Racionalidade terapêutica: elementos médico-sanitários nas demandas judiciais de medicamentos

Abstract

OBJECTIVE:To characterize the main medical, scientifi c and health-related procedural elements upon which decisions are made in individual lawsuits demanding medicines that are considered essential to the Court of Justice. METHODS:Retrospective descriptive study based on 27 cases ruled on by the Court of Appeals in Rio de Janeiro, Southeastern Brazil, in 2006. The original proceedings were solicited from the Central Archive of the Court of Justice of the State of Rio de Janeiro and were photographed and analyzed in full. RESULTS:Prescriptions and medical certifi cates were present in 100% of the lawsuits. All prescriptions lacked conformity to legislation. No expert medical reports were added, and only 7.4% of the lawsuits presented complementary examinations. In spite of the scarcity of medical information present in the records, all of the demands were granted. CONCLUSIONS:The admission of judicial demands devoid of clinical and diagnostic substantiation results in managerial and health-related constraints on the health system. Besides creating havoc in standard pharmaceutical services, badly justifi ed medicine demands may compromise rational drug use.

Studies published in indexed journals on lawsuits for medicines in Brazil: a systematic review

“…The first year of the publications included in the review was 2005, and there was a peak in the years 2010 and 2011. The data refer to studies done in the states of Pernambuco 5 , Rio Grande do Sul 2,6 , Minas Gerais 7,8 , Rio de Janeiro 9,10,11,12 , and São Paulo 13,14,15,16,17 , besides one article that collected data directly from the Ministry of Health in Brasilia 18 . The studies that examined the most lawsuits (between 2,000 and 2,927 cases) were done in the states of São Paulo, Rio de Janeiro, and Santa Catarina 7,12,14,16,19 .…”

“…As for the data sources, the majority of the studies analyzed the legal proceedings (83.3%), and one study only examined the initial lower court rulings 13 , while another examined both initial rulings and the results of appeals 9 . The main data sources were: State Health Departments (41.2%) and the São Paulo State Online System for Monitoring Legal Proceedings (17.6%) ( Table 2).…”

“…Three articles 2,6,10 (17.6%) examined petitions for advance relief or other types of court injunctions, and the results were the following: two studies showed 100% of such petitions 6,10 and one 98% 2 . The majority of the studies (76.5%; n = 13) collected specific data to determine whether there was more than one defendant in the suits, four conducted this analysis 2,6,9,10 , in two of them the defendants were states and municipalities 9,13 and in the others the defendants were states, municipalities, and the Federal Government 2,6 . Characteristics of the claims examined in the articles Table 4 shows the characteristics of the type of drug involved in the claim, type of health care service (public versus private), supply of the drug to the patient, presence of the drug on standard government lists, and registration of the drug in Brazil.…”

“…Ten studies analyzed the plaintiffs' legal representation 2,6,7,8,9,10,14,16,17,20 , of which three 7,14,16 examined more than two thousand lawsuits, whose plaintiffs were represented predominantly by private attorneys. These studies were done in São Paulo, Rio de Janeiro, and Minas Gerais, states with large populations, and two of the three Table 2 Characterization of types of documents and agencies used as data sources.…”

“…...In eleven studies 2,6,7,8,9,10,11,15,17,19,20 , the authors avalyzed the most frequent therapeutic indications. Diabetes mellitus and hypertension led the list (n = 6 and 4, respectively), followed by chronic obstructive pulmonary disease (COPD), chronic hepatitis C, cancer (n = 3), rheumatoid arthritis and kidney disease (n = 2)...…”