from Leadership Medica n. 3/2000

Already before Minister Bindi, with an imperative act, sanctioned the National Health Service sole right of the Hospital and universities physicians' relations, there was in Italy who, wanting to advance this norm, took this decision completely free.
But even being few, they realized soon that practice was not in fact feasible, standing the serious lack of structures that could ensure those who opt, when free from contractual activities in ward, to practice the profession that, just in function or their choice, they could not practice outside the structure.
Naturally, having suffered a patrimonial damage, they enjoined the Hospital structure (Hospital of Vercelli), by legal proceedings, the payment of the damages they underwent.The Hospital Enterprise demurred the lack of competence of the judge and the case ended to the Supreme Court of Cassation that, in joint session, just these days, stated with the legal decision n. 41-2000, that the damaged physicians could apply directly for the lower court judge to get the reimbursement for the damage of no-income.
Many underwent passively this oppressive behaviour of the Bindi act, keeping inactive in front of a norm that, just in virtue of the so called silence-consent, turns inertia in consent, something of doubtful constitutionality and that will provoke avalanches of exceptions that will feed infinitive administrative cases.In a collective agreement it is not possible, indeed, in front of acts of very big contractual, professional and economic importance, personal level, to sanction a norm involving the acceptance of binds or benefits without an undersigning giving value to the real will of acceptance by the signatory.
But others and most serious are the reasons that will feed the infinitive administrative cases concerning this collective agreement that some trade unions wanted to undersign in exchange of a partiality of the economic and career advantages, deserved only to those members subjected to the norm and penalizing heavily who, even if represented by the same trade union, would not accept binds.
The very serious discrimination based on the stop to the careers of the physicians who are carrying on their hospital activity by carrying out the same tasks, in the same hours, in the same wards and with the same diligence as the other ones, may lead to different treatments.
But, getting back to the physicians of Vercelli, the greatest damage the Hospital Enterprises and the Italian health will have, will come just from the almost complete extension of the act that will enable practically to enforce itself, since it is not thinkable that Hospitals are able to ensure all physicians the practice of its professional activity inside Hospitals and therefore they will be compelled to reach an agreement with external structures (provided they are enough) and to pay damages to the myriad of claimants that, not practicing their profession, will apply for the lower court judge, to get paid the damages of the no-income.
Surely there's no reason to deceive oneself about the intervention and prospective surveys by the State Auditors' Department, but surely the delegation exerted by the Minister will open the floodgates to colossal administrative disputes that will keep the Hospital Enterprises in a continuous state of war against physicians and will go on creating bad health.

Amedeo Pavone