Naples, shadows cast over compulsory medical treatment at the Ospedale del Mare: a judge proposes compensation for Alfredo Fico's death.

Naples – A verdict that lifts the veil on controversial healthcare protocols and hospital silence: the Civil Court of Naples has concluded that a "lack of care" halved, by at least 20%, the survival chances of Alfredo Fico, the 25-year-old man who died on April 9, 2019, in the psychiatric ward of the Ospedale del Mare, after being subjected to compulsory medical treatment (TSO) with sedation and mechanical restraints.

The judge's consultants, in an expert report filed today, point to a "failure to closely monitor the ECG" in the post-ictal phase, which should have examined the QT interval—the period of time during which the heart's ventricles contract and relax, a key indicator of arrhythmic risk in patients on psychotropic drugs. "The healthcare professionals' behavior was not negligent in the acute phase," the experts admit, "but that gap in monitoring significantly reduced the likelihood of a 'best-expected outcome.'"

Alfredo's family, represented by attorney Amedeo Di Pietro—the same lawyer who yesterday announced a complaint in a similar case—has welcomed the compensation proposal to the ASL Napoli 1 Centro as a first step toward justice, albeit a bitter one. "The compulsory medical treatment was imposed without the necessary authorizations," Di Pietro complained when contacted by this editorial staff this afternoon.

"Alfredo arrived at the hospital on March 28th, in the throes of a pantoclastic fit: an uncontrollable urge to destroy everything around him, which repeated itself in a loop. They administered drugs, then sedated him, and tied him to the bed. On the morning of his death, during a routine round, they found him lifeless, still tied up like a forgotten package."

The parents, a retired worker and a housewife from the Sanità district, have experienced these six years as an ordeal: complaints filed, criminal investigations stalled, and a mourning that echoes in the courtrooms. This is not an isolated case, and the precedent "yesterday" makes it a deafening alarm bell.

On October 10th, Di Pietro made public the complaint regarding the death of a 39-year-old Neapolitan woman—her name changed to Cristina to protect her privacy—who died on September 12th in the same emergency room at the Ospedale del Mare.

"Too many shadows," thunders the lawyer, who sees in the two incidents a pattern of "deadly restraint": emergency protocols implemented hastily, with no de-escalation options, in a hospital already mired in controversy. The family of the woman, originally from the Spanish Quarter, is demanding "truth and respect for human dignity," as they reiterated in an interview with a local newspaper, focusing on an autopsy that could reveal complications from medications or physical stress.

Ospedale del Mare, the flagship of De Luca's plan for healthcare decentralization, is once again in the spotlight for tragedies related to compulsory medical treatment (TSO)—the legislative provision (Article 34 of the Basaglia Decree) that authorizes forced interventions for those who put themselves or others at risk, but often bordering on abuse.

Consider Salvatore D'Aniello, another 39-year-old who died in June 2021 in the same psychiatric ward after a compulsory medical treatment for bipolar disorder. His family reported "negligence" and excessive restraints, and an investigation came to nothing. Cases like these, accumulating over the years, paint an alarming picture: between 2019 and 2025, there were at least four suspicious deaths following compulsory medical treatment in Naples, with peaks in reports during the pandemic, when wards were overwhelmed and staff were exhausted.

"Lost opportunities can't be compensated with a check," reflects Di Pietro, who estimates the Ficos' compensation at between €200 and €300, to be negotiated with the local health authority. But the lawyer doesn't give up: "We're calling for urgent reforms to restraint protocols, mandatory training on induced trauma, and real-time ECG monitoring for at-risk patients."

When contacted, the Naples Local Health Authority (ASL) 1 responded with a laconic statement: "We will accept the judge's proposal for an amicable settlement, confirming that the protocols have been respected." Meanwhile, the Forum for Rights and Mental Health of Naples—which has followed the 39-year-old's case—has announced a demonstration in front of the hospital on October 18: "Enough deaths in chains. Mental health is not a prison."

In Naples, a city of emotional volcanoes and contradictions, these stories of lethal compulsory medical treatment (TSO) reignite the debate over a healthcare system that runs too fast, tying bodies and hopes together. For the Fico family, it's a glimmer of hope after the darkness: "Alfredo deserved to live, not to be a number in an expert report." The hearing to validate the compensation is scheduled for November 25th. Until then, the Ospedale del Mare remains an ambiguous symbol: salvation for thousands, a trap for too many. And the families, united by their grief, remain vigilant.