Judicialization of health during the COVID-19 pandemic in Pará state, Northern region of Brazil
DOI:
https://doi.org/10.33448/rsd-v9i9.7127Keywords:
Health's Judicialization; COVID-19; Intensive Care Units.Abstract
In Brazil, the right to health has constitutional universal provision. However, its incompleteness and the scarcity of structural and human resources leads people who would benefit from access to specific health services, mainly the ones in intensive care need - as currently intensified by the COVID-19 pandemic -, to appeal to judicial way to obtain access to them. The aim of this study was to problematize the relation between the insufficient number of ICU (Intensive Care Unit) beds at the current demands for them due to the COVID-19 pandemic through judicialization. The data from the Ministry of Health database were confronted with the literature on the judicialization of health within the national scope, with attention to the statistical data of Pará state’s Court of Justice. There were 14 actions aimed at guaranteeing access to the ICU beds in the period from 03/20/2020 to 05/25/2020 in Pará state. The availability of these in the state (1,718) represents 9% of the total number of beds, below the national average, both beneath the ideal determined by the World Health Organization (ideal rate of 3 to 5 ICU beds for every thousand inhabitants). In conclusion, the judicialization of health can be a sign of dysfunctions and failures in the management of the health systems, evidenced by the COVID-19 pandemic, which could lead to the possibility of scarcity of health resources in the country.
References
AMIB, Associação de Medicna Intensiva Brasileira (2016). Censo AMIB 2016. Retrieved from:http://www.amib.com.br/pdf/Analise_de_Dados_v4_1.20.1095_AMIB_Atualizado_by_AM_24Fev17_Templat eAMIB.pdf.
Berlinger, N., Wynia, M., Powell, T., Hester, D. M., Milliken, A., Fabi, R., & Jenks, N. P. (2020). Ethical framework for health care institutions responding to novel Coronavirus SARS-CoV-2 (COVID-19) guidelines for institutional ethics services responding to COVID-19. Safeguarding Communities, Guiding Practice, 2.
Boccia, S., Ricciardi, W., & Ioannidis, J. P. (2020). What other countries can learn from Italy during the COVID-19 pandemic. JAMA internal medicine. 180(7):927-928.
Brasil (2020). Cadastro Nacional de Estabelecimentos de Saúde. Retrieved from: http://cnes.datasus.gov.br/.
Carlini, A. (2017). A judicialização da saúde privada no Brasil: reflexões a partir da segurança jurídica e do protagonismo judicial. Rio de Janeiro: GZ editora, (33)7052-7069.
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., ... & Yu, T. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507-513.
Conselho Federal De Medicina (2012). Resolução CFM nº 1.995/2012. Brasília, Diário Oficial da União. Retrieved from: https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2012/1995.
Conselho Federal De Medicina (2016). Resolução CFM Nº 2.156/2016. Brasília, Diário Oficial da União. Retrieved from: https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2016/2156.
Conselho Nacional De Saúde. Resolução Nº 510/2016. Retrieved from: http://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf.
Diniz, D., Machado, T. R. D. C., & Penalva, J. (2014). A judicialização da saúde no Distrito Federal, Brasil. Ciência & Saúde Coletiva, 19, 591-598.
Drosten, C., Günther, S., Preiser, W., Van Der Werf, S., Brodt, H. R., Becker, S., ... & Berger, A. (2003). Identification of a novel coronavirus in patients with severe acute respiratory syndrome. New England journal of medicine, 348(20), 1967-1976.
Eastman, N., Philips, B., & Rhodes, A. (2010). Triaging for adult critical care in the event of overwhelming need. Intensive care medicine, 36(6), 1076-1082.
Emanuel, E. J., Persad, G., & Upshur, R. Fair allocation of scarce medical resources in the time of Covid-19 [published online ahead of print March 23, 2020]. N Engl J Med. 382:2049-2055.
FIOCRUZ, Fundação Oswaldo Cruz (2020a). Interiorização do Covid-19 e as redes de atendimento em saúde. Retrieved from: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/monitoracovid_notatecnica_04_05_20.pdf.
FIOCRUZ, Fundação Oswaldo Cruz (2020b). A Disponibilidade de Leitos em Unidade de Tratamento Intensivo no SUS e nos Planos de Saúde Diante da Epidemia da COVID-19 no Brasil. Retrieved from: http://www.ensp.fiocruz.br/portal-ensp/informe/site/arquivos/anexos/a92729d3eae11d7fe26e4f4bd9a663c16f13a410.PDF
Gruber, J., & Sommers, B. D. (2020). Paying for Medicaid—state budgets and the case for expansion in the time of coronavirus. New England Journal of Medicine. 382,2280-2282.
Grasselli, G., Pesenti, A., & Cecconi, M. (2020). Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. Jama, 323(16), 1545-1546.
Lintern S. (2020). ‘We are making diuicult choices’: Italian doc- tor tells of struggle against coronavirus. The Independent, Retrieved from: https://www.independent.co.uk/news/health/coronavirus-italy-hospitals-doctor-lockdown-quarantine-intensive-care-a9401186.html.
Ministério Da Saúde (2020). Coronavírus Brasil. Retrieved from: https://covid.saude.gov.br/.
Machado, T. R. (2015). Judicialização da saúde e contribuições da teoria de justiça de Norman Daniels. Revista de Direito Sanitário, 16(2), 52-76.
Moreira, R. D. S. (2020). COVID-19: unidades de terapia intensiva, ventiladores mecânicos e perfis latentes de mortalidade associados à letalidade no Brasil. Cadernos de Saúde Pública, 36, e00080020.
Nascimento, C. B. D. (2015). A judicialização no Distrito Federal, no Setor Saúde, na área de álcool e drogas.
Oerlemans, A. J., Wollersheim, H., van Sluisveld, N., van der Hoeven, J. G., Dekkers, W. J., & Zegers, M. (2015). Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians. BMC anesthesiology, 16(1), 25.
Ordacgi, F. N. V. (2019). Judicialização na ocupação dos leitos de UTI. Escola da Magistratura do Estado do Rio de Janeiro. Rio de Janeiro. Retrieved from: https://www.emerj.tjrj.jus.br/paginas/biblioteca_videoteca/monografia/Monografia_pdf/2019/FernandaNepomucemoVarejao.pdf.
OCDE, Organização para a Cooperação e Desenvolvimento Econômico (2020). Hospital Beds. Retrieved from: https://data.oecd.org/healtheqt/hospital-beds.htm.
Pessôa, L. R., Santos, I. S., Machado, J. P., Martins, A. C. M., & Lima, C. R. D. A. (2016). Reallocating the Unified Health System's supply to face attend future problems: the case of traumatology in Brazil. Saúde em Debate, 40, 9-19.
Pollack, M. M., Katz, R. W., Ruttimann, U. E., & Getson, P. R. (1986). Improving The Outcome And Efficiency Of Pediatric Intensive Care: Impact Of An Intensivist. Critical Care
Medicine, 14(4), 417.
Ramos, J. G. R., Passos, R. D. H., Baptista, P. B. P., & Forte, D. N. (2017). Fatores potencialmente associados à decisão de admissão à unidade de terapia intensiva em um país em desenvolvimento: um levantamento de médicos brasileiros. Revista Brasileira de Terapia Intensiva, 29(2), 154-162.
Ramos, R. D. S., Gomes, A. M. T., Oliveira, D. C. D., Marques, S. C., Spindola, T., &
Nogueira, V. P. F. (2016). Access the Unified Health System actions and services from the perspective of judicialization. Revista Latino-Americana de Enfermagem, 24.
Vergano, M., Bertolini, G., Giannini, A., Gristina, G. R., Livigni, S., Mistraletti, G., ... & Petrini, F. (2020). Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic.
Rhodes, A., Chiche, J. D., & Moreno, R. (2011). Improving the quality of training programs in intensive care: a view from the ESICM.
Rubiatti, D. D. C. (2020). Pará : falta de coordenação entre governo do estado e prefeituras. Retrieved from: https://www.nexojornal.com.br/especial/2020/05/10/Como-os-governos-estaduais-lidam-com-a-pandemia/.
Satomi, E., Souza, P. M. R. D., Thomé, B. D. C., Reingenheim, C., Werebe, E., Troster, E. J., ... & Bueno, M. A. S. (2020). Alocação justa de recursos de saúde escassos diante da pandemia de COVID-19: considerações éticas. Einstein (São Paulo), 18.
SESPA, Secretaria De Saúde Pública Do Estado Do Pará (2020). Coronavírus no Pará. Retrieved from:http://www.saude.pa.gov.br/coronavirus/.
Silva, P. F. A. D., & Baptista, T. W. D. F. (2014). Os sentidos e disputas na construção da Política Nacional de Promoção da Saúde. Physis: Revista de Saúde Coletiva, 24, 441-465.
Sinuff, T., Kahnamoui, K., Cook, D. J., Luce, J. M., & Levy, M. M. (2004). Rationing critical care beds: a systematic review. Critical care medicine, 32(7), 1588-1597.
Stevens, G. A., Alkema, L., Black, R. E., Boerma, J., Collins, G. S., Ezzati, M., ... & Lawn, J. E. (2017). Diretrizes para o relato preciso e transparente de estimativas de saúde: a declaração GATHER. Epidemiologia e Serviços de Saúde, 26, 215-222.
Sousa Júnior, A. S., Carneiro, T. X., Oliveira J.S.S., Moraes, T. M., Pinheiro, B. V.S., ... & Xavier, M. B. (2020). Geoepidemiologia da COVID-19 no Pará: Evolução Espaço-temporal da 12ª a 22ª Semanas. Belém. Retrieved from: https://zenodo.org/record/3893811#.XzafN-hKjIU.
Thompson, M. H., & Khot, A. S. (1985). Impact of neonatal intensive care. Archives of disease in childhood, 60(3), 213-214.
Tsang, K. W., Ho, P. L., Ooi, G. C., Yee, W. K., Wang, T., Chan-Yeung, M., ... & Wong, P. C. (2003). A cluster of cases of severe acute respiratory syndrome in Hong Kong. New England Journal of Medicine, 348(20), 1977-1985.
TCU, Tribunal De Contas Da União (2014). Relatório Sistêmico de Fiscalização 2014. Retrieved from: https://portal.tcu.gov.br/biblioteca-digital/relatorio-sistemico-de-fiscalizacao-saude. htm.
Wang, D. W. L., de Vasconcelos, N. P., de Oliveira, V. E., & Terrazas, F. V. (2014). Os impactos da judicialização da saúde no município de São Paulo: gasto público e organização federativa. Revista de Administração Pública, 48(5), 1191-1206.
Wang, D., & de Lucca-Silveira, M. (2020). Escolhas Dramaticas em Contextos Tragicos: Alocac ao de Va-gas em UTI Durante a Crise da COVID-19. Nota Técnica n.5. 2020. IEPS: São Paulo.
WHO, World Health Organization. Novel coronavirus (2019-nCoV). Situation report 11. https:// www.who.int/docs/default-source/corona viruse/situation-reports/20200131-sitrep11-ncov.pdf?sfvrsn=de7c0f7_4 (acessado em 12/Abr/2020).
WHO, World Health Organization. Novel coronavirus (2019-nCoV). Situation report 51. https:// www.who.int/docs/default-source/corona viruse/situation-reports/20200311-sitrep51-covid-19.pdf?sfvrsn=1ba62e57_10 (acessado em 12/Abr/2020).
Yamin, A. E., & Frisancho, A. (2015). Human-rights-based approaches to health in Latin America. The Lancet, 385(9975), e26-e29.
Yang, X., Yu, Y., Xu, J., Shu, H., Liu, H., Wu, Y., ... & Wang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine.
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., ... & Niu, P. (2020). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine.727-33.
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