Description
This study examines how a particular set of calculative practices and classification systems
helped to guide the emergency responses to the 2009 earthquake in Abruzzo, Italy.
Accounting classifications worked in tandem with scientific classifications to define the
seismic event as a site for exceptional governance, to demarcate the temporal and spatial
boundaries, and to guide the immediate and subsequent healthcare-related humanitarian
responses. Accounting classification schemes were borrowed and built by the local health
authorities as the federal government made the provision of disaster relief funding contingent
on the identification of additional and traceable earthquake-related expenditures.
Earthquakes, exceptional government and extraordinary
accounting
Massimo Sargiacomo
?
Department of Management and Business Administration, G. d’Annunzio University, Viale Pindaro 42, 65123 Pescara, Italy
a r t i c l e i n f o
Article history:
Available online 13 March 2015
a b s t r a c t
This study examines how a particular set of calculative practices and classi?cation systems
helped to guide the emergency responses to the 2009 earthquake in Abruzzo, Italy.
Accounting classi?cations worked in tandem with scienti?c classi?cations to de?ne the
seismic event as a site for exceptional governance, to demarcate the temporal and spatial
boundaries, and to guide the immediate and subsequent healthcare-related humanitarian
responses. Accounting classi?cation schemes were borrowed and built by the local health
authorities as the federal government made the provision of disaster relief funding contin-
gent on the identi?cation of additional and traceable earthquake-related expenditures. The
analysis also shows the maneuvers that occurred around the accounting classi?cations as
public healthcare providers attempted to use the classi?cations to solve day-to-day health
treatment funding problems and the federal government tried to exert control at a dis-
tance. The analysis provided both contributes to our understanding of the governance of
these exceptional events and brings to the fore the challenges associated with such
humanitarian responses.
Ó 2015 Elsevier Ltd. All rights reserved.
Introduction
A severe earthquake rated 5.9 on the Richter scale
struck the region of Abruzzo in central Italy on April 6th
2009, killing more than 300 people. This paper examines
how a particular set of calculative practices and classi?ca-
tion systems (Bowker & Star, 1999; Foucault, 1979, 1991;
Miller, 2001) helped to guide the emergency responses.
Accounting classi?cations worked in tandem with scienti-
?c classi?cations to de?ne the seismic event as a site for
exceptional governance, to demarcate the temporal and
spatial boundaries, and to guide the immediate and subse-
quent healthcare-related humanitarian responses.
Accounting classi?cation schemes were borrowed and
built by the local health authorities as the federal govern-
ment made the provision of disaster relief funding
contingent on the identi?cation of additional and traceable
earthquake-related expenditures. The analysis also shows
the maneuvers that occurred around the accounting classi-
?cations as public healthcare providers attempted to use
the classi?cations to solve day-to-day health treatment
funding problems and the federal government tried to
exert control at a distance. A combination of oral
testimonies
1
as well as primary and secondary archival
sources provide the data for the study.
The current study seeks to understand how accounting
practices, including the classi?catory schemes that are
integral to them, are used in these moments when an
immediate health-related humanitarian response is
needed, and when that response does not ?t within exist-
ing classi?catory schemes. Previous research, for example,
has tended to focus on settings where accounting is used tohttp://dx.doi.org/10.1016/j.aos.2015.02.001
0361-3682/Ó 2015 Elsevier Ltd. All rights reserved.
?
Tel.: +39 085 4537597; fax: +39 085 4537917.
E-mail address: [email protected]
1
Details of the interviews are provided in the list of references.
Respondents were informed of questions in advance of interviews.
Accounting, Organizations and Society 42 (2015) 67–89
Contents lists available at ScienceDirect
Accounting, Organizations and Society
j our nal homepage: www. el sevi er. com/ l ocat e/ aos
both change and govern routine and day-to-day healthcare
activities (cf. Kurunmäki, 2004; Llewellyn & Northcott,
2005; Preston, Chua, & Neu, 1997; Rahaman, Neu, &
Everett, 2010). The current study, in contrast, focuses on
healthcare systems during a moment of humanitarian cri-
sis. Such settings are characterized by an immediate per-
ceived necessity to act, and a need to eventually phase
out and terminate the intervention. These moments of
intervention create a space of action that potentially over-
laps with extant healthcare provision, where existing clas-
si?catory schemes and accounting practices are sometimes
borrowed and modi?ed to deal with the immediate emer-
gency, as well as the aftermath. The current study attempts
to shed new light on the emergence and deployment of
what is described here as extraordinary accounting: that
is, a set of calculative technologies that co-exist alongside
and at times overlap with ordinary accounting practices.
The focus of the current study complements and
extends the taken-for-granted ways that accounting stan-
dard setters and ?nancial statement users think about
the reporting of infrequent and unusual events
(Bramwell, 2014). For standard setters, the accounting
treatment of such events has historically attempted to dis-
tinguish between accounting transactions that are ‘normal’
versus those that are not, focusing on where these two
groups of transactions will appear within the ?nancial
statements.
2
The current study complements these under-
standings as well as previous research (Beattie et al., 1994)
by illustrating the strategic aspects of such classi?cation
decisions in this case because the classi?cation decision
potentially impacts on the ?ow of ?nancial resources from
governments to the affected regions. These pre-classi?cation
decisions are important in that they in?uence whether an
event will be deemed to be a natural disaster and, hence,
whether ?nancial resources will ?ow from governments to
the affected region and thus need to be accounted for. In
these ways, the analysis draws attention to the sequence
of classi?cations and the associated practices that lie behind
the out-of-the ordinary items that ?nally appear in a set of
?nancial statements.
3
The paper is organized as follows. Section ‘Classifying
natural disasters’ outlines the role of particular classi?ca-
tory devices in de?ning and demarcating the existence,
severity, and consequences of natural disasters.
Section ‘Governing natural disasters’ outlines the theoreti-
cal framing which informs the analysis, focusing on
accounting, government and classi?cation. The concept of
exceptionalism is introduced, together with the suggestion
that accounting may be implicated in the construction and
quanti?cation of states of exceptional government for the
population’s healthcare, in this case following a natural dis-
aster. Section ‘The organization, funding, government and
ordinary accounting of Abruzzo healthcare’ offers a brief
overview of the Italian National Health Service, its funding
model, and how healthcare was organized in the Abruzzo
Region prior to the seismic disaster. Section ‘Exceptional
government and extraordinary accounting’ discusses the
launching of exceptional government in the context of the
humanitarian crisis caused by the earthquake, as well as
the rise of novel classi?cations, lists and rudimentary
accounting practices. Section ‘The operational program’
then examine howthese exceptional classi?catory schemes
and the associated accounting practices worked across time
and space. Finally, Section ‘Conclusion’ discusses the
insights of the study and offers suggestions for further
research.
Classifying natural disasters
Natural disasters, as their name suggests, are adverse
natural events that occur relatively infrequently through-
out the developed and developing worlds (Fassin &
Pandol?, 2010). In recent years, these events have appar-
ently become more numerous, as climate change and glo-
bal warming exacerbate the frequency and severity of
these natural occurrences. Undoubtedly, the proliferation
of social media channels has contributed to the visibility
of such events as rich photo and video images are available
almost instantaneously from the far reaches of the globe.
For example, video footage of ?ooding in the Philippines
and avalanches in Nepal can now be consumed in real time
on You tube and elsewhere.
While social media helps make visible adverse natural
events, it is a series of interrelated classi?cation processes
that in?uences if and how local governments and the inter-
national community responds. The ?rst set of classi?ca-
tions pertains to the scale of the natural event. These
classi?cations are premised on scienti?c measurements,
and are typically accepted by both the scienti?c commu-
nity and the governments and international organizations
that use the classi?cations to frame action. For example,
earthquakes are usually measured and classi?ed according
to the Mercalli or the Richter Scale. The Richter Magnitude
Scale assigns individual seismic shocks to categories, rang-
ing from micro earthquakes (measuring less than ‘two’ on
the scale) to massive disasters (measuring more than ‘ten’
on the scale). The Mercalli Scale spans from 1 (a ‘micro’
earthquake), to 10–12 (a ‘massive’ earthquake) (Lee,
Jennings, Kisslinger, & Kanamori, 2002; Richter, 1935).
Likewise hurricanes are measured by the Saf?r-Simpson
1–5 scale (Simpson, 1974) whereas volcanic eruptions
are observed by the Volcanic Explosivity 0–8 Index
(Newhall & Self, 1982).
Such classi?cation of adverse natural events is the start-
ing point for a classi?cation of the social and economic
consequences by governments and others. In Italy, for
example, the legislation draws on international classi?ca-
tory schemes to categorize natural disasters (art.2, Law
2
In July 2014, FASB released an exposure draft that proposes to remove
the category of extraordinary items since stakeholders have complained
that ‘‘the concept of extraordinary items causes uncertainty because it is
unclear when an item should be considered both unusual and infrequent’’
(Bramwell, 2014). For example, in 2005, FASB declared that Hurricane
Katrina was not ‘‘infrequent in nature and unusual in occurrence’’ (http://
www.accountingweb.com/topic/cfo/accounting-purposes-katrina-consid-
ered-ordinary) whereas the eruption of the volcano Mount St. Helens in
1980 was (Bramwell, 2014). The exposure draft proposals are similar to
IFRS (IAS 1 87) which does not allow the use of an extraordinary item
category (http://annualreporting.info/ifrs_standards/ias-1-87-ex-
traordinary-items-other-comprehensive-income-section).
3
Arguably similar sequences of classi?cations exist within IFRS, espe-
cially with respect to future site restoration costs (cf. CPA 2013, p. 31).
68 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
n.225, 24 February 1992). Natural disasters (and responses
to them) are identi?ed as one of three categories of emer-
gency: (a) natural events where the emergency may be
addressed at the local government level in an ‘ordinary
manner’; (b) natural events which require a coordinated
response at the province/regional level in an ‘ordinary
manner’; and (c) natural calamities, catastrophes or other
events which, due to their intensity and scope, require
the application of extraordinary means and powers.
Importantly, in emergencies classi?ed as ‘(c)’ the Council
of Ministers determines a ‘state of emergency’ and de?nes
the duration and territorial scope of governmental
responses (art.5, Newhall & Self, 1982). The declaration of
a ‘state of emergency’ following an earthquake would typi-
cally arise from a seismic shock equal or higher than 6 on
the Mercalli scale, or its equivalent in the Richter Scale
(Bignami, 2010).
Within the international community, similar classi?ca-
tion devices are used to decide whether humanitarian and
economic assistance should be provided. For example, the
European Union applies a severity threshold that considers
the economic consequences of a disaster. It allocates soli-
darity funds when natural disasters cause damage over
€3 billion, or 0.6% of the GNI of the country struck by the
catastrophe (see:http://ec.europa.eu/regional_policy/the-
funds/solidarity/index_it.cfm).
These classi?cations are important to the governance of
natural disasters, for they frame and in?uence if, when, and
how governments and the international community
respond to natural disasters, a social and political process
that is not separable from other governance activities.
Furthermore, the calculation and classi?cation of the con-
sequences must occur almost immediately (because of
the urgency of the situation), and yet be built up from a
series of more micro ‘data’. The next section considers
how these and other classi?cations organize the process
of responding to natural disasters, including the ways that
they relate to and intersect with day-to-day governance
activities.
Governing natural disasters
In his lectures on security, territory and population,
Foucault suggested that government, in the current era,
is about the correct way of disposing of things (2009).
Furthermore, he noted that government was less about
imposition and more about arranging the conduct of con-
duct (2000, p. 341). The current study starts from these
observations and proposes that classi?cation—used here
to denote both classi?catory schemes and the actions that
occur around these schemes—are central to governance.
Classi?catory devices and the associated activities both
help to frame the conduct of conduct, and are part of the
response to it. Further, classi?cation and the apparatuses
of disposal exist in relation to other classi?catory devices
and apparatuses of disposal. Additionally, the schemes
and the ways that they are enacted sometimes have a tem-
poral dimension in that they change as circumstances
change The remainder of this section elaborates on these
ideas and outlines how this framing brings to the fore
some key aspects of the governance of natural disasters.
Classi?catory schemes are an integral part of current
day government. Bowker and Star, for example, comment
that ‘‘classi?cation systems are integral to any working
infrastructure’’ (1999, p. 16). Classi?cations identify and
differentiate individuals, things, territories and spaces;
and they mark the boundaries between the normal and
the abnormal, thereby determining inclusion or exclusion
in relation to pre-established norms (Foucault, 1991, pp.
177–184). As Foucault suggested in his earlier work, divid-
ing practices are premised on classi?cation, since it is clas-
si?cation that constructs similarity and difference
(Foucault, 1979, pp. 99, 148–9, 156). In the words of
Foucault (1970):
. . .It is not a question of linking consequences, but of
grouping and isolating, of matching and pigeon-holing
concrete contents. . .. there is nothing more tentative,
nothing more empirical. . .. than the process of estab-
lishing order among things. . . nothing that demands a
sharper eye or a surer better articulated language.... in
fact there is no similitude and the distinction, even for
the wholly untrained perception, that is not the result
of a precise operation and of the application of a pre-
liminary criterion. . ..
[1970, pp. xix–xx]
Written classi?catory devices—classi?catory artefacts—
are an important type of classi?catory device. These arte-
facts are both a congealed dividing practice and something
that facilitates subsequent dividing practices. More impor-
tantly, however, classi?catory artefacts allow for the
attachment of resources and actions to different categories
thereby helping to facilitate the conduct of conduct. Stated
differently, such artefacts divide, but in a way that pro-
vides the impulse for certain actions.
The idea that accounting classi?cations are a useful
technology of governance has a long lineage within the
accounting and related literatures. Miller and Rose (1990,
p. 13), for example, explicitly note that governance
involves acts of classi?cation and that accounting partici-
pates in these processes. Similarly, Preston et al. (1997)
illustrate how the classi?catory schemes that were embed-
ded in DRG costing artefacts allowed the United States
government to attach funding consequences to different
categories, thereby motivating certain strategies on the
part of hospitals, medical staff and patients. Field studies
examining healthcare in Africa (Rahaman et al. 2010),
Australia (Abernethy & Stoelwinder 1995; Chua 1995),
the United Kingdom (Llewellyn & Northcott, 2005;
Preston, Cooper, & Coombs 1992) and the United States
(Arnold & Oakes, 1998; Pizzini, 2006), have illustrated
the different ways that accounting inscriptions, and the
classi?catory devices that they are constituted by, partici-
pate in organizing the conduct of conduct. More speci?-
cally, this prior research shows that it is often the
impregnation of accounting classi?cations with funding
consequences that both facilitates governance and con-
tributes to the salience of such classi?cations.
One of the reasons that these practices are potentially
powerful is because they facilitate judgment and action
at a distance. Prior research illustrates how accounting
inscriptions facilitate governance because they are
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 69
portable, comparable and combinable (Robson, 1991;
Robson, 1992). These features allow government bureau-
crats and others to make calculations regarding distant
locales, to compare them to other sites, and to make judg-
ments about their activities (Miller & Rose, 1990, p. 9). As
Rose and Miller (1992, p. 175) argue ‘‘knowledge is thus
central to these activities of government and to the very
formation of its objects, for government is a domain of cog-
nition, calculation, experimentation and evaluation’’.
Accordingly, numbers, tables and statistics play a pivotal
role in analyzing and diagnosing government interven-
tions. Accounting classi?cation devices, and the associated
inscriptions, provide the impulse for this mediating pro-
cess: ‘‘to exercise power over events and processes distant
from oneself it is necessary to turn them into traces that
can be mobilized and accumulated’’ (Rose, 1991, p. 676).
These traces ‘‘make the domain in question susceptible to
evaluation, calculation and intervention’’ (Rose & Miller,
1992, p. 185). Furthermore, these inscriptions allow pol-
icy-makers and those controlling the funding to not only
judge and intervene in these distant sites, but also to adjust
and change the classi?catory schemes themselves. These
acts of adjustment on the part of policy makers, both in
terms of how the classi?catory device is used, and in terms
of the device itself, are central to the current study.
Acts of adjustment are part of the games and strategies
that occur around classi?cations (cf. Foucault, 2000, pp.
346–347). The governance of the conduct of conduct, as
Foucault observed, is always partial because these tech-
niques of governance rely on a mixture of arrangements
that attempt to manage possibilities for action (2000, p.
341). From this vantage point, ‘‘one can interpret the
mechanisms brought into play in power relations in terms
of strategies’’ (p. 346). These mechanisms act on the ‘free
will’ of the acting subject but in a way that is always lim-
ited by the reality that the targets of governance are
simultaneously acting subjects (p. 342). One of the conse-
quences of this is that games of strategy—involving both
those with the ability to in?uence such mechanisms and
those targeted by them—occur around the mechanisms
that have been introduced to organize the conduct of con-
duct. These games of strategy around classi?cations poten-
tially contribute to the eternally optimistic yet perpetually
failing nature of governance (Miller & Rose 1990, p. 10).
4
Previous research illustrates that social actors strategize
around and with accounting classi?cations. Sometimes
these strategies involve the ways that classi?catory arte-
facts are ?lled in (Neu, Ocampo Gomez, Graham, &
Heincke 2006, p. 659), since it is possible to both in?uence
what distant policymakers will see and perhaps more
importantly what contingent funding will be received. In
other cases, participants on the ground exercise discretion
in terms of how the classi?catory device will be inter-
preted and applied, perhaps in the attempt to buffer their
patients, students, and clients from the classi?catory con-
sequences (Weiner, Maxwell, Sapolsky, Hsiao, & Dunn
1987, p. 471). This prior research draws attention to the
importance of how participants, including policy makers,
respond to and with classi?cation devices.
One of the ideas present in Foucault’s lectures on gov-
ernment is the distinction between normal and extraordin-
ary government. For example, he comments that
government also involves the ‘‘negative aspects of life’’
including ‘‘accidents such as ?re and ?ood’’ (2002, p.
318), and that action is needed ‘‘to remedy the accidents’’
caused by disasters (2009, p. 331). Rose (2005, p. 245)
echoes this, commenting that despite the fact that the
world is constructed on the notion of ‘normal’, ‘‘the usual,
the average the common’’ (Rose, 2005, p. 245), moments
arise when this state of affairs is disrupted and where
urgent action is required. This sentiment is explicit within
Ferejohn & Pasquino‘s essay entitled ‘‘The Law of
Exception’’ (2004) which recapitulates different models of
emergency state powers and suggests that the ‘norm’
refers to ‘‘an empirical regularity in the natural world or
in the society’’ re?ected in ‘‘regular government’’. But there
are also ‘‘exceptions, differences, deviations vis-à-vis the
norm’’ (2004, pp. 221–222) instigated by special or emer-
gency circumstances. In these situations, such as civil
war, terrorist attacks and invasions, the state may assume
‘‘emergency powers’’ which involve the suspension of, or
partial deviation from, the normal mode of constitutional
government (idem, pp. 222–223).
More recently, Agamben (2005) has referred to a ‘‘glo-
bal civil war’’ to illustrate that ‘‘the state of exception tends
increasingly to appear as the dominant paradigm of gov-
ernment in contemporary politics’’. Here, provisional
exceptional measures are transformed into ‘‘a technique
of government’’ (2005, pp. 2–3). Agamben has also empha-
sized that ‘‘The declaration of a state of siege on the occa-
sion of the earthquake of Messina and Reggio Calabria on
December 28, 1908 is only apparently a different situation’’
(idem, p. 17), thereby indirectly including natural disasters
among the exceptional circumstances which trigger states
of exceptions. However, Lazar (2009), in States of
Emergency in Liberal Democracies, argues that ‘‘there is no
principled reason to make an ontological distinction
between terrorist threats and other kinds of threats.
Infrastructure disasters... ?oods, earthquakes, indeed any-
thing that poses a real and urgent threat on a grand scale
is an emergency, insofar as one aspect of a government’s
job is to keep its citizens safe’’ (p. 8). Indeed, humanitarian
crises resulting from war, natural disasters or political col-
lapse are all usually perceived as breaks from normality
which spur emergency responses, interventions, tech-
niques and regimes of practice.
While exceptional moments may appear self-evident,
we examine here how they are constructed and de?ned
vis-à-vis classi?cations such as the aforementioned scien-
ti?c and socio-political classi?cations. Furthermore, we
suggest that the modes of response after an event has been
named as a natural disaster are guided by a distinctive set
of classi?cations and interventions.
Previous research suggests that accounting calculations
may feed into the initial determination of whether an
event will be classi?ed as a natural disaster. Much like sit-
uations of normal government, accounting numbers help
4
Foucault suggests that governance is achieved when ‘‘stable mecha-
nisms replace the free play of antagonistic reactions’’ (p. 346) however
Miller and Rose (1990), along with others, question whether such stability
is ever more than temporary.
70 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
to calculate and quantify the ‘economic’ magnitude of the
event. Accounting, as ‘‘an inherently territorializing activ-
ity’’ (Miller & Mennicken, 2012), involves dividing territo-
ries and people from those most affected to those not
affected at all, attaching ?nancial and costing measures
to those so categorized, and developing boundaries for
such issues as healthcare fee exoneration or income tax
exemption. These activities help to construct, represent
and quantify the crisis, thus separating the exceptional
from the normal, and thus providing the impulse for
immediate and extraordinary action.
When extraordinary action is seen to be warranted,
there is still the issue of how it will be organized, and what
will be the relationship between the normal and extraor-
dinary disposition of things. The process of achieving out-
comes that are convenient for ‘‘each of the things that are
to be governed’’ is more complex in the context of an emer-
gency (Foucault, 1991, p. 95). A crisis creates a situation
which not only has to be governed, but one where things
must be disposed of quickly, by authorities on the ground
and at a distance. Thus a key set of questions pertain to the
origins of the extraordinary accounting classi?cations and
associated practices. Second, there is the issue of how they
relate to, intersect with, and possibly contradict the exist-
ing programs of disposition? Finally, there is the matter of
how these classi?catory practices change as the crisis
recedes, and how they eventually come to stop?
In terms of the ?rst question, prior research suggests
that accounting classi?cations and practices are sometimes
borrowed from other settings, thus functioning as a ready-
made technology (Miller & Rose, 1990; Rahaman et al.
2010). Given that natural disasters can occur relatively fre-
quently, classi?catory templates and response protocols
exist within international aid agencies and also govern-
ments (Amin & Goldstein, 2008). At the same time, not
every situation is identical, and the politics of the situation
will in?uence the response (Fengler & Kharas, 2010). Thus
it is likely that the acts of classi?cation and the associated
practices will be an amalgam of things borrowed and built.
These classi?catory artefacts will be constructed to detect,
record, and report such items as the extraordinary health-
care costs and activities sustained by regional/local gov-
ernments and their local health units in the aftermath of
a natural disaster. However, they will also be used to
foment, guide and perhaps constrain emergency responses
(cf. Rahaman et al. 2010). And, as might be expected, these
acts of construction and disposition often enlist groups of
accounting and ?nancial management experts to identify
solutions, modify and adapt existing practices, and deploy
them in the exceptional space (e.g., World Bank, Fengler,
Ihsan, & Kaiser, 2008).
The relationships among extraordinary and normal dis-
position assemblages are also salient. For example, health-
care disposition assemblages have often been guided by a
mentality of rationing, where the goal is to deliver a ?xed
amount of health services in the most cost effective man-
ner (cf. Preston et al. 1997). One of the consequences is that
health delivery providers are almost always operating in a
resource constrained fashion, and almost always looking
for opportunities to obtain additional ?nancial resources
to cover operating costs (Broadbent, Laughlin, & Read,
1991). Traditionally, these opportunities are contained by
using a combination of post-delivery reimbursement
mechanisms and auditing practices (Preston et al., 1992;
Tediosi, Gabriele, & Longo, 2009). In contrast, extraordinary
disposition assemblages are more likely to be guided by a
mentality of urgency, at least in the initial moments after
the disaster. Such assemblages often forego immediate
accountability by using block funding transfer mechanisms
and post spending accountability mechanisms (Fengler &
Kharas, 2010; Fengler et al., 2008). Furthermore, national
laws often devolve responsibility to apply funds for emer-
gency purposes to the affected regional/local governments,
leaving a space of discretion regarding the types of service
providers (public vs. private) and the types of spending
(drugs, temporary accommodations, medical services,
etc.). Not surprisingly, this creates a discretionary space
where politicians and others may attempt to appropriate
some of these funds, and where public healthcare provi-
ders will try to obtain reimbursement for ‘normal’ health-
care treatment activities.
Finally, there is the question of whether and how the
novel classi?cation devices change as the crisis recedes,
and the time since the initial event increases. In the
immediate aftermath of the disaster, healthcare needs
are, and are made to appear as urgent. As mentioned pre-
viously, traditional media and social media outlets provide
a plethora of almost real-time visual images to the nation
and the globe about the scale and scope of the disaster in
question. In these moments, the disposition assemblages
may be both more rudimentary and more liberally applied
than in normal times of government (Alexander, 2000,
2002; Coppola, 2011). However, this is likely to change as
the initial emergency recedes, as the media focus shifts
to other calamities, and as disposition assemblages ‘evolve’
to decrease the spaces for discretion, thus strengthening
novel and purpose built information systems (Fengler &
Zaki, 2010). These observations raise questions as to the
trajectory of disposition assemblages, including whether
they are eventually terminated, or whether they morph
into a normal form of governance such as the case of
HIV/Aids in Africa (Rahaman et al., 2010). The subsequent
case considers these questions in more detail.
The organization, funding, government and ordinary
accounting of Abruzzo healthcare
The Italian National Health Service
According to the Constitution of the Italian Republic,
health is a guaranteed right. A National Healthcare
Service (INHS) was founded in 1978. It aims to provide uni-
form and comprehensive healthcare and is ?nanced by
general taxation (France, Taroni, & Donatini, 2005). The
INHS has undergone major reforms in the last 20 years,
with the result that the regions are now responsible for
the organization and administration of healthcare (Ianni,
2008). Although regions are expected to provide basic
and equal levels of essential care (Torbica & Fattore,
2005), they are free to adopt different organizational and
funding models, thereby giving rise to diverse regional sys-
tems (Jommi, Cantù, & Anessi Pessina, 2001).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 71
Since 2000 (and Legislative Decree n. 56/2000) Italy has
attempted to introduce ?scal federalism (Oates, 1999), in
order to ensure greater ?nancial accountability for regional
governments. However, there remains a multi-tier struc-
ture, with regional differences in the ability to contain
health expenditures within the limits of available funding
(Tediosi et al., 2009). While many regions have achieved
?scal federalism, a small but signi?cant number (such as
Abruzzo, Lazio, Campania, Molise), continue to experience
?nancial distress. Under the pressure of federalist thought
these regions were asked, in the ?rst half of 2007, to sign
an agreement on a budgetary balance plan to be negotiated
with, and controlled by, the Ministry of Health and the
Ministry of Economics and Finance (Lega, 2008).
In 2008, the said regions failed to satisfy the budgetary
stipulations, and the Italian government appointed
experts, named ‘Commissioners ad acta’, whose function
was to provide quarterly reports on the implementation
of the plans and the achievement (or otherwise) of govern-
ment objectives. Furthermore, a series of measures – such
as limits on pharmaceutical expenditures and no auto-
matic right to replace personnel when posts become
vacant after people retirement – were applied to non-com-
pliant regions, and access was prevented to a special tran-
sitional fund, which was previously created by the
government to sustain regions facing higher de?cits (i.e.,
over 7% of total funding) (Tediosi et al., 2009). In order to
co-fund their de?cits, regions suffering ?nancial stress
were permitted (under the 2007 Financial Law) to increase
regional taxation on productive activities (i.e., the so-called
‘Imposta Regionale sulle Attività Produttive’ – IRAP), and
impose surcharges on personal income tax (i.e., the so-
called ‘Imposta sul Reddito delle Persone Fisiche’ –
IRPEF). These represent some of the major sources of fund-
ing for the INHS, together with value added tax (VAT) and
excise duty on petrol (Manzoli, Villari, & Boccia, 2008).
The Abruzzo Regional Health Service
At the time of the earthquake on 5 April 2009, the INHS
at the regional level in Abruzzo was organized around six
Aziende Sanitarie Locali (Local Health Authorities – LHAs).
LHAs are integrated delivery systems providing a full range
of health and social services, whose public funding was
based on a capitation quota, proportional to the population
of the four provinces
5
of the region (Chieti, Pescara, Teramo
and L’Aquila) and of neighboring smaller municipalities (i.e.,
Avezzano-Sulmona, Lanciano-Vasto). Healthcare expenses
accounted for 86% of the total assets of the Abruzzo
Region, whose LHAs were managed by public CEOs.
As portrayed in Fig. 1, the ?nancial results of each LHA
can be greatly affected by the mobility of the population to
and from other LHAs, inside and outside the Abruzzo
Region. The ?nancial results of the Region and the LHAs
can also be negatively in?uenced by the ?ow of residents
to ‘private’ status in the provision of hospital, diagnostic,
rehabilitative and integrative care, but they can also be
enhanced by the LHA’s own sources of income (e.g.,
patients’ payments for diagnostic investigations, or for
medicines) (Sargiacomo, 2002).
In September 2008, a Commissioner with experience as
a CEO of local governments and CFO of a large LHA was
appointed for Abruzzo to achieve governmental aims. As
a consequence of the Budget Recovery Plan enforced by
this Commissioner (n. 14/09, 12 March 2009), ?nancial dis-
tress targets were a pivotal part of the measures imposed
for the Abruzzo and related territory – the ‘social space’
of normal governmental action. Healthcare fees were
imposed to increase the internal autonomous funding of
Fig. 1. Funding model of the Abruzzo region healthcare.
5
Italy is organized in 20 regions, each of which contains a number of
provinces.
72 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
the Abruzzo Region. Blocking staff turnover and reducing
personnel were implemented to contain ?xed costs and
to reduce healthcare expenses. Expenditure caps were also
imposed in relation to general practitioners, private care,
public hospital care, building maintenance and pharma-
ceutical care, whilst non-prescription over-the-counter
drugs were regularly paid for by patients/inhabitants of
the Abruzzo Region.
The accounting/administrative and reporting apparatus
associated with normal government action was primarily a
double-entry bookkeeping system, sustained by an annual
asset and liability statement and a pro?t and loss account.
Since 2008 there had been a uniform regional plan of
accounts and cost centres to which the LHAs had to con-
form. In terms of pharmaceutical distribution procedures,
no drug could be obtained in local pharmacies without a
medical prescription issued by a doctor working in the
region. In order to authorize and document public care
costs and activities, the CEOs inserted ordinary delibera-
tions, orders, and invoices, along with their respective
accounting and non-accounting data, into a regional IT
information system. The CEOs of LHAs were thus obliged
to respect tight budgetary targets for 2009 and to provide
quarterly reports (Ianni, 2008) in order to demonstrate
adherence to the regional Budgetary Balance Plan. This
plan was controlled at a distance by state inspectors, and
routinely audited on a three-month basis. Moreover, ordin-
ary checking procedures, aimed at testing the correctness
of ordinary costs and activities recorded, were ensured
by matching the ?scal codes of the inhabitants of the
Abruzzo region with the records of the healthcare costs
pertaining to them.
These ‘normal’ arrangements for the government,
administration and ?nancing of regional healthcare, and
their respective ordinary accounting architecture, were
disrupted when, in the early morning hours of April 6,
2009, an earthquake struck the Abruzzo region.
Exceptional government and extraordinary accounting
De?ning, classifying and demarcating the terrain of
exceptional governance
Preliminary information about the earthquake from the
Italian seismic service indicated that the magnitude was
approximately 7 on the Mercalli scale. Reports from the
police and other local authorities indicated both civilian
casualties and signi?cant damage. These events and
reports put into motion a series of steps and activities that
culminated in an exceptional government program and
extraordinary accounting. The remainder of this section
describes these steps and outlines the contours of the
program.
On April 6th, as reports regarding the number of deaths
and the extent of the damage continued to trickle in, Prime
Minister Berlusconi, after conferring with his cabinet,
declared a national state of emergency. Funds and person-
nel were allocated through an Ordinance of the President
of the Council of Ministers (OPCM, n. 3753, 6 April 2009).
The Head of the Civil Defence Department – who at that
time was also acting as Undersecretary of the State – was
delegated to oversee post-disaster operations. He was
given the authority to do what was necessary ‘‘in order
to satisfy the paramount life needs of the affected pop-
ulations’’ (Art.1, OPCM n. 3753, 6 April 2009).
It is important to note that these initial actions were
somewhat tentative, as the scale and scope of the earth-
quake and its consequences were largely unknown. The
earthquake itself had damaged the telecommunications
infrastructure compromising communications within the
region and beyond. This, along with the dispersed nature
of the population and the extent of the damage, made it
dif?cult to identify the number of persons missing or
injured. In this regard, the declaration of a state of emer-
gency notwithstanding, the implementation of a program
of exceptional government needed to await additional
information. In the absence of this information, the health-
care Commissioner announced on 7 April 2009 that the
local health authorities had permission to exceed expense
thresholds established in the Budget Recovery Plan (DCaa,
Note Prot. 9426, 6 April 2009). Later in the day, he sus-
pended the Budgetary Recovery Plan altogether for the
LHAs, the territories and the citizens belonging to the
Province of L’Aquila (DCaa, n. 23/09, 7 April 2009).
Given the confusion that reigned in the days immedi-
ately after the disaster, it was not clear how many local
authorities were struck by the earthquake. The Head of
the Civil Defence enlisted the seismic service to demarcate
the terrain of exceptional governance, de?ned as those
areas experiencing an intensity equal to, or higher than,
six degrees on the Mercalli Scale. The available seismic
data was plotted on a map of the region to identify the
communities that would be the targets of exceptional gov-
ernment and the corresponding health authorities that
would participate in the distribution of things. These acts
of classi?cation and demarcation took approximately ten
days. On April 16, the Civil Defence issued a decree de?n-
ing the earthquake territory as the 49 municipalities in
the Provinces of L’Aquila, Pescara and Teramo (DCD, n.3,
16 April 2009). This area thus became the target of excep-
tional government (see Fig. 2).
These classi?cation exercises had important implica-
tions for the inhabitants of the region in that these activi-
ties not only partitioned physical space but also people.
People living outside the de?ned area continued to be sub-
ject to normal government actions, whilst earthquake-af-
fected citizens were to be assisted through exceptional
measures. This distinction was not lost on the population
and their politicians. In July 2009, three months after the
earthquake and after prolonged behind-the-scenes lobby-
ing, the list of affected municipalities and towns was
increased to include additional municipalities and towns
6
.
Immediate humanitarian aid
Two of the most pressing needs in the days immediately
after the earthquake were the provision of accommodation
and prescription medicines for the injured. To address these
needs, two temporary disposition assemblages were
6
DCD n. 11, 17 July 2009, upgraded the number of municipalities to 56.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 73
immediately deployed both by the Head of the Civil Defence
and by the healthcare Commissioner. In terms of
accommodations, displaced persons were moved to hotels
located on the Adriatic coast, mostly – but not only – in
the towns of Francavilla al Mare, Pescara, Silvi and
Giulianova, which are at more than 100 km distance from
L’Aquila. This area was selected because it was thought to
be safe from any aftershocks and because the hotels were
mostly empty since it was not yet the tourist season. Thus,
the Head of the Civil Defence ensured ‘‘support to the over
30,000people that have beentransferredfromthe epicenter
area toward the coast and were lodged in the hotel facilities
whose costs were shouldered by the civil defence system’’.
Moreover, ‘‘buses of the regional company ARPA were uti-
lized for the transfer of evacuees to the hotel structures ‘‘
(Report of the Undersecretary of the State to EU, 2009, pp.
25–27). These costs were directly born by the Department
of Civil Defence and were not charged to the LHAs. Indeed
the Civil Defence Department had been assigned a large
amount of public funds to urgently launch, manage and
pay broad emergency relief activities (Sargiacomo, Ianni, &
Everett, 2014).
The healthcare Commissioner concurrently relaxed the
usual medication distribution procedures, introducing on
April 7 a ticket exemption that consisted of both a way
to distribute medications to the population and a method
to account for these distributions. An identi?cation code,
‘Resident of the L’Aquila LHA’, was introduced that allowed
these ‘identi?ed’ individuals to obtain medications without
payment and without a prescription. The code was chan-
ged the day after to ‘T09’ (the Italian acronym of
Earthquake09). The new policy stated that:
hospital and private accredited pharmacies.... will dis-
burse the products/drugs needed even in absence of
the authorization of the respective competent health-
care of?ces, being not compulsory in this ?rst emer-
gency phase to follow the normal procedures.
[DCaa, Note Prot. n. 9560/S, April 8 2009]
As the subsequent comments by the Commissioner
indicated, the intention was to grant humanitarian discre-
tion to hospitals and pharmacies in order to allow them to
provide urgent healthcare to earthquake-injured people.
Given that in the days immediately after the disaster nei-
ther mobile or ?xed phones, nor internet connections,
were working, the Commissioner disseminated the policy
of free medications to the population through TV and
newspaper media.
At the same time, the introduction of a new classi?ca-
tory code both made possible and implied the need to
account for the code-speci?c expenditures. For example,
the Commissioner decreed that:
. . .each LHA will promptly open a speci?c cost centre on
which there have to be recorded the expenses sustained
by the LHAs deriving from the healthcare assistance to
be guaranteed [underlined in original] to the citizens
hit by the quake....
[DCaa, Note Prot. n. 9560/S, April 8 2009]
i
i
Fig. 2. Territorial demarcation of the classi?ed ‘‘crater space’’ struck by the quacke.
74 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
However he also recognized that this space for discretion
could be subject to abuse. Thus he simultaneously pre-
scribed that:
. . . it is disposed that the hospital and private accredited
pharmacies. . .will disburse products/drugs needed even
in absence of the authorization of the respective compe-
tent healthcare of?ces, being not compulsory in this
?rst emergency phase to follow the normal
procedures. . .. The Direction of Health Policy of the
Abruzzo Region is going to get the list of the names
of. . . citizens/patients eligible to have the respective
therapies. The mentioned list will be promptly sent to
the pharmacies in order to permit the administration
of drugs.... The list of identity records and personal
details of all the citizens/patients... will be available to
any interested party. . . in order to facilitate the identi?-
cation of the patients deprived by any identity card or
?scal code. . ..
[DCaa, Note Prot. n. 9560/S, April 8 2009]
This later prescription was intended to limit the num-
ber of people that could take advantage of the space for
discretion.
Gordon (1991, p. 10) states that policing, and by impli-
cation governing, ‘‘is a science of endless lists and classi?-
cation’’. The above excerpts indicate that in the days
immediately after the shock, matched lists of patients/dis-
eases emerged and were enlisted to help organize the
emergency response. Also apparent is the initial construc-
tion of the parallel reporting and calculative procedures
needed to support the administration of the fee exemption
for pharmaceutical drugs and healthcare assistance.
Further reporting procedures were also enacted on the fol-
lowing day, 9 April, when the Commissioner emphasized
that:
. . .in order to achieve a correct accounting and report-
ing. . . each prescription holding the T09 code must be
gathered in separate rolls and brought to the LHA, in
whose territory is located the pharmacy which has
delivered the prescription. . .. The set of forms prear-
ranged to deliver C Class Drugs should be likewise
rounded up in separate rolls and handed out to the
LHA, in whose territory is located the Pharmacy which
has delivered the prescriptions according to the above
manners. . . [and] that the current deliberation be given
the maximum diffusion through the media (TV and
newspapers) as well as on the Abruzzo Region website.
[DCaa, 8/47, 9 April 2009]
The above rudimentary accounting and reporting tech-
niques, were borrowed from and de?ned in relation to the
pre-existing normal modes of accounting for dispositions.
Whereas the T09 code was something new, it was inserted
into the already existing accounting system, adding a new
category into which costs could be accumulated. Likewise
the list of eligible patients was generated from the infor-
mation already in the healthcare database. While these
recording and classi?cation activities made it possible to
account for disaster-related costs, at this early stage, the
need to ‘‘guarantee healthcare assistance’’ seemed to
supersede any ‘normal’ administrative/accounting proce-
dure. This ?rst phase of the healthcare emergency crisis
was set by the Commissioner to end on 30 May 2009.
In this initial period, the new classi?cation-based dis-
position procedures introduced had tangible consequences
for residents within, and outside, the region. Individuals
classi?ed as residing outside the borders of the earth-
quake-crater continued to be de?ned as normal citizens.
They remained subject to the ongoing stipulations of the
Budget recovery plan. Thus they usually paid fees for phar-
maceutical assistance, non-prescription over-the-counter
drugs, and specialist and diagnostic health assistance.
7
By
contrast, those classi?ed as part of the affected populations
acquired visibility and the status of ‘‘earthquake-injured peo-
ple’’. This rendered them valid recipients of the exceptional
government healthcare program. The inhabitants located in
the territories devastated by the earthquake bene?ted from
healthcare ticket suspension, free medicine, and specialist
and diagnostic heath assistance. Importantly, in the social
space of exceptional government, the previously established
pharmaceutical cap was abolished, as a pharmaceutical assis-
tance exemption was immediately stipulated (See DCaa n.23,
7 April 2009). It was also established that non-prescription
over-the-counter drugs were to be distributed free of charge
(DCaa, Note Prot. n. 9560/S, April 8 2009) to the classi?ed
territories and their lists of inhabitants.
Accounting for extraordinary costs
At the same time that these events were unfolding in
the region, the national government was deliberating over
what additional aid to provide. Despite the ongoing federal
government ideas of ?nancial restraint, which a priori
impeded any further appropriation of funds from the state
to the Abruzzo Region, the Legislative Decree (LD) n. 39, on
28 April 2009 (later converted into Law 77, 24 June 2009),
allocated €40 million to the Abruzzo Region to meet the
extraordinary costs and activities incurred in relation to
earthquake-related healthcare services. These funds, how-
ever, were tied to and embedded within a disposition
assemblage that attempted to limit the space for discre-
tion. This section considers the activities of coding,
classifying, training and funding that were used to orga-
nize the conduct of conduct.
As the emergency healthcare crisis receded, and amidst
federal government concerns that the resources assigned
might be misapplied by a region in ?nancial distress, a
presidential ordinance (OPCM, n. 3782, 17 June 2009)
made access to funds conditional on the Commissioner’s
presentation of an ‘‘Operational Program to further face
the dif?culties caused by the seismic events’’ (art.2). This
decree was intended to explicitly signal that federal fund-
ing was contingent and that an explicit stewardship
relationship existed between the federal government and
the Commissioner regarding the use of the extra monies.
The Commissioner was expected to gather ?nancial infor-
mation from the various regional LHAs, collate it, and
7
Moreover, normal citizens continued to be subjected to the state/region
ordinary ?scal regime, thus paying, for example, all forms of income or
personal property taxes.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 75
prepare an ‘acceptable’ OP prior to being able to access the
funds.
The Commissioner responded immediately. On 24 June
2009, the same day as the approval of the Law 77/2009
which allocated extra-funding to the Abruzzo Region, he
convened a small team of accounting experts, supported
by an institutional advisory agency of the region, to
develop and share uniform criteria for the recording of
costs and activities connected to the earthquake (DCaa
45/09, attachment 1, p. 1). The Commissioner comments:
Considering that. . .. the seismic event renders actual
both the need to track down the increasing costs of
the INHS for the year 2009 and the following costs
due to the earthquake, as well as the re-modulation of
the cost containment manoeuvres already deployed by
the Budget Recovery Plan. . .. recognizing the opportunity
to de?ne criteria in order to uniformly record the costs and
the activities of all the regional LHAs and to make them
comparable.... having consequently considered the
fundamental need to distinguish the costs of regular health
assistance from those deriving from the seismic event,
according to the following macro-categories (e.g., per-
sonnel costs; purchase of sanitary and non-sanitary
goods; purchase of sanitary and non-sanitary services,
etc.) . . .. The deliberation is urgent, as for the need to
allow in the shortest time possible the start of the
recording and accounting of costs connected to the seis-
mic event which occurred on 6 April 2009
[DCaa n. 45/09, pp. 2–3 [emphasis added]]
Shortly after the Commissioner’s announcement, the
team of accountants began to meet, initially focussing on
the construction of appropriate criteria. As the manage-
ment accounting of?cer of the Pescara LHA
8
recollects:
When we started to meet together we felt an incredible
sense of emergency around us, as well as time pressure
to write down the new criteria as soon as possible. They
had to be crafted very quickly in order to record, docu-
ment, report and control the post-seism extraordinary
costs and activities, but there were no previous exam-
ples to imitate. An intra-regional accounting system
had been working since 2008, which made all the
LHAs costs and ordinary activities comparable and con-
trollable. Nevertheless, in order to access the extraor-
dinary funds allocated by the state for the exceptional
post-seism government, and later re-distribute them
according to the different activities developed by each
LHA, we were asked to build up a management account-
ing architecture, which had to run in parallel to the
already existing regime.
This individual
9
went on to recall:
We have quite immediately realized that we have to
hurry to ful?l our mandate, and after a couple of meet-
ings it was very clear to us that we had to work on the
existing regional plan of accounts, schemes and cost
categories... accordingly we began to work to modify
ordinary practices, adapting them to the disaster cir-
cumstances... in order to build homogeneous extraor-
dinary cost-accounting criteria and classi?cations and
install them on the already existing working electronic
and paper-based regional infrastructure, so that each
operator working in any Abruzzo LHA might have used
them correctly.
The above observations are interesting for three rea-
sons. First, the comments capture the sense of urgency that
the staff of the LHA felt regarding the classi?cation activi-
ties in that federal funding would not be forthcoming until
an adequate cost classi?cation scheme was developed.
Second, ready-made classi?cation devices did not exist, at
least within the affected region, and thus the accountants
involved felt as if they were starting from scratch in the
development of a classi?cation scheme. Finally, the
accountants recognized that the new classi?cation had to
somehow integrate with the existing accounting infras-
tructure. This recognition both made the job easier—be-
cause classi?cation practices could be borrowed and
modi?ed—and more dif?cult because there had to be some
consistency with the existing infrastructure.
Skimming through the document containing the criteria
(attached to DCaa n. 45/09), it is clear that government was,
in part, organizing the conduct of conduct by imposing cer-
tain accounting rules and practices on the LHA’s. For exam-
ple, it was required that: ‘‘Each LHA must open a cost centre
speci?cally addressed to record the costs of the earthquake’’
(p. 1). The latter prescription had already been stipulated by
the Commissioner immediately after the disaster (DCaa,
Note Prot. n. 9560/S, April 8 2009), but in the document it
was stated that ‘‘some LHAs have not already done it’’ (p.
1). Paper-based documentation was also mandated in the
event of a lack of IT records. Further, ‘‘existing paper docu-
ments in any case should be enclosed to justify the recorded
cost’’ (p. 1). The criteria also required modi?cation of the
vertical scheme of the (value-added) pro?t and loss account
of the LHA. This served to enhance the ‘‘visibility’’ of earth-
quake-related costs, by adding a new ‘‘separate column
[which] referred to the earthquake, conventionally named
CE T09’’ (p. 1), Contrary to what happened in the ?rst phase
of the emergency, the consequences of non-conformity with
these last requirements were asserted. For example, ‘‘incase
of a lack of a documentary accumulation it will be impossi-
ble to attribute the sustained costs to the earthquake’’ (p. 1),
thereby arguing that, after the ?rst phase of the emergency,
there was no further scope for humanitarian discretion.
Additionally, the federal government provided some
general criteria as to how earthquake-related costs should
be classi?ed:
– ‘‘additional’’ costs that, apart from the enactment of an
appropriate deliberation, have represented an answer
to the emergency, and have resulted in an extension
of already existing health services. . .. These services
require separate invoicing and separate orders indicat-
ing the earthquake cost centre. . . (e.g., cost of direct dis-
tribution of medicines, health transports, prosthesis
distribution, etc.),
8
Interview (November 2010).
9
Interview (January 2013).
76 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
– ‘‘additional’’ unforeseen costs that cannot be deducted
from regular activities, and whose estimate must be
done on the basis of agreed criteria (p. 2).
– costs singled out speci?cally through an appropriate
deliberation, referring directly to the earthquake, and
thereby easily traceable. . . (e.g., increase of health
guard; paediatric assistance, etc.);
The distinction between additional versus non-addi-
tional costs and the requirement that costs be easily trace-
able and justi?able was an attempt, on the part of the
federal government, to guide and constrain the cost classi-
?cation activities of the accounting experts.
The aforementioned general criteria were supplemented
with a listing of 26 compulsory criteria that healthcare
operators belonging to the ?ve LHAs (i.e., Teramo, Pescara,
Avezzano-Sulmona, Lanciano-Vasto and Chieti) were to fol-
lowin order to record and prove the extraordinary costs and
activities triggered by the earthquake (pp. 3–6). Each extra-
ordinary cost-accounting criterion had a number, a label,
and an explanation of the procedures to be followed for cor-
rect recording. In some cases there were also sub-classi?ca-
tions which further speci?ed the cost/procedures
typologies, thus unveiling an implicit connection between
the establishment of criteria and classi?cations, and the
deployment and coordination of homogeneous work prac-
tices in the ?ve LHAs. Table 1 contains some examples of
the criteria.
Importantly, as noted by the following interviewee
10
, the
combination of the newaccounting criteria and related train-
ing sessions were pivotal to diffusing and homogenizing the
accounting practices in the different LHAs. They also incul-
cated a new modus operandi and established a speci?c
vocabulary among the operators in the post-seismic
environment:
Before the earthquake none of us had an idea of what
extraordinary general healthcare activities would be
developed in such post-seismic cases, as well as which
accounting and control architecture had to be erected
and used. After the building of the criteria and the train-
ing meetings we had in the Region for the standardiza-
tion of the new accounting processes and practices, and
once implemented for several months, each of us had
gained much more general and speci?c capabilities
and competences. Moreover, the T09 codi?cation, and
the related classi?cations and criteria, became a part
of our new habits, daily glossary, and knowledge.
This observation is consistent with the view that ‘‘when
lists are used to coordinate important work... a correspond-
ingly complex organizational structure and infrastructure
evolves’’ (Bowker & Star, 1999, p. 10). Moreover, the will
to train, shape and normalize the accounting behavior of
the ?ve regional LHAs and their operators was also stressed
at the end of the description of the 26 criteria, where it was
stated that ‘‘in case further costs typologies—not considered
here—will emerge, the recording and evaluation criteria
must be shared by all LHAs before proceeding to their
recording’’ (p. 6).
While the provision of criteria for classifying and
recording costs as well as the training of staff potentially
guided the conduct of conduct, it was the inclusion of
funding consequences that arguably caught the attention
of healthcare administrators. During this second phase of
the emergency, federal government funds were not to be
provided in advance and later accounted for, but rather
the receipt of federal funds was to be contingent on the
provision of appropriate costing evidence—where expendi-
tures were directly and readily traceable to the earthquake.
More speci?cally, the federal government stated that reim-
bursable costs were:
Table 1
Examples of the ‘‘Criteria for the recording of extraordinary costs and
activities arising from the 6 April 2009 earthquake in the LHAs of Teramo,
Pescara, Avezzano-Sulmona, Lanciano-Vasto and Chieti’’.
No. Criteria
1 Territorial pharmaceutical assistance: all that is passed
through prescriptions, is traced via T09 code and residence of
the citizen, and is computer recorded. . .
4 House oxygen distribution: . . . a different behavior must be
followed in the following cases:
– contracted-out house oxygen therapy: a separate invoice
must be required from the provider, and hence a speci?c
booking must be made; discharges from orders/invoices
must be done at the earthquake cost centre;
– house oxygen therapy carried out by local public pharma-
cies: this falls within the recording system at point 1;
– house oxygen therapy carried out directly by the LHA: the
oxygen consumption referred to earthquake victims must
be reported and supported by paper-based documentation.
14 Admissions in Psycho-Rehabilitation Structures: private
providers since 2009 have been invoicing directly the LHAs
where they are located, despite the residence of the patient.
Those private providers must be asked to separately invoice
everything pertaining to the T09 code. Also in this case a
computer control on the residence of patients must be done . . .
15 Admissions to hospitals made by private accredited providers:
Since 2009, structures have been invoicing directly the LHAs
where they are located, despite the residence of the patient.
Those private providers must be asked to separately invoice
everything pertainin to the T09 code. Also in this case a
computer control on the residence of patients must be done . . .
19 Personnel: Since LHAs have hired people as a consequence of
the earthquake through appropriate deliberation, only related
costs must be reported. The cost of this personnel will have to
be recorded in the Earthquake Cost Center. In the period
spanning the earthquake till the moment when speci?c hiring
has been done, LHAs can report costs for longer overtime,
additional performances, or leave not taken but already
authorized.
– Overtime: monthly hours must be recorded according to
quali?cation, subtracting the hours carried out on average
in January, February and March 2009. . .
– Additional performances: must be recorded according to
quali?cation and must be justi?ed by speci?c authoriza-
tions and by the clock out time.
– Leave not taken: only those already authorized and
revoked for the earthquake are considered, differentiated
by job quali?cation.Overtime, additional performances
and leave not taken will have to be valued according to
job quali?cation on the basis of what is prescribed by col-
lective labor agreements in force.
10
Interview (November 2010).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 77
– all costs justi?ed by the presence of the code T09,
regardless of the residence of the citizens assisted
within the ?rst 15 days after the earthquake, can be
considered pertaining to the earthquake;
– all costs for those considered earthquake victims
between the sixteenth day after the earthquake till
May 30, must be justi?ed by the presence of the code
T09, and residence in the municipalities of the
Province of L’Aquila, in order to be reimbursed by the
State;
– all the costs justi?ed by the presence of the code T09, as
well as by the residency of the citizens in one of the
forty-nine municipalities considered earthquake-vic-
tims, for the activities developed after May 30, can be
considered pertaining to the earthquake (p. 2).
These criteria introduced a temporal and spatial dimen-
sion into the reimbursement mechanism, thus
emphasizing Bowker and Star’s argument that ‘‘list making
is foundational for coordinating activity distributed in time
and space’’ (1999, p. 38). Importantly, not only was
reimbursement contingent on an appropriate T09 coding
but also on belonging to a constantly shrinking spatial ter-
ritory. Fig. 3 illustrates how these time–space-residence
writing techniques narrowed the terrain of exceptional
government in the successive temporal periods. This res-
onates with the ‘‘spatio-temporal segmentation of the
world’’ highlighted by Bowker and Star (1999, p. 10).
This section illustrates how the federal government
attempted to organize the conduct of conduct through
the introduction of speci?c classi?cation, coding, training
and funding mechanisms. These mechanisms emphasized
the ideas of direct, additional and easily traceable costs.
Furthermore, they made the release of monies contingent
on the provision of appropriate costing information. In this
regard, the federal government was, at this time, moving
Fig. 3. Time–space-residence disciplinary writing techniques coupled with the speci?c T09 in the 5 LHAs.
78 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
toward exercising a form of normal governance regarding
an exceptional event. This strategy shifted the onus of
urgency to the LHAs, since funds would only be released
after an accounting classi?cation scheme had been con-
structed and implemented, and after the federal govern-
ment was satis?ed with the accounts provided. However,
as subsequent sections highlight, the federal government
strategies encouraged healthcare administers to strategize
with and around these classi?cation devices.
The special case of L’Aquila LHA
At the same time that the Commissioner was attempt-
ing to homogenize costing practices and make the regions
comparable, he distinguished between ‘‘L’Aquila (the epi-
center) and other affected regional areas’’. The DCaa stipu-
lated both the ‘‘Criteria for the recording of extraordinary
costs and activities connected to the 6 April 2009 earth-
quake for the LHAs of Teramo, Pescara, Avezzano-
Sulmona, Lanciano-Vasto, Chieti’’ and the ‘‘Criteria for the
recording of extraordinary costs and activities connected
to the earthquake of 6 April 2009 for the LHA of L’Aquila’’
(p. 3). This distinction encouraged the introduction of extra
– extra-ordinary accounting criteria within L’Aquila, differ-
ent from those enacted for the other ?ve regional LHAs.
The preamble to the L’Aquila document (document n. 2
attached to DCaa n. 45/09) stated that:
Whilst for the other regional LHAs it is a matter of distin-
guishing which costs have been sustained for the earth-
quake, as far as L’Aquila LHA is concerned almost all
costs sustained have to be considered related to the earth-
quake. From this perspective, it seems relevant, from the
one hand, to track down the costs sustained for regular
activities. . . and, from the other hand, it is necessary to
measure the terminating as well as growing costs caused
by the earthquake.... Hence it is a matter of seeing the
various accounts of the general accounting system
and, starting from the costs of the last year, and con-
sidering a stable management till March, for the period
after the 6 of April 2009 it is necessary to evaluate the
costs no longer sustained as well as those that have
arisen due to the earthquake (p. 1).
[emphasis added]
As the preamble indicates, accounting in the LHA of
L’Aquila was complicated by the development of health
activities and administrative tasks in a ?eld hospital, which
temporarily replaced the services previously provided by
the now destroyed hospital buildings of the LHA:
The administrative of?ce. . . is not accessible. . . and per-
sonnel are working in tent/containers. . . the internal
medicine distribution is working under a tent. . . each
activity has been paper documented but has not been
completely loaded in the information system. . . the
accounting system is not completely operating. . .. In
the very ?rst days after the shock it has been impossible
to check personnel presence. . .. Since April 23 work
attendances have been paper-based recorded and
they’ve still to be ?lled in the electronic procedure
(p. 1).
As in the other regions affected, L’Aquila healthcare pro-
viders focused initially on the continuous provision of
assistance, and later, on how to account for healthcare
related to earthquake damage. The act of accounting for
the costs was complicated by the fact that, at the time of
stipulating the criteria (24 June 2009), many activities
were only paper-documented and not yet uploaded in
the new IT window information mask. In this scenario, it
was necessary to manually classify and record both the
terminating and growing costs since this was a new way
of partitioning costs. However to ‘guide’ these activities,
and to presumably limit discretion, the government direc-
tive de?ned the costs that were expected to increase and
those that were expected to cease and indicated how they
should be calculated. Table 2 illustrates some of these
criteria:
Similar to the guidelines for the other LHAs, the govern-
ment directive imposed a particular set of accounting clas-
si?cations thereby narrowing the potential range of
recording activities.
On the surface, the L’Aquila regional territory was
receiving preferential treatment. In that general infrastruc-
ture needs could potentially be included in the category of
increasing costs, needs that otherwise might have gone
unfunded during this period of ?nancial restraint. In speak-
ing with the management accounting of?cer for the LHA of
L’Aquila, he was acutely aware of this potential disparity
and also of the need to justify the differential treatment
11
:
Our situation was very different from the other Abruzzo
LHAs, whose activities and populations were partially
affected by the disaster.... In our case, everything
around us has been struck by the earthquake.
However he also felt a sense of urgency that was pre-
sent, but to a lesser extent, within the other affected regio-
nal areas:
It was a survival issue for us to ?nd a way to make visi-
ble terminating as well as growing costs, which other-
wise... would have been invisible to the Region and to
the State, thus hampering the reimbursement process
of additional resources destined to Abruzzo.... This is
why our adopted criteria were in many parts different
from those of the remaining Abruzzo LHAs.... because
the situation of L’Aquila was completely different....
This said, the government’s decision to apply different
criteria in order to ?nd the appropriate con?guration ‘‘for
each of the things that are to be governed’’ (Foucault,
1991, p. 95) caused tensions with the other affected
regional areas. These tensions, in part, related to the
resource-constrained situation that all of the LHA’s were
experiencing prior to the earthquake and, in part, to
the fact that the consequences in the epicentre ‘travelled’
to other LHAs. For example, the CEO of the Pescara LHA
recalls
12
:
For us it was clear from the very beginning that inside
the region we were the LHA destined to assist the
11
Interview (January 2013).
12
Interview (November 2010).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 79
highest number of evacuees escaping from L’Aquila and
moving to the hotels located along the safe Pescara
coast. Accordingly, whilst it was crucial for us to face
any emergency healthcare issues, it was also pivotal
to account, represent and document any sustained
extraordinary costs and activities, and conform to the
new cost-accounting criteria, in order to maximize the
probability of receiving the extra-funding. Indeed, my
LHA was normally funded for assisting 20% of the
Abruzzo population. In the aftermath of the earthquake
we were serving about 25% of our total regional inhabi-
tants, thereby incurring huge incremental costs, and
less revenue for fee exemptions of cost-free drugs or
activities. We did not want to incur punishments from
the state, in terms of objections or rejections to our
reimbursement, whilst we were stimulated to obtain
the appropriate refunds for the extraordinary costs
and activities shouldered by our LHA to manage the
population’s healthcare in the post-seism scenario.
He later added
13
:
It is rather obvious that many organizational, manage-
ment and accounting issues emerged in the post-earth-
quake situation. . . it is quite impossible to list them all.
For example, in order to allow evacuees living in hotels
on the coast (and not owning cars) to receive drugs, my
LHA had to organize gathering places for the INHS pre-
scriptions as well as convenient drugs delivery proce-
dures managed with the local pharmacies and hotels.
Accordingly, we had to send extra personnel—that is
GPs or medical guards—for on-site visits to patients, ?ll-
ing-in and returning drug prescriptions and taking
notes of their needs. Then we had to send the prescrip-
tions and notes to the pharmacies in the LHA territory
which were closest to the hotels where the evacuees
were located. Finally pharmacy personnel delivered
the cost-free drugs, the non-prescription over the coun-
ter drugs, and also milk and general products for infants
(free of charge) to the evacuees.
These quotations highlight how the spatial seg-
mentation of earthquake-affected regions resulted in ten-
sions among the different parties, especially with regards
to the apparent failure of the funding-impregnated classi-
?cation to recognize the mobility of the epicentre
population.
The preceding illustrates how different classi?cation
practices were used in the different regions, and how this
spatial separation not only created different zones for dis-
cretion but also caused tensions among the LHAs. In this
regard, it offers insights to the ‘‘practical politics of
classifying’’ (Bowker & Star, 1999, p. 44) and how the
minutiae of classi?cations in?uence both ‘‘what will be
visible or invisible within the system’’ (Bowker & Star,
1999, p. 44) and, equally importantly, what will be reim-
bursed within the constraints of ?nite extraordinary
resources.
The operational program
Knowledge is pivotal to the activities of government
(Miller & Rose, 1990; Rose & Miller, 1992).
Documentation and calculation were especially important
to the implementation of exceptional government in the
post-seismic scenario. Indeed, as mentioned earlier, each
LHA was asked to calculate the extraordinary costs gener-
ated by the earthquake in order for the Commissioner to
elaborate an Operational Program, which would be sub-
mitted to the state in order to unlock the emergency funds
for healthcare that had been allocated. In doing so, ‘‘the
social economy’’ of the post-seismic scenario was ‘‘also
evaluated through its numericization’’ and, accordingly,
accounting data, numbers, tables and schemes became
Table 2
Examples of the ‘‘Criteria for the recording of extraordinary costs and activities connected to the 6 April 2009 earthquake for the LHA of L’Aquila’’.
Ledger Productive factor Ceasing costs caused by the earthquake Growing costs caused by the earthquake
30 Purchase of sanitary goods All the products present in the inventory
made available to the other regional LHAs.
Costs must be valued according to the
weighted average cost [method], VAT
included, as it results from inventory
procedures
Potential speci?c purchases made for the
earthquake . . .. Products expired, or
destroyed by, the earthquake
34 Pharmaceutical assistance . . .the cost budget 2009, once subtracted
the use made by the remaining [citizens],
is a ceasing earthquake cost
Pharmaceutical fees which have not been
collected represent rising costs
40 Services from regional LHAs Larger passive mobility for health services
provided by regional LHAs directly linked
to the earthquake
41 Services from extra-regional LHAs Larger passive mobility for the health
services provided by extra-regional LHAs
directly linked to the earthquake
43 Advice Interrupted advice, for which no services
have been provided, are here included
All activated advice services caused by the
earthquake
45 Health Personnel Overtime, availability, etc. . . costs must be
deducted
Total costs of personnel unable to perform
duties with regard to the volume of the
delivered services, have to be calculated
13
Interview (December 2010).
80 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
‘‘intrinsic to the formulation and justi?cation of [the post-
earthquake] governmental [healthcare] programs’’ (Rose,
1991, p. 674). Further, the ‘‘accounting inscriptions’’
(Robson, 1992) accumulated at a micro level, being porta-
ble, combinable and comparable, were grouped and repre-
sented in the Operational Program, before submission to
the state for examination.
The September 2009 operational program
On 9 September 2009, only two months after the fed-
eral government had stipulated criteria for determining
appropriate costs, the Commissioner presented his
Operational Program to the Ministry of Health and the
Ministry of Economics and Finance. The ‘‘Estimate of the
costs attributable to the 6th April 2009 shock’’ – the bulk
of the OP – is represented in Table 3.
As Table 3 illustrates, the Commissioner, in his pre-
sentation of the earthquake-related costs chose to include
four cost categories. Additional operating costs were the
?rst category and amounted to €31.055 million. More than
75% of these increased operating costs arose due to the
mobility of regional patients to private providers. The
remaining 25% are attributed to the increasing costs of per-
sonnel, goods and services in the LHAs, and to other extra-
ordinary costs. These costs were ‘supported’ by the
inclusion of, and reference to, the speci?c aggregation
codes that were used to accumulate the costs within the
?nancial accounting system.
In addition to this ?rst category, there were three other
categories of costs that would prove to be more con-
tentious. The second category, totalling €12.637 million,
pertain to the reimbursement of ‘‘unproductive ?xed
costs’’. These concerned the costs of tenured personnel of
Table 3
Estimate of the costs attributable to the 6 April 2009 shock.
Commissioner ad acta for the ful?llment of the recovery plan of the Abruzzo region
Estimate of the costs attributable to the 6 april 2009 shock
The shock costs are referred to the april/december 2009 time period
Aggregation Code Item Estimate of the
Regional shock
costs (€/000)
Items of the synthetic scheme of the CE [pro?t and loss account]
Production costs
A01 Personnel costs + irap [regional tax on productive activities] 2,173
A02 Pharmaceutical products
A03 Other goods and services 932
A04 Services of territorial health assistance
A05 Pharmaceutical accredited care
A06 Specialist health assistance made by private accredited
providers
3,192
A07 Rehabilitative services made by private accredited providers
A08 Prosthetic assistance by accredited private providers
A09 Admissions in hospitals made by private accredited providers 9,300
A10 Other assistance made by private providers 11,113
A11 Other assistance by public providers
A12 Other expense components
A13 Allowances
A14 Interests and others
A15 Balance of extraordinary items 4,345
A16 Balance of intra-moenia activities
A17 Infra-regional passive mobility
Total expense 31,055
Unproductive ?xed costs determined by the 6 april 2009 shock
Personnel 10,000
Goods and services 2,637
Total unproductive ?xed costs 12,637
Lower receipts determined by the 6 april 2009 shock
Lower tickets for specialist assistance 2,500
Lower tickets for pharmaceutical assistance 1,800
Smaller extra-regional active mobility (San Salvatore hospital, year 2008) 7,875
Lower regional tax receipts 32,800
Total lower receipts 44,975
Total earthquake costs sustained by the LHAS 88,667
Further expenses to be charged to the civil defense
Expenses to be charged to the civil defense Provision of temporary lodging [tents] 2,737
Relief services 10,813
Costs for the emergency management 2,000
Safety measures 116
Clearing of devastated areas 990
Total expenses to be charged to the civil defense 16,656
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 81
the LHA of L’Aquila who, though receiving a regular salary,
were unable to work from 6 April to 31 May 2009 due to
the inaccessibility of hospital buildings damaged by the
earthquake. The third category, amounting to €44.975 mil-
lion, asked for the reimbursement of lower operating
receipts (diminished collection of tickets for specialist
and pharmaceutical assistance, reduced mobility into
L’Aquila LHA, and lower regional tax receipts) that were
the direct consequence of the earthquake. Finally the
Commissioner asked to be reimbursed for the expenditures
that the region incurred on behalf of the Department of
Civil Defense in the days immediately after the earthquake.
The Commissioner noted that in case the early emergency
expenses (€16.656 million for the provision of temporary
lodging, disaster relief services, safety measures and clear-
ing of devastated areas) were not paid by the Civil Defence
(p. 6), this would have caused further dif?culties in meet-
ing the ?nancial targets stipulated by the Budget Recovery
Plan. Thus in total, the Operational Program calculated that
the impact of the earthquake on the operating costs of the
Abruzzo healthcare services amounted to €88.667 mil-
lion
14
, not including the monies to be reimbursed by the
Civil Defense Department. On the basis of the operational
plan provided, the Commissioner requested an additional
€50 million above and beyond the €40 million already pro-
mised by the federal government (p. 10).
Not surprisingly, the government decided to review the
plan, asking the Ministries of Economics and Health to con-
duct an examination of the numbers and their assumptions.
As one of the state inspectors that participated in this pro-
cess noted, one of the purposes was to ensure that expendi-
tures pertaining to‘normal’ healthcare activities didnot ?nd
their way into the request for extraordinary funds
15
:
Although a State Commissioner was already working
on-site in Abruzzo to manage the post-earthquake sit-
uation, the state was also obliged to control centrally
all the post-earthquake extraordinary costs and the
documentation of the additional activities. The state
was already controlling the advancement of the normal
rationalization program of government, through a pre-
viously adopted homogeneous accounting system.
Indeed the state was deploying a strict federalist
reform, where no extra-money might be accorded to
non-virtuous regions, and Abruzzo was already suffer-
ing from healthcare ?nancial distress. Accordingly,
while €40 million had been stipulated by the emer-
gency Law to sustain the post-seism healthcare addi-
tional actions, leaving the Abruzzo Region the freedom
to use them to deploy any post-seism activity, the state
and all the other Italian regions wanted to be sure that
the funded extra-money was destined only to incre-
mental extraordinary costs, and not to cover previously
existing regional de?cits.
The above quotation is interesting because it illustrates
how techniques of examination were enlisted in the
attempt to maintain the distinction between the categories
of normal and exceptional government.
The examination of the OP performed by ministry
experts took two months (October and November 2009)
and raised serious concerns about what costs were
included and how the costs were classi?ed. For example,
the inspectors noted that ‘‘some recorded costs that have
been charged to the Regional Health Service by the
Commissioner do not represent additional costs’’ (p. 2). In
particular, the experts objected to the reimbursement of
the aforementioned ‘‘unproductive ?xed costs’’ (of
€12.637 million) in that ‘‘the costs of unproductive person-
nel as well as of goods and services have already been
included in the CE [pro?t and loss account] and are not
additional [costs]’’ (p. 2). They also stated that the OP
included costs that pertained to ?scal periods after the cur-
rent ?scal year-end (FY09). In particular they referred to
the geographical mobility of patients and the expected
€7.875 million cost ‘‘that will be accounted only. . . in
future balances’’ (in 2010), and which did not therefore
represent lower receipts ‘‘to be balanced for the FY 2009’’
(p. 2). Similarly, the expected lower regional tax receipts
of €32.800 million pertain to future periods and thus can-
not be included in the claim for emergency funds for
2009 but rather should be postponed to 2010. Finally, con-
trary to the view of the Commissioner, the ministerial
experts argued that the reimbursement of the expendi-
tures made on behalf of the Civil Defence Department
should not be included in the OP.
Given these concerns, the OP was ‘‘not approved’’ and
the affected regions were unable to access the €40 million
in extraordinary funds allocated for the emergency nor to
secure the additional requested €50 million in funding.
Rather, the government requested that the OP be reformu-
lated and resubmitted by January 31, 2010. In response to
this decision, the Commissioner declared in the newspa-
pers his intention to continue to request €50 million of
additional funds to cover extraordinary healthcare costs
(Piccinino, 2009). On the same day he resigned.
The games of strategy involving the Commissioner and
the federal government utilized accounting classi?cations
and accounting experts. In his attempt to access additional
funds for the region, the Commissioner directed his team
of accountants to follow but modify the federal govern-
ment’s criteria regarding the accumulation of additional
costs. These modi?cations involved including foregone
revenue in?ows and including future-oriented items in
the current period. They also involved the adoption of a
different reporting format, one that foregrounded the
earthquake-related expenditures by downplaying and,
indeed, obscuring the normal healthcare expenditures.
The federal government, in turn, relied on its own team
of experts to scrutinize the accounts provided.
14
The costs for the reconstruction of the hospital, restoration and
infrastructure adjustments are excluded by the calculi presented, but they
will worsen the balance of the Abruzzo Region healthcare system in future
years. The damages incurred by S. Salvatore Hospital, L’Aquila accounted
for €74 million. Only €44 million was covered by insurance that had a ?xed
maximum amount of reimbursement. At the time of writing only 1/3 of the
remaining extra costs for rebuilding the hospital is to be funded by public
resources allocated by the state.
15
The OP was ?rstly examined on 10 November 2009, but the decision
not to approve it was taken only in December by the Ministries of Health
and Economics and Finance. In this and in the following sub-section
reference will be made verbatim, to this report, as well as to the interview
with one of the inspectors (October 2010).
82 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
Furthermore, at the end of the day, it was the federal gov-
ernment that controlled the funds and thus it was able to
reject the OP and send it back to the Commissioner for
revision. These visible confrontations between the
Commissioner and government highlight how funding-im-
pregnated classi?cation mechanisms may be a site of
struggle. At this moment in time, stable mechanisms had
not yet replaced the free play of antagonistic relations
(cf. Foucault, 2000, p. 346) but rather were the terrain
around which these struggles took place.
The January 2010 operational program
One day after the Commissioner’s resignation, the
Council of Ministers replaced him with the Governor of
the Abruzzo Region (De Frenza, 2009) and on 13 January
2010 also appointed two sub-Commissioners
16
to support
his work. These acts reinforced state control over both the
Budget Recovery Plan for healthcare and the allocation of
emergency funds. The Governor of the Abruzzo Region – act-
ing as Commissioner – was asked by ministerial experts to
reformulate the OP and provide ‘‘an adequate quanti?cation
of the costs connected to the earthquake’’ (Minutes of the
meeting of 18 December 2009, Ministries of Economics/
Health, p. 11). In order to better exert ‘control at a distance’
over the re-formulated OP, the state requested the compul-
sory use of the ordinary vertical scheme for the regional pro?t
andloss account, withthe ‘‘additionof a newseparate column
for earthquake-related expenditures, conventionally named
T09 column’’ (DCaa 45/09). This permitted the state inspec-
tors (who were the same team checking the ordinary
accounts) to disclose ordinary and extraordinary costs on
the same rows, thus quantifying and comparing the costs of
normal and exceptional government. A further measure was
also introduced. The state stipulated that the allocation of
the ?nal instalment of the normal healthcare funds for the
?nancial year 2008 would be subject to the approval of the
earthquake OP (idem, p. 12). The re-formulated OP presented
in Table 4, was sent to the central government at the end of
January 2010, and was examined by ministry experts at the
end of April.
The ?nal OP requested total funds of €40.729 million,
less than half of the previous regional request and almost
exactly the amount that the federal government had
offered for disaster relief. Comparing the September 2009
estimate with the January 2010 ex post OP it is possible
to see that much of the private care costs were removed.
A more articulated and detailed portrayal of public care
costs was provided, one which followed analytically the
approved extraordinary cost criteria, with the unique
exception of the contested criterion no. 45 relating to ‘‘un-
productive ?xed costs’’. Moreover, all the estimates which
had generated no ?nancial repercussions for FY 2009 were
postponed to subsequent years, while objected costs com-
pletely disappeared. Although there were no contestations
on the accounting data represented in the January 2010 OP,
the ministerial experts complained that ‘‘the content of the
action plans adopted’’ by the Region ‘‘to face the further
dif?culties caused by the seismic event’’ was still missing
(Minutes of the meeting of April 28, 2010, Ministries of
Economics/Health, p. 1). Accordingly, the state emphasized
that ‘‘it is necessary to obtain that content. . . in order to
proceed to the approval and the consequent allocation of
resources’’ (De Frenza, 2009). Whilst the state did not raise
objections about accounting inconsistencies or assume the
submission of massaged numbers, it imposed the stringent
condition that resources would only be transferred to the
Abruzzo Region once the additional information requested
had been received.
Once the action plans were sent to central government
(in September 2010), they were approved by ministry
experts without any objection at a meeting on 2
December 2010. Thus, whilst the emergency healthcare
stage had ended on 31 December 2009, the post-earth-
quake healthcare OP was approved a year later. This also
Table 4
Damages and interventions carried out after the 2009 earthquake
represented in the ?nal OP.
Damage and interventions Costs (€)
Clinical materials damaged/destroyed in the
L’Aquila hospitals/clinics
5,088,686.00
Clinical equipment destroyed in the L’Aquila
hospital (sum not amortized)
3,125,000.00
Distribution of sanitary and prosthesis material to
the population in the ?rst few days following
the disaster
1,499,494.37
Out-patient and hospital assistance for the injured
and entire population hit by the quake in the
?rst few days after the earthquake
2,431,883.63
Increase of personnel in public structures due to
the increase in activities caused by the presence
of evacuees in the regional territory
3,003,031.81
Residential assistance for the elderly 1,738,182.58
Increase in transfusion collection to confront
emergencies
493,116.00
Sanitary transportation for patients needing
transference
66,014.70
Sanitary transport in helicopter ambulances and
technical logistic organization heliport base
254,151.10
Recovery of the 118 emergency communication
system
274,836.90
Improvement of 118 emergency services on the
territory affected by the quake
22,100.82
Veterinarian assistance in areas affected by the
quake
1,795.68
Technical testing of safety in medical buildings 757,418.20
General medical assistance for evacuees 907,169.15
Increase in accommodation and logistic services
for management of evacuee sanitary needs and
small maintenance
1,202,308.24
Private specialist assistance for the population
affected by the quake
17,246.54
Private rehabilitation assistance for the population
affected by the quake
1,650,381.50
Fee exemption from prescriptions for drugs and
out-patient services
5,449,578.92
Ordinary maintenance of buildings for temporary
restoration of sanitary activities
8,062,495.52
Rentals for reactivation of healthcare services 93,972.00
Purchase of healthcare equipment for temporary
recovery of activities
1,405,382.00
Activation of passive rental in order to carry out
surgical activities and recovery of healthcare
services
3,185,084.00
Total €40,729,329.66
16
One of the two sub-commissioners resigned immediately.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 83
activated an emergency termination process, thereby trig-
gering the subsequent allocation (for 2011) of the extra
post-earthquake healthcare funding to the Abruzzo
Region for FY 2009. It also appropriated the ?nal instal-
ment for FY 2008, which had been previously locked by
the state until the OP had been examined and approved.
While it might appear that the initial allocation by the
federal government had been an excellent estimate of the
expected costs, the reality appears more ambiguous. On
the one hand, accounting classi?cations were an essential
component of the disaster response. For example, the
Director of the Abruzzo Health Region states
17
:
The new accounting criteria and procedures crafted
after the earthquake have been pivotal for us in docu-
menting and representing the extraordinary activities
and costs, as well as the smaller revenues, in order to
access state emergency funds. Without the extraordin-
ary accounting, nobody would have been able to docu-
ment and represent the above digits and actions, as well
as to re-allocate resources to each LHA, private provi-
ders, local pharmacies, etc. . . thereby disabling the
reimbursement of the extra-funds. This would have
meant for us either to reduce the extraordinary post-
seism activities, or to pay for them by increasing regio-
nal personal income taxes, the regional tax on produc-
tive activities and the excise duties on petrol, as well
as putting higher healthcare payments for the
population. . .Any of these last decisions would have
been awful for a population already devastated by a
major earthquake.
On the other hand, the acts involved in classifying an
itemof expenditure as either normal or extraordinary were
certainly not clear cut and were never separate from the
games of strategy and politics around the earthquake. As
this same individual recalls
18
:
We had to increase the personnel working in our public
structures besides that in the LHA of L’Aquila. Indeed,
the shortage of personnel in relation to ordinary activi-
ties previously established by the implementation of
the Budget Recovery Plan made it impossible to conduct
the exceptional activities for the evacuees via a normal
production capacity. Accordingly, it was necessary to
employ extra personnel in order to provide services
for the evacuees. Nevertheless, it was not always possi-
ble to ?nd extra personnel, and therefore it was neces-
sary to resort to staff doing overtime as well as being on
call.... The main personnel costs amounted to
€3,003,031.81. The extraordinary costs and activities
for the maintenance of buildings were mainly
concentrated in the LHA of L’Aquila, which absorbed a
major part of the total amount (i.e., 88% of
€8,062,495.52). . .. Some of the remaining LHAs were
obliged to develop actions and spend extra-money,
but on a different scale.
And:
Public hospitals were obliged to provide extra-work for
the out-patient and hospital assistance devoted to the
injured and the entire population hit by the quake in
the ?rst weeks after the disaster (€2,431,883.63), as well
as private facilities (€1,650,381.50). Among the many
people injured in the earthquake, those considered to
be most affected by the disaster were undoubtedly the
elderly and weak individuals who had been previously
assisted within their own families, and for whom, in
most cases, it was necessary to organize hospitalization
in regional and extra-regional residential structures. The
relative costs for this exceptional assistance, provided
both in public (€449,891) and private (€1,288,291)
structures, totalled €1,738,182. The earthquake also
brought less revenue into the Region as far as the
medical system was concerned due to the fact that most
medical services were provided by exemption to the
populations affected, for both outpatient services and
pharmaceutical products (€5,449,578.92).
Some of the above expenditures did not fall neatly into
or outside the extraordinary category, yet, when included,
they were the items that were challenged and thoroughly
inspected by the government’s experts.
The above comments highlight not only the high degree
of complexity in the ‘‘calculated management of life’’
(Foucault, 1981) but also the struggles that occur in these
situations. As previous research has acknowledged, gov-
ernance almost always involves the distribution of scarce
resources (Preston et al., 1997) and these distributions
become even more complicated in exceptional moments
when there is an overlapping sphere of action between
the normal and the extraordinary. In these circumstances,
it may take several iterations before mechanisms of dis-
position, such as the funding-impregnated classi?cation
scheme are ‘accepted’ by the involved participants. The
irony, of course, is that this mechanism only became stable
(cf. Foucault, 2000, p. 347) at the point that the program of
exceptional government was being terminated and where
all healthcare funding for the region would be disposed
of via the normal mechanisms of distribution that were
implicit in the Budget Recovery Act.
Conclusion
This study has attempted to explore the extraordinary
accounting apparatus established following the Abruzzo
earthquake of 2009. Using the insights of previous research
on governmentality, as well as work on classi?cation and
its effects, the study has analyzed the construction, quan-
ti?cation and termination of a period of exceptional gov-
ernment. Whereas prior research has tended to
emphasize how accounting helps to facilitate normal gov-
ernance, the current paper emphasizes that things do not
always proceed according to plan and unexpected events
require departures from the ‘normal’ (Miller & Rose,
1990, p. 11; Rose, 2005, p. 245). These departures encour-
age the investigation of episodes of government during
‘‘states of exceptions’’ (Agamben, 2005) and the related
17
Interview (December 2010).
18
Interview (December 2010).
84 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
regimes of extraordinary practices (such as accounting)
that emerge in the aftermath of crisis events such as natu-
ral disasters.
The analysis provided has sought to complement and
extend prior accounting research in three ways. First, and
perhaps most obviously, the analysis has illustrated the
central role of ‘accounting’ and ‘non-accounting’ classi?ca-
tory devices in programmes of governance. Classi?cations
were important component of exceptional governance,
helping in the construction and demarcation of the natural
disaster as well as in the disposition of things in the earth-
quake’s aftermath. Scienti?c classi?cation of the severity of
the earthquake as being above six on the Mercalli Scale
(Lee et al., 2002; Richter, 1935) helped to focus visibility
on the event and encouraged the Italian government to
declare a ‘state of emergency’ (Bignami, 2010).
Classi?cations, rankings and lists of municipalities and
their inhabitants were subsequently identi?ed on maps
and cartographies (Foucault, 1979; Foucault, 1991) and
were used in tandem with calculative practices (Miller,
2001) to not only classify the Abruzzo earthquake as ‘‘a
disaster’’, but also to de?ne its boundaries, quantify the
economic magnitude of the shock, and to put into motion
an exceptional government assemblage. Accounting
classi?cations were integral to this assemblage, in that
they helped to distribute differential resources to different
population segments and made access to government
funding by the LHAs contingent on these funding-impreg-
nated classi?catory devices. Taken together, such devices
were crucial for constructing a post-seismic ‘‘working
infrastructure’’ (Bowker & Star, 1999, p. 10) and for giving
order and visibility to earthquake-injured people and
the associated ‘additional’ costs. Thus, in these ways,
accounting classi?cations were one of the technologies
that made ‘exceptional’ governance possible (Miller &
Rose 1990, p. 8).
Second, the analysis has highlighted the interrelations
between normal and extraordinary accounting in moments
of exceptional governance. Consistent with the observa-
tions of Miller and Rose (1990, p. 11), the case study shows
how programmes of governance often enlist a complex
amalgam of borrowed and built accounting technologies.
The launch of exceptional governmental measures in the
?rst days after the disaster gave rise to a rudimentary
extraordinary accounting and reporting apparatus. While
the immediate response of the government to the earth-
quake emphasized that ‘‘healthcare assistance’’ had ‘‘to
be guaranteed to the citizens hit by the quake’’ (Note
Prot. 9560/S, April 8, 2009), within two days on-the-
ground personnel were instructed to begin to account for
what was happening. Matched lists of T09-classi?ed
inhabitants-diseases were sent to local pharmacies to
document the administration of fee exemption drugs and
healthcare assistance. These lists, which were borrowed
and generated from the existing normal accounting sys-
tem, became one of the building blocks for identifying
the costs of the earthquake. And when the initial health-
care emergency started to recede, the classifying and
recording of costs began to assume even more importance,
in part because the national government made disaster
assistance contingent the provision of an acceptable
Operational Programme. The contingent funding, along
with the urgency to the regions to access these funds, pro-
vided the impulse for the LHAs to enlist the help of
accounting experts to develop a system of accounting clas-
si?cations to identify and measure the incremental health-
care costs associated with the earthquake. As the analysis
highlights, the system of classi?cations that emerged bor-
rowed from the existing normal accounting system yet
was distinct, especially in terms of how certain types of
costs were classi?ed. In these ways, the study
complements and extends prior research by providing an
example of how a programme of accounting was
constructed in an exceptional moment. Put simply, it
shows how a serious earthquake becomes an important
accounting event, and how that in turn facilitates or
constrains resource ?ows.
Finally, the analysis foregrounds the games of strategy
that occur around accounting classi?cations in such cir-
cumstances. The speci?cation by the federal government
that the access to emergency funding was contingent on
the provision of an acceptable Operational Plan and the
provision of speci?c classi?catory rules attempted to orga-
nize the conduct of conduct so to speak, on the part of the
involved LHAs. The initial response of the Commissioner,
however, classi?ed and accumulated costs in a way that
suggested that the amount of emergency funds needed
was more than double what the national government indi-
cated was available. This, in turn, encouraged the national
government to enlist its own experts to review the lists
and to declare the plan as unacceptable. The rejection of
the plan precipitated the resignation of the Commissioner,
the appointment of a more pliable Commissioner by the
federal government, the submission of an OP that accumu-
lated costs in a way that was consistent with the available
monies, and the eventual acceptance of the OP and the
release of the available funding. This sequence of events
illustrates the iterative nature of governance and how
strategy involves the tentative search for ‘winning’ solu-
tions (Foucault, 2000, p. 346). Arguably, neither the federal
government’s ?rst attempt to organize the conduct of con-
duct, nor the response of the ?rst Commissioner, were a
winning solution. However, as the analysis highlights,
these confrontations were worked out (cf. Foucault, 2000,
p. 347) as the moment of exceptional government
eventually morphed back into a pattern of normal
government. More speci?cally, this working out involved
the use of a standardized reporting format, the ordinary
vertical scheme of the pro?t and loss account with the
addition of a T09 column, and a more strict adherence to
the government’s guidelines on the recording and
classi?cation of costs. After a small amount of additional
negotiation, the OP provided was approved on 2
December 2010, bringing to an end the programme of
exceptional government and extraordinary accounting,
thus returning the region back ‘normalcy’.
In recent decades earthquakes and natural disasters
have caused wide-scale destruction in a number of coun-
tries, resulting in death, injury and dislocation of the
affected populations, and it is surprising that they have
received so little attention from accounting scholars. This
disregard is all the more surprising when it is recalled that
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 85
‘‘natural disasters are far more destructive than wars’’
(Yahoo News, 28 August 2007) and the costs of recovery
and rehabilitation are enormous. Indeed, according to the
World Bank, since 1980 the economic cost of disasters in
developing countries has amounted to $1.2 trillion, equiva-
lent to about one third of all of?cial development aid
(Word Bank, 10 April 2013). The costs associated with
individual disasters such as Hurricane Katrina in 2005
were $300 billion, whilst the Haiti earthquake in 2010
required $3 billion in emergency funds and a further $1 bil-
lion for reconstruction. Importantly, the UN Of?ce for
Disaster Risk Reduction (UNISDR) declared on 14 March
2013 that, ‘‘for the ?rst time in history the world has
experienced three consecutive years where annual eco-
nomic losses have exceeded $100 billion due to an enor-
mous increase in exposure of industrial asset and private
property to extreme disaster events’’ (http://www.unisdr.
org/archive/31685).
The preceding statistics suggest that natural disasters
have very real consequences for the planet and for the peo-
ple affected by them. However these disasters are also ‘fo-
cusing events’ which bring contemporary practices and
structures into sharp relief. As focusing events, they have
the potential to provide us with new insights regarding
the intersections among governance and accounting,
including the consequences for people and the planet
(Atkeson & Maestas, 2012, p. 27; Walker, 2000). Calls for
the academy to pursue a ‘phronetic social science’
(Cooper & Morgan, 2008) suggests a focus on investigating
‘things which really do matter to people’. Earthquakes and
other natural disasters are clearly sites where accounting
does matter.
Acknowledgments
The author is grateful for the helpful and insightful
comments provided by Peter Miller, Dean Neu and Steve
Walker on earlier drafts of this paper. In addition, the
author acknowledges with gratitude the constructive and
helpful comments of the two anonymous referees. The
author would like to thank participants at the APIRA
Conference, Sydney, 2010; the 35th EAA Annual Congress,
Ljubljana, 2012.
Appendix A. Primary sources
A.1. National ordinances, laws and decrees
A.1.1. Decrees of the President of the Council of Ministers
(DPCM)
DPCM 6 April 2009 – Declaration of the national
‘‘state of risk’’, and ‘‘appointment of the Head of the Civil
Defense, Guido Bertolaso, as Commissioner delegated to
guide the post-disaster operations’’.
DPCM 7 April 2009 – Declaration of the national ‘‘state
of emergency’’.
A.1.2. Legislative Decrees and Laws (DL and L)
DL n. 39/09, Legislative Decree n. 39, 28 April 2009,
‘‘Urgent interventions in favor of the populations struck
by the seismic events occurred in the Abruzzo Region in
April 2009 and further urgent interventions about civil
defence’’. This DL has been later converted into L n.77, 24
June 2009.
[this DL allotted €40 million for the extraordinary
activities and costs sustained for the earthquake-related
healthcare emergency services, increased the previously
established pharmaceutical expenditure cap and concur-
rently gave priority to later obtain further national funds
for the earthquake-proof reconstruction/reorganization of
health facilities]
A.1.3. Ordinances of the President of the Council of Ministers
(OPCM)
OPCM n. 3753, 6 April 2009, ’’First urgent interventions
consequent to the seismic events which struck the
Province of L’Aquila and other municipalities of the
Abruzzo Region on 6th April 2009’’.
OPCM. n. 3782, 17 June 2009 ‘‘Further urgent interven-
tions destined to face the seismic events occurred in the
Abruzzo Region on 6th April 2009’’. [This OPCM, among
other things, conditioned the access to the resources allot-
ted by the DL n.39/09 upon presentation of an ‘‘Operational
Plan to further face the dif?culties caused by the seismic
events’’, ex Art.2 ]
A.1.4. Decrees of the Commissioner Delegated to post-disaster
operations (DCD)
DCD n. 3, 16 April 2009, ‘‘Spotting the municipalities
damaged by the earthquake which struck the Province of
L’Aquila and other municipalities of the Abruzzo Region
on 6th April 2009’’.
DCD n. 11, 17 July 2009, ‘‘Modi?cations and
integrations to the DCD n. 3, 16 April 2009, related to
the ‘‘Spotting the municipalities damaged by the
earthquake which struck the Province of L’Aquila and
other municipalities of the Abruzzo Region on 6th April
2009’’.
A.2. Deliberations and notes of the healthcare governmental
Commissioner ad acta (DCaa)
DCaa Deliberation n. 14/09, 12 March 2009
‘‘Interventions addressed to the recovery of the healthcare
de?cit’’.
DCaa, Note n. 9246, 6 April 2009 ‘‘ Possibility of over-
coming of the thresholds imposed by the Budget
Recovery Plan because of the urgent earthquake healthcare
assistance’’
DCaa Deliberation n. 23/09, 7 April 2009: ‘‘Earthquake
of the Province of L’Aquila – Suspension of the deliberation
of the Commissioner ad acta for the deployment of the
Recovery Plan n. 14/09 of 12 March 2009, limited to the
residents in the LHA of L’Aquila [territory]’’. [Through this
deliberation, among other things, the Commissioner pre-
scribed the ticket exemption for all citizens resident in
the L’Aquila LHA territory].
DCaa Note 9560/S, 8 April 2009 ‘‘Healthcare assistance
to patients hit by the seismic events of 6 April 2009’’.
86 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
DCaa, DG 8/47, 9 April 2009 ‘‘Urgent measures related
to pharmaceutical assistance in favor of earthquake vic-
tims – C Class Drugs’’.
DCaa, n.24/09: Deliberation n. 24/09, 22 April 2009:
‘‘Earthquake of the Province of L’Aquila – Modi?cations
and integrations to the urgent measures referred to the
pharmaceutical assistance to earthquake victims’’ [through
this deliberation the Commissioner prescribed also pay-
ment exemption for all citizens resident in the L’Aquila
LHA territory for particular medicines usually completely
paid by patients]’’.
DCaa, n.28/09: Deliberation n. 28/09, 6 May 2009:
‘‘Earthquake of the Province of L’Aquila – Modi?cations
and integrations to previous deliberations’’. [Through this
deliberation the Commissioner con?rmed the previous
DCaa 23 & 24, broadening the exemption zone to all the
49 municipalities belonging to the ‘‘earthquake crater
identi?ed by the DCD n. 3, 16 April 2009. By so doing
whilst the exemption zone was also applied to some towns
belonging to the neighbor Provinces of Pescara and
Teramo, some municipalities belonging to the Province of
L’Aquila – that were not damaged by the earthquake – were
excluded from it]’’.
DCaa n. 45/09: Deliberation n. 45/09, 24 June 2009:
‘‘De?nition of uniform criteria for the recording of costs
and activities referred to the 6 April 2009 earthquake’’.
Document attached n.1: ‘‘Criteria for the recording of
extraordinary costs and activities connected to the 6
April 2009 earthquake for the LHAs of Teramo, Pescara,
Avezzano-Sulmona, Lanciano-Vasto, Chieti.
Document attached n.2: ‘‘Criteria for the recording of
extraordinary costs and activities connected to the earth-
quake of 6 April 2009 for the LHA of L’Aquila’’.
DCaa, OP, September 2009: ‘‘Operational Programme
for the dif?culties caused by the seismic events’’.
DCaa, OP, January 2010: ‘‘Operational Programme for
the dif?culties caused by the seismic events’’. [this
deliberation has been taken by the new Commissioner ad
acta, that is the Governor of the Region]
A.3. Miscellaneous
Minutes of the meeting of November 10, 2009,
Ministries of Health/Economics. [when the ‘‘Operational
Programme’’ of the Commissioner ad acta has been exam-
ined by the experts].
Report of the Ministries of Health/Economics on the
Operational Programme, December 2009. [when the
‘‘Operational Programme’’ of the Commissioner ad acta
has not been approved].
Minutes of the meeting of December 18, 2009,
Ministries of Health/Economics. [when the Governor of
the Abruzzo Region – acting as new Commissioner ad acta
– has been asked to re-formulate the ‘‘Operational
Programme’’].
Minutes of the meeting of April 28, 2010, Ministries of
Economics/Health. [when the ‘‘Operational Programme’’
re-formulated by the new Commissioner ad acta – the
Governor of the Abruzzo Region – has been re-examined
by the experts].
Minutes of the meeting of December 2, 2010, Ministries
of Health/Economics [when it has been permitted to allo-
cate the FY 2009 post-earthquake additional resources to
the Abruzzo Region, thus closing the ‘‘Operational
Programme examination procedure].
Interviews
Interviewee Day City Location Duration
Director of the Health 29/11/2010 Pescara Health Policy Of?ce of the Abruzzo Region 2 h
Policy Of?ce of the 06/12/2010 Pescara Health Policy Of?ce of the Abruzzo Region 2 h
Abruzzo Region 07/12/2010 Pescara Health Policy Of?ce of the Abruzzo Region 1 h
12/01/2011 Pescara Health Policy Of?ce of the Abruzzo Region 1.5 h
14/01/2011 Pescara Health Policy Of?ce of the Abruzzo Region 1 h
CEO of the LHA of 19/11/2010 Pescara CEO Of?ce of the LHA of Pescara 2 h
Pescara 29/11/2010 Pescara CEO Of?ce of the LHA of Pescara 1.5 h
02/12/2010 Pescara CEO Of?ce of the LHA of Pescara 1 h
Director of the 19/11/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Management Accounting 29/11/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Of?ce of the LHA of 02/12/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Pescara 11/01/2013 Pescara Management Accounting Of?ce of the LHA of Pescara 1 h
CEO of the LHA of 26/11/2010 L’Aquila CEO Of?ce of the LHA of L’Aquila 2 h
L’Aquila 11/01/2011 L’Aquila CEO Of?ce of the LHA of L’Aquila 1 h
15/02/2011 L’Aquila CEO Of?ce of the LHA of L’Aquila 1 h
Management Accounting 26/11/2010 L’Aquila Management Accounting Of?ce of the LHA of Pescara 2 h
Of?cer of the LHA of 11/01/2011 L’Aquila Management Accounting Of?ce of the LHA of Pescara 2 h
L’Aquila 15/02/2011 L’Aquila Management Accounting Of?ce of the LHA of Pescara 1 h
17/01/2013 L’Aquila Management Accounting Of?ce of the LHA of Pescara 1 h
Director of the 26/11/2010 L’Aquila Balance Of?ce of the LHA of L’Aquila 2 h
Of?ce Balance of 11/01/2010 L’Aquila Balance Of?ce of the LHA of L’Aquila 2 h
The LHA of L’Aquila 15/02/2011 L’Aquila Balance Of?ce of the LHA of L’Aquila 1 h
Inspector of the Ministry of
Eonomics & Finance – Healthcare
05/10/2010 Rome Rome Of?ce 2 h
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 87
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M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 89
doc_983781301.pdf
This study examines how a particular set of calculative practices and classification systems
helped to guide the emergency responses to the 2009 earthquake in Abruzzo, Italy.
Accounting classifications worked in tandem with scientific classifications to define the
seismic event as a site for exceptional governance, to demarcate the temporal and spatial
boundaries, and to guide the immediate and subsequent healthcare-related humanitarian
responses. Accounting classification schemes were borrowed and built by the local health
authorities as the federal government made the provision of disaster relief funding contingent
on the identification of additional and traceable earthquake-related expenditures.
Earthquakes, exceptional government and extraordinary
accounting
Massimo Sargiacomo
?
Department of Management and Business Administration, G. d’Annunzio University, Viale Pindaro 42, 65123 Pescara, Italy
a r t i c l e i n f o
Article history:
Available online 13 March 2015
a b s t r a c t
This study examines how a particular set of calculative practices and classi?cation systems
helped to guide the emergency responses to the 2009 earthquake in Abruzzo, Italy.
Accounting classi?cations worked in tandem with scienti?c classi?cations to de?ne the
seismic event as a site for exceptional governance, to demarcate the temporal and spatial
boundaries, and to guide the immediate and subsequent healthcare-related humanitarian
responses. Accounting classi?cation schemes were borrowed and built by the local health
authorities as the federal government made the provision of disaster relief funding contin-
gent on the identi?cation of additional and traceable earthquake-related expenditures. The
analysis also shows the maneuvers that occurred around the accounting classi?cations as
public healthcare providers attempted to use the classi?cations to solve day-to-day health
treatment funding problems and the federal government tried to exert control at a dis-
tance. The analysis provided both contributes to our understanding of the governance of
these exceptional events and brings to the fore the challenges associated with such
humanitarian responses.
Ó 2015 Elsevier Ltd. All rights reserved.
Introduction
A severe earthquake rated 5.9 on the Richter scale
struck the region of Abruzzo in central Italy on April 6th
2009, killing more than 300 people. This paper examines
how a particular set of calculative practices and classi?ca-
tion systems (Bowker & Star, 1999; Foucault, 1979, 1991;
Miller, 2001) helped to guide the emergency responses.
Accounting classi?cations worked in tandem with scienti-
?c classi?cations to de?ne the seismic event as a site for
exceptional governance, to demarcate the temporal and
spatial boundaries, and to guide the immediate and subse-
quent healthcare-related humanitarian responses.
Accounting classi?cation schemes were borrowed and
built by the local health authorities as the federal govern-
ment made the provision of disaster relief funding
contingent on the identi?cation of additional and traceable
earthquake-related expenditures. The analysis also shows
the maneuvers that occurred around the accounting classi-
?cations as public healthcare providers attempted to use
the classi?cations to solve day-to-day health treatment
funding problems and the federal government tried to
exert control at a distance. A combination of oral
testimonies
1
as well as primary and secondary archival
sources provide the data for the study.
The current study seeks to understand how accounting
practices, including the classi?catory schemes that are
integral to them, are used in these moments when an
immediate health-related humanitarian response is
needed, and when that response does not ?t within exist-
ing classi?catory schemes. Previous research, for example,
has tended to focus on settings where accounting is used tohttp://dx.doi.org/10.1016/j.aos.2015.02.001
0361-3682/Ó 2015 Elsevier Ltd. All rights reserved.
?
Tel.: +39 085 4537597; fax: +39 085 4537917.
E-mail address: [email protected]
1
Details of the interviews are provided in the list of references.
Respondents were informed of questions in advance of interviews.
Accounting, Organizations and Society 42 (2015) 67–89
Contents lists available at ScienceDirect
Accounting, Organizations and Society
j our nal homepage: www. el sevi er. com/ l ocat e/ aos
both change and govern routine and day-to-day healthcare
activities (cf. Kurunmäki, 2004; Llewellyn & Northcott,
2005; Preston, Chua, & Neu, 1997; Rahaman, Neu, &
Everett, 2010). The current study, in contrast, focuses on
healthcare systems during a moment of humanitarian cri-
sis. Such settings are characterized by an immediate per-
ceived necessity to act, and a need to eventually phase
out and terminate the intervention. These moments of
intervention create a space of action that potentially over-
laps with extant healthcare provision, where existing clas-
si?catory schemes and accounting practices are sometimes
borrowed and modi?ed to deal with the immediate emer-
gency, as well as the aftermath. The current study attempts
to shed new light on the emergence and deployment of
what is described here as extraordinary accounting: that
is, a set of calculative technologies that co-exist alongside
and at times overlap with ordinary accounting practices.
The focus of the current study complements and
extends the taken-for-granted ways that accounting stan-
dard setters and ?nancial statement users think about
the reporting of infrequent and unusual events
(Bramwell, 2014). For standard setters, the accounting
treatment of such events has historically attempted to dis-
tinguish between accounting transactions that are ‘normal’
versus those that are not, focusing on where these two
groups of transactions will appear within the ?nancial
statements.
2
The current study complements these under-
standings as well as previous research (Beattie et al., 1994)
by illustrating the strategic aspects of such classi?cation
decisions in this case because the classi?cation decision
potentially impacts on the ?ow of ?nancial resources from
governments to the affected regions. These pre-classi?cation
decisions are important in that they in?uence whether an
event will be deemed to be a natural disaster and, hence,
whether ?nancial resources will ?ow from governments to
the affected region and thus need to be accounted for. In
these ways, the analysis draws attention to the sequence
of classi?cations and the associated practices that lie behind
the out-of-the ordinary items that ?nally appear in a set of
?nancial statements.
3
The paper is organized as follows. Section ‘Classifying
natural disasters’ outlines the role of particular classi?ca-
tory devices in de?ning and demarcating the existence,
severity, and consequences of natural disasters.
Section ‘Governing natural disasters’ outlines the theoreti-
cal framing which informs the analysis, focusing on
accounting, government and classi?cation. The concept of
exceptionalism is introduced, together with the suggestion
that accounting may be implicated in the construction and
quanti?cation of states of exceptional government for the
population’s healthcare, in this case following a natural dis-
aster. Section ‘The organization, funding, government and
ordinary accounting of Abruzzo healthcare’ offers a brief
overview of the Italian National Health Service, its funding
model, and how healthcare was organized in the Abruzzo
Region prior to the seismic disaster. Section ‘Exceptional
government and extraordinary accounting’ discusses the
launching of exceptional government in the context of the
humanitarian crisis caused by the earthquake, as well as
the rise of novel classi?cations, lists and rudimentary
accounting practices. Section ‘The operational program’
then examine howthese exceptional classi?catory schemes
and the associated accounting practices worked across time
and space. Finally, Section ‘Conclusion’ discusses the
insights of the study and offers suggestions for further
research.
Classifying natural disasters
Natural disasters, as their name suggests, are adverse
natural events that occur relatively infrequently through-
out the developed and developing worlds (Fassin &
Pandol?, 2010). In recent years, these events have appar-
ently become more numerous, as climate change and glo-
bal warming exacerbate the frequency and severity of
these natural occurrences. Undoubtedly, the proliferation
of social media channels has contributed to the visibility
of such events as rich photo and video images are available
almost instantaneously from the far reaches of the globe.
For example, video footage of ?ooding in the Philippines
and avalanches in Nepal can now be consumed in real time
on You tube and elsewhere.
While social media helps make visible adverse natural
events, it is a series of interrelated classi?cation processes
that in?uences if and how local governments and the inter-
national community responds. The ?rst set of classi?ca-
tions pertains to the scale of the natural event. These
classi?cations are premised on scienti?c measurements,
and are typically accepted by both the scienti?c commu-
nity and the governments and international organizations
that use the classi?cations to frame action. For example,
earthquakes are usually measured and classi?ed according
to the Mercalli or the Richter Scale. The Richter Magnitude
Scale assigns individual seismic shocks to categories, rang-
ing from micro earthquakes (measuring less than ‘two’ on
the scale) to massive disasters (measuring more than ‘ten’
on the scale). The Mercalli Scale spans from 1 (a ‘micro’
earthquake), to 10–12 (a ‘massive’ earthquake) (Lee,
Jennings, Kisslinger, & Kanamori, 2002; Richter, 1935).
Likewise hurricanes are measured by the Saf?r-Simpson
1–5 scale (Simpson, 1974) whereas volcanic eruptions
are observed by the Volcanic Explosivity 0–8 Index
(Newhall & Self, 1982).
Such classi?cation of adverse natural events is the start-
ing point for a classi?cation of the social and economic
consequences by governments and others. In Italy, for
example, the legislation draws on international classi?ca-
tory schemes to categorize natural disasters (art.2, Law
2
In July 2014, FASB released an exposure draft that proposes to remove
the category of extraordinary items since stakeholders have complained
that ‘‘the concept of extraordinary items causes uncertainty because it is
unclear when an item should be considered both unusual and infrequent’’
(Bramwell, 2014). For example, in 2005, FASB declared that Hurricane
Katrina was not ‘‘infrequent in nature and unusual in occurrence’’ (http://
www.accountingweb.com/topic/cfo/accounting-purposes-katrina-consid-
ered-ordinary) whereas the eruption of the volcano Mount St. Helens in
1980 was (Bramwell, 2014). The exposure draft proposals are similar to
IFRS (IAS 1 87) which does not allow the use of an extraordinary item
category (http://annualreporting.info/ifrs_standards/ias-1-87-ex-
traordinary-items-other-comprehensive-income-section).
3
Arguably similar sequences of classi?cations exist within IFRS, espe-
cially with respect to future site restoration costs (cf. CPA 2013, p. 31).
68 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
n.225, 24 February 1992). Natural disasters (and responses
to them) are identi?ed as one of three categories of emer-
gency: (a) natural events where the emergency may be
addressed at the local government level in an ‘ordinary
manner’; (b) natural events which require a coordinated
response at the province/regional level in an ‘ordinary
manner’; and (c) natural calamities, catastrophes or other
events which, due to their intensity and scope, require
the application of extraordinary means and powers.
Importantly, in emergencies classi?ed as ‘(c)’ the Council
of Ministers determines a ‘state of emergency’ and de?nes
the duration and territorial scope of governmental
responses (art.5, Newhall & Self, 1982). The declaration of
a ‘state of emergency’ following an earthquake would typi-
cally arise from a seismic shock equal or higher than 6 on
the Mercalli scale, or its equivalent in the Richter Scale
(Bignami, 2010).
Within the international community, similar classi?ca-
tion devices are used to decide whether humanitarian and
economic assistance should be provided. For example, the
European Union applies a severity threshold that considers
the economic consequences of a disaster. It allocates soli-
darity funds when natural disasters cause damage over
€3 billion, or 0.6% of the GNI of the country struck by the
catastrophe (see:http://ec.europa.eu/regional_policy/the-
funds/solidarity/index_it.cfm).
These classi?cations are important to the governance of
natural disasters, for they frame and in?uence if, when, and
how governments and the international community
respond to natural disasters, a social and political process
that is not separable from other governance activities.
Furthermore, the calculation and classi?cation of the con-
sequences must occur almost immediately (because of
the urgency of the situation), and yet be built up from a
series of more micro ‘data’. The next section considers
how these and other classi?cations organize the process
of responding to natural disasters, including the ways that
they relate to and intersect with day-to-day governance
activities.
Governing natural disasters
In his lectures on security, territory and population,
Foucault suggested that government, in the current era,
is about the correct way of disposing of things (2009).
Furthermore, he noted that government was less about
imposition and more about arranging the conduct of con-
duct (2000, p. 341). The current study starts from these
observations and proposes that classi?cation—used here
to denote both classi?catory schemes and the actions that
occur around these schemes—are central to governance.
Classi?catory devices and the associated activities both
help to frame the conduct of conduct, and are part of the
response to it. Further, classi?cation and the apparatuses
of disposal exist in relation to other classi?catory devices
and apparatuses of disposal. Additionally, the schemes
and the ways that they are enacted sometimes have a tem-
poral dimension in that they change as circumstances
change The remainder of this section elaborates on these
ideas and outlines how this framing brings to the fore
some key aspects of the governance of natural disasters.
Classi?catory schemes are an integral part of current
day government. Bowker and Star, for example, comment
that ‘‘classi?cation systems are integral to any working
infrastructure’’ (1999, p. 16). Classi?cations identify and
differentiate individuals, things, territories and spaces;
and they mark the boundaries between the normal and
the abnormal, thereby determining inclusion or exclusion
in relation to pre-established norms (Foucault, 1991, pp.
177–184). As Foucault suggested in his earlier work, divid-
ing practices are premised on classi?cation, since it is clas-
si?cation that constructs similarity and difference
(Foucault, 1979, pp. 99, 148–9, 156). In the words of
Foucault (1970):
. . .It is not a question of linking consequences, but of
grouping and isolating, of matching and pigeon-holing
concrete contents. . .. there is nothing more tentative,
nothing more empirical. . .. than the process of estab-
lishing order among things. . . nothing that demands a
sharper eye or a surer better articulated language.... in
fact there is no similitude and the distinction, even for
the wholly untrained perception, that is not the result
of a precise operation and of the application of a pre-
liminary criterion. . ..
[1970, pp. xix–xx]
Written classi?catory devices—classi?catory artefacts—
are an important type of classi?catory device. These arte-
facts are both a congealed dividing practice and something
that facilitates subsequent dividing practices. More impor-
tantly, however, classi?catory artefacts allow for the
attachment of resources and actions to different categories
thereby helping to facilitate the conduct of conduct. Stated
differently, such artefacts divide, but in a way that pro-
vides the impulse for certain actions.
The idea that accounting classi?cations are a useful
technology of governance has a long lineage within the
accounting and related literatures. Miller and Rose (1990,
p. 13), for example, explicitly note that governance
involves acts of classi?cation and that accounting partici-
pates in these processes. Similarly, Preston et al. (1997)
illustrate how the classi?catory schemes that were embed-
ded in DRG costing artefacts allowed the United States
government to attach funding consequences to different
categories, thereby motivating certain strategies on the
part of hospitals, medical staff and patients. Field studies
examining healthcare in Africa (Rahaman et al. 2010),
Australia (Abernethy & Stoelwinder 1995; Chua 1995),
the United Kingdom (Llewellyn & Northcott, 2005;
Preston, Cooper, & Coombs 1992) and the United States
(Arnold & Oakes, 1998; Pizzini, 2006), have illustrated
the different ways that accounting inscriptions, and the
classi?catory devices that they are constituted by, partici-
pate in organizing the conduct of conduct. More speci?-
cally, this prior research shows that it is often the
impregnation of accounting classi?cations with funding
consequences that both facilitates governance and con-
tributes to the salience of such classi?cations.
One of the reasons that these practices are potentially
powerful is because they facilitate judgment and action
at a distance. Prior research illustrates how accounting
inscriptions facilitate governance because they are
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 69
portable, comparable and combinable (Robson, 1991;
Robson, 1992). These features allow government bureau-
crats and others to make calculations regarding distant
locales, to compare them to other sites, and to make judg-
ments about their activities (Miller & Rose, 1990, p. 9). As
Rose and Miller (1992, p. 175) argue ‘‘knowledge is thus
central to these activities of government and to the very
formation of its objects, for government is a domain of cog-
nition, calculation, experimentation and evaluation’’.
Accordingly, numbers, tables and statistics play a pivotal
role in analyzing and diagnosing government interven-
tions. Accounting classi?cation devices, and the associated
inscriptions, provide the impulse for this mediating pro-
cess: ‘‘to exercise power over events and processes distant
from oneself it is necessary to turn them into traces that
can be mobilized and accumulated’’ (Rose, 1991, p. 676).
These traces ‘‘make the domain in question susceptible to
evaluation, calculation and intervention’’ (Rose & Miller,
1992, p. 185). Furthermore, these inscriptions allow pol-
icy-makers and those controlling the funding to not only
judge and intervene in these distant sites, but also to adjust
and change the classi?catory schemes themselves. These
acts of adjustment on the part of policy makers, both in
terms of how the classi?catory device is used, and in terms
of the device itself, are central to the current study.
Acts of adjustment are part of the games and strategies
that occur around classi?cations (cf. Foucault, 2000, pp.
346–347). The governance of the conduct of conduct, as
Foucault observed, is always partial because these tech-
niques of governance rely on a mixture of arrangements
that attempt to manage possibilities for action (2000, p.
341). From this vantage point, ‘‘one can interpret the
mechanisms brought into play in power relations in terms
of strategies’’ (p. 346). These mechanisms act on the ‘free
will’ of the acting subject but in a way that is always lim-
ited by the reality that the targets of governance are
simultaneously acting subjects (p. 342). One of the conse-
quences of this is that games of strategy—involving both
those with the ability to in?uence such mechanisms and
those targeted by them—occur around the mechanisms
that have been introduced to organize the conduct of con-
duct. These games of strategy around classi?cations poten-
tially contribute to the eternally optimistic yet perpetually
failing nature of governance (Miller & Rose 1990, p. 10).
4
Previous research illustrates that social actors strategize
around and with accounting classi?cations. Sometimes
these strategies involve the ways that classi?catory arte-
facts are ?lled in (Neu, Ocampo Gomez, Graham, &
Heincke 2006, p. 659), since it is possible to both in?uence
what distant policymakers will see and perhaps more
importantly what contingent funding will be received. In
other cases, participants on the ground exercise discretion
in terms of how the classi?catory device will be inter-
preted and applied, perhaps in the attempt to buffer their
patients, students, and clients from the classi?catory con-
sequences (Weiner, Maxwell, Sapolsky, Hsiao, & Dunn
1987, p. 471). This prior research draws attention to the
importance of how participants, including policy makers,
respond to and with classi?cation devices.
One of the ideas present in Foucault’s lectures on gov-
ernment is the distinction between normal and extraordin-
ary government. For example, he comments that
government also involves the ‘‘negative aspects of life’’
including ‘‘accidents such as ?re and ?ood’’ (2002, p.
318), and that action is needed ‘‘to remedy the accidents’’
caused by disasters (2009, p. 331). Rose (2005, p. 245)
echoes this, commenting that despite the fact that the
world is constructed on the notion of ‘normal’, ‘‘the usual,
the average the common’’ (Rose, 2005, p. 245), moments
arise when this state of affairs is disrupted and where
urgent action is required. This sentiment is explicit within
Ferejohn & Pasquino‘s essay entitled ‘‘The Law of
Exception’’ (2004) which recapitulates different models of
emergency state powers and suggests that the ‘norm’
refers to ‘‘an empirical regularity in the natural world or
in the society’’ re?ected in ‘‘regular government’’. But there
are also ‘‘exceptions, differences, deviations vis-à-vis the
norm’’ (2004, pp. 221–222) instigated by special or emer-
gency circumstances. In these situations, such as civil
war, terrorist attacks and invasions, the state may assume
‘‘emergency powers’’ which involve the suspension of, or
partial deviation from, the normal mode of constitutional
government (idem, pp. 222–223).
More recently, Agamben (2005) has referred to a ‘‘glo-
bal civil war’’ to illustrate that ‘‘the state of exception tends
increasingly to appear as the dominant paradigm of gov-
ernment in contemporary politics’’. Here, provisional
exceptional measures are transformed into ‘‘a technique
of government’’ (2005, pp. 2–3). Agamben has also empha-
sized that ‘‘The declaration of a state of siege on the occa-
sion of the earthquake of Messina and Reggio Calabria on
December 28, 1908 is only apparently a different situation’’
(idem, p. 17), thereby indirectly including natural disasters
among the exceptional circumstances which trigger states
of exceptions. However, Lazar (2009), in States of
Emergency in Liberal Democracies, argues that ‘‘there is no
principled reason to make an ontological distinction
between terrorist threats and other kinds of threats.
Infrastructure disasters... ?oods, earthquakes, indeed any-
thing that poses a real and urgent threat on a grand scale
is an emergency, insofar as one aspect of a government’s
job is to keep its citizens safe’’ (p. 8). Indeed, humanitarian
crises resulting from war, natural disasters or political col-
lapse are all usually perceived as breaks from normality
which spur emergency responses, interventions, tech-
niques and regimes of practice.
While exceptional moments may appear self-evident,
we examine here how they are constructed and de?ned
vis-à-vis classi?cations such as the aforementioned scien-
ti?c and socio-political classi?cations. Furthermore, we
suggest that the modes of response after an event has been
named as a natural disaster are guided by a distinctive set
of classi?cations and interventions.
Previous research suggests that accounting calculations
may feed into the initial determination of whether an
event will be classi?ed as a natural disaster. Much like sit-
uations of normal government, accounting numbers help
4
Foucault suggests that governance is achieved when ‘‘stable mecha-
nisms replace the free play of antagonistic reactions’’ (p. 346) however
Miller and Rose (1990), along with others, question whether such stability
is ever more than temporary.
70 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
to calculate and quantify the ‘economic’ magnitude of the
event. Accounting, as ‘‘an inherently territorializing activ-
ity’’ (Miller & Mennicken, 2012), involves dividing territo-
ries and people from those most affected to those not
affected at all, attaching ?nancial and costing measures
to those so categorized, and developing boundaries for
such issues as healthcare fee exoneration or income tax
exemption. These activities help to construct, represent
and quantify the crisis, thus separating the exceptional
from the normal, and thus providing the impulse for
immediate and extraordinary action.
When extraordinary action is seen to be warranted,
there is still the issue of how it will be organized, and what
will be the relationship between the normal and extraor-
dinary disposition of things. The process of achieving out-
comes that are convenient for ‘‘each of the things that are
to be governed’’ is more complex in the context of an emer-
gency (Foucault, 1991, p. 95). A crisis creates a situation
which not only has to be governed, but one where things
must be disposed of quickly, by authorities on the ground
and at a distance. Thus a key set of questions pertain to the
origins of the extraordinary accounting classi?cations and
associated practices. Second, there is the issue of how they
relate to, intersect with, and possibly contradict the exist-
ing programs of disposition? Finally, there is the matter of
how these classi?catory practices change as the crisis
recedes, and how they eventually come to stop?
In terms of the ?rst question, prior research suggests
that accounting classi?cations and practices are sometimes
borrowed from other settings, thus functioning as a ready-
made technology (Miller & Rose, 1990; Rahaman et al.
2010). Given that natural disasters can occur relatively fre-
quently, classi?catory templates and response protocols
exist within international aid agencies and also govern-
ments (Amin & Goldstein, 2008). At the same time, not
every situation is identical, and the politics of the situation
will in?uence the response (Fengler & Kharas, 2010). Thus
it is likely that the acts of classi?cation and the associated
practices will be an amalgam of things borrowed and built.
These classi?catory artefacts will be constructed to detect,
record, and report such items as the extraordinary health-
care costs and activities sustained by regional/local gov-
ernments and their local health units in the aftermath of
a natural disaster. However, they will also be used to
foment, guide and perhaps constrain emergency responses
(cf. Rahaman et al. 2010). And, as might be expected, these
acts of construction and disposition often enlist groups of
accounting and ?nancial management experts to identify
solutions, modify and adapt existing practices, and deploy
them in the exceptional space (e.g., World Bank, Fengler,
Ihsan, & Kaiser, 2008).
The relationships among extraordinary and normal dis-
position assemblages are also salient. For example, health-
care disposition assemblages have often been guided by a
mentality of rationing, where the goal is to deliver a ?xed
amount of health services in the most cost effective man-
ner (cf. Preston et al. 1997). One of the consequences is that
health delivery providers are almost always operating in a
resource constrained fashion, and almost always looking
for opportunities to obtain additional ?nancial resources
to cover operating costs (Broadbent, Laughlin, & Read,
1991). Traditionally, these opportunities are contained by
using a combination of post-delivery reimbursement
mechanisms and auditing practices (Preston et al., 1992;
Tediosi, Gabriele, & Longo, 2009). In contrast, extraordinary
disposition assemblages are more likely to be guided by a
mentality of urgency, at least in the initial moments after
the disaster. Such assemblages often forego immediate
accountability by using block funding transfer mechanisms
and post spending accountability mechanisms (Fengler &
Kharas, 2010; Fengler et al., 2008). Furthermore, national
laws often devolve responsibility to apply funds for emer-
gency purposes to the affected regional/local governments,
leaving a space of discretion regarding the types of service
providers (public vs. private) and the types of spending
(drugs, temporary accommodations, medical services,
etc.). Not surprisingly, this creates a discretionary space
where politicians and others may attempt to appropriate
some of these funds, and where public healthcare provi-
ders will try to obtain reimbursement for ‘normal’ health-
care treatment activities.
Finally, there is the question of whether and how the
novel classi?cation devices change as the crisis recedes,
and the time since the initial event increases. In the
immediate aftermath of the disaster, healthcare needs
are, and are made to appear as urgent. As mentioned pre-
viously, traditional media and social media outlets provide
a plethora of almost real-time visual images to the nation
and the globe about the scale and scope of the disaster in
question. In these moments, the disposition assemblages
may be both more rudimentary and more liberally applied
than in normal times of government (Alexander, 2000,
2002; Coppola, 2011). However, this is likely to change as
the initial emergency recedes, as the media focus shifts
to other calamities, and as disposition assemblages ‘evolve’
to decrease the spaces for discretion, thus strengthening
novel and purpose built information systems (Fengler &
Zaki, 2010). These observations raise questions as to the
trajectory of disposition assemblages, including whether
they are eventually terminated, or whether they morph
into a normal form of governance such as the case of
HIV/Aids in Africa (Rahaman et al., 2010). The subsequent
case considers these questions in more detail.
The organization, funding, government and ordinary
accounting of Abruzzo healthcare
The Italian National Health Service
According to the Constitution of the Italian Republic,
health is a guaranteed right. A National Healthcare
Service (INHS) was founded in 1978. It aims to provide uni-
form and comprehensive healthcare and is ?nanced by
general taxation (France, Taroni, & Donatini, 2005). The
INHS has undergone major reforms in the last 20 years,
with the result that the regions are now responsible for
the organization and administration of healthcare (Ianni,
2008). Although regions are expected to provide basic
and equal levels of essential care (Torbica & Fattore,
2005), they are free to adopt different organizational and
funding models, thereby giving rise to diverse regional sys-
tems (Jommi, Cantù, & Anessi Pessina, 2001).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 71
Since 2000 (and Legislative Decree n. 56/2000) Italy has
attempted to introduce ?scal federalism (Oates, 1999), in
order to ensure greater ?nancial accountability for regional
governments. However, there remains a multi-tier struc-
ture, with regional differences in the ability to contain
health expenditures within the limits of available funding
(Tediosi et al., 2009). While many regions have achieved
?scal federalism, a small but signi?cant number (such as
Abruzzo, Lazio, Campania, Molise), continue to experience
?nancial distress. Under the pressure of federalist thought
these regions were asked, in the ?rst half of 2007, to sign
an agreement on a budgetary balance plan to be negotiated
with, and controlled by, the Ministry of Health and the
Ministry of Economics and Finance (Lega, 2008).
In 2008, the said regions failed to satisfy the budgetary
stipulations, and the Italian government appointed
experts, named ‘Commissioners ad acta’, whose function
was to provide quarterly reports on the implementation
of the plans and the achievement (or otherwise) of govern-
ment objectives. Furthermore, a series of measures – such
as limits on pharmaceutical expenditures and no auto-
matic right to replace personnel when posts become
vacant after people retirement – were applied to non-com-
pliant regions, and access was prevented to a special tran-
sitional fund, which was previously created by the
government to sustain regions facing higher de?cits (i.e.,
over 7% of total funding) (Tediosi et al., 2009). In order to
co-fund their de?cits, regions suffering ?nancial stress
were permitted (under the 2007 Financial Law) to increase
regional taxation on productive activities (i.e., the so-called
‘Imposta Regionale sulle Attività Produttive’ – IRAP), and
impose surcharges on personal income tax (i.e., the so-
called ‘Imposta sul Reddito delle Persone Fisiche’ –
IRPEF). These represent some of the major sources of fund-
ing for the INHS, together with value added tax (VAT) and
excise duty on petrol (Manzoli, Villari, & Boccia, 2008).
The Abruzzo Regional Health Service
At the time of the earthquake on 5 April 2009, the INHS
at the regional level in Abruzzo was organized around six
Aziende Sanitarie Locali (Local Health Authorities – LHAs).
LHAs are integrated delivery systems providing a full range
of health and social services, whose public funding was
based on a capitation quota, proportional to the population
of the four provinces
5
of the region (Chieti, Pescara, Teramo
and L’Aquila) and of neighboring smaller municipalities (i.e.,
Avezzano-Sulmona, Lanciano-Vasto). Healthcare expenses
accounted for 86% of the total assets of the Abruzzo
Region, whose LHAs were managed by public CEOs.
As portrayed in Fig. 1, the ?nancial results of each LHA
can be greatly affected by the mobility of the population to
and from other LHAs, inside and outside the Abruzzo
Region. The ?nancial results of the Region and the LHAs
can also be negatively in?uenced by the ?ow of residents
to ‘private’ status in the provision of hospital, diagnostic,
rehabilitative and integrative care, but they can also be
enhanced by the LHA’s own sources of income (e.g.,
patients’ payments for diagnostic investigations, or for
medicines) (Sargiacomo, 2002).
In September 2008, a Commissioner with experience as
a CEO of local governments and CFO of a large LHA was
appointed for Abruzzo to achieve governmental aims. As
a consequence of the Budget Recovery Plan enforced by
this Commissioner (n. 14/09, 12 March 2009), ?nancial dis-
tress targets were a pivotal part of the measures imposed
for the Abruzzo and related territory – the ‘social space’
of normal governmental action. Healthcare fees were
imposed to increase the internal autonomous funding of
Fig. 1. Funding model of the Abruzzo region healthcare.
5
Italy is organized in 20 regions, each of which contains a number of
provinces.
72 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
the Abruzzo Region. Blocking staff turnover and reducing
personnel were implemented to contain ?xed costs and
to reduce healthcare expenses. Expenditure caps were also
imposed in relation to general practitioners, private care,
public hospital care, building maintenance and pharma-
ceutical care, whilst non-prescription over-the-counter
drugs were regularly paid for by patients/inhabitants of
the Abruzzo Region.
The accounting/administrative and reporting apparatus
associated with normal government action was primarily a
double-entry bookkeeping system, sustained by an annual
asset and liability statement and a pro?t and loss account.
Since 2008 there had been a uniform regional plan of
accounts and cost centres to which the LHAs had to con-
form. In terms of pharmaceutical distribution procedures,
no drug could be obtained in local pharmacies without a
medical prescription issued by a doctor working in the
region. In order to authorize and document public care
costs and activities, the CEOs inserted ordinary delibera-
tions, orders, and invoices, along with their respective
accounting and non-accounting data, into a regional IT
information system. The CEOs of LHAs were thus obliged
to respect tight budgetary targets for 2009 and to provide
quarterly reports (Ianni, 2008) in order to demonstrate
adherence to the regional Budgetary Balance Plan. This
plan was controlled at a distance by state inspectors, and
routinely audited on a three-month basis. Moreover, ordin-
ary checking procedures, aimed at testing the correctness
of ordinary costs and activities recorded, were ensured
by matching the ?scal codes of the inhabitants of the
Abruzzo region with the records of the healthcare costs
pertaining to them.
These ‘normal’ arrangements for the government,
administration and ?nancing of regional healthcare, and
their respective ordinary accounting architecture, were
disrupted when, in the early morning hours of April 6,
2009, an earthquake struck the Abruzzo region.
Exceptional government and extraordinary accounting
De?ning, classifying and demarcating the terrain of
exceptional governance
Preliminary information about the earthquake from the
Italian seismic service indicated that the magnitude was
approximately 7 on the Mercalli scale. Reports from the
police and other local authorities indicated both civilian
casualties and signi?cant damage. These events and
reports put into motion a series of steps and activities that
culminated in an exceptional government program and
extraordinary accounting. The remainder of this section
describes these steps and outlines the contours of the
program.
On April 6th, as reports regarding the number of deaths
and the extent of the damage continued to trickle in, Prime
Minister Berlusconi, after conferring with his cabinet,
declared a national state of emergency. Funds and person-
nel were allocated through an Ordinance of the President
of the Council of Ministers (OPCM, n. 3753, 6 April 2009).
The Head of the Civil Defence Department – who at that
time was also acting as Undersecretary of the State – was
delegated to oversee post-disaster operations. He was
given the authority to do what was necessary ‘‘in order
to satisfy the paramount life needs of the affected pop-
ulations’’ (Art.1, OPCM n. 3753, 6 April 2009).
It is important to note that these initial actions were
somewhat tentative, as the scale and scope of the earth-
quake and its consequences were largely unknown. The
earthquake itself had damaged the telecommunications
infrastructure compromising communications within the
region and beyond. This, along with the dispersed nature
of the population and the extent of the damage, made it
dif?cult to identify the number of persons missing or
injured. In this regard, the declaration of a state of emer-
gency notwithstanding, the implementation of a program
of exceptional government needed to await additional
information. In the absence of this information, the health-
care Commissioner announced on 7 April 2009 that the
local health authorities had permission to exceed expense
thresholds established in the Budget Recovery Plan (DCaa,
Note Prot. 9426, 6 April 2009). Later in the day, he sus-
pended the Budgetary Recovery Plan altogether for the
LHAs, the territories and the citizens belonging to the
Province of L’Aquila (DCaa, n. 23/09, 7 April 2009).
Given the confusion that reigned in the days immedi-
ately after the disaster, it was not clear how many local
authorities were struck by the earthquake. The Head of
the Civil Defence enlisted the seismic service to demarcate
the terrain of exceptional governance, de?ned as those
areas experiencing an intensity equal to, or higher than,
six degrees on the Mercalli Scale. The available seismic
data was plotted on a map of the region to identify the
communities that would be the targets of exceptional gov-
ernment and the corresponding health authorities that
would participate in the distribution of things. These acts
of classi?cation and demarcation took approximately ten
days. On April 16, the Civil Defence issued a decree de?n-
ing the earthquake territory as the 49 municipalities in
the Provinces of L’Aquila, Pescara and Teramo (DCD, n.3,
16 April 2009). This area thus became the target of excep-
tional government (see Fig. 2).
These classi?cation exercises had important implica-
tions for the inhabitants of the region in that these activi-
ties not only partitioned physical space but also people.
People living outside the de?ned area continued to be sub-
ject to normal government actions, whilst earthquake-af-
fected citizens were to be assisted through exceptional
measures. This distinction was not lost on the population
and their politicians. In July 2009, three months after the
earthquake and after prolonged behind-the-scenes lobby-
ing, the list of affected municipalities and towns was
increased to include additional municipalities and towns
6
.
Immediate humanitarian aid
Two of the most pressing needs in the days immediately
after the earthquake were the provision of accommodation
and prescription medicines for the injured. To address these
needs, two temporary disposition assemblages were
6
DCD n. 11, 17 July 2009, upgraded the number of municipalities to 56.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 73
immediately deployed both by the Head of the Civil Defence
and by the healthcare Commissioner. In terms of
accommodations, displaced persons were moved to hotels
located on the Adriatic coast, mostly – but not only – in
the towns of Francavilla al Mare, Pescara, Silvi and
Giulianova, which are at more than 100 km distance from
L’Aquila. This area was selected because it was thought to
be safe from any aftershocks and because the hotels were
mostly empty since it was not yet the tourist season. Thus,
the Head of the Civil Defence ensured ‘‘support to the over
30,000people that have beentransferredfromthe epicenter
area toward the coast and were lodged in the hotel facilities
whose costs were shouldered by the civil defence system’’.
Moreover, ‘‘buses of the regional company ARPA were uti-
lized for the transfer of evacuees to the hotel structures ‘‘
(Report of the Undersecretary of the State to EU, 2009, pp.
25–27). These costs were directly born by the Department
of Civil Defence and were not charged to the LHAs. Indeed
the Civil Defence Department had been assigned a large
amount of public funds to urgently launch, manage and
pay broad emergency relief activities (Sargiacomo, Ianni, &
Everett, 2014).
The healthcare Commissioner concurrently relaxed the
usual medication distribution procedures, introducing on
April 7 a ticket exemption that consisted of both a way
to distribute medications to the population and a method
to account for these distributions. An identi?cation code,
‘Resident of the L’Aquila LHA’, was introduced that allowed
these ‘identi?ed’ individuals to obtain medications without
payment and without a prescription. The code was chan-
ged the day after to ‘T09’ (the Italian acronym of
Earthquake09). The new policy stated that:
hospital and private accredited pharmacies.... will dis-
burse the products/drugs needed even in absence of
the authorization of the respective competent health-
care of?ces, being not compulsory in this ?rst emer-
gency phase to follow the normal procedures.
[DCaa, Note Prot. n. 9560/S, April 8 2009]
As the subsequent comments by the Commissioner
indicated, the intention was to grant humanitarian discre-
tion to hospitals and pharmacies in order to allow them to
provide urgent healthcare to earthquake-injured people.
Given that in the days immediately after the disaster nei-
ther mobile or ?xed phones, nor internet connections,
were working, the Commissioner disseminated the policy
of free medications to the population through TV and
newspaper media.
At the same time, the introduction of a new classi?ca-
tory code both made possible and implied the need to
account for the code-speci?c expenditures. For example,
the Commissioner decreed that:
. . .each LHA will promptly open a speci?c cost centre on
which there have to be recorded the expenses sustained
by the LHAs deriving from the healthcare assistance to
be guaranteed [underlined in original] to the citizens
hit by the quake....
[DCaa, Note Prot. n. 9560/S, April 8 2009]
i
i
Fig. 2. Territorial demarcation of the classi?ed ‘‘crater space’’ struck by the quacke.
74 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
However he also recognized that this space for discretion
could be subject to abuse. Thus he simultaneously pre-
scribed that:
. . . it is disposed that the hospital and private accredited
pharmacies. . .will disburse products/drugs needed even
in absence of the authorization of the respective compe-
tent healthcare of?ces, being not compulsory in this
?rst emergency phase to follow the normal
procedures. . .. The Direction of Health Policy of the
Abruzzo Region is going to get the list of the names
of. . . citizens/patients eligible to have the respective
therapies. The mentioned list will be promptly sent to
the pharmacies in order to permit the administration
of drugs.... The list of identity records and personal
details of all the citizens/patients... will be available to
any interested party. . . in order to facilitate the identi?-
cation of the patients deprived by any identity card or
?scal code. . ..
[DCaa, Note Prot. n. 9560/S, April 8 2009]
This later prescription was intended to limit the num-
ber of people that could take advantage of the space for
discretion.
Gordon (1991, p. 10) states that policing, and by impli-
cation governing, ‘‘is a science of endless lists and classi?-
cation’’. The above excerpts indicate that in the days
immediately after the shock, matched lists of patients/dis-
eases emerged and were enlisted to help organize the
emergency response. Also apparent is the initial construc-
tion of the parallel reporting and calculative procedures
needed to support the administration of the fee exemption
for pharmaceutical drugs and healthcare assistance.
Further reporting procedures were also enacted on the fol-
lowing day, 9 April, when the Commissioner emphasized
that:
. . .in order to achieve a correct accounting and report-
ing. . . each prescription holding the T09 code must be
gathered in separate rolls and brought to the LHA, in
whose territory is located the pharmacy which has
delivered the prescription. . .. The set of forms prear-
ranged to deliver C Class Drugs should be likewise
rounded up in separate rolls and handed out to the
LHA, in whose territory is located the Pharmacy which
has delivered the prescriptions according to the above
manners. . . [and] that the current deliberation be given
the maximum diffusion through the media (TV and
newspapers) as well as on the Abruzzo Region website.
[DCaa, 8/47, 9 April 2009]
The above rudimentary accounting and reporting tech-
niques, were borrowed from and de?ned in relation to the
pre-existing normal modes of accounting for dispositions.
Whereas the T09 code was something new, it was inserted
into the already existing accounting system, adding a new
category into which costs could be accumulated. Likewise
the list of eligible patients was generated from the infor-
mation already in the healthcare database. While these
recording and classi?cation activities made it possible to
account for disaster-related costs, at this early stage, the
need to ‘‘guarantee healthcare assistance’’ seemed to
supersede any ‘normal’ administrative/accounting proce-
dure. This ?rst phase of the healthcare emergency crisis
was set by the Commissioner to end on 30 May 2009.
In this initial period, the new classi?cation-based dis-
position procedures introduced had tangible consequences
for residents within, and outside, the region. Individuals
classi?ed as residing outside the borders of the earth-
quake-crater continued to be de?ned as normal citizens.
They remained subject to the ongoing stipulations of the
Budget recovery plan. Thus they usually paid fees for phar-
maceutical assistance, non-prescription over-the-counter
drugs, and specialist and diagnostic health assistance.
7
By
contrast, those classi?ed as part of the affected populations
acquired visibility and the status of ‘‘earthquake-injured peo-
ple’’. This rendered them valid recipients of the exceptional
government healthcare program. The inhabitants located in
the territories devastated by the earthquake bene?ted from
healthcare ticket suspension, free medicine, and specialist
and diagnostic heath assistance. Importantly, in the social
space of exceptional government, the previously established
pharmaceutical cap was abolished, as a pharmaceutical assis-
tance exemption was immediately stipulated (See DCaa n.23,
7 April 2009). It was also established that non-prescription
over-the-counter drugs were to be distributed free of charge
(DCaa, Note Prot. n. 9560/S, April 8 2009) to the classi?ed
territories and their lists of inhabitants.
Accounting for extraordinary costs
At the same time that these events were unfolding in
the region, the national government was deliberating over
what additional aid to provide. Despite the ongoing federal
government ideas of ?nancial restraint, which a priori
impeded any further appropriation of funds from the state
to the Abruzzo Region, the Legislative Decree (LD) n. 39, on
28 April 2009 (later converted into Law 77, 24 June 2009),
allocated €40 million to the Abruzzo Region to meet the
extraordinary costs and activities incurred in relation to
earthquake-related healthcare services. These funds, how-
ever, were tied to and embedded within a disposition
assemblage that attempted to limit the space for discre-
tion. This section considers the activities of coding,
classifying, training and funding that were used to orga-
nize the conduct of conduct.
As the emergency healthcare crisis receded, and amidst
federal government concerns that the resources assigned
might be misapplied by a region in ?nancial distress, a
presidential ordinance (OPCM, n. 3782, 17 June 2009)
made access to funds conditional on the Commissioner’s
presentation of an ‘‘Operational Program to further face
the dif?culties caused by the seismic events’’ (art.2). This
decree was intended to explicitly signal that federal fund-
ing was contingent and that an explicit stewardship
relationship existed between the federal government and
the Commissioner regarding the use of the extra monies.
The Commissioner was expected to gather ?nancial infor-
mation from the various regional LHAs, collate it, and
7
Moreover, normal citizens continued to be subjected to the state/region
ordinary ?scal regime, thus paying, for example, all forms of income or
personal property taxes.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 75
prepare an ‘acceptable’ OP prior to being able to access the
funds.
The Commissioner responded immediately. On 24 June
2009, the same day as the approval of the Law 77/2009
which allocated extra-funding to the Abruzzo Region, he
convened a small team of accounting experts, supported
by an institutional advisory agency of the region, to
develop and share uniform criteria for the recording of
costs and activities connected to the earthquake (DCaa
45/09, attachment 1, p. 1). The Commissioner comments:
Considering that. . .. the seismic event renders actual
both the need to track down the increasing costs of
the INHS for the year 2009 and the following costs
due to the earthquake, as well as the re-modulation of
the cost containment manoeuvres already deployed by
the Budget Recovery Plan. . .. recognizing the opportunity
to de?ne criteria in order to uniformly record the costs and
the activities of all the regional LHAs and to make them
comparable.... having consequently considered the
fundamental need to distinguish the costs of regular health
assistance from those deriving from the seismic event,
according to the following macro-categories (e.g., per-
sonnel costs; purchase of sanitary and non-sanitary
goods; purchase of sanitary and non-sanitary services,
etc.) . . .. The deliberation is urgent, as for the need to
allow in the shortest time possible the start of the
recording and accounting of costs connected to the seis-
mic event which occurred on 6 April 2009
[DCaa n. 45/09, pp. 2–3 [emphasis added]]
Shortly after the Commissioner’s announcement, the
team of accountants began to meet, initially focussing on
the construction of appropriate criteria. As the manage-
ment accounting of?cer of the Pescara LHA
8
recollects:
When we started to meet together we felt an incredible
sense of emergency around us, as well as time pressure
to write down the new criteria as soon as possible. They
had to be crafted very quickly in order to record, docu-
ment, report and control the post-seism extraordinary
costs and activities, but there were no previous exam-
ples to imitate. An intra-regional accounting system
had been working since 2008, which made all the
LHAs costs and ordinary activities comparable and con-
trollable. Nevertheless, in order to access the extraor-
dinary funds allocated by the state for the exceptional
post-seism government, and later re-distribute them
according to the different activities developed by each
LHA, we were asked to build up a management account-
ing architecture, which had to run in parallel to the
already existing regime.
This individual
9
went on to recall:
We have quite immediately realized that we have to
hurry to ful?l our mandate, and after a couple of meet-
ings it was very clear to us that we had to work on the
existing regional plan of accounts, schemes and cost
categories... accordingly we began to work to modify
ordinary practices, adapting them to the disaster cir-
cumstances... in order to build homogeneous extraor-
dinary cost-accounting criteria and classi?cations and
install them on the already existing working electronic
and paper-based regional infrastructure, so that each
operator working in any Abruzzo LHA might have used
them correctly.
The above observations are interesting for three rea-
sons. First, the comments capture the sense of urgency that
the staff of the LHA felt regarding the classi?cation activi-
ties in that federal funding would not be forthcoming until
an adequate cost classi?cation scheme was developed.
Second, ready-made classi?cation devices did not exist, at
least within the affected region, and thus the accountants
involved felt as if they were starting from scratch in the
development of a classi?cation scheme. Finally, the
accountants recognized that the new classi?cation had to
somehow integrate with the existing accounting infras-
tructure. This recognition both made the job easier—be-
cause classi?cation practices could be borrowed and
modi?ed—and more dif?cult because there had to be some
consistency with the existing infrastructure.
Skimming through the document containing the criteria
(attached to DCaa n. 45/09), it is clear that government was,
in part, organizing the conduct of conduct by imposing cer-
tain accounting rules and practices on the LHA’s. For exam-
ple, it was required that: ‘‘Each LHA must open a cost centre
speci?cally addressed to record the costs of the earthquake’’
(p. 1). The latter prescription had already been stipulated by
the Commissioner immediately after the disaster (DCaa,
Note Prot. n. 9560/S, April 8 2009), but in the document it
was stated that ‘‘some LHAs have not already done it’’ (p.
1). Paper-based documentation was also mandated in the
event of a lack of IT records. Further, ‘‘existing paper docu-
ments in any case should be enclosed to justify the recorded
cost’’ (p. 1). The criteria also required modi?cation of the
vertical scheme of the (value-added) pro?t and loss account
of the LHA. This served to enhance the ‘‘visibility’’ of earth-
quake-related costs, by adding a new ‘‘separate column
[which] referred to the earthquake, conventionally named
CE T09’’ (p. 1), Contrary to what happened in the ?rst phase
of the emergency, the consequences of non-conformity with
these last requirements were asserted. For example, ‘‘incase
of a lack of a documentary accumulation it will be impossi-
ble to attribute the sustained costs to the earthquake’’ (p. 1),
thereby arguing that, after the ?rst phase of the emergency,
there was no further scope for humanitarian discretion.
Additionally, the federal government provided some
general criteria as to how earthquake-related costs should
be classi?ed:
– ‘‘additional’’ costs that, apart from the enactment of an
appropriate deliberation, have represented an answer
to the emergency, and have resulted in an extension
of already existing health services. . .. These services
require separate invoicing and separate orders indicat-
ing the earthquake cost centre. . . (e.g., cost of direct dis-
tribution of medicines, health transports, prosthesis
distribution, etc.),
8
Interview (November 2010).
9
Interview (January 2013).
76 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
– ‘‘additional’’ unforeseen costs that cannot be deducted
from regular activities, and whose estimate must be
done on the basis of agreed criteria (p. 2).
– costs singled out speci?cally through an appropriate
deliberation, referring directly to the earthquake, and
thereby easily traceable. . . (e.g., increase of health
guard; paediatric assistance, etc.);
The distinction between additional versus non-addi-
tional costs and the requirement that costs be easily trace-
able and justi?able was an attempt, on the part of the
federal government, to guide and constrain the cost classi-
?cation activities of the accounting experts.
The aforementioned general criteria were supplemented
with a listing of 26 compulsory criteria that healthcare
operators belonging to the ?ve LHAs (i.e., Teramo, Pescara,
Avezzano-Sulmona, Lanciano-Vasto and Chieti) were to fol-
lowin order to record and prove the extraordinary costs and
activities triggered by the earthquake (pp. 3–6). Each extra-
ordinary cost-accounting criterion had a number, a label,
and an explanation of the procedures to be followed for cor-
rect recording. In some cases there were also sub-classi?ca-
tions which further speci?ed the cost/procedures
typologies, thus unveiling an implicit connection between
the establishment of criteria and classi?cations, and the
deployment and coordination of homogeneous work prac-
tices in the ?ve LHAs. Table 1 contains some examples of
the criteria.
Importantly, as noted by the following interviewee
10
, the
combination of the newaccounting criteria and related train-
ing sessions were pivotal to diffusing and homogenizing the
accounting practices in the different LHAs. They also incul-
cated a new modus operandi and established a speci?c
vocabulary among the operators in the post-seismic
environment:
Before the earthquake none of us had an idea of what
extraordinary general healthcare activities would be
developed in such post-seismic cases, as well as which
accounting and control architecture had to be erected
and used. After the building of the criteria and the train-
ing meetings we had in the Region for the standardiza-
tion of the new accounting processes and practices, and
once implemented for several months, each of us had
gained much more general and speci?c capabilities
and competences. Moreover, the T09 codi?cation, and
the related classi?cations and criteria, became a part
of our new habits, daily glossary, and knowledge.
This observation is consistent with the view that ‘‘when
lists are used to coordinate important work... a correspond-
ingly complex organizational structure and infrastructure
evolves’’ (Bowker & Star, 1999, p. 10). Moreover, the will
to train, shape and normalize the accounting behavior of
the ?ve regional LHAs and their operators was also stressed
at the end of the description of the 26 criteria, where it was
stated that ‘‘in case further costs typologies—not considered
here—will emerge, the recording and evaluation criteria
must be shared by all LHAs before proceeding to their
recording’’ (p. 6).
While the provision of criteria for classifying and
recording costs as well as the training of staff potentially
guided the conduct of conduct, it was the inclusion of
funding consequences that arguably caught the attention
of healthcare administrators. During this second phase of
the emergency, federal government funds were not to be
provided in advance and later accounted for, but rather
the receipt of federal funds was to be contingent on the
provision of appropriate costing evidence—where expendi-
tures were directly and readily traceable to the earthquake.
More speci?cally, the federal government stated that reim-
bursable costs were:
Table 1
Examples of the ‘‘Criteria for the recording of extraordinary costs and
activities arising from the 6 April 2009 earthquake in the LHAs of Teramo,
Pescara, Avezzano-Sulmona, Lanciano-Vasto and Chieti’’.
No. Criteria
1 Territorial pharmaceutical assistance: all that is passed
through prescriptions, is traced via T09 code and residence of
the citizen, and is computer recorded. . .
4 House oxygen distribution: . . . a different behavior must be
followed in the following cases:
– contracted-out house oxygen therapy: a separate invoice
must be required from the provider, and hence a speci?c
booking must be made; discharges from orders/invoices
must be done at the earthquake cost centre;
– house oxygen therapy carried out by local public pharma-
cies: this falls within the recording system at point 1;
– house oxygen therapy carried out directly by the LHA: the
oxygen consumption referred to earthquake victims must
be reported and supported by paper-based documentation.
14 Admissions in Psycho-Rehabilitation Structures: private
providers since 2009 have been invoicing directly the LHAs
where they are located, despite the residence of the patient.
Those private providers must be asked to separately invoice
everything pertaining to the T09 code. Also in this case a
computer control on the residence of patients must be done . . .
15 Admissions to hospitals made by private accredited providers:
Since 2009, structures have been invoicing directly the LHAs
where they are located, despite the residence of the patient.
Those private providers must be asked to separately invoice
everything pertainin to the T09 code. Also in this case a
computer control on the residence of patients must be done . . .
19 Personnel: Since LHAs have hired people as a consequence of
the earthquake through appropriate deliberation, only related
costs must be reported. The cost of this personnel will have to
be recorded in the Earthquake Cost Center. In the period
spanning the earthquake till the moment when speci?c hiring
has been done, LHAs can report costs for longer overtime,
additional performances, or leave not taken but already
authorized.
– Overtime: monthly hours must be recorded according to
quali?cation, subtracting the hours carried out on average
in January, February and March 2009. . .
– Additional performances: must be recorded according to
quali?cation and must be justi?ed by speci?c authoriza-
tions and by the clock out time.
– Leave not taken: only those already authorized and
revoked for the earthquake are considered, differentiated
by job quali?cation.Overtime, additional performances
and leave not taken will have to be valued according to
job quali?cation on the basis of what is prescribed by col-
lective labor agreements in force.
10
Interview (November 2010).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 77
– all costs justi?ed by the presence of the code T09,
regardless of the residence of the citizens assisted
within the ?rst 15 days after the earthquake, can be
considered pertaining to the earthquake;
– all costs for those considered earthquake victims
between the sixteenth day after the earthquake till
May 30, must be justi?ed by the presence of the code
T09, and residence in the municipalities of the
Province of L’Aquila, in order to be reimbursed by the
State;
– all the costs justi?ed by the presence of the code T09, as
well as by the residency of the citizens in one of the
forty-nine municipalities considered earthquake-vic-
tims, for the activities developed after May 30, can be
considered pertaining to the earthquake (p. 2).
These criteria introduced a temporal and spatial dimen-
sion into the reimbursement mechanism, thus
emphasizing Bowker and Star’s argument that ‘‘list making
is foundational for coordinating activity distributed in time
and space’’ (1999, p. 38). Importantly, not only was
reimbursement contingent on an appropriate T09 coding
but also on belonging to a constantly shrinking spatial ter-
ritory. Fig. 3 illustrates how these time–space-residence
writing techniques narrowed the terrain of exceptional
government in the successive temporal periods. This res-
onates with the ‘‘spatio-temporal segmentation of the
world’’ highlighted by Bowker and Star (1999, p. 10).
This section illustrates how the federal government
attempted to organize the conduct of conduct through
the introduction of speci?c classi?cation, coding, training
and funding mechanisms. These mechanisms emphasized
the ideas of direct, additional and easily traceable costs.
Furthermore, they made the release of monies contingent
on the provision of appropriate costing information. In this
regard, the federal government was, at this time, moving
Fig. 3. Time–space-residence disciplinary writing techniques coupled with the speci?c T09 in the 5 LHAs.
78 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
toward exercising a form of normal governance regarding
an exceptional event. This strategy shifted the onus of
urgency to the LHAs, since funds would only be released
after an accounting classi?cation scheme had been con-
structed and implemented, and after the federal govern-
ment was satis?ed with the accounts provided. However,
as subsequent sections highlight, the federal government
strategies encouraged healthcare administers to strategize
with and around these classi?cation devices.
The special case of L’Aquila LHA
At the same time that the Commissioner was attempt-
ing to homogenize costing practices and make the regions
comparable, he distinguished between ‘‘L’Aquila (the epi-
center) and other affected regional areas’’. The DCaa stipu-
lated both the ‘‘Criteria for the recording of extraordinary
costs and activities connected to the 6 April 2009 earth-
quake for the LHAs of Teramo, Pescara, Avezzano-
Sulmona, Lanciano-Vasto, Chieti’’ and the ‘‘Criteria for the
recording of extraordinary costs and activities connected
to the earthquake of 6 April 2009 for the LHA of L’Aquila’’
(p. 3). This distinction encouraged the introduction of extra
– extra-ordinary accounting criteria within L’Aquila, differ-
ent from those enacted for the other ?ve regional LHAs.
The preamble to the L’Aquila document (document n. 2
attached to DCaa n. 45/09) stated that:
Whilst for the other regional LHAs it is a matter of distin-
guishing which costs have been sustained for the earth-
quake, as far as L’Aquila LHA is concerned almost all
costs sustained have to be considered related to the earth-
quake. From this perspective, it seems relevant, from the
one hand, to track down the costs sustained for regular
activities. . . and, from the other hand, it is necessary to
measure the terminating as well as growing costs caused
by the earthquake.... Hence it is a matter of seeing the
various accounts of the general accounting system
and, starting from the costs of the last year, and con-
sidering a stable management till March, for the period
after the 6 of April 2009 it is necessary to evaluate the
costs no longer sustained as well as those that have
arisen due to the earthquake (p. 1).
[emphasis added]
As the preamble indicates, accounting in the LHA of
L’Aquila was complicated by the development of health
activities and administrative tasks in a ?eld hospital, which
temporarily replaced the services previously provided by
the now destroyed hospital buildings of the LHA:
The administrative of?ce. . . is not accessible. . . and per-
sonnel are working in tent/containers. . . the internal
medicine distribution is working under a tent. . . each
activity has been paper documented but has not been
completely loaded in the information system. . . the
accounting system is not completely operating. . .. In
the very ?rst days after the shock it has been impossible
to check personnel presence. . .. Since April 23 work
attendances have been paper-based recorded and
they’ve still to be ?lled in the electronic procedure
(p. 1).
As in the other regions affected, L’Aquila healthcare pro-
viders focused initially on the continuous provision of
assistance, and later, on how to account for healthcare
related to earthquake damage. The act of accounting for
the costs was complicated by the fact that, at the time of
stipulating the criteria (24 June 2009), many activities
were only paper-documented and not yet uploaded in
the new IT window information mask. In this scenario, it
was necessary to manually classify and record both the
terminating and growing costs since this was a new way
of partitioning costs. However to ‘guide’ these activities,
and to presumably limit discretion, the government direc-
tive de?ned the costs that were expected to increase and
those that were expected to cease and indicated how they
should be calculated. Table 2 illustrates some of these
criteria:
Similar to the guidelines for the other LHAs, the govern-
ment directive imposed a particular set of accounting clas-
si?cations thereby narrowing the potential range of
recording activities.
On the surface, the L’Aquila regional territory was
receiving preferential treatment. In that general infrastruc-
ture needs could potentially be included in the category of
increasing costs, needs that otherwise might have gone
unfunded during this period of ?nancial restraint. In speak-
ing with the management accounting of?cer for the LHA of
L’Aquila, he was acutely aware of this potential disparity
and also of the need to justify the differential treatment
11
:
Our situation was very different from the other Abruzzo
LHAs, whose activities and populations were partially
affected by the disaster.... In our case, everything
around us has been struck by the earthquake.
However he also felt a sense of urgency that was pre-
sent, but to a lesser extent, within the other affected regio-
nal areas:
It was a survival issue for us to ?nd a way to make visi-
ble terminating as well as growing costs, which other-
wise... would have been invisible to the Region and to
the State, thus hampering the reimbursement process
of additional resources destined to Abruzzo.... This is
why our adopted criteria were in many parts different
from those of the remaining Abruzzo LHAs.... because
the situation of L’Aquila was completely different....
This said, the government’s decision to apply different
criteria in order to ?nd the appropriate con?guration ‘‘for
each of the things that are to be governed’’ (Foucault,
1991, p. 95) caused tensions with the other affected
regional areas. These tensions, in part, related to the
resource-constrained situation that all of the LHA’s were
experiencing prior to the earthquake and, in part, to
the fact that the consequences in the epicentre ‘travelled’
to other LHAs. For example, the CEO of the Pescara LHA
recalls
12
:
For us it was clear from the very beginning that inside
the region we were the LHA destined to assist the
11
Interview (January 2013).
12
Interview (November 2010).
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 79
highest number of evacuees escaping from L’Aquila and
moving to the hotels located along the safe Pescara
coast. Accordingly, whilst it was crucial for us to face
any emergency healthcare issues, it was also pivotal
to account, represent and document any sustained
extraordinary costs and activities, and conform to the
new cost-accounting criteria, in order to maximize the
probability of receiving the extra-funding. Indeed, my
LHA was normally funded for assisting 20% of the
Abruzzo population. In the aftermath of the earthquake
we were serving about 25% of our total regional inhabi-
tants, thereby incurring huge incremental costs, and
less revenue for fee exemptions of cost-free drugs or
activities. We did not want to incur punishments from
the state, in terms of objections or rejections to our
reimbursement, whilst we were stimulated to obtain
the appropriate refunds for the extraordinary costs
and activities shouldered by our LHA to manage the
population’s healthcare in the post-seism scenario.
He later added
13
:
It is rather obvious that many organizational, manage-
ment and accounting issues emerged in the post-earth-
quake situation. . . it is quite impossible to list them all.
For example, in order to allow evacuees living in hotels
on the coast (and not owning cars) to receive drugs, my
LHA had to organize gathering places for the INHS pre-
scriptions as well as convenient drugs delivery proce-
dures managed with the local pharmacies and hotels.
Accordingly, we had to send extra personnel—that is
GPs or medical guards—for on-site visits to patients, ?ll-
ing-in and returning drug prescriptions and taking
notes of their needs. Then we had to send the prescrip-
tions and notes to the pharmacies in the LHA territory
which were closest to the hotels where the evacuees
were located. Finally pharmacy personnel delivered
the cost-free drugs, the non-prescription over the coun-
ter drugs, and also milk and general products for infants
(free of charge) to the evacuees.
These quotations highlight how the spatial seg-
mentation of earthquake-affected regions resulted in ten-
sions among the different parties, especially with regards
to the apparent failure of the funding-impregnated classi-
?cation to recognize the mobility of the epicentre
population.
The preceding illustrates how different classi?cation
practices were used in the different regions, and how this
spatial separation not only created different zones for dis-
cretion but also caused tensions among the LHAs. In this
regard, it offers insights to the ‘‘practical politics of
classifying’’ (Bowker & Star, 1999, p. 44) and how the
minutiae of classi?cations in?uence both ‘‘what will be
visible or invisible within the system’’ (Bowker & Star,
1999, p. 44) and, equally importantly, what will be reim-
bursed within the constraints of ?nite extraordinary
resources.
The operational program
Knowledge is pivotal to the activities of government
(Miller & Rose, 1990; Rose & Miller, 1992).
Documentation and calculation were especially important
to the implementation of exceptional government in the
post-seismic scenario. Indeed, as mentioned earlier, each
LHA was asked to calculate the extraordinary costs gener-
ated by the earthquake in order for the Commissioner to
elaborate an Operational Program, which would be sub-
mitted to the state in order to unlock the emergency funds
for healthcare that had been allocated. In doing so, ‘‘the
social economy’’ of the post-seismic scenario was ‘‘also
evaluated through its numericization’’ and, accordingly,
accounting data, numbers, tables and schemes became
Table 2
Examples of the ‘‘Criteria for the recording of extraordinary costs and activities connected to the 6 April 2009 earthquake for the LHA of L’Aquila’’.
Ledger Productive factor Ceasing costs caused by the earthquake Growing costs caused by the earthquake
30 Purchase of sanitary goods All the products present in the inventory
made available to the other regional LHAs.
Costs must be valued according to the
weighted average cost [method], VAT
included, as it results from inventory
procedures
Potential speci?c purchases made for the
earthquake . . .. Products expired, or
destroyed by, the earthquake
34 Pharmaceutical assistance . . .the cost budget 2009, once subtracted
the use made by the remaining [citizens],
is a ceasing earthquake cost
Pharmaceutical fees which have not been
collected represent rising costs
40 Services from regional LHAs Larger passive mobility for health services
provided by regional LHAs directly linked
to the earthquake
41 Services from extra-regional LHAs Larger passive mobility for the health
services provided by extra-regional LHAs
directly linked to the earthquake
43 Advice Interrupted advice, for which no services
have been provided, are here included
All activated advice services caused by the
earthquake
45 Health Personnel Overtime, availability, etc. . . costs must be
deducted
Total costs of personnel unable to perform
duties with regard to the volume of the
delivered services, have to be calculated
13
Interview (December 2010).
80 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
‘‘intrinsic to the formulation and justi?cation of [the post-
earthquake] governmental [healthcare] programs’’ (Rose,
1991, p. 674). Further, the ‘‘accounting inscriptions’’
(Robson, 1992) accumulated at a micro level, being porta-
ble, combinable and comparable, were grouped and repre-
sented in the Operational Program, before submission to
the state for examination.
The September 2009 operational program
On 9 September 2009, only two months after the fed-
eral government had stipulated criteria for determining
appropriate costs, the Commissioner presented his
Operational Program to the Ministry of Health and the
Ministry of Economics and Finance. The ‘‘Estimate of the
costs attributable to the 6th April 2009 shock’’ – the bulk
of the OP – is represented in Table 3.
As Table 3 illustrates, the Commissioner, in his pre-
sentation of the earthquake-related costs chose to include
four cost categories. Additional operating costs were the
?rst category and amounted to €31.055 million. More than
75% of these increased operating costs arose due to the
mobility of regional patients to private providers. The
remaining 25% are attributed to the increasing costs of per-
sonnel, goods and services in the LHAs, and to other extra-
ordinary costs. These costs were ‘supported’ by the
inclusion of, and reference to, the speci?c aggregation
codes that were used to accumulate the costs within the
?nancial accounting system.
In addition to this ?rst category, there were three other
categories of costs that would prove to be more con-
tentious. The second category, totalling €12.637 million,
pertain to the reimbursement of ‘‘unproductive ?xed
costs’’. These concerned the costs of tenured personnel of
Table 3
Estimate of the costs attributable to the 6 April 2009 shock.
Commissioner ad acta for the ful?llment of the recovery plan of the Abruzzo region
Estimate of the costs attributable to the 6 april 2009 shock
The shock costs are referred to the april/december 2009 time period
Aggregation Code Item Estimate of the
Regional shock
costs (€/000)
Items of the synthetic scheme of the CE [pro?t and loss account]
Production costs
A01 Personnel costs + irap [regional tax on productive activities] 2,173
A02 Pharmaceutical products
A03 Other goods and services 932
A04 Services of territorial health assistance
A05 Pharmaceutical accredited care
A06 Specialist health assistance made by private accredited
providers
3,192
A07 Rehabilitative services made by private accredited providers
A08 Prosthetic assistance by accredited private providers
A09 Admissions in hospitals made by private accredited providers 9,300
A10 Other assistance made by private providers 11,113
A11 Other assistance by public providers
A12 Other expense components
A13 Allowances
A14 Interests and others
A15 Balance of extraordinary items 4,345
A16 Balance of intra-moenia activities
A17 Infra-regional passive mobility
Total expense 31,055
Unproductive ?xed costs determined by the 6 april 2009 shock
Personnel 10,000
Goods and services 2,637
Total unproductive ?xed costs 12,637
Lower receipts determined by the 6 april 2009 shock
Lower tickets for specialist assistance 2,500
Lower tickets for pharmaceutical assistance 1,800
Smaller extra-regional active mobility (San Salvatore hospital, year 2008) 7,875
Lower regional tax receipts 32,800
Total lower receipts 44,975
Total earthquake costs sustained by the LHAS 88,667
Further expenses to be charged to the civil defense
Expenses to be charged to the civil defense Provision of temporary lodging [tents] 2,737
Relief services 10,813
Costs for the emergency management 2,000
Safety measures 116
Clearing of devastated areas 990
Total expenses to be charged to the civil defense 16,656
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 81
the LHA of L’Aquila who, though receiving a regular salary,
were unable to work from 6 April to 31 May 2009 due to
the inaccessibility of hospital buildings damaged by the
earthquake. The third category, amounting to €44.975 mil-
lion, asked for the reimbursement of lower operating
receipts (diminished collection of tickets for specialist
and pharmaceutical assistance, reduced mobility into
L’Aquila LHA, and lower regional tax receipts) that were
the direct consequence of the earthquake. Finally the
Commissioner asked to be reimbursed for the expenditures
that the region incurred on behalf of the Department of
Civil Defense in the days immediately after the earthquake.
The Commissioner noted that in case the early emergency
expenses (€16.656 million for the provision of temporary
lodging, disaster relief services, safety measures and clear-
ing of devastated areas) were not paid by the Civil Defence
(p. 6), this would have caused further dif?culties in meet-
ing the ?nancial targets stipulated by the Budget Recovery
Plan. Thus in total, the Operational Program calculated that
the impact of the earthquake on the operating costs of the
Abruzzo healthcare services amounted to €88.667 mil-
lion
14
, not including the monies to be reimbursed by the
Civil Defense Department. On the basis of the operational
plan provided, the Commissioner requested an additional
€50 million above and beyond the €40 million already pro-
mised by the federal government (p. 10).
Not surprisingly, the government decided to review the
plan, asking the Ministries of Economics and Health to con-
duct an examination of the numbers and their assumptions.
As one of the state inspectors that participated in this pro-
cess noted, one of the purposes was to ensure that expendi-
tures pertaining to‘normal’ healthcare activities didnot ?nd
their way into the request for extraordinary funds
15
:
Although a State Commissioner was already working
on-site in Abruzzo to manage the post-earthquake sit-
uation, the state was also obliged to control centrally
all the post-earthquake extraordinary costs and the
documentation of the additional activities. The state
was already controlling the advancement of the normal
rationalization program of government, through a pre-
viously adopted homogeneous accounting system.
Indeed the state was deploying a strict federalist
reform, where no extra-money might be accorded to
non-virtuous regions, and Abruzzo was already suffer-
ing from healthcare ?nancial distress. Accordingly,
while €40 million had been stipulated by the emer-
gency Law to sustain the post-seism healthcare addi-
tional actions, leaving the Abruzzo Region the freedom
to use them to deploy any post-seism activity, the state
and all the other Italian regions wanted to be sure that
the funded extra-money was destined only to incre-
mental extraordinary costs, and not to cover previously
existing regional de?cits.
The above quotation is interesting because it illustrates
how techniques of examination were enlisted in the
attempt to maintain the distinction between the categories
of normal and exceptional government.
The examination of the OP performed by ministry
experts took two months (October and November 2009)
and raised serious concerns about what costs were
included and how the costs were classi?ed. For example,
the inspectors noted that ‘‘some recorded costs that have
been charged to the Regional Health Service by the
Commissioner do not represent additional costs’’ (p. 2). In
particular, the experts objected to the reimbursement of
the aforementioned ‘‘unproductive ?xed costs’’ (of
€12.637 million) in that ‘‘the costs of unproductive person-
nel as well as of goods and services have already been
included in the CE [pro?t and loss account] and are not
additional [costs]’’ (p. 2). They also stated that the OP
included costs that pertained to ?scal periods after the cur-
rent ?scal year-end (FY09). In particular they referred to
the geographical mobility of patients and the expected
€7.875 million cost ‘‘that will be accounted only. . . in
future balances’’ (in 2010), and which did not therefore
represent lower receipts ‘‘to be balanced for the FY 2009’’
(p. 2). Similarly, the expected lower regional tax receipts
of €32.800 million pertain to future periods and thus can-
not be included in the claim for emergency funds for
2009 but rather should be postponed to 2010. Finally, con-
trary to the view of the Commissioner, the ministerial
experts argued that the reimbursement of the expendi-
tures made on behalf of the Civil Defence Department
should not be included in the OP.
Given these concerns, the OP was ‘‘not approved’’ and
the affected regions were unable to access the €40 million
in extraordinary funds allocated for the emergency nor to
secure the additional requested €50 million in funding.
Rather, the government requested that the OP be reformu-
lated and resubmitted by January 31, 2010. In response to
this decision, the Commissioner declared in the newspa-
pers his intention to continue to request €50 million of
additional funds to cover extraordinary healthcare costs
(Piccinino, 2009). On the same day he resigned.
The games of strategy involving the Commissioner and
the federal government utilized accounting classi?cations
and accounting experts. In his attempt to access additional
funds for the region, the Commissioner directed his team
of accountants to follow but modify the federal govern-
ment’s criteria regarding the accumulation of additional
costs. These modi?cations involved including foregone
revenue in?ows and including future-oriented items in
the current period. They also involved the adoption of a
different reporting format, one that foregrounded the
earthquake-related expenditures by downplaying and,
indeed, obscuring the normal healthcare expenditures.
The federal government, in turn, relied on its own team
of experts to scrutinize the accounts provided.
14
The costs for the reconstruction of the hospital, restoration and
infrastructure adjustments are excluded by the calculi presented, but they
will worsen the balance of the Abruzzo Region healthcare system in future
years. The damages incurred by S. Salvatore Hospital, L’Aquila accounted
for €74 million. Only €44 million was covered by insurance that had a ?xed
maximum amount of reimbursement. At the time of writing only 1/3 of the
remaining extra costs for rebuilding the hospital is to be funded by public
resources allocated by the state.
15
The OP was ?rstly examined on 10 November 2009, but the decision
not to approve it was taken only in December by the Ministries of Health
and Economics and Finance. In this and in the following sub-section
reference will be made verbatim, to this report, as well as to the interview
with one of the inspectors (October 2010).
82 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
Furthermore, at the end of the day, it was the federal gov-
ernment that controlled the funds and thus it was able to
reject the OP and send it back to the Commissioner for
revision. These visible confrontations between the
Commissioner and government highlight how funding-im-
pregnated classi?cation mechanisms may be a site of
struggle. At this moment in time, stable mechanisms had
not yet replaced the free play of antagonistic relations
(cf. Foucault, 2000, p. 346) but rather were the terrain
around which these struggles took place.
The January 2010 operational program
One day after the Commissioner’s resignation, the
Council of Ministers replaced him with the Governor of
the Abruzzo Region (De Frenza, 2009) and on 13 January
2010 also appointed two sub-Commissioners
16
to support
his work. These acts reinforced state control over both the
Budget Recovery Plan for healthcare and the allocation of
emergency funds. The Governor of the Abruzzo Region – act-
ing as Commissioner – was asked by ministerial experts to
reformulate the OP and provide ‘‘an adequate quanti?cation
of the costs connected to the earthquake’’ (Minutes of the
meeting of 18 December 2009, Ministries of Economics/
Health, p. 11). In order to better exert ‘control at a distance’
over the re-formulated OP, the state requested the compul-
sory use of the ordinary vertical scheme for the regional pro?t
andloss account, withthe ‘‘additionof a newseparate column
for earthquake-related expenditures, conventionally named
T09 column’’ (DCaa 45/09). This permitted the state inspec-
tors (who were the same team checking the ordinary
accounts) to disclose ordinary and extraordinary costs on
the same rows, thus quantifying and comparing the costs of
normal and exceptional government. A further measure was
also introduced. The state stipulated that the allocation of
the ?nal instalment of the normal healthcare funds for the
?nancial year 2008 would be subject to the approval of the
earthquake OP (idem, p. 12). The re-formulated OP presented
in Table 4, was sent to the central government at the end of
January 2010, and was examined by ministry experts at the
end of April.
The ?nal OP requested total funds of €40.729 million,
less than half of the previous regional request and almost
exactly the amount that the federal government had
offered for disaster relief. Comparing the September 2009
estimate with the January 2010 ex post OP it is possible
to see that much of the private care costs were removed.
A more articulated and detailed portrayal of public care
costs was provided, one which followed analytically the
approved extraordinary cost criteria, with the unique
exception of the contested criterion no. 45 relating to ‘‘un-
productive ?xed costs’’. Moreover, all the estimates which
had generated no ?nancial repercussions for FY 2009 were
postponed to subsequent years, while objected costs com-
pletely disappeared. Although there were no contestations
on the accounting data represented in the January 2010 OP,
the ministerial experts complained that ‘‘the content of the
action plans adopted’’ by the Region ‘‘to face the further
dif?culties caused by the seismic event’’ was still missing
(Minutes of the meeting of April 28, 2010, Ministries of
Economics/Health, p. 1). Accordingly, the state emphasized
that ‘‘it is necessary to obtain that content. . . in order to
proceed to the approval and the consequent allocation of
resources’’ (De Frenza, 2009). Whilst the state did not raise
objections about accounting inconsistencies or assume the
submission of massaged numbers, it imposed the stringent
condition that resources would only be transferred to the
Abruzzo Region once the additional information requested
had been received.
Once the action plans were sent to central government
(in September 2010), they were approved by ministry
experts without any objection at a meeting on 2
December 2010. Thus, whilst the emergency healthcare
stage had ended on 31 December 2009, the post-earth-
quake healthcare OP was approved a year later. This also
Table 4
Damages and interventions carried out after the 2009 earthquake
represented in the ?nal OP.
Damage and interventions Costs (€)
Clinical materials damaged/destroyed in the
L’Aquila hospitals/clinics
5,088,686.00
Clinical equipment destroyed in the L’Aquila
hospital (sum not amortized)
3,125,000.00
Distribution of sanitary and prosthesis material to
the population in the ?rst few days following
the disaster
1,499,494.37
Out-patient and hospital assistance for the injured
and entire population hit by the quake in the
?rst few days after the earthquake
2,431,883.63
Increase of personnel in public structures due to
the increase in activities caused by the presence
of evacuees in the regional territory
3,003,031.81
Residential assistance for the elderly 1,738,182.58
Increase in transfusion collection to confront
emergencies
493,116.00
Sanitary transportation for patients needing
transference
66,014.70
Sanitary transport in helicopter ambulances and
technical logistic organization heliport base
254,151.10
Recovery of the 118 emergency communication
system
274,836.90
Improvement of 118 emergency services on the
territory affected by the quake
22,100.82
Veterinarian assistance in areas affected by the
quake
1,795.68
Technical testing of safety in medical buildings 757,418.20
General medical assistance for evacuees 907,169.15
Increase in accommodation and logistic services
for management of evacuee sanitary needs and
small maintenance
1,202,308.24
Private specialist assistance for the population
affected by the quake
17,246.54
Private rehabilitation assistance for the population
affected by the quake
1,650,381.50
Fee exemption from prescriptions for drugs and
out-patient services
5,449,578.92
Ordinary maintenance of buildings for temporary
restoration of sanitary activities
8,062,495.52
Rentals for reactivation of healthcare services 93,972.00
Purchase of healthcare equipment for temporary
recovery of activities
1,405,382.00
Activation of passive rental in order to carry out
surgical activities and recovery of healthcare
services
3,185,084.00
Total €40,729,329.66
16
One of the two sub-commissioners resigned immediately.
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 83
activated an emergency termination process, thereby trig-
gering the subsequent allocation (for 2011) of the extra
post-earthquake healthcare funding to the Abruzzo
Region for FY 2009. It also appropriated the ?nal instal-
ment for FY 2008, which had been previously locked by
the state until the OP had been examined and approved.
While it might appear that the initial allocation by the
federal government had been an excellent estimate of the
expected costs, the reality appears more ambiguous. On
the one hand, accounting classi?cations were an essential
component of the disaster response. For example, the
Director of the Abruzzo Health Region states
17
:
The new accounting criteria and procedures crafted
after the earthquake have been pivotal for us in docu-
menting and representing the extraordinary activities
and costs, as well as the smaller revenues, in order to
access state emergency funds. Without the extraordin-
ary accounting, nobody would have been able to docu-
ment and represent the above digits and actions, as well
as to re-allocate resources to each LHA, private provi-
ders, local pharmacies, etc. . . thereby disabling the
reimbursement of the extra-funds. This would have
meant for us either to reduce the extraordinary post-
seism activities, or to pay for them by increasing regio-
nal personal income taxes, the regional tax on produc-
tive activities and the excise duties on petrol, as well
as putting higher healthcare payments for the
population. . .Any of these last decisions would have
been awful for a population already devastated by a
major earthquake.
On the other hand, the acts involved in classifying an
itemof expenditure as either normal or extraordinary were
certainly not clear cut and were never separate from the
games of strategy and politics around the earthquake. As
this same individual recalls
18
:
We had to increase the personnel working in our public
structures besides that in the LHA of L’Aquila. Indeed,
the shortage of personnel in relation to ordinary activi-
ties previously established by the implementation of
the Budget Recovery Plan made it impossible to conduct
the exceptional activities for the evacuees via a normal
production capacity. Accordingly, it was necessary to
employ extra personnel in order to provide services
for the evacuees. Nevertheless, it was not always possi-
ble to ?nd extra personnel, and therefore it was neces-
sary to resort to staff doing overtime as well as being on
call.... The main personnel costs amounted to
€3,003,031.81. The extraordinary costs and activities
for the maintenance of buildings were mainly
concentrated in the LHA of L’Aquila, which absorbed a
major part of the total amount (i.e., 88% of
€8,062,495.52). . .. Some of the remaining LHAs were
obliged to develop actions and spend extra-money,
but on a different scale.
And:
Public hospitals were obliged to provide extra-work for
the out-patient and hospital assistance devoted to the
injured and the entire population hit by the quake in
the ?rst weeks after the disaster (€2,431,883.63), as well
as private facilities (€1,650,381.50). Among the many
people injured in the earthquake, those considered to
be most affected by the disaster were undoubtedly the
elderly and weak individuals who had been previously
assisted within their own families, and for whom, in
most cases, it was necessary to organize hospitalization
in regional and extra-regional residential structures. The
relative costs for this exceptional assistance, provided
both in public (€449,891) and private (€1,288,291)
structures, totalled €1,738,182. The earthquake also
brought less revenue into the Region as far as the
medical system was concerned due to the fact that most
medical services were provided by exemption to the
populations affected, for both outpatient services and
pharmaceutical products (€5,449,578.92).
Some of the above expenditures did not fall neatly into
or outside the extraordinary category, yet, when included,
they were the items that were challenged and thoroughly
inspected by the government’s experts.
The above comments highlight not only the high degree
of complexity in the ‘‘calculated management of life’’
(Foucault, 1981) but also the struggles that occur in these
situations. As previous research has acknowledged, gov-
ernance almost always involves the distribution of scarce
resources (Preston et al., 1997) and these distributions
become even more complicated in exceptional moments
when there is an overlapping sphere of action between
the normal and the extraordinary. In these circumstances,
it may take several iterations before mechanisms of dis-
position, such as the funding-impregnated classi?cation
scheme are ‘accepted’ by the involved participants. The
irony, of course, is that this mechanism only became stable
(cf. Foucault, 2000, p. 347) at the point that the program of
exceptional government was being terminated and where
all healthcare funding for the region would be disposed
of via the normal mechanisms of distribution that were
implicit in the Budget Recovery Act.
Conclusion
This study has attempted to explore the extraordinary
accounting apparatus established following the Abruzzo
earthquake of 2009. Using the insights of previous research
on governmentality, as well as work on classi?cation and
its effects, the study has analyzed the construction, quan-
ti?cation and termination of a period of exceptional gov-
ernment. Whereas prior research has tended to
emphasize how accounting helps to facilitate normal gov-
ernance, the current paper emphasizes that things do not
always proceed according to plan and unexpected events
require departures from the ‘normal’ (Miller & Rose,
1990, p. 11; Rose, 2005, p. 245). These departures encour-
age the investigation of episodes of government during
‘‘states of exceptions’’ (Agamben, 2005) and the related
17
Interview (December 2010).
18
Interview (December 2010).
84 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
regimes of extraordinary practices (such as accounting)
that emerge in the aftermath of crisis events such as natu-
ral disasters.
The analysis provided has sought to complement and
extend prior accounting research in three ways. First, and
perhaps most obviously, the analysis has illustrated the
central role of ‘accounting’ and ‘non-accounting’ classi?ca-
tory devices in programmes of governance. Classi?cations
were important component of exceptional governance,
helping in the construction and demarcation of the natural
disaster as well as in the disposition of things in the earth-
quake’s aftermath. Scienti?c classi?cation of the severity of
the earthquake as being above six on the Mercalli Scale
(Lee et al., 2002; Richter, 1935) helped to focus visibility
on the event and encouraged the Italian government to
declare a ‘state of emergency’ (Bignami, 2010).
Classi?cations, rankings and lists of municipalities and
their inhabitants were subsequently identi?ed on maps
and cartographies (Foucault, 1979; Foucault, 1991) and
were used in tandem with calculative practices (Miller,
2001) to not only classify the Abruzzo earthquake as ‘‘a
disaster’’, but also to de?ne its boundaries, quantify the
economic magnitude of the shock, and to put into motion
an exceptional government assemblage. Accounting
classi?cations were integral to this assemblage, in that
they helped to distribute differential resources to different
population segments and made access to government
funding by the LHAs contingent on these funding-impreg-
nated classi?catory devices. Taken together, such devices
were crucial for constructing a post-seismic ‘‘working
infrastructure’’ (Bowker & Star, 1999, p. 10) and for giving
order and visibility to earthquake-injured people and
the associated ‘additional’ costs. Thus, in these ways,
accounting classi?cations were one of the technologies
that made ‘exceptional’ governance possible (Miller &
Rose 1990, p. 8).
Second, the analysis has highlighted the interrelations
between normal and extraordinary accounting in moments
of exceptional governance. Consistent with the observa-
tions of Miller and Rose (1990, p. 11), the case study shows
how programmes of governance often enlist a complex
amalgam of borrowed and built accounting technologies.
The launch of exceptional governmental measures in the
?rst days after the disaster gave rise to a rudimentary
extraordinary accounting and reporting apparatus. While
the immediate response of the government to the earth-
quake emphasized that ‘‘healthcare assistance’’ had ‘‘to
be guaranteed to the citizens hit by the quake’’ (Note
Prot. 9560/S, April 8, 2009), within two days on-the-
ground personnel were instructed to begin to account for
what was happening. Matched lists of T09-classi?ed
inhabitants-diseases were sent to local pharmacies to
document the administration of fee exemption drugs and
healthcare assistance. These lists, which were borrowed
and generated from the existing normal accounting sys-
tem, became one of the building blocks for identifying
the costs of the earthquake. And when the initial health-
care emergency started to recede, the classifying and
recording of costs began to assume even more importance,
in part because the national government made disaster
assistance contingent the provision of an acceptable
Operational Programme. The contingent funding, along
with the urgency to the regions to access these funds, pro-
vided the impulse for the LHAs to enlist the help of
accounting experts to develop a system of accounting clas-
si?cations to identify and measure the incremental health-
care costs associated with the earthquake. As the analysis
highlights, the system of classi?cations that emerged bor-
rowed from the existing normal accounting system yet
was distinct, especially in terms of how certain types of
costs were classi?ed. In these ways, the study
complements and extends prior research by providing an
example of how a programme of accounting was
constructed in an exceptional moment. Put simply, it
shows how a serious earthquake becomes an important
accounting event, and how that in turn facilitates or
constrains resource ?ows.
Finally, the analysis foregrounds the games of strategy
that occur around accounting classi?cations in such cir-
cumstances. The speci?cation by the federal government
that the access to emergency funding was contingent on
the provision of an acceptable Operational Plan and the
provision of speci?c classi?catory rules attempted to orga-
nize the conduct of conduct so to speak, on the part of the
involved LHAs. The initial response of the Commissioner,
however, classi?ed and accumulated costs in a way that
suggested that the amount of emergency funds needed
was more than double what the national government indi-
cated was available. This, in turn, encouraged the national
government to enlist its own experts to review the lists
and to declare the plan as unacceptable. The rejection of
the plan precipitated the resignation of the Commissioner,
the appointment of a more pliable Commissioner by the
federal government, the submission of an OP that accumu-
lated costs in a way that was consistent with the available
monies, and the eventual acceptance of the OP and the
release of the available funding. This sequence of events
illustrates the iterative nature of governance and how
strategy involves the tentative search for ‘winning’ solu-
tions (Foucault, 2000, p. 346). Arguably, neither the federal
government’s ?rst attempt to organize the conduct of con-
duct, nor the response of the ?rst Commissioner, were a
winning solution. However, as the analysis highlights,
these confrontations were worked out (cf. Foucault, 2000,
p. 347) as the moment of exceptional government
eventually morphed back into a pattern of normal
government. More speci?cally, this working out involved
the use of a standardized reporting format, the ordinary
vertical scheme of the pro?t and loss account with the
addition of a T09 column, and a more strict adherence to
the government’s guidelines on the recording and
classi?cation of costs. After a small amount of additional
negotiation, the OP provided was approved on 2
December 2010, bringing to an end the programme of
exceptional government and extraordinary accounting,
thus returning the region back ‘normalcy’.
In recent decades earthquakes and natural disasters
have caused wide-scale destruction in a number of coun-
tries, resulting in death, injury and dislocation of the
affected populations, and it is surprising that they have
received so little attention from accounting scholars. This
disregard is all the more surprising when it is recalled that
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 85
‘‘natural disasters are far more destructive than wars’’
(Yahoo News, 28 August 2007) and the costs of recovery
and rehabilitation are enormous. Indeed, according to the
World Bank, since 1980 the economic cost of disasters in
developing countries has amounted to $1.2 trillion, equiva-
lent to about one third of all of?cial development aid
(Word Bank, 10 April 2013). The costs associated with
individual disasters such as Hurricane Katrina in 2005
were $300 billion, whilst the Haiti earthquake in 2010
required $3 billion in emergency funds and a further $1 bil-
lion for reconstruction. Importantly, the UN Of?ce for
Disaster Risk Reduction (UNISDR) declared on 14 March
2013 that, ‘‘for the ?rst time in history the world has
experienced three consecutive years where annual eco-
nomic losses have exceeded $100 billion due to an enor-
mous increase in exposure of industrial asset and private
property to extreme disaster events’’ (http://www.unisdr.
org/archive/31685).
The preceding statistics suggest that natural disasters
have very real consequences for the planet and for the peo-
ple affected by them. However these disasters are also ‘fo-
cusing events’ which bring contemporary practices and
structures into sharp relief. As focusing events, they have
the potential to provide us with new insights regarding
the intersections among governance and accounting,
including the consequences for people and the planet
(Atkeson & Maestas, 2012, p. 27; Walker, 2000). Calls for
the academy to pursue a ‘phronetic social science’
(Cooper & Morgan, 2008) suggests a focus on investigating
‘things which really do matter to people’. Earthquakes and
other natural disasters are clearly sites where accounting
does matter.
Acknowledgments
The author is grateful for the helpful and insightful
comments provided by Peter Miller, Dean Neu and Steve
Walker on earlier drafts of this paper. In addition, the
author acknowledges with gratitude the constructive and
helpful comments of the two anonymous referees. The
author would like to thank participants at the APIRA
Conference, Sydney, 2010; the 35th EAA Annual Congress,
Ljubljana, 2012.
Appendix A. Primary sources
A.1. National ordinances, laws and decrees
A.1.1. Decrees of the President of the Council of Ministers
(DPCM)
DPCM 6 April 2009 – Declaration of the national
‘‘state of risk’’, and ‘‘appointment of the Head of the Civil
Defense, Guido Bertolaso, as Commissioner delegated to
guide the post-disaster operations’’.
DPCM 7 April 2009 – Declaration of the national ‘‘state
of emergency’’.
A.1.2. Legislative Decrees and Laws (DL and L)
DL n. 39/09, Legislative Decree n. 39, 28 April 2009,
‘‘Urgent interventions in favor of the populations struck
by the seismic events occurred in the Abruzzo Region in
April 2009 and further urgent interventions about civil
defence’’. This DL has been later converted into L n.77, 24
June 2009.
[this DL allotted €40 million for the extraordinary
activities and costs sustained for the earthquake-related
healthcare emergency services, increased the previously
established pharmaceutical expenditure cap and concur-
rently gave priority to later obtain further national funds
for the earthquake-proof reconstruction/reorganization of
health facilities]
A.1.3. Ordinances of the President of the Council of Ministers
(OPCM)
OPCM n. 3753, 6 April 2009, ’’First urgent interventions
consequent to the seismic events which struck the
Province of L’Aquila and other municipalities of the
Abruzzo Region on 6th April 2009’’.
OPCM. n. 3782, 17 June 2009 ‘‘Further urgent interven-
tions destined to face the seismic events occurred in the
Abruzzo Region on 6th April 2009’’. [This OPCM, among
other things, conditioned the access to the resources allot-
ted by the DL n.39/09 upon presentation of an ‘‘Operational
Plan to further face the dif?culties caused by the seismic
events’’, ex Art.2 ]
A.1.4. Decrees of the Commissioner Delegated to post-disaster
operations (DCD)
DCD n. 3, 16 April 2009, ‘‘Spotting the municipalities
damaged by the earthquake which struck the Province of
L’Aquila and other municipalities of the Abruzzo Region
on 6th April 2009’’.
DCD n. 11, 17 July 2009, ‘‘Modi?cations and
integrations to the DCD n. 3, 16 April 2009, related to
the ‘‘Spotting the municipalities damaged by the
earthquake which struck the Province of L’Aquila and
other municipalities of the Abruzzo Region on 6th April
2009’’.
A.2. Deliberations and notes of the healthcare governmental
Commissioner ad acta (DCaa)
DCaa Deliberation n. 14/09, 12 March 2009
‘‘Interventions addressed to the recovery of the healthcare
de?cit’’.
DCaa, Note n. 9246, 6 April 2009 ‘‘ Possibility of over-
coming of the thresholds imposed by the Budget
Recovery Plan because of the urgent earthquake healthcare
assistance’’
DCaa Deliberation n. 23/09, 7 April 2009: ‘‘Earthquake
of the Province of L’Aquila – Suspension of the deliberation
of the Commissioner ad acta for the deployment of the
Recovery Plan n. 14/09 of 12 March 2009, limited to the
residents in the LHA of L’Aquila [territory]’’. [Through this
deliberation, among other things, the Commissioner pre-
scribed the ticket exemption for all citizens resident in
the L’Aquila LHA territory].
DCaa Note 9560/S, 8 April 2009 ‘‘Healthcare assistance
to patients hit by the seismic events of 6 April 2009’’.
86 M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89
DCaa, DG 8/47, 9 April 2009 ‘‘Urgent measures related
to pharmaceutical assistance in favor of earthquake vic-
tims – C Class Drugs’’.
DCaa, n.24/09: Deliberation n. 24/09, 22 April 2009:
‘‘Earthquake of the Province of L’Aquila – Modi?cations
and integrations to the urgent measures referred to the
pharmaceutical assistance to earthquake victims’’ [through
this deliberation the Commissioner prescribed also pay-
ment exemption for all citizens resident in the L’Aquila
LHA territory for particular medicines usually completely
paid by patients]’’.
DCaa, n.28/09: Deliberation n. 28/09, 6 May 2009:
‘‘Earthquake of the Province of L’Aquila – Modi?cations
and integrations to previous deliberations’’. [Through this
deliberation the Commissioner con?rmed the previous
DCaa 23 & 24, broadening the exemption zone to all the
49 municipalities belonging to the ‘‘earthquake crater
identi?ed by the DCD n. 3, 16 April 2009. By so doing
whilst the exemption zone was also applied to some towns
belonging to the neighbor Provinces of Pescara and
Teramo, some municipalities belonging to the Province of
L’Aquila – that were not damaged by the earthquake – were
excluded from it]’’.
DCaa n. 45/09: Deliberation n. 45/09, 24 June 2009:
‘‘De?nition of uniform criteria for the recording of costs
and activities referred to the 6 April 2009 earthquake’’.
Document attached n.1: ‘‘Criteria for the recording of
extraordinary costs and activities connected to the 6
April 2009 earthquake for the LHAs of Teramo, Pescara,
Avezzano-Sulmona, Lanciano-Vasto, Chieti.
Document attached n.2: ‘‘Criteria for the recording of
extraordinary costs and activities connected to the earth-
quake of 6 April 2009 for the LHA of L’Aquila’’.
DCaa, OP, September 2009: ‘‘Operational Programme
for the dif?culties caused by the seismic events’’.
DCaa, OP, January 2010: ‘‘Operational Programme for
the dif?culties caused by the seismic events’’. [this
deliberation has been taken by the new Commissioner ad
acta, that is the Governor of the Region]
A.3. Miscellaneous
Minutes of the meeting of November 10, 2009,
Ministries of Health/Economics. [when the ‘‘Operational
Programme’’ of the Commissioner ad acta has been exam-
ined by the experts].
Report of the Ministries of Health/Economics on the
Operational Programme, December 2009. [when the
‘‘Operational Programme’’ of the Commissioner ad acta
has not been approved].
Minutes of the meeting of December 18, 2009,
Ministries of Health/Economics. [when the Governor of
the Abruzzo Region – acting as new Commissioner ad acta
– has been asked to re-formulate the ‘‘Operational
Programme’’].
Minutes of the meeting of April 28, 2010, Ministries of
Economics/Health. [when the ‘‘Operational Programme’’
re-formulated by the new Commissioner ad acta – the
Governor of the Abruzzo Region – has been re-examined
by the experts].
Minutes of the meeting of December 2, 2010, Ministries
of Health/Economics [when it has been permitted to allo-
cate the FY 2009 post-earthquake additional resources to
the Abruzzo Region, thus closing the ‘‘Operational
Programme examination procedure].
Interviews
Interviewee Day City Location Duration
Director of the Health 29/11/2010 Pescara Health Policy Of?ce of the Abruzzo Region 2 h
Policy Of?ce of the 06/12/2010 Pescara Health Policy Of?ce of the Abruzzo Region 2 h
Abruzzo Region 07/12/2010 Pescara Health Policy Of?ce of the Abruzzo Region 1 h
12/01/2011 Pescara Health Policy Of?ce of the Abruzzo Region 1.5 h
14/01/2011 Pescara Health Policy Of?ce of the Abruzzo Region 1 h
CEO of the LHA of 19/11/2010 Pescara CEO Of?ce of the LHA of Pescara 2 h
Pescara 29/11/2010 Pescara CEO Of?ce of the LHA of Pescara 1.5 h
02/12/2010 Pescara CEO Of?ce of the LHA of Pescara 1 h
Director of the 19/11/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Management Accounting 29/11/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Of?ce of the LHA of 02/12/2010 Pescara Management Accounting Of?ce of the LHA of Pescara 2 h
Pescara 11/01/2013 Pescara Management Accounting Of?ce of the LHA of Pescara 1 h
CEO of the LHA of 26/11/2010 L’Aquila CEO Of?ce of the LHA of L’Aquila 2 h
L’Aquila 11/01/2011 L’Aquila CEO Of?ce of the LHA of L’Aquila 1 h
15/02/2011 L’Aquila CEO Of?ce of the LHA of L’Aquila 1 h
Management Accounting 26/11/2010 L’Aquila Management Accounting Of?ce of the LHA of Pescara 2 h
Of?cer of the LHA of 11/01/2011 L’Aquila Management Accounting Of?ce of the LHA of Pescara 2 h
L’Aquila 15/02/2011 L’Aquila Management Accounting Of?ce of the LHA of Pescara 1 h
17/01/2013 L’Aquila Management Accounting Of?ce of the LHA of Pescara 1 h
Director of the 26/11/2010 L’Aquila Balance Of?ce of the LHA of L’Aquila 2 h
Of?ce Balance of 11/01/2010 L’Aquila Balance Of?ce of the LHA of L’Aquila 2 h
The LHA of L’Aquila 15/02/2011 L’Aquila Balance Of?ce of the LHA of L’Aquila 1 h
Inspector of the Ministry of
Eonomics & Finance – Healthcare
05/10/2010 Rome Rome Of?ce 2 h
M. Sargiacomo / Accounting, Organizations and Society 42 (2015) 67–89 87
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