of your medical records and circumstances
Accurate quantification using the differential method
Full representation through litigation or settlement