Telemedical care for maritime workers: health care liability issues related to possible regulatory decoupl.

Abstract: Telemedicine has now spread globally because of the many benefits it offers both to health care facilities and to people living in unfavorable conditions (the elderly, patients with reduced mobility, residents in remote areas, etc.). The COVID-19 pandemic has resulted in further impetus for telemedicine application development, to maximize available resources. However, this innovative type of physician/healthcare facility/patient relationship has opened up several questions in relation to various possible assumptions of professional liability. In fact, the medico-legal issues that can arise in scenarios involving equipment, professionals and patients that also belong to different nationalities and, therefore, subject to different regulatory systems are obvious: precisely the regulatory decoupling represents one of the thorniest and most debated issues at the international level on the subject of teleme-dicine. In the maritime sphere, this issue could be further amplified (e.g., telehealth for a patient from one nation, on ships under the flag of a different nationality, within the maritime boundaries of a third nation). In Italy, the use of telemedicine has its roots precisely in the maritime sector back in the early 20th century, when the International Center for Medical Radiocommunications (CIRM) was established. In 2002, CIRM was identified internationally as the Italian Center Responsible for Maritime Telemedical Assistance (TMAS), with the purpose of providing remote health care for passengers on any ship that required it, 24 hours a day, while also being able to suggest their transfer to land. Indeed, since TMAS is a national competence, should professional liability profiles occur, CIRM physicians would be liable under Italian law. Therefore, the example of CIRM as a referral center for telemedicine in the maritime sphere could be a model for reference in other contexts as well: in particular, the identification of telemedicine service delivery centers dependent on the National Health Services (NHS) could allow for the appropriate regulatory contextualization of telemedical malpractice cases, thereby resolving the medico-legal uncertainties that could hinder the dissemination as well as the proper application of telemedicine.