Medicine: Night Calls

Late one night in June 1950, Giovanna Ricci, 35, wife of a Venice shopkeeper, gave birth to a fine, healthy boy. She had already borne two children without difficulty, and at first all seemed well. Then the attending midwife noticed symptoms of post-partum hemorrhage. Alarmed, she urged the Ricci family to call in Dr. Giovanni Lavezzi, who had examined Giovanna ten days before.

On the telephone Dr. Lavezzi demurred. It was late, he said, and he had to get up early next day to treat an out-of-town patient. Giovanna’s sister-in-law told Lavezzi that they would get another doctor and called Dr. Luigi Gardin, obstetrical consultant at Venice’s Ospedale al Mare. Gardin agreed to come, told Giovanna’s husband Carlo to meet him at a square near his house. Ricci waited at the appointed place for 40 minutes, then telephoned Gardin again. The doctor’s excuse: “I don’t have the instruments for the job. The case has been turned over to Bruno Tagliapietra, staff doctor on duty at the city hospital.”

Fatal Buck-Passing. Actually, Obstetrician Gardin had no assurance that Tagliapietra would take the case. In fact, Tagliapietra in the meantime had merely ordered a nurse to call still another physician, Feliciano Torres, a fashionable young doctor with a private practice. But Torres, too, pleaded lack of proper instruments. Moreover, he added, the Riccis’ house was much too far from his own.

Unaware of this buck-passing, Ricci started home after making his phone call, but met his brother-in-law, who reported that Giovanna now needed emergency treatment. Ricci ran over to the city hospital to find Tagliapietra, only to be informed that the doctor was busy.

By then it was 3 :30 a.m., and Giovanna had been hemorrhaging for an hour and 40 minutes. Frantically, Ricci finally went to the home of Dr. Francesco Strina, one of the city’s best-known gynecologists. Awakened, Strina refused to go to Giovanna’s aid; he would not “repair damage done” by the midwife, who, besides, worked with Dr. Lavezzi, a competitor.

Carlo Ricci hurried home and with his relatives carried his wife to San Cassiano Hospital. There, Dr. Lavezzi, who had finally appeared in response to a second call, tried to stop the hemorrhage. It was too late. At 4:30 a.m. Giovanna Ricci died.

Free to Continue. Anguished Carlo Ricci went to the police, and after due investigation Drs. Gardin, Tagliapietra, Torres and Strina were charged with manslaughter through negligence. (Dr.

Lavezzi was cleared on the ground that the Ricci family had told him they would get another doctor.) Last week, after lengthy investigation, Venice’s criminal court ruled on the case. Dr. Torres was fully exonerated, because he had not been called directly by the family. Dr. Gardin and Dr. Tagliapietra were both found guilty. Penalty: suspended five-month prison sentences, payment of court costs and damages yet to be fixed. The last and best-known of the four, 73-year-old Francesco Strina, won acquittal but only because of lack of sufficient evidence. The verdict in effect admitted that Strina’s intervention probably could not have saved Giovanna, but it implicitly rejected his plea that, as a private practitioner, he was not obliged to intervene in the first place.

If sustained, the ruling would establish a new precedent in Italian law, to the effect that any doctor has a legal as well as a moral responsibility to treat the critically ill, even though he holds no public post.* But at week’s end, guilty and innocent, all four doctors were free to continue their practice.

* No such legal requirement exists in the U.S., but as an unwritten rule, it is not broken lightly. If found guilty by his colleagues, an errant doctor can expect to lose his membership in the American Medical Association, resulting in virtual boycott by the profession.