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Revista Brasileira de Cirurgia Cardiovascular

On-line version ISSN 1678-9741

Rev Bras Cir Cardiovasc vol.21 no.1 São José do Rio Preto Jan./Mar. 2006 



SUS and the High Complexity Assistance in Natal, RN



Marcelo Matos Cascudo*



The state of Rio Grande do Norte has a population of 2,923,287 and the Health Ministry has determined that there should be a hemodynamics service and a cardiac surgery service available for every 600,000 inhabitants. Currently, in our state, there are six hospitals equipped with facilities that comply to the norms and demands of the National Health Program for High Complexity Assistance in Cardiovascular Diseases laid down by the federal government. There is an excessive number of beds for cardiovascular government healthcare (SUS) patients in the state, considering that, the total of these services, has the capacity to address a population of 3,600,000.

The city hall of Natal has been accredited with the full management role SUS and is thus in charge of the coordination of treatment of patients suffering from cardiovascular diseases. It is the city hall's responsibility to allocate hospital beds, to manage the financial resources transferred by the Ministry of Health and to remunerate physicians with the possibility of complementing their fees using its own resources according to the Health Ministry decree of September 11, 2001. Additionally, the city hall must comply with the norms and regulations of SUS with possible punishment if the administration breaks these constitutional obligations. The mayor is liable for administratively misleading, as the city hall does not have a hospital of its own to provide high complexity assistance to the population.

The ideology of a healthcare system managed solely with public money opposes the evolution of modern developed countries that have, in their private-public partnerships, the basis for development of the state and improvements in the social sphere. These agreements between the administration and private companies are solely aimed at meeting the public-social necessities in a way of benefiting the population with high quality and agile services, which the government, due to the lack of human and financial resources, cannot provide with dignity and respect. The healthcare system aimed at by the local government of Natal is retrograde, obtuse and out-dated. The city hall administratively characterizes itself only as an intermediary of federal resources, not as having a functional administrative obligation of providing a healthcare program, let alone high complexity treatment, to its population in its own hospital network.

The municipal administration, intrinsically feeling its managerial incapacity coupled to the lack of experience in healthcare turned against registered physicians. On August 31, 2005 it issued the decree (nº 160/2005), which determines that 'code 07' would not be used in the processing of independent physicians honoraria, forcing the hospitals to collect payments for health services rendered and afterwards to pay the professionals who performed the services. Thus, the municipal administrators washed their hands of their obligations, which are the responsibility of the government as set forth by the ministerial decree dated September 30, 2005 which states in Article 02, § 1, "all discounts, taxes and other contributions shall be the responsibility of the financial section of the states, the Federal District as well as the municipals with full management control of health services".

The aforementioned municipal decree opposes the wishes and freedom of physicians to exercise their occupation. The Medical Ethics Code and the Federal Medical Council place physicians answerable for their autonomy and postulated contractual agreements and to decide how they receive their fees. Furthermore, the medical code states that no legal, statuary or management action shall interfere in the physicians' preferential right to render their services and to receive their fees. Complying with the determination of the Federal Medical Council and following the impositions of the municipal management system in respect to our exclusion from the government healthcare system, we found it impossible to assist these patients. Even so, through lies and cowardice, the city council blamed the physicians for the chaotic situation, that it itself caused, and declared a state of public emergency in the municipal of Natal on November 25, 2005. It urged the Public Ministry, that in its turn was travestied as world police, ignorant in relation to healthcare and breaking ministerial laws and decrees, requested the Judicial system through a preliminary injunction, to force autonomous physicians to immediately provide healthcare services to the population or be imprisoned with the opening of a police enquiry. Sixty-seven days were necessary to solve the problem. Four deaths occurred due to the irresponsibility and managerial incapacity of the municipal administrators, deaths that have still not been investigated with nobody being held liable or indicted by the judicial authorities.

The state government was obliged to intervene in the process and to solve the problem, signing a contract with the 140 physicians of 16 specialties, supplementing their fees by increases of 100% on the SUS remuneration. What was the purpose of the arbitrary and dictatorial attitude of the city council of Natal and the public prosecution service? Perhaps it was only to give legitimacy to the lack of administrative competence in public healthcare and to eviscerate the public prosecutors' dictatorial arrogance when treading on the constitutional rights of free citizens. Counting on the intrepid figure of a young and inexperienced prosecutor with the approval of a mayor who is unable to continue administering the National Health Program for High Complexity Assistance tried in Brasília, to hand this responsibility back to the Federal Government. How sad! To know that our population has a government which is unable to listen, to discuss or take the advice of a medical society. And so, it thinks it is the lord of power, of the truth and of the knowledge, but that truly it has neither direction nor political sensitivity and not even a moral commitment with the healthcare system of Brazil.



* Member of the Cardiovascular Surgery Brazilian Society (SBCCV)
Head of the InCor-Natal Cardiovascular Surgery Division
SBCCV Deliberative Council Member
Cardiac Pacing Department Treasurer

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