"As of December 25, 2025, the mandates of the extraordinary commissioners of the regional health service companies must be considered terminated." The communication arrived shortly after 9:00 PM on a post-Christmas Saturday evening. The sender of the document, sent to 8:00 AM local health authorities, the Cagliari and Sassari health authorities, the Brotzu hospital, and the Areus hospital, is Luciano Giovanni Oppo, director general of the regional health department.

Here, then, is the Region's official interpretation of the effects of the Constitutional Court ruling that rejected the (non) reform that had led to the appointment of a commissioner to administer all Sardinia's health care institutions : an illegitimate operation, the Court ruled.

But now, who makes the decisions and signs the documents to keep the complex healthcare system functioning? Oppo offers a solution, explaining that it's simply a matter of enforcing the law. But paralysis poses more than a risk.

"The termination of the commissioners' duties will result in the vacancy of the office of general manager of the companies and the absence of the relevant legal representative," the communication states. However, "in the event of a vacancy in the office," the regulations provide for the manager to "exercise his or her functions on a substitute basis, in order to ensure the continuity of administrative action." The substitute, according to Oppo, would be "the administrative director or the health director," who must exercise "ordinary administrative powers," issue "urgent and non-deferrable acts," and "all acts necessary to ensure the continuity of services and essential levels of care." The provisional regime, according to the department led ad interim by Alessandra Todde, "is strictly temporary and according to the ordinary procedures established by current legislation."