There is a new problem in healthcare that has escaped all control: the hiring abroad by Italian public and private hospitals of doctors and nurses without any verification of their qualifications. There are thousands of them, even in the most delicate departments. Working alongside suitably qualified Italian and foreign colleagues are operators who do not understand the language, do not know the names and active ingredients of the drugs, much less the medical nomenclature. Gaps highlighted in the shocking report of a doctor on call the night between 5 and 6 December at the San Raffaele hospital in Milan (here is the link).

San Raffaele and emergency solutions

The chaos for days in the high intensity advanced care medicine department (we also talked about it here) is in fact proof that this dangerous practice has infected even the national excellences of scientific research. From rooms to retirement homes, this adventurous approach to health – thanks to recruitment through cooperatives and subcontracting – has entered emergency rooms to the point of bringing chaos and incompetence into the most delicate specialties. Below is a notice, published on 3 December last, for the immediate hiring of nurses by a cooperative, to be allocated to San Raffaele in Milan (research by Alberto Berlini).

The complaint is qualified because it comes from Roberto Carlo Rossi, president of the Milan Medical Association. These are his words entrusted to the specialized newspaper “Quotidiano Sanità”: “There is a legal channel that allows operators not subjected to rigorous ordinary checks to enter highly complex departments, where any error can result in harm to citizens. A real madness. The situation that has been created in the high intensity departments, with staff recruited through an exceptional procedure, has shown such difficulties as to force the area to be blocked, patients to be diverted and emergency interventions to be taken”.

The emergency practice born from the pandemic

This is all incredibly legal. The practice began in the worst months of the pandemic, with article 13 of the Cura Italia decree. It was then extended by law decree 34/2023 and then renewed by the majority of Giorgia Meloni until 2027 with law number 187 of 2024. All these rules allow doctors and nurses with foreign qualifications, including non-EU ones, to work in Italy, bypassing the rigorous procedures for checking degrees and diplomas, department qualification, registration in the Orders and Italian language exam.

“We don’t even know how many there are – reveals the Milanese president of the Order of Doctors to Quotidiano Sanità -. There is not a single official, regional or national figure to understand how many doctors or nurses have entered hospitals in derogation of any sign of common sense. This law must be canceled now, not tomorrow. It is in fact creating a parallel system without the essential guarantees for the safety of care”.

The parallel system without guarantees

“A double track. On the one hand, those who follow the regular path: recognition of the qualification, language exam, registration in the Register, ethical responsibility. On the other, an alternative system, built in an emergency, which allows access to the profession without these fundamental guarantees. It is a wrong, dangerous approach and today we see the consequences. The San Raffaele case – insists Rossi – demonstrates that we are not faced with an abstract problem. We must close with this regulatory parenthesis”.

Recruitment abroad, however, becomes necessary to cope with the collapse in enrollments in university courses for nurses. “Young people don’t enroll because the process has become too long – explains Daniela Rottoli who with Margherita Napoletano, a trade unionist from Cub Sanità, prepared the report to the police on the events at San Raffaele (photo above) -. Once upon a time, three years of high school was enough to get you to nursing schools. Today you have to get to high school and then do another three years of university, for salaries and treatment in the ward that are no longer attractive. At this point they enroll in Medicine”.

Nurses paid a thousand euros a night: after the chaos, record expenses and resignation – by Fabrizio Gatti

The San Donato Group, after the resignation of the sole director of San Raffaele Francesco Galli, entrusted the clinical and strategic coordination of the departments to Silvio Berlusconi’s doctor, the head of Anesthesia and general resuscitation, Alberto Zangrillo. He won’t have an easy task. The shortcuts of paid doctors, who perhaps earn in a weekend as much as their permanent colleagues earn in a month, and of nurses recruited by cooperatives are also the emergency solution to the lack or flight of staff, towards public contracts richer than 300 or 400 euros per month. The chaos is therefore the consequence of the inability of the healthcare system – from the minister to the universities, down to the healthcare companies – to plan our future.

Incompetent contract nurses, dangerous situation and chaos in Medicine at San Raffaele: read the shock report – by Fabrizio Gatti