Reporting suspected technopathy: regulatory novelties and critical issues, application suggestions

[La denuncia di sospetta tecnopatia: novità e criticità normative, suggerimenti applicativi]

The Italian Legislative Decree n. 151 of 14 September 2015 lays down new provisions concerning the DPR 1124/65. The major developments occur with Article 53 of Presidential Decree 1124/65, which transfer the obligation to send the medical certificate, attached to the report of accident and occupational disease, from the employer to the physician - every physician lends immediate assistance to an injured worker or to a worker that suffers from an occupational disease - using telematic systems, either directly or through the health facilities. There are however residual critical issues not easily overcome by the general pratictioner or by the physician not specialist in occupational medicine, because of the impossibility of knowing the real occupational causative agents of disease and the production cycle. So, the general practitioner cannot properly study the link between damage to health and work. In addition, there are no indications for diseases not included by tables (DM 09.04.2008) and lists (DM 10.06.2014), which should be evaluated about the possible occupational origin. Moreover, there is no indication of reporting for the pathologies present in the tables of occupational diseases, but not included in the lists of the DM 10.06.2014, and for the diseases with nosological differences between the tables of occupational diseases and lists, as well as those that the doctor believed to be linked to exposure at work, although not included in the two documents (tables or lists). To date, there are other technical critical issues that the legislation seems to overlook. In any of the laws reported (and even in the recent legislation) is mentioned the key element essential to evaluate, according to technical and scientific criteria, the first occupational origin attribution of a suspected technopathy: the results of an appropriate and specific risk assessment of the recognized causative agent. We propose an operational way to create a technical and sustainable system of reporting suspicious technopathies.
This system should be based on the figure and the role of occupational physician, both as a "competent" physician, according to the Legislative Decree n. 81/08 (in Italy), both as a doctor inserted in the community and hospital health services (in Lombardy these services are organized in the Health Protection Agencies - ATS - and in the Operative Unit Hospital of Occupational Medicine (UOOML of socio-territorial health companies - ASST). Complementarily, an organized reporting system should be based on risk assessment (according to art. 17 of Legislative Decree n. 81/08). Other aims are to overcome outdated practices, create a constant channel of dialogue between the territorial and the hospital health centers, send and capture in a structured and efficient way reports of technopathy, track all occupational disease reports and create a dedicated archive.