Sentenza n. 198 del 2025

Judgment No. 198 of 2025 - AI translated

JUDGMENT NO. 198

YEAR 2025

ITALIAN REPUBLIC

IN THE NAME OF THE ITALIAN PEOPLE

THE CONSTITUTIONAL COURT

composed of:

President: Giovanni AMOROSO;

Judges: Francesco VIGANÒ, Luca ANTONINI, Stefano PETITTI, Emanuela NAVARRETTA, Maria Rosaria SAN GIORGIO, Filippo PATRONI GRIFFI, Marco D’ALBERTI, Giovanni PITRUZZELLA, Antonella SCIARRONE ALIBRANDI, Massimo LUCIANI, Maria Alessandra SANDULLI, Roberto Nicola CASSINELLI, Francesco Saverio MARINI,
has pronounced the following

JUDGMENT

in the constitutional legitimacy proceeding concerning Articles 6, paragraph 1, and 14 of the Law of the Sardinia Region of March 11, 2025, no. 8 (Urgent provisions for the adjustment of the organizational and institutional structure of the regional health system. Amendments to Regional Law no. 24 of September 11, 2020), promoted by the President of the Council of Ministers with an appeal notified on May 10, 2025, filed in the Registry on the following May 12, registered under no. 19 of the appeals registry for 2025 and published in the Official Gazette of the Republic no. 22, special first series, of the year 2025.

Having seen the statement of defense of the Autonomous Region of Sardinia;

having heard in the public hearing of December 2, 2025, the Reporting Judge Maria Alessandra Sandulli;

having heard the State Attorney Marina Russo for the President of the Council of Ministers, as well as the attorney Sonia Sau for the Autonomous Region of Sardinia;

deliberated in the council chamber of December 2, 2025.

Facts Considered

1.– With an appeal notified on May 10, 2025, and filed on the following May 12, registered under no. 19 of the appeals registry for 2025, the President of the Council of Ministers, represented and defended by the State Attorney General, promoted questions of constitutional legitimacy regarding Article 6, paragraph 1, of the Law of the Sardinia Region of March 11, 2025, no. 8 (Urgent provisions for the adjustment of the organizational and institutional structure of the regional health system. Amendments to Regional Law no. 24 of September 11, 2020), which replaces paragraph 1 of Article 13 of the Law of the Sardinia Region of September 11, 2020, no. 24 (Reform of the regional health system and systematic reorganization of regulations thereon. Repeal of Regional Law no. 10 of 2006, Regional Law no. 23 of 2014, and Regional Law no. 17 of 2016, and other sectoral regulations), limited to the second sentence of the replaced paragraph, with reference to Articles 97, second paragraph, 98, first paragraph, and 117, second paragraph, letter l), of the Constitution. He also promoted questions of constitutional legitimacy regarding Article 14 of the same regional law, with reference to Articles 3, 97, and 117, third paragraph, of the Constitution, the latter in relation to Articles 2, paragraph 2-octies, 3, paragraph 6, and 3-bis, paragraph 2, of Legislative Decree no. 502 of December 30, 1992 (Reorganization of discipline in the health sector, pursuant to Article 1 of Law no. 421 of October 23, 1992) and to Articles 1 and 2 of Legislative Decree no. 171 of August 4, 2016, laying down provisions concerning "Implementation of the delegation under Article 11, paragraph 1, letter p), of Law no. 124 of August 7, 2015, on health management".

Specifically, Article 6, paragraph 1, of Regional Law no. 8 of 2025, in replacing the aforementioned Article 13, paragraph 1, establishes, inter alia, in its second sentence, that "[f]ollowing the installation of the top management body of the entity, the general manager, within the subsequent sixty days, shall confirm or replace the administrative director, the health director, and the director of social-health services, if appointed".

Article 14 of the same regional law, titled "Organizational-functional adjustment and commissioning of health entities," establishes that "[f]or the realization of the efficiency process and the overall reorganization of the institutional and organizational structures of the Regional Health Service envisaged by this law, the Regional Executive, upon proposal of the Regional Assessor competent in health matters, within forty-five days from the entry into force of this law, shall extraordinarily commission the eight local social-health entities, the 'G. Brotzu' ARNAS hospital entity, AREUS, and the two university hospital entities. Limited to the university hospital entities, the extraordinary commissioners shall be appointed in agreement with the rectors of the competent Universities. On the date of the commissioner's installation for each entity, the incumbent general manager shall be dismissed and immediately cease from office. 2. The extraordinary commissioners referred to in paragraph 1, within ninety days of their installation: a) shall draw up a reorganization and requalification plan for health and administrative services according to the provisions of this law, with particular reference to the actions necessary to implement the provisions of Article 20, paragraph 3-ter, of Regional Law no. 24 of 2020, introduced by Article 8 of this law, based on the directives of the regional assessor competent in health matters; b) for the purposes of implementing Article 32, paragraph 5, letter g-bis) of Regional Law no. 24 of 2020, shall draw up, following a territorial analysis of the demand for social-health services, the evolution of the social, health, and demographic context, of human, instrumental, and financial resources, as well as the level of provision of essential health services, a document containing a proposal for an assistance mission for each reference hospital-health facility according to the methods, directives, and criteria identified by the regional assessor competent in health matters. 3. The Regional Executive, upon proposal of the Assessor competent in health matters, within sixty days from the fulfillment of the provisions under paragraph 2, shall approve the guidelines for the adoption of the corporate acts of the entities of the Regional Health Service. 4. The extraordinary commissioners whose term expires after six months, renewable only once, shall be selected from the subjects included in the national list of general managers pursuant to Article 2, paragraph 2, of Legislative Decree no. 171 of August 4, 2016 (Implementation of the delegation under Article 11, paragraph 1, letter p), of Law no. 124 of August 7, 2015, on health management). The commissioners, in addition to the extraordinary functions provided for by this Article, shall perform the functions assigned to the general managers, and their economic treatment shall be that provided for the same general managers pursuant to current legislation as established by the Regional Executive. The extraordinary commissioners, within forty-five days of their installation, shall appoint the health directors and administrative directors, as well as, where provided, the directors of social-health services. 5. Extraordinary commissioners shall also be vested with the power to undertake extraordinary and emergency actions in order to guarantee essential health services, according to the indications of the competent regional assessor and in full synergy between the entities of the Regional Health Service."

2.– In the opinion of the appellant, the first challenged provision, by introducing "the possibility of an automatic dismissal of the entity's top management, thus configuring a hypothesis of spoils system," would primarily conflict with the principles of good governance and continuity of administrative action under Article 97, second paragraph, of the Constitution, "by linking the early termination of the relevant relationships to the cessation of the general manager and, therefore, disregarding the existence of reasons, to be assessed with the guarantees of due process, related to the concrete manner in which the duties are performed." The constitutional jurisprudence (specifically judgments No. 224 of 2010 and No. 104 of 2007) is cited to this effect, which has repeatedly censured the spoils system mechanism, deeming illegitimate the causes of termination of managerial positions other than those provided for by law and not related to the assessment of the prior conduct of the functions.

Article 98, first paragraph, of the Constitution, furthermore, would be violated because the challenged provision, by making the continuation in office dependent on factors extraneous to the employment relationship and the manner in which it is performed, in addition to exposing the employee to measures adoptable without a guarantee of adversarial proceedings concerning the reasons for termination, would conflict with the duty of neutrality, which, as stated by the judgment No. 228 of 2011 of this Court, quoted verbatim by the appellant, "imposes upon the official, regardless of their personal convictions, the correct and loyal execution of directives originating from the political body, whatever the incumbent holder of the latter may be" and does not require, instead, "the sharing of the political orientations of the natural person holding the political office or personal loyalty towards them."

Finally, in the appellant's view, the challenged regional provision would conflict with Article 117, second paragraph, letter l), of the Constitution, as it interferes with the regulation of employment relationships, falling within the matter of "civil law," reserved for the exclusive legislative competence of the State. In particular, the new text of Article 13, paragraph 1, of Regional Law no. 24 of 2020, as a result of the amendments introduced by the challenged Article 6, paragraph 1, "shows that the confirmation or replacement of the administrative director, the health director, and the director of social-health services are attributable to the absolute discretion of the general manager," thereby establishing a regulation different from that provided for by Article 3 of Legislative Decree no. 171 of 2016, which stipulates that "[i]n the event of a manifest violation of laws or regulations or the principle of good governance and impartiality of the administration, the general manager, after notice and in compliance with the principle of adversarial proceedings, shall terminate the contract, declaring the forfeiture of the administrative director and the health director, and where provided by regional laws, of the director of social-health services, with a reasoned measure and shall provide for their replacement through the procedures referred to in this Article."

3.– The challenged Article 14, in turn, by providing in paragraph 1 for the extraordinary commissioning of all local social-health, hospital, and university hospital entities in Sardinia, as well as the immediate forfeiture and cessation from office of the general manager in office on the date of the commissioner's installation for each entity, would primarily violate Article 117, third paragraph, of the Constitution, in relation to the fundamental principles concerning health under Articles 2, paragraph 2-octies, 3, paragraph 6, and 3-bis, paragraph 2, of Legislative Decree no. 502 of 1992 and Articles 1 and 2 of Legislative Decree no. 171 of 2016, and would exceed the legislative powers recognized to the Region by its special statute, which subjects regional legislative intervention in matters of public hygiene and health to the fundamental principles established by State laws.

In particular, the appellant observes that within the framework resulting from the aforementioned State provisions, "the regional legislator is precluded from providing for the generic possibility of appointing an extraordinary commissioner without specifying the obstructive reasons for replacing the general manager and without establishing the necessary procedures and requirements for such appointment, without this inevitably resulting in effects prejudicial to the sphere of State competence." Citing judgments No. 189 of 2022, No. 209 of 2021, and No. 87 of 2019 of this Court, the State Attorney General adds that the challenged provision "does not link the commissioning to an extraordinary need or to a proven and justified impossibility of filling the vacancy through the ordinary procedure, nor to any of the exemplifying situations indicated [in those judgments], given that, moreover, all general managers are regularly in office."

4.– In the appellant's opinion, finally, the generic possibility of appointing an extraordinary commissioner, resulting in the automatic forfeiture of the directors of the involved entities and bodies, entirely unlinked to any management default or the ascertainment of failure to achieve objectives by the entity's top management, would also realize a violation of the principles of reasonableness, adequacy, and good governance of the administration under Articles 3 and 97 of the Constitution, creating "an atypical and undefined regime as to the prerequisites, requirements, and procedural methods for the appointment of the top management of the Regional Health Service entities," and would also exceed the competences recognized to the Autonomous Region of Sardinia by Article 4, letter i), of Constitutional Law no. 1 of February 26, 1948 (Special Statute for Sardinia), which subjects regional legislative intervention in matters of public hygiene and health to the limits referred to in Article 3 of the same statute and to the principles established by State laws.

The requested annulment of paragraph 1 would entail the automatic overturning of the subsequent paragraphs, which govern the powers and duties of the extraordinary commissioners, as well as the duration of their term.

5.– The Autonomous Region of Sardinia filed a defense, arguing the inadmissibility of the challenge to Article 14 of Regional Law no. 8 of 2025, as, "in relation to a provision clear in expressing the will to resort to the commissioning of health entities for the purposes of rationalization of the Regional Health Service, with assignment of extraordinary administrative functions to the commissioners for a defined period, [the] appellant, in this regard, has limited himself to asserting that the challenged provision did not provide for commissioning for extraordinary needs and has subsequently formulated the exceptions of unconstitutionality as if the regional provision had provided for commissioning as an alternative method to that provided for by State laws, for filling vacancies in the office of general manager of health entities and for the appointment and dismissal of General Managers."

6.– On the merits, the regional defense requests that both questions be declared unfounded.

Reversing the order of examination of the questions raised, it first addresses those relating to Article 14, arguing that the commissioning, being aimed at the reorganization and requalification of health and administrative services, with the goal of guaranteeing essential health services (EHS), would fall under the concurrent legislative matter of health protection, under Article 117, third paragraph, of the Constitution and Article 4, paragraph 1, letter i), of the Special Statute for Sardinia. Therefore, there would be no violation of State legislative competence in the matter of civil law, given that the extraordinary commissioners have duties different from the ordinary duties of general managers. It adds the consideration that "only extraordinary bodies with a reduced time horizon for the term of office can undertake, in the quickest time allowed by the extraordinary nature of the appointment and powers, incisive reform actions without being influenced by the strong, even parochial, resistance that always accompanies attempts to implement organizational and appropriateness choices for the Regional Health Service that are destined to affect the scope of powers or the number and type of facilities pertaining to each health entity and its competence area."

The Region further argues that the question of constitutional legitimacy of Article 14 "would in any case be unfounded even if the regional law had provided, in general terms, for the automatic forfeiture of the general managers of health entities appointed during the previous legislature," justifying this assertion on the grounds that "[t]he health service has always been the public sector most affected by political influence" and that, "even after the entry into force of Legislative Decree 171/2016, which provided for the choice [of general managers] from among those enrolled in a national list of suitable candidates, essentially reproducing the original provision of Article 3 of Legislative Decree 502/1992, the entitled persons are still thousands, thus a more than sufficient number to allow appointment based on political consonance."

A violation of Article 97 of the Constitution would therefore also be excluded, assuming that the good governance of the public administration and the health system "also depends on the exercise of the fundamental task of politics to establish its organization, even in total discontinuity between one legislature and the next," with the Regional Executive responsible for "identifying the top figures suitable for achieving the objectives that each political body deems necessary to attain." The regional defense thus argues that "assigning new and different objectives to the General Managers appointed by the previous regional government, for the few remaining years of their term, and then reassigning them to different subjects, is a factor of discontinuity more than their eventual replacement by those elected to change the system, with subjects who will immediately have to operate with such a mandate and who, given its entirety, can be sanctioned and removed if they fail to perform."

7.– Regarding the challenge to Article 6, paragraph 1, of Regional Law no. 8 of 2025, the regional defense maintains that the administrative and health directors are not bodies of the health entities, but coadjutors of the top management body, holders of an autonomous intellectual work contract, which the general manager, "on the basis of an exclusively trust-based choice, temporarily involves in the top management of the health entities through an autonomous intellectual work contract" and with whom they share "the same characteristic of having been chosen on a trust basis in view of achieving the objectives assigned by the political body."

On the basis of this assertion, it excludes a violation of Articles 97 and 98 of the Constitution, noting that the challenged provision does not provide for the automatic and simultaneous forfeiture of the aforementioned figures, but the faculty of the newly appointed top body to confirm or replace those whom the law allows it to choose as its collaborators. Since this concerns the termination of an autonomous work relationship, conferred on an exclusively trust basis, the regulation would not be constitutionally illegitimate, at least in relation to subjects holding office for at least three years, this being the minimum term provided for by State law for administrative and health director positions.

8.– In the memorandum filed close to the public hearing, the Region insisted on its position, further highlighting that the appointment of commissioners aims to allow, in a short time, the transition to the new structure of the Regional Health Service, given that they are endowed with extraordinary powers and are not bound by any procedure. This objective, in the opinion of the regional defense, could not be achieved with the figure of the general managers who, being bodies of ordinary administration, perform management functions in compliance with the corporate act, which is approved through a complex procedure, governed by Article 16 of Regional Law no. 24 of 2020, which concludes, on average, about one year after the appointment.

Considered in Law

1.– With the appeal indicated in the heading (Reg. Rec. No. 19 of 2025), the President of the Council of Ministers challenged Articles 6, paragraph 1, insofar as it replaces paragraph 1 of Article 13 of Regional Law no. 24 of 2020, limited to the second sentence of the replaced paragraph, and 14 of Regional Law no. 8 of 2025, alleging the violation of various constitutional parameters and intermediate norms.

In the appellant's view, the challenged Article 6, paragraph 1, by replacing the aforementioned Article 13, paragraph 1, of Regional Law no. 24 of 2020, established, in the second sentence thereof, that "[f]ollowing the installation of the top management body of the entity, the general manager, within the subsequent sixty days, shall confirm or replace the administrative director, the health director, and the director of social-health services," would primarily violate Article 97, second paragraph, of the Constitution, in relation to the principle of good governance and continuity of administrative action, since, "by linking the early termination of the relevant relationships to the cessation of the general manager and, therefore, disregarding the existence of reasons, to be assessed with the guarantees of due process, related to the concrete manner in which the duties are performed," it would introduce "the possibility of an automatic forfeiture of the entity's top management, thus configuring a hypothesis of spoils system."

Article 98, first paragraph, of the Constitution would then be violated, as the challenged provision, by making the continuation in office dependent on factors extraneous to the employment relationship and the manner in which it is performed, would conflict with the official's duty of neutrality and the correct and loyal execution of directives originating from the political body, whatever the incumbent holder of the latter may be, in addition to exposing the employee to measures adoptable without a guarantee of adversarial proceedings concerning the reasons for termination.

Finally, in the opinion of the State Attorney General, the challenged regional provision would conflict with Article 117, second paragraph, letter l), of the Constitution, as, by attributing the confirmation or replacement of the administrative director, the health director, and the director of social-health services to the "absolute discretion of the general manager," it would interfere with the regulation of employment relationships, falling within the matter of "civil law," reserved for the exclusive legislative competence of the State, as it dictates a regulation different from that provided for by Article 3 of Legislative Decree no. 171 of 2016, which only allows for the termination of the contract and the declaration of forfeiture of the aforementioned positions "[i]n the event of a manifest violation of laws or regulations or the principle of good governance and impartiality of the administration […] after notice and in compliance with the principle of adversarial proceedings […] with a reasoned measure."

The challenged Article 14, in turn, by providing, in paragraph 1, for the extraordinary commissioning of all local social-health, hospital, and university hospital entities in Sardinia, as well as the immediate forfeiture and cessation from office of the general manager in office on the date of the commissioner's installation for each entity, would violate, primarily, Article 117, third paragraph, of the Constitution, in relation to the fundamental principles concerning health under Articles 2, paragraph 2-octies, 3, paragraph 6, and 3-bis, paragraph 2, of Legislative Decree no. 502 of 1992 and Articles 1 and 2 of Legislative Decree no. 171 of 2016, and would exceed the legislative powers recognized to the Region by its special statute, which subjects regional legislative intervention in matters of public hygiene and health to the fundamental principles established by State laws. The commissioned measure, in fact, would not be linked "to an extraordinary need or to a proven and justified impossibility of filling the vacancy through the ordinary procedure, nor to any of the exemplifying situations indicated [by the constitutional jurisprudence], given that, moreover, all general managers are regularly in office."

In the appellant's view, furthermore, Article 14, by establishing an automatic forfeiture of the directors of the involved entities and bodies, entirely unlinked to any management default or the ascertainment of failure to achieve objectives by the entity's top management, would also realize a violation of the principles of reasonableness, adequacy, and good governance of the administration under Articles 3 and 97 of the Constitution, creating "an atypical and undefined regime as to the prerequisites, requirements, and procedural methods for the appointment of the top management of the Regional Health Service entities," and would also exceed the statutory powers recognized to the Autonomous Region of Sardinia by Article 4, letter i), of its special statute, which subjects regional legislative intervention in matters of public hygiene and health to the limits referred to in Article 3 of the same statute and to the principles established by State laws.

2.– It is appropriate to preface that the challenged provisions affect the regulation of management in the entities of the Regional Health Service, which "the now constant constitutional jurisprudence has attributed to the matter of 'health protection,' of concurrent competence between the State and the Regions under Article 117, third paragraph, of the Constitution" (Judgment No. 87 of 2019, point 4.1. of the Considered in Law).

In this context, therefore, "it is incumbent upon the State to identify the fundamental principles of the matter, in order to better qualify the profile of these managers and to reduce the scope of political discretion in their selection, in protection of the impartiality and good governance of the public administration, given the impact that the regulation of these positions has on health services provided to users (see judgments No. 87 of 2019, No. 159 of 2018, No. 190 of 2017, No. 124 of 2015, No. 295 of 2009, No. 449 of 2006, and No. 422 of 2005). The legislation of Regions with special autonomy must also adhere to these principles (Judgment No. 159 of 2018), given that in this area the statutory powers are less extensive than those identified by the constitutional text (Judgment No. 231 of 2017)" (Judgment No. 209 of 2021, point 3.1. of the Considered in Law).

3.– With reference to the challenge to Article 14, the Region objected to the inadmissibility of the appeal, asserting that the appellant, "in relation to a provision clear in expressing the will to resort to the commissioning of health entities for the purposes of rationalization of the Regional Health Service, with assignment of extraordinary administrative functions to the commissioners for a defined period" and therefore not constituting an "alternative method to that provided by State laws, for filling vacancies in the office of general manager of health entities and for the appointment and dismissal of General Managers," had peremptorily excluded the existence of extraordinary needs and had erroneously invoked, "as intermediate norms, those concerning the replacement of [general managers] or the filling of vacancies in the office, although the regional law has not introduced, for these specific cases, a regulation different from the State one." The reference to judgment No. 189 of 2022 of this Court, concerning a provision "that regulated commissioning as the ordinary method of filling a vacancy in the office" and therefore referring to a situation in no way comparable to the present one, would also be irrelevant. Conversely, the President of the Council of Ministers would not have put forward any argument concerning the possible absence of the prerequisites for resorting to extraordinary commissioning, which was, moreover, recognized in the pre-litigation phase by the Ministry of Health.

The Region added that the appellant, by alleging the violation of "multiple State norms relating to mutually exclusive situations (vacancy of office and replacement of the incumbent General Manager)," would have failed in the obligation to identify the specific State provision violated.

3.1.– The objection is unfounded.

It is appropriate to recall that, "According to the constant jurisprudence of this Court, where the violation of Article 117, third paragraph, of the Constitution is alleged, it is incumbent upon the appellant to specifically indicate the intermediate State provision that is claimed to be violated and, in particular, the fundamental principle of the matter allegedly infringed (ex plurimis, Judgment No. 54 of 2015)" (Judgment No. 159 of 2018, point 5 of the Considered in Law). More specifically, this Court has clarified that the appellant has the obligation "also to substantiate the reasons for the alleged conflict with clear, complete, and sufficiently articulated arguments [...] proposing a reasoning that is not merely assertive but contains a specific and congruent indication of the reasons for which there is a conflict with the invoked parameters, supported by a concise statement of merit" (Judgment No. 126 of 2025, point 4.1. of the Considered in Law and precedents cited therein).

In the present case, this obligation can be considered fulfilled by the appellant, who has identified the violated parameter (Article 117, third paragraph, of the Constitution) and the relevant intermediate norms, describing the set of State provisions on health management from which he infers the existence of the fundamental principle – binding, as already noted (supra, point 2), also for Regions with special autonomy – according to which the Region may terminate the relationship with the top management of the entities only when specific conditions occur (necessarily indicated by the State legislator itself) and, in any case, after notice and in compliance with the principle of adversarial proceedings.

To this end, the appeal specifically refers to Article 3-bis, paragraph 7, of Legislative Decree no. 502 of 1992, subsequently transposed into Article 2, paragraph 5, of Legislative Decree no. 171 of 2016, according to which "[t]he Region, after notice and in compliance with the principle of adversarial proceedings, shall provide, within thirty days from the commencement of the procedure, to terminate the contract, declaring the immediate forfeiture of the general manager with a reasoned measure and shall provide for their replacement through the procedures referred to in this Article, if serious and proven reasons exist, or if the management presents a situation of serious deficit attributable to the failure to achieve the objectives referred to in paragraph 3, or in the event of manifest violation of law or regulations or the principle of good governance and impartiality of the administration, as well as violation of transparency obligations [...]".

The provisions invoked by the appellant as intermediate parameters are certainly expressions of a fundamental principle in the matter of health protection, as in this matter, as already observed by this Court, "the intervention of the State legislator has been characterized, since Legislative Decree-Law no. 158 of September 13, 2012 (Urgent provisions to promote the development of the Country through a higher level of health protection), converted, with amendments, into Law no. 189 of November 8, 2012, by the intent to limit the choice of managers – entrusted to the Regions – among candidates possessing proven professional titles and skills, enrolled in specific lists, in order to free health management from political conditioning and favor selection criteria that ensure effective management capabilities and a high managerial quality of the general manager" (Judgment No. 159 of 2018, point 5 of the Considered in Law).

Like the provisions on appointment, those on termination of office also serve this purpose and, as will be shown (infra, point 4), in an even more stringent way, as they can only be terminated in the presence of serious breaches by the general manager, precisely to reduce the scope of political discretion in all phases of the relationship.

Nor can it be argued, contrary to what the Region claims, that the appellant failed to adequately consider the will of the regional legislator to commission the health entities for rationalization and reorganization purposes, since the issue pertains to the possibility of using the instrument of extraordinary commissioning for this purpose when it implies the replacement of incumbent general managers. Any assessment on this aspect, therefore, pertains to the merits of the matter.

4.– The question raised against Article 6, paragraph 1, of Regional Law no. 8 of 2025, in that it replaces paragraph 1 of Article 13 of Regional Law no. 24 of 2020, limited to the second sentence of the replaced paragraph, with reference to Article 97, second paragraph, of the Constitution, is well-founded.

This Court has dealt several times with spoils system mechanisms, increasingly valuing, since judgment No. 233 of 2006 onwards, the need to respect the principles of good governance and continuity of administrative action. Subsequent constitutional jurisprudence after 2006, in fact, specified that such mechanisms, when referring to non-top management figures, conflict with Article 97 of the Constitution, "as they prejudice the continuity of administrative action, introduce an element of partiality into the latter, deprive the declared forfeited subject of the guarantees of due process, and disassociate the removal of the manager from the objective assessment of the results achieved." Similarly, the termination of the general manager from the relationship with the region "for a cause extraneous to the events of the relationship itself, and not on the basis of assessments concerning corporate results or the achievement of health protection and service operation objectives, or – again – for one of the other causes that would legitimize termination for breach of the relationship" was deemed in conflict with Article 97 of the Constitution (Judgment No. 224 of 2010, point 4.2. of the Considered in Law).

In particular, the latter judgment, in declaring the unconstitutionality of a regional norm that automatically linked, according to the principle *simul stabunt, simul cadent*, the fate of a non-top figure, such as the administrative director, to that of the general manager, is significant in two respects. First, it affirmed that "[t]he trust-based choice of the administrative director – which must be made with a reasoned, but still broadly discretionary measure, by the general manager [...] – does not imply, in fact, that the interruption of the relationship, which is established as a result of this choice, can occur with the same margin of discretionary appreciation that characterizes the latter. Once, in fact, the employment relationship is established, with the contractual predetermination of its duration, other aspects come into play, connected, in particular, on the one hand, to the needs of the hospital administration concerning the continuous performance of the managerial functions proper to the administrative director, and, on the other hand, to the judicially protected protection of the interested party's subjective rights, inherent in the position." Secondly, it deemed irrelevant that "the norm provided for the possibility of confirming the administrative director. The power of the general manager to confirm the latter does not, in fact, confer any significant guarantee on the ongoing managerial relationship with the interested party, given that the failure to exercise the aforementioned power leads to automatic forfeiture under the challenged norm" (Judgment No. 224 of 2010, point 4.3. of the Considered in Law).

These principles, already in line with what was stated in the previous judgments No. 81 of 2010, No. 161 of 2008, and No. 104 of 2007, are also reaffirmed in the subsequent judgment No. 228 of 2011, where it is specified that "automatic forfeiture mechanisms, which must also include those that manifest as the termination of the relationship in the event of non-confirmation within a short time frame – non-confirmation which is decided based on a completely discretionary determination […] – conflict with Article 97 of the Constitution – under the dual profile of impartiality and good governance – as they prejudice the continuity of administrative action, introduce an element of partiality into the latter, deprive the subject declared forfeited of the guarantees of due process, and disassociate the removal of the manager from the objective assessment of the results achieved" (point 3.1. of the Considered in Law).

More recently, this Court, with reference to a regional provision that did not link the interruption of the ongoing office relationship to "internal reasons" within the relationship itself, found a violation of the principle of good governance of administrative action under Article 97 of the Constitution, given "the failure to provide for a procedural phase that makes 'forfeiture dependent on the prior liability of the manager'," causing a discontinuity of management without justified motivation (Judgment No. 26 of 2023, point 3.2. of the Considered in Law).

4.1.– That being established, the challenged Article 6, in the part where it sets a term of 60 days within which the new general manager "shall confirm or replace" the administrative director, the health director, and the director of social-health services, if appointed, introduces an element of partiality into the relationship, granting the top management body of the health entity, merely by having taken office, the power to terminate the ongoing terms of non-top managers before their natural expiration, based on purely discretionary assessments and in total absence of a procedural scrutiny of the reasons internal to the relationship.

This places the challenged provision in conflict with Article 97 of the Constitution, under the dual profile of impartiality and good governance of administrative action, exposing the manager to measures adoptable without the guarantee of adversarial proceedings and without the possibility of reviewing the reasons for the decision.

The identified conflict with Article 97 of the Constitution, moreover, cannot be called into question even by the possibility of confirmation of the same directors recognized by the challenged provision, because it does not grant the interested parties any guarantee regarding the continuation of the relationship, since, as stated above, the choice between one solution or the other is left to the absolute discretion of the general manager, regardless of any assessment of the manner in which the term was carried out and the results obtained.

4.2.– The regional defense itself, moreover, is based, rather singularly, on the argument that the health director and the administrative director are coadjutors of the general manager, appointed "on the basis of an exclusively trust-based choice" and "tasked with ensuring the continuity of the top management body (the General Manager), as legally indispensable, by replacing them in cases of vacancy, absence, or impediment"; and, sharing with the general manager "the characteristic of having been chosen on a trust basis in view of achieving objectives assigned by the political body," the newly appointed general manager would legitimately have the faculty to "confirm or replace those whom the law provides they may choose as their collaborators and substitutes." However, as noted above, this Court has already clarified that "[t]he trust-based choice of the administrative director [...] does not imply [...] that the interruption of the relationship, which is established as a result of this choice, can occur with the same margin of discretionary appreciation" (Judgment No. 224 of 2010, point 4.3. of the Considered in Law).

4.3.– In light of the preceding considerations, the unconstitutionality of Article 6, paragraph 1, of Regional Law no. 8 of 2025 must be declared, in that it replaces paragraph 1 of Article 13 of Regional Law no. 24 of 2020, limited to the second sentence of the replaced paragraph, for violation of Article 97, second paragraph, of the Constitution.

The further censures raised by the appellant are absorbed.

5.– Likewise well-founded is the question raised against Article 14 of Regional Law no. 8 of 2025, with reference to Article 117, third paragraph, of the Constitution, in the matter of health protection.

This Court has already had occasion to address the constitutional legitimacy of regional norms that provide for the extraordinary commissioning of entities and bodies of the Regional Health Service. In particular, it noted that, although this institute does not find specific regulation in Legislative Decree no. 502 of 1992, "[n]otwithstanding this, almost all Regions [...] have provided by law for the possibility of appointing extraordinary commissioners, possessing the same requirements for the position of general manager, in cases of vacancy of the general manager position, for a limited period (not exceeding twelve months)," linking it to the "impossibility of filling the vacancy within the sixty-day period" provided for by Article 3-bis, paragraph 2, of the aforementioned Legislative Decree (Judgment No. 87 of 2019, point 4.2. of the Considered in Law).

The aforementioned ruling, in this regard, specifically emphasized that "while in principle the commissioning of Regional Health Service entities by the Region can be considered admissible, what matters most are the prerequisites for it. These, in fact, cannot be found in the mere vacancy of the office, as in that way the provision of Article 3-bis, paragraph 2, of Legislative Decree no. 502 of 1992 would effectively be violated, with circumvention of the peremptory term of sixty days for filling that vacancy. In other words, it must be a proven and justified impossibility to proceed with such filling according to the ordinary procedure." On that occasion, this Court also listed exemplarily the cases in which it is admissible to resort to the institute in question, referring to "the case where the vacancy of the position occurs during the transition between one legislature and another; to that of the resignation of the entire health management; to the case of resignation of the general manager for reasons that make even the substitution by the health or administrative director inappropriate; to rationalization interventions through the merger of health entities" (Judgment No. 87 of 2019, point 4.2. of the Considered in Law).

The institute of extraordinary commissioning was therefore clearly linked to hypotheses where there was no incumbent general manager.

The subsequent judgment No. 209 of 2021 then specified that "Regions can indeed regulate the institute of extraordinary commissioning of Regional Health Service entities, for extraordinary needs or due to a proven and justified impossibility of appointing top management according to the ordinary procedure. Such needs may also arise from rationalization interventions in the health system, as in the present case, in which the extraordinary commissioners have the task of designing and planning the transition from the old to the new structure of the Regional Health Service, thus performing functions of extraordinary administration with transition goals and tasks to ordinary administration" (point 4.1. of the Considered in Law and, in the same sense, Judgment No. 189 of 2022). Both of the latter judgments refer to regional provisions that provided for the appointment of the extraordinary commissioner in cases where there was no incumbent general manager.

5.1.– In particular, judgment No. 189 of 2022 referred to a hypothesis of vacancy of the relevant office, and judgment No. 209 of 2021 ruled precisely on Regional Law no. 24 of 2020 (amended by the provisions challenged herein), which contained a broad reorganization plan for the entities of the regional health system, to be implemented also through the institute of extraordinary commissioning, in order to move from a centralized administration system, consisting of a single entity (ATS) that had incorporated the previous local social-health entities and was divided into local social-health areas, to a decentralized system, composed of multiple newly established entities (the Regional Health Entity and eight local social-health entities), all endowed with public legal personality and organizational, administrative, asset, and accounting autonomy. The commissioned entities were therefore all newly established and without an incumbent top management body, and there was an urgency to fill these positions.

However, the reorganization ordered by Regional Law no. 8 of 2025 does not have the same characteristics as that of 2020. The new regional law, in fact, in order to lay down "urgent provisions for the adjustment, rationalization, and functionalization of the organizational and institutional structure of the Regional Health System (RHS) [...] also with the aim of guaranteeing adequate provision of essential health services throughout the regional territory," maintains the same decentralized system, leaving the division between the entities established in 2020 intact and carrying out essentially internal reorganization within them, through a series of interventions, ranging from the transfer of hospital facilities from one entity to another (Art. 7) to the attribution of new competencies (Art. 8) and the integration and creation of new territorial departments (Arts. 12 and 13) within the already existing entities.

5.2.– The extraordinary commissioning provided for by the challenged Article 14, paragraph 1, disregarding situations of vacancy of general managers and being aimed at a mere internal reorganization of already existing RHS entities to adapt the sector to the new directives and objectives of the newly elected political body, without, however, modifying the general structure of the administrative system of that Service, therefore does not comply with the prerequisites outlined by constitutional jurisprudence for the use of this instrument.

Consequently, the automatic forfeiture introduced by the challenged provision, by linking the termination of the relationship with the general manager to the installation of the extraordinary commissioner, conflicts with the fundamental principles enshrined in Article 2, paragraph 5, of Legislative Decree no. 171 of 2016, which, among the substantive prerequisites and procedural methods for exercising the Region's power to declare the immediate forfeiture of the general manager, does not include resorting to an "extraordinary commissioning" for the reasons identified by the regional law under review.

5.3.– In light of the preceding considerations, the unconstitutionality of Article 14 of Regional Law no. 8 of 2025 must be declared, for violation of Article 117, third paragraph, of the Constitution, in the matter of health protection, in relation to Article 2, paragraph 5, of Legislative Decree no. 171 of 2016.

The further challenges raised by the appellant are absorbed.

for these reasons

THE CONSTITUTIONAL COURT

1) declares the unconstitutionality of Article 6, paragraph 1, of the Law of the Autonomous Region of Sardinia of March 11, 2025, no. 8 (Urgent provisions for the adjustment of the organizational and institutional structure of the regional health system. Amendments to Regional Law no. 24 of September 11, 2020), insofar as it replaces paragraph 1 of Article 13 of the Law of the Sardinia Region of September 11, 2020, no. 24 (Reform of the regional health system and systematic reorganization of regulations thereon. Repeal of Regional Law no. 10 of 2006, Regional Law no. 23 of 2014, and Regional Law no. 17 of 2016, and other sectoral regulations), limited to the second sentence of the replaced paragraph;

2) declares the unconstitutionality of Article 14 of Regional Law no. 8 of 2025.

Decided in Rome, at the seat of the Constitutional Court, Palazzo della Consulta, on December 2, 2025.

Signed:

Giovanni AMOROSO, President

Maria Alessandra SANDULLI, Rapporteur

Roberto MILANA, Director of the Registry

Filed in the Registry on December 23, 2025