The National Institute of Social Services for Retirees and Pensioners (INSSJyP-PAMI) must provide a patient from the Upper Río Negro Valley with a medication “as long as the medical prescription lasts and in the dosage, forms and quantities prescribed by the acting professional.” She is a 59-year-old woman who has had cancer since she was 32, and It depends on a medicine that costs more than a million pesos.
The patient filed an action for protection before the federal court of Roca because the PAMI, to which she is affiliated, denied her medication with the argument that ““It is outside of protocols.” of social work.
In his writing, he recalled that in a previous ruling the Judiciary established that “the fact that the requested benefit is not within the PMO (Mandatory Medical Program), is not in itself sufficient cause to exempt the defendant of its obligation to provide adequate health service. The PMO constitutes a minimum performance floor and not a closed list – not a ceiling.
The presentation was made with the legal sponsorship of Milton Hernán Kees, Analía Andrea Dabus and Vanesa Ruiz, who have their studio in Neuquén. Over 20 pages, it details all the medical treatments that the patient underwent, and the prescription of two treating doctors.
Life risk
One of the professionals “prescribes me to take the medication Abemaciclib 150 mg”, states “that the indicated treatment “has an urgent nature” and that “if I don’t receive the medication my illness “It can progress, putting my life at risk.”.
In the lawsuit he adds: “I note that the procedures before PAMI are no longer about simple bureaucracy, but about a mockery in response to the absurd requirements they make of their members that we are going through adulthood, destroying the aforementioned principles, rights and guarantees recognized by the Inter-American Convention on the Protection of the Human Rights of Older Persons, Law No. 27,360 and corresponding regulations.
Order and fine
The federal judge of Roca, Hugo Greca, granted the precautionary measure and ordered the National Institute of Social Services for Retirees and Pensioners to «within five days “provide authorization and immediate delivery of the drug Abemaciclib 150 mg Venzeno tablets.”
You must do so “as long as the medical prescription lasts and in the dosage, forms and quantities prescribed by the acting professional.”
If he does not do so, the judge ordered the application of astreintes (a type of fine) of 30,000 pesos for each day of delay.
Consultations and protections
Lawyer Hernán Kees, one of the sponsors, told RÍO NEGRO newspaper that in recent times “Queries have skyrocketed and we made several protections”. Many “have to do with people who had prepaid plans and can no longer pay them” while “social and prepaid works, as a result of the deficit in affiliates, show a cash deficit and are more reticent about coverage.”
Asked about the impact of these procedures on the health of patients, he pointed out that “the situation overexposes patients and the State, from different levels. Going to court is not free, which is why it is often impossible to hire a lawyer to prosecute the problem. ends up being a barrier to access to health“.
traumatic experience
Kees also highlighted that “going to court, in addition to the economic cost, has an emotional cost for the patient. It is not free to go through a trial from the emotional level. Even if you win the process and it ends in a conviction against the social work or the prepaid “It continues to be largely a negative and even traumatic experience that re-victimizes the patient.”.
«It is a decision that condenses and crowns patient fatiguewho after wandering for months through different offices in search of health coverage end up colliding with an inexplicable bureaucracy, with the apathy of social works and, clearly, with a speculative situation: many patients prisoners of this fatigue or lack of resources “They end up giving up on their claims or turning to the public health system.”he added.
That “not only generates a perverse dynamic “which benefits social and prepaid works, but ends up overloading the already crowded public hospitals.”
The lawyer summarized: “the situation negatively impacts different orders as well“Not only due to the proliferation of lawsuits, but this crisis of the private health system has led to a massive renunciation of prepaid coverage and that primary coverage ends up being reabsorbed by the State through its health system.”