Legal and technical basis of the sentences of the Special Courts of the Public Treasury of Rio de Janeiro (RJ), 2012-2018

Saad, Elizabeth Maria; Braga, José; Maciel, Elvira Maria Godinho de

doi:10.1590/0103-11042019S407

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ORIGINAL ARTICLE • Saúde debate 43 (spe4) • Dec 2019 • https://doi.org/10.1590/0103-11042019S407 copy

Legal and technical basis of the sentences of the Special Courts of the Public Treasury of Rio de Janeiro (RJ), 2012-2018

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The paper analyzes the factual and legal reasons and sentences issued by the Special Courts of the Public Treasury of the city of Rio de Janeiro (2012-2018). It was sought to know how decisions on medication requests are made, seeking legal arguments, opinions from the Court's Technical Support Center (TSC), and scientific evidence. A total of 19.773 processes were retrieved and a 500 processes simple random sample was selected, being 290 about drugs. In 94.1% of the cases, the decision was based on medical report, followed by the medical prescription; and, although TSC consultation is mandatory, the technical opinion was used only in 22.2%. Of 221 judgments on merits, 94.6% were based on article 196 of the Federal Constitution; 85.5% in jurisprudence of the higher courts; and 62.5% rejected theses of the Public Treasury from the reservation of the possible and principle of budgetary legality. Most requested drugs treated endocrine-metabolic diseases (insulin, ranibizumab), kidney diseases (cinacalcet), obstetric complications (enoxaparin), immune and inflammatory diseases (adalimumab). Only 32% had scientifically based drug recommendation, 14% 'not recommended', and 54% 'recommended without a scientific basis'. It is concluded that the technical opinion is little used, but when present, it does not explain scientific evidence, since, only in obstetric causes, 100% of the recommendations were scientifically based.

KEYWORDS
Health's judicialization; Pharmaceutical services; Evidence-based medicine; Unified Health System; Drug utilization

Order	N	%
Medicine not incorporated into the SUS list	180	56.3
Incorporated medicine, but needs use outside PCDT	72	22.5
Medicine without registration with Anvisa	5	1.6
Medicine incorporated into the list, but lacking	27	8.4
Medicine not incorporated and off-label use according to package insert	6	1.9
Medicine incorporated into SUS, but does not integrate list due to the short time of incorporation	25	7.8
Medicine incorporated without association required by the part	5	1.6
Total requests for medicines	320	100.0

Basis	N	%
Proof of illness (medical report)	208	94.1
Need for medicine (prescription)	154	69.7
Opinion of the NAT	49	22.2
Need to prove prior care and administrative refusal to supply the medicine	1	0.5
Total of sentences on the merit	221	-
Sentences without merit	49	-
Not sentenced	20	-
Total	290	-

Basis	N	%
1 - Article 6 of the Federal Constitution: right to health	33	14.9
2 - Article 23, II of the Federal Constitution: solidarity between federal entities	71	32.1
4 - Article 196 of the Federal Constitution: health is the right of everyone and duty of the State.	209	94.6
5 - Article 198 of the Federal Constitution: SUS	90	40.7
7 - Precedent 65 TJRJ	125	56.6
8 - Precedent 180 TJRJ	60	27.1
9 - Article 3 of the Federal Constitution: social welfare	58	26.2
10 - Law nº 8.080/90	48	21.7
11 - The part is financial hyposufficient	51	23.1
12 - Article 5 of the Federal Constitution - right to life	34	15.4
13 - Article 6 of Law nº 8.080/90: Comprehensive and Pharmaceutical Therapeutic Assistance of SUS	188	85.1
14 - Law nº 12.153/09: Provides for the Special Courts of the Public Treasury within the states, FD.	1	0.5
15 - Obligation of federative entities to supply medication even outside the SUS list	76	34.4
16 - It removes the theses of the Public Treasury from the possible reserve and principle of budgetary legality.	144	65.2
17 - RE 855178 RG, Rep.: Minister Luiz Fux, Joint liability of the federated entities. General repercussion recognized. Reaffirmation of jurisprudence	4	1.8
18 - Resp. 1.657.156/RJ STJ. Judged by the general repercussion regime, Thesis nº 106 of the STJ	11	5.0
19 - Jurisprudence of the Superior Courts on the subject (TJRJ/STJ/STF)	189	85.5
Total of sentences on the merit	221	-

Group of diseases	INS	CCA	ADM	RBZ	ENX	Other	Total
Group of diseases	N	N	N	N	N	N	N
Endocrine-metabolic diseases	29	0	0	22	0	17	68
Kidney diseases and complications	0	31	0	0	0	18	49
Immune and inflammatory diseases	0	0	6	0	0	37	43
Neuropsychiatric Diseases	0	0	0	0	1	35	36
Genetic diseases	0	0	0	0	1	6	7
Diseases and obstetric complications	0	0	0	0	12	0	12
Neoplasms	0	0	0	0	0	9	9
Respiratory diseases	0	0	0	0	0	11	11
Eye diseases	0	0	0	9	0	12	21
Lymphohematopoietic and thromboembolic diseases	0	0	0	0	0	6	6
Other	0	0	0	0	0	28	28
Total	29	31	6	31	14	179	290

Group of diseases	What does the opinion of NAT say?
	NOT recommended		Recommended with NO basis		Recommended WITH basis		Total
	N	%	N	%	N	%	N	%
Endocrine-metabolic diseases	8	11.8	47	69.1	13	19.1	68	100.0
Kidney diseases and complications	0	0.0	26	53.1	23	46.9	49	100.0
Immune and inflammatory diseases	11	25.6	19	44.2	13	30.2	43	100.0
Neuropsychiatric diseases	3	8.3	24	66.7	9	25.0	36	100.0
Genetic diseases	3	42.9	1	14.3	3	42.9	7	100.0
Diseases and obstetric complications	0	0.0	0	0.0	12	100.0	12	100.0
Neoplasms	1	11.1	2	22.2	6	66.7	9	100.0
Respiratory diseases	2	18.2	7	63.6	2	18.2	11	100.0
Eye diseases	6	28.6	14	66.7	1	4.8	21	100.0
Lymphohematopoietic and thromboembolic diseases	1	16.7	3	50.0	2	33.3	6	100.0
Other	6	21.4	13	46.4	9	32.1	28	100.0
Total	41	14.1	156	53.8	93	32.1	290	100.0

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E-mail: revista@saudeemdebate.org.br

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[1] Collaborators

Saad EM (0000-0002-3924-6230)^* * Orcid (Open Researcher and Contributor ID). and Braga J (0000-0001-5247-007X)^* * Orcid (Open Researcher and Contributor ID). contributed to the conception, planning, analysis and interpretation of data. Maciel EMG (0000-0002-9095-3141)^* * Orcid (Open Researcher and Contributor ID). contributed to the planning, analysis and interpretation of data, critical review and approval of the final version.