Giovanni Landolfo, former head of General Surgery at the State Hospital, wants to return early from the leave of absence he began in June 2025. The ISS (Istituto per la Sicurezza Sociale, San Marino’s social security institute) isn’t questioning his right to return, but it must determine in what capacity – since the department has carried on under another director in the meantime.
Two opposition parties have sensed political interference.
The paperwork tells a much simpler story.
No one is disputing the surgeon’s standing.
In nearly twenty years at the State Hospital he also served as director of the Hospital Department, and he was head of Surgery when the robotic surgery system arrived in the operating theatre. What’s at issue is something else: whether a leave of absence also keeps a chair warm.
Here are the facts, in order.
At the start of 2025, Landolfo requested leave of absence.
He asked for three years; the previous ISS management granted him two, starting in June.
That’s in line with public-sector rules, which cap personal leave at two consecutive years.
His reasons are his own, and there’s nothing to object to: that’s precisely what leave of absence is for.
A hospital, however, doesn’t go on leave.
General Surgery is one of the pillars the State Hospital rests on, and someone had to run it.
The ISS entrusted it to Dr Nicola Cautero, who headed Day Surgery and is a surgeon with extensive experience, including in transplants.
He is now acting director. A detail worth noting: when Cautero was appointed head of Day Surgery in 2024, it was Landolfo himself who introduced him to the hospital community.
So the department didn’t end up in careless hands.
Now, roughly a year and a half in – exactly half the time he himself had requested – Landolfo has changed his plans.
That’s his right.
The ISS has put it in writing: his return is not in question, nor is his professional worth.
What’s at issue is how. In the meantime the department has reorganised, and other doctors have taken on responsibilities they didn’t have before.
And this is where the matter becomes very simple indeed.
A department has one director – only one.
If Landolfo returns to lead it, whoever has kept it running these past months must step aside. That’s not politics, it’s arithmetic. And there’s no automatic entitlement: in San Marino’s civil service, early return from leave is, by its very name, a “concession.”
One requests it, and the administration assesses it. The logic of the rules is explicit. The very regulation on leave of absence allows for shorter periods than the minimum only if it doesn’t require a replacement and doesn’t harm the functioning of the service.
Service first, individual needs second.
To see who’s right, just flip the question around.
Imagine any department head could ask for three years, take two, come back whenever it suits them, and find the chair waiting empty.
Who would agree to run a department as acting director, knowing they’re merely filling a gap on a timeline someone else controls?
And which hospital could plan operating theatres, teams and waiting lists on such a basis?
It has been repeated these past few days that San Marino struggles to retain doctors.
That’s true – until a few years ago many ISS job postings went unanswered.
But the argument cuts both ways: a country losing doctors cannot afford to treat the ones who stayed as substitutes to be dismissed the moment the bell rings.
Retaining professionals also means guaranteeing that whoever takes on a responsibility won’t see it evaporate the instant someone else has second thoughts.
Whether politics had a hand in this affair will be revealed by the answers to the parliamentary question already filed – and it’s right to ask: in San Marino, that question is never idle.
But to understand the ISS’s caution, you don’t need politics – just a calendar and an organisational chart.
And if, in the end, Landolfo returns without leading the department, that would be neither a humiliation nor a scandal: it would be the predictable consequence of his own choice.
Along the Adriatic coast, even children know this: a towel left on a sunbed at dawn doesn’t count as a reservation.
And whoever reappears at midday can’t ask the lifeguard to evict the person who spent the hottest hours of the day under that beach umbrella.
The ISS is acting like a conscientious lifeguard: there’s a spot for whoever comes back, but the rules don’t get rewritten for whoever changes their mind.
