The Region was right: the Constitutional Court rejected the Council of Ministers' appeal against the law which raised the number of patients who can be followed by each family doctor to 1800 (from the ordinary 1500) . In a nutshell: for the Council, the right to health, if there is an emergency, prevails over the rigid legislation that leads to the drafting of national contractual agreements and their regional integrations.
The topic of the State-Region dispute was the law on "Urgent provisions regarding primary care", desired by the Health Councilor Carlo Doria and approved by the Regional Council in March last year.
Among the other provisions, there was an increase in the ceiling for general practitioners: on a voluntary basis, the possibility was given of expanding the number of patients up to 1800, when the ordinary ceiling was 1500. A necessary intervention, given the drastic decline in doctors in the area (between limited numbers and retirements) which has left thousands of Sardinians without assistance. Not a structural solution, but at least something had been done.
The Government, however, argued that that law was unconstitutional. In June he challenged it before the Council. Read in hand, the thesis of Palazzo Chigi supported by the State Attorney's Office was: any increase in patients treated by each doctor can only be decided within the context of national collective bargaining, followed by possible regional integration. And in any case it can only be done for a limited period of time (two months), not provided for by Sardinian law. We read in the text of the appeal that the Regions are precluded from adopting legislation that affects an employment relationship that has already arisen and, in regulating its legal and economic treatment, from substituting collective bargaining, an essential source of discipline (.. .) Therefore, the state defense maintains that the contested provision constitutes the exercise of a competence that goes beyond those recognized to the regional legislator by the relevant state legislation, as it «authorizes an increasing derogation from the maximum number of beneficiaries, replacing the provisions of the bargaining integrative and, at the same time, departing from those of national collective bargaining".
The Region opposed it, bringing forward normative and substantive arguments. The legal office of Villa Devoto underlined that Sardinia «already due to its territorial conformation, characterized by a few large urban centers and multiple towns scattered over a vast territory, distant and poorly connected, also located on smaller islands and in the mountains, has structurally difficult to guarantee primary care in disadvantaged areas". Furthermore, the national legislation which authorized early retirements has «dramatically reduced the number of doctors in service, further worsening the situation, and Covid has further made doctors' choice of training in general medicine unattractive and, in any case of this type of assignment".
On a regulatory level then, the Region «pending the adoption of the new regional supplementary agreement, the discussions of which have already been started, has exercised the faculty granted» by the national law of reference «providing, for this period of time, that the doctors who operating in disadvantaged areas can ask to be authorized to exceed the ceiling of 1,500".
In short: there was a hole that needed to be plugged and the Region did it, waiting to close the regional negotiations on the renewal of the contract. For the judges of the Consulta, the choice was right. Or, in any case, it was adopted in compliance with the Constitution.
