I manage the Complex Risk Management Unit at the Gaetano Pini Orthopaedic Institute in Milan, presiding over the Clinical Risk Management Committee (C.G.R.C.) and the Claims Evaluation Committee (C.V.S.).

I took part in the Commission on Risk Management and medical legal problems at numerous Scientific Societies. I developed protocols for clinical risk management and helped implement several innovative procedures that have been acquired by Scientific Societies and implemented in several Italian hospitals including Gaetano Pini.

I helped implement various procedures and created and set up a checklist that is also used as a reference in the Lombardy Region General Health Directorate. I have participated in numerous courses at IREF.

I am part of the regional network and I also participates as a teacher at numerous training courses structured by the Lombardy Region.

I have been accredited since 1986 as an Expert Witness at the court in Milan and other cities, carrying out intensive survey activities particularly on the issue of medical liability.

I have been recognised and qualified by the Order of Physicians in Milan as an expert in Legal Medicine and Insurance.

Legal medicine has taken on increasing strategic importance for me. We must avoid defensive medicine and head back to harmony between doctors and patients, in a relationship of mutual respect for the roles and responsibilities as well as rights and duties. For years I have been organising conferences and seminars with national and international experts in the legal, medical and insurance field because I believe that medicine can only be improved through professional synergy in serving citizens.

Every year I organise national conferences and seminars regarding legal medicine. I work as a mediator and am

an Expert Witness

for the Public Prosecutor's Office.

Private Expert Witness

Technical consultant for insurance and multinational companies

Expert in institutional scientific committees

Mediator (with title recognised on both a national level and at the Milan order of physicians)

I work at the Complex Risk Management Unit at the Gaetano Pini Orthopaedic Institute. I have developed medical protocols and am part of the Committee for Risk Assessment in hospital legal medical disputes.

I helped implement various innovative procedures and created and set up a checklist that is also used as a reference in the Lombardy Region General Health Directorate. I have participated in numerous courses at IREF.

The Risk Management Policy implemented in the Lombardy Region starting on December 27, 2004 with Circular 46/SA of the General Directorate and subsequently ratified by Council Resolution on June 18, 2008 now seems definitively acquired by all structures in the Regional health System. At the G. Pini Institute these strategies have been received, making a real contribution to the structure of this upstanding path. In this regard a Complex "Reparative Orthopaedic Surgery - Risk Management" structure was created.

The innovative result of this clinical and managerial combination is in seeking to provide all around treatment to the patient who comes to the structure for the necessary medical treatments thus considering both correct management of clinic risk and disputes and concrete resolution of the potential biological damage of malpractice or poor patient care.

Analysis of the available data shows that the Orthopaedics and Traumatology specialisation:

Is the primary source of incidents and litigation;

Presents a greater perception of damage since it affects the locomotor apparatus, primarily involving the limbs.

Causes a severe dysfunctional problem that requires a burdensome human and economic expenditure for rehabilitation and social re-integration of the patient;

Frequently produces civil disability.

Even more, it seems important to complete the proactive and/or retroactive damage management as compensation for the injury to the person and property, reinforcing the possibility of a more favourable out of court settlement that is, however, practicable only if there is a way to contain the damage at the source.

In reality, the injured patient:

Only in exceptional cases will appeal to the criminal court against the health service... asks the proportioning of a sentence intending to point the responsibility at a specific healthcare provider and wants to pursue a criminal case; the organisation is less relevant as such, probably because it is attributable to evidence of the severity of the fault, if not fraudulent intent.

More frequently requests recognition by the civil court of damage in terms of compensation, both personal and property related.

s almost always confident at the beginning of the contractual relationship that binds him more to the company than the individual health worker to ensure the required treatment.

Is always looking for resolution of their illness, especially if iatrogenic or due to negligent error during recovery or outpatient care.

Almost always loses faith in the health care worker held responsible for the damage.

Often loses faith in the organisation that is the primary guarantor of the diagnostic-therapeutic treatment and consequently in the entire Health System with which the company is associated.

The difference lies in the medical or surgical correction of the damage, provided by recognised specialists in the field as organised in highly specialised and excellent hospitals. They are different from the original health care workers, but still agents within the same Regional Health System.

The winning Risk Management strategy introduced to improve the patient health guarantee as also recognised by the Constitution (Art. 32 Const. Rep. It.) is then implemented in a decisive way by taking care of the patient who is potentially or effectively injured but also with clinical specialised surgical treatments as both an outpatient or in the hospital.

These specialised and dedicated treatments are performed by proven professionals with recognised experience both surgically and managerially in resolving problematic data and complications being able to use a preferential channel to the services. This activity is especially aimed at respecting the patient as an individual.

This activity requires the allocations of means and resources as needed at a regional reference centre and for this reason must be established and structured for Orthopaedics and Traumatology at a prominent Specialised institute on a national and regional level such as G. Pini in Milan. This structure becomes the regional reference centre for treating those potentially injured with orthopaedic and traumatology diseases, acquiring cases from the entire regional and national territory and abroad as it is the COR already recognised as a reference centre by the SIOT and the European Advisory Board.

This skill and central service will help minimize loses and maximize the effectiveness of the final result according to an ergonomic criteria of economic sustainability as already evidenced by original studies in the pharmaco-economics sector.

It should be noted that such a regional reference centre with these specific tasks, which must have its own resources for the necessary structuring of the service and to rationalize the inevitable costs, must be part of a selected treatment centre with highly qualified and trained staff.