There are 11 "improvement actions" indicated by the Ministry of Health report for the "critical issues" detected at the Center for Gender Dysphoria in Careggi. Among these it highlights "the absolute need to urgently produce detailed procedures for the diagnosis and management of subjects with gender dysphoria" and suggests detailing the path "by including regular evaluations by the child neuropsychiatrist in all adolescents for the purposes of prescribing and reimbursing triptorelin". Furthermore "it is necessary to ensure that all cases without exception are visited by a child neuropsychiatrist".
According to the report sent to the Tuscany Region by the Ministry of Health "the times for taking charge of the patient and the subsequent meetings are too far apart", therefore "it is necessary to organize an appropriately timed path". Furthermore - still listing the 11 actions that the ministry describes to implement improvement actions of the center for Gender Dysphoria in Careggi - we read that "the psychotherapeutic path must be structured and organized according to a suitable program" and in line with the determinations of the AIFA. For the report it is necessary to strengthen the staff through "an increase in staff with reference to the figure of the psychologist/psychotherapist" and it is necessary to define "a specific care path in a precise manner".
On the data transmission front, the Ministry requests that the Region transmit the clinical monitoring data of triptorelin to AIFA, so that a monitoring tool is provided for possible side effects.
Finally, the compilation of the medical record is required "according to the criteria of usability and clarity". The document then ends with the invitation to the Tuscany Region to "implement corrective actions to the critical issues identified also by following up on the suggested improvement actions, planning what is necessary and providing feedback to this Ministry, within 30 days of receiving this letter". The progress report is required within 90 days.