Obituary: Dr. Franco Rotelli (1942-2023)
I was fortunate, honored, to meet Dr. Franco Rotelli last September in Trieste. Sadly, yesterday a towering figure of the psychiatric reform and democratic psychiatry left us. As a simple, heart-felt homage, I am posting a translation into English of the law 180/1978 (first published in the Official Gazette of the Republic, no. 133, in 16 May 1978), on voluntary and mandatory health checks and treatments:1
Article 1 - Voluntary and mandatory health checks and treatments.
Health checks and treatments are voluntary.
In the cases referred to in this law and in those expressly provided for by state laws, the health authority may order compulsory medical checks and treatments in compliance with the dignity of the person and the civil and political rights guaranteed by the Constitution, including as far as possible the right the free choice of doctor and place of treatment.
The mandatory health checks and treatments paid by the State and public bodies or institutions are implemented by the territorial public health centers and, where hospitalization is required, in public or affiliated hospitals.
During compulsory medical treatment, those subjected to it have the right to communicate with whoever they deem appropriate.
The mandatory health checks and treatments referred to in the previous paragraphs must be accompanied by initiatives aimed at ensuring the consent and participation of those who are obliged to do so.
Compulsory health checks and treatments are arranged by provision of the mayor, in his capacity as local health authority, on the motivated proposal of a doctor.
Article 2 - Obligatory health checks and treatments for mental illness.
The measures referred to in the second paragraph of the previous article can be ordered for people with mental illnesses.
In the cases referred to in the previous paragraph, the proposal for compulsory medical treatment may provide that the treatments are provided in hospital conditions only if there are psychic alterations such as to require urgent therapeutic interventions, if these are not accepted by the patient and if there is no are the conditions and circumstances that allow timely and suitable non-hospital health measures to be adopted.
The provision which provides for compulsory medical treatment in hospital conditions must be preceded by the validation of the proposal referred to in the last paragraph of article 1 by a doctor of the public health facility and must be motivated in relation to the provisions in the previous paragraph.
Article 3 - Proceedings relating to compulsory health checks and treatments in conditions of hospitalization due to mental illness.
The provision referred to in article 2 with which the mayor orders compulsory medical treatment in hospital conditions, accompanied by the motivated medical proposal referred to in the last paragraph of article 1 and the validation referred to in the last paragraph of the article 2, must be notified, within 48 hours of hospitalization, by municipal messenger, to the tutelary judge in whose district the municipality falls.
The guardianship judge, within the following 48 hours, having received the information and ordered any investigations, provides with a reasoned decree to validate or not validate the provision and informs the mayor. In the event of non-validation, the mayor orders the cessation of compulsory medical treatment in hospital conditions.
If the provision referred to in the first paragraph of this article is ordered by the mayor of a municipality other than that of residence of the patient, the mayor of this last municipality must be notified. If the provision referred to in the first paragraph of this article is adopted against foreign citizens or stateless persons, the Ministry of the Interior and the competent consulate must be notified, via the prefect.
In cases in which the compulsory medical treatment should continue beyond the seventh day, and in those of further extension, the medical professional in charge of the psychiatric service referred to in article 6 is required to formulate, in good time, a reasoned proposal to the mayor which has ordered the hospitalization, which communicates it to the guardianship judge, with the modalities and for the fulfilments referred to in the first and second paragraph of this article, indicating the further presumable duration of the treatment itself.
The doctor referred to in the previous paragraph is required to inform the mayor, both in the event of discharge of the patient and in the event of continuity of hospitalization, of the cessation of the conditions which require compulsory medical treatment; it also communicates any supervening impossibility to continue the treatment itself. The mayor, within 48 hours of receiving the communication from the doctor, informs the guardianship judge.
If the need arises, the guardianship judge adopts the urgent measures that may be necessary to conserve and administer the assets of the sick person.
The omission of the communications referred to in the first, fourth and fifth paragraph of this article.
Article 4 - Revocation and modification of the provision of compulsory medical treatment.
Anyone can apply to the mayor for the revocation or modification of the provision with which the compulsory medical treatment was ordered or extended.
The mayor decides on the request for revocation or modification within ten days. The revocation or modification provisions are adopted with the same procedure as the revoked or modified provision.
Article 5 - Judicial protection.
Whoever is subjected to compulsory medical treatment, and whoever has an interest in it, can propose to the competent court for the territory an appeal against the provision validated by the guardianship judge.
Within the term of thirty days, starting from the expiry of the term referred to in the second paragraph of article 3, the mayor may propose a similar appeal against the failure to validate the provision which provides for compulsory medical treatment.
In the process before the court, the parties can stand before the trial without defending themselves and be represented by a person with a written mandate at the bottom of the appeal or in a separate deed. The appeal can be presented to the court by registered letter with acknowledgment of receipt.
The president of the court fixes the hearing for the parties to appear with a decree at the bottom of the appeal which, by the clerk, is notified to the parties as well as to the public prosecutor.
The president of the court, having acquired the provision which ordered the compulsory medical treatment and having heard the public prosecutor, can suspend the same treatment even before the appearance hearing is held.
The president of the court shall act on the request for suspension within ten days.
The court decides in private, having heard the public prosecutor, after having obtained information and collected the evidence ordered by the office or requested by the parties.
Appeals and subsequent proceedings are exempt from stamp duty. The trial decision is not subject to registration.
Article 6 - Modalities relating to compulsory health checks and treatments in conditions of hospitalization due to mental illness.
The interventions of prevention, treatment and rehabilitation related to mental illnesses are normally carried out by the non-hospital psychiatric services and facilities.
Starting from the entry into force of this law, medical treatments for mental illnesses which involve the need for hospitalization and which are paid for by the State or public bodies and institutions are carried out, except as provided for in the following article 8, in the psychiatric services referred to in the following paragraphs.
The regions and autonomous provinces of Trento and Bolzano, also with reference to the territorial areas envisaged by the second and third paragraph of article 25 of the decree of the President of the Republic of 24 July 1977, n. 616, identify the general hospitals in which, within sixty days of the entry into force of this law, specific psychiatric diagnosis and treatment services must be established.
The services referred to in the second and third paragraph of this article - which are ordered according to the provisions of the decree of the President of the Republic of 27 March 1969, n. 128, for compulsory special services in general hospitals and which must not have a number of beds exceeding 15 - in order to guarantee the continuity of the medical intervention to protect mental health they are organically and functionally connected, in departmental form with the other psychiatric services and facilities existing in the area.
The regions and autonomous provinces of Trento and Bolzano identify the private hospitalization and treatment institutions, in possession of the prescribed requisites, in which compulsory and voluntary health treatments can be implemented in hospitalization.
In relation to welfare needs, the provinces can stipulate agreements with the institutions referred to in the previous paragraph pursuant to the following article 7.
Article 7 - Transfer of functions in the field of psychiatric hospital assistance to the regions
From the entry into force of this law, the administrative functions concerning psychiatric assistance in hospital conditions, already exercised by the provinces, are transferred, for the territories under their competence, to the ordinary regions and those with special statute. The current competence of the autonomous provinces of Trento and Bolzano remains unchanged.
Hospital assistance governed by articles 12 and 13 of the decree-law of 8 July 1974, number 264, converted with amendments into the law of 17 August 1974, n. 386, includes hospital admissions for psychic alterations. The provisions in force regarding the competence of the expenditure remain unchanged until 31 December 1978.
From the entry into force of this law, the regions also exercise the functions vis-Ã -vis psychiatric hospitals that they perform vis-Ã -vis other hospitals.
Until the date of entry into force of the health reform, and in any case no later than 1 January 1979, the provinces continue to exercise the administrative functions relating to the management of psychiatric hospitals and any other function relating to psychiatric and mental health services.
The regions and autonomous provinces of Trento and Bolzano plan and coordinate the organization of psychiatric and mental health facilities and services with the other health facilities operating in the area and implement the gradual elimination of psychiatric hospitals and the different use of existing structures and those under construction. These initiatives cannot lead to higher costs for the budgets of the provincial administrations.
In any case, it is forbidden to build new psychiatric hospitals, to use those currently existing as specialized psychiatric divisions of general hospitals, to set up psychiatric divisions or sections in general hospitals and to use neurological or neuropsychiatric divisions or sections as such.
The prohibitions set forth in article 6 of the decree-law of 29 December 1977, n. 946, converted with amendments into law 27 February 1978, n. 43.
Personnel of psychiatric hospitals and non-hospital public psychiatric services and facilities are in charge of the psychiatric diagnosis and treatment services of general hospitals, referred to in article 6.
Relations between the provinces, hospitals and other hospitalization and treatment facilities are regulated by special agreements, in accordance with a standard scheme, to be approved within thirty days of the date this law comes into force, with a decree from the Minister of Health in agreement with the regions and the Union of Italian provinces and having consulted, as regards personnel problems, the most representative trade union organisations.
The standard agreement scheme will have to regulate, among other things, the organic and functional connection referred to in the fourth paragraph of article 6, the financial relations between the provinces and the hospitalization institutions and the employment, also through secondment, of the personnel referred to in the eighth paragraph of this article.
With effect from 1 January 1979, during the renewal of the contract, rules will be established for the gradual homogenization between the economic treatment and the regulatory institutions of an economic nature for the personnel of public psychiatric hospitals and public psychiatric and mental health facilities and services and the treatment economy and the regulatory institutes of an economic nature of the corresponding categories of hospital staff2.
Article 8 - Patients already hospitalized in psychiatric hospitals.
The provisions of this law also apply to the sick admitted to psychiatric hospitals at the time of entry into force of the law itself.
The head physician responsible for the division, within ninety days of the entry into force of this law, with single reasoned reports, communicates to the mayor of the respective municipalities of residence, the names of the patients for whom he deems it necessary to continue the compulsory medical treatment at the same facility of hospitalization, indicating the presumable duration of the treatment itself. The chief physician in charge of the division is also required to fulfill the obligations referred to in the fifth paragraph of article 3.
The mayor orders the provision of compulsory medical treatment in conditions of hospitalization according to the rules referred to in the last paragraph of article 2 and communicates it to the guardianship judge in the manner and for the fulfilments referred to in article 3.
The omission of the communications referred to in the preceding paragraphs determines the cessation of all effects of the provision and constitutes, unless the details of a more serious crime exist, the crime of omission of official acts.
Taking into account the provisions of the fifth paragraph of article 7 and temporarily derogating from the provisions of the second paragraph of article 6, only those who were hospitalized before the date of entry into force of this law and who require psychiatric treatment in hospital conditions.
Article 9 - Duties of the medical staff of psychiatric hospitals.
The attributions in health matters of the director, the primary doctors, the assistants and the assistants of the psychiatric hospitals are those established, respectively, by articles 4 and 5 and by article 7 of the decree of the President of the Republic of 27 March 1969, n. 128.
Article 10 - Amendments to the penal code.
In the heading of book III, title I, chapter I, section III, paragraph 6 of the penal code the words are deleted: "of insane people".
In the heading of article 716 of the penal code the words are deleted: "mentally ill or".
In the same article the words are deleted: "to a health establishment or".
Article 11 - Final rules.
Articles 1, 2, 3 and 3-bis of the law of 14 February 1904, n. 36, concerning "Provisions on asylums and alienated persons" and subsequent amendments, article 420 of the civil code, articles 714, 715 and 717 of the penal code, n. 1 of article 2 and article 3 of the consolidated text of the laws containing rules for the discipline of the active electorate and for the keeping and revision of the electoral lists, approved with decree of the President of the Republic 20 March 1967, n. 223, as well as any other provision incompatible with this law.
The provisions contained in articles 1, 2, 3, 4, 5, 6, 7, 8 and 9 of this law remain in force until the date of entry into force of the law establishing the national health service.
Until the provisions in force on international prophylaxis and infectious and diffusive diseases, including compulsory vaccinations, are amended, coordinated and brought together in a single text, the powers of the authorities are without prejudice to the military personnel, port, airport and border doctors and masters of ships or aircraft.
This law enters into force on the day following that of its publication in the Official Gazette of the Republic.
See the articles 64 and following, Law 23 December 1978, n. 833.
See the article 64, Law 23 December 1978, n. 833.