Legal and health variations in drug litigation injunctions granted in Minas Gerais

Abstract

OBJECTIVE To investigate the factors related to the granting of preliminary court orders [injunctions] in drug litigations.METHODS A retrospective descriptive study of drug lawsuits in the State of Minas Gerais, Southeastern Brazil, was conducted from October 1999 to 2009. The database consists of 6,112 lawsuits, out of which 6,044 had motions for injunctions and 5,167 included the requisition of drugs. Those with more than one beneficiary were excluded, which totaled 5,072 examined suits. The variables for complete, partial, and suppressed motions were treated as dependent and assessed in relation to those that were independent – lawsuits (year, type, legal representation, defendant, court in which it was filed, adjudication time), drugs (level five of the anatomical therapeutic chemical classification), and diseases (chapter of the International Classification of Diseases). Statistical analyses were performed using the Chi-square test.RESULTS Out of the 5,072 lawsuits with injunctions, 4,184 (82.5%) had the injunctions granted. Granting varied from 95.8% of the total lawsuits in 2004 to 76.9% in 2008. Where there was legal representation, granting exceeded 80.0% and in lawsuits without representation, it did not exceed 66.9%. In public civil actions (89.1%), granting was higher relative to ordinary lawsuits (82.8%) and injunctions (80.1%). Federal courts granted only 68.6% of the injunctions, while the state courts granted 84.8%. Diseases of the digestive system and neoplasms received up to 87.0% in granting, while diseases of the nervous system, mental and behavioral disorders, and diseases of the skin and subcutaneous tissue received granting below 78.6% and showed a high proportion of suspended injunctions (10.9%). Injunctions involving paroxetine, somatropin, and ferrous sulfate drugs were all granted, while less than 54.0% of those involving escitalopram, sodium diclofenac, and nortriptyline were granted.CONCLUSIONS There are significant differences in the granting of injunctions, depending on the procedural and clinical variances. Important trends in the pattern of judicial action were observed, particularly, in the reduced granting [of injunctions] over the period.

Access the Unified Health System actions and services from the perspective of judicialization

“…The above testimony ratifies experts' position, who affirm that judicialization is a strategy the citizens adopt to safeguard their rights, initially employed individually, and more recently in the collective dimension ( 11 ) . The prevalence of individual over collective rights stands out when observing that collective were replaced by individual historical forms of struggle, through the use of the legal route, in which the Judiciary Power is acknowledged as an ally of citizenship ( 12 ) . Nevertheless, the prevalence of merely legal and not political language can harm the group, management and the implementation of policies at the different health levels and contexts ( 1 , 12 ) .…”

Health Policy on the pages of Revista de Saúde Pública

“…The articles of Marques and Dallari 57 and Vieira 98 can be considered milestones in that field. Subsequently, several articles on legal demands for medications in many States of Brazil 22 , 53 , 90 were published. The relations between the productive sector of medications with high technological incorporation and the legal system were unveiled by Chieffi and Barata 20 , which identified that a small number of lawyers answered by most of the lawsuits filed against SUS.…”

O acesso à medicamentos: aspectos da judicialização da saúde

“…8 Tal fato é destacado pelo exemplo exposto no estudo de Silva et al (2017), 9 em que a incorporação da alfaglicosidase ao SUS em 2014 gerou queda nos gastos com a judicialização deste: de R$ 2.153.732,50 em 2015 para R$ 637.198,97 de janeiro a agosto de 2016. Dada a importância disso, oito estudos 9,10,14,15,23,24,25,28 discorreram sobre os custos de medicamentos e seu impacto financeiro, além de 12 publicações 3,8,9,10,16,19,21,[23][24][25][26][27] dissertarem sobre a demanda de medicamentos.…”

“…Neste raciocínio e considerando a totalidade de concessão de liminares por parte dos juízes neste estudo e a necessidade em alguns casos de comprovação clínica patológica, 21 uma vez que tais não apresentam formação acadêmica médica, acabam por designar um médico perito para avaliar indicação da prescrição ou avaliam os argumentos daquele que assiste o demandante, sempre tomando por base documentos médicos e não jurídicos. 16 Os magistrados têm de julgar um parecer médico sem apresentar profundo conhecimento sobre tais causas 16 o que pode influenciar no julgamento.…”

“…13,21 No que tange aos medicamentos, o número de medicamentos demandados foram descritos em 14 publicações. 3,[8][9][10][11][12]16,19,21,[23][24][25][26][27] Já a somatória dos custos também foram descritas. 9,10,14,15,23,24,25,28 Dados referentes a incorporação dos medicamentos em listas oficiais encontram-se em 9 estudos.…”