SP breaks law to start treating cancer in 60 days – 06/02/2023 – Health

Leaving the house in Largo do Paiçandu and walking to a health center in Praça do Patriarca, in downtown São Paulo, has become part of the daily life of the self-employed Francisca Meira Cilda, 56, in recent months. There, she asks the same question: whether an appointment was made for her husband with an oncologist. “The answer is always the same, there is no prediction,” she says.

Raymundo Thury de Castro, 70, her husband, was diagnosed in March with a tumor on his face, and the general practitioner who treated him at the UBS (Basic Health Unit) República recommended urgent referral of the case to an oncologist.

The elderly’s desperate routine, that of waiting without prospects for a consultation with a cancer specialist, as the family defines it, is more common than one imagines in São Paulo, a city with a balance of approximately R$ 35 billion in cash in public coffers and budget of R$ 16.4 billion for the Municipal Health Department this year.

“At these times, we only think of bad things”, says the freelancer, who sought care at the UBS, which is practically in front of the office of Mayor Ricardo Nunes (MDB).

The situation is the same in other regions of the city. Only at the Hospital Dia de São Miguel Paulista, in the east zone, there are more than 60 people in line to see an oncologist specialized in head and neck cancer, according to members of the unit’s management council.

In a note, the municipal health department says that the report on May 29 pointed to a lower number and that four patients were waiting for a consultation with a specialist in head-neck oncology at the unit.

The delay is contrary to the 2012 law. It establishes that the first oncological treatment in the SUS must begin within a maximum period of 60 days from the signature of the pathological report or in a shorter period, as necessary.

A little over a year ago, in May 2022, during the inauguration of a high-tech center for oncology diagnosis and intervention at Hospital Municipal Dr. Gilson de Cássia Marques de Carvalho, in Vila Santa Catarina, south zone, the city hall said that the city could comply with federal legislation to start cancer treatment in up to 60 days, with the opening of that modern structure.

“That was Bruno Covas’s dream, to give the population that had this disease the same treatment he had [em hospital particular]”, said Edson Aparecido, former municipal secretary of Health and current secretary of government of the city hall, during the inauguration of the place that bears the name of the former mayor mentioned by him, who died of cancer in 2021.

Questioned about the size of the queue of patients to start cancer treatment and why the municipal network did not meet the 60-day deadline, the Nunes administration did not respond, but says in a note that the offer of vacancies is dynamic, with entries and daily departures on Siga (Integrated Health Care Management System).

Juliana Hasse, president of the Health Law Commission of the OAB (Ordem dos Advogados do Brasil) in São Paulo, says that one of the ways to try to seek medical attention is to go to court — looking for the Public Defender’s Office is an option for those who cannot afford it. legal help, she advises—, although there is no guarantee.

“However, it’s no use [juiz] give a court order to start the service if there is no availability”, he says. “But it’s valid, as well as looking for the Health Department of the municipality and putting your foot down.”

According to the Court of Justice of São Paulo, from January to April, 142 cases were distributed with requests for medical treatment by the public network in the city of São Paulo (not just against cancer). The number is similar to the same period last year (143).

The lawyer recalls that a change in the law, in 2019, reduced the carrying out of tests to 30 days when there is a chance of a diagnosis of cancer. “These people have rights.”

For the doctor Maria Ignez Braghiroli, coordinator of the Committee on Upper Gastrointestinal Tumors of the SBOC (Brazilian Society of Clinical Oncology), the difficulty of arriving at the diagnosis can be even greater.

“In fact, there are several setbacks, but I think the biggest problem is not even scheduling an appointment. Even making the diagnosis is a pilgrimage”, she says, who has been working through the SUS since 2008.

One day after the report asked about the lack of care for the elderly Castro, the family received the news that he would finally be seen, on July 4, that is, about three months after the diagnosis.

The same happened to Luiz Ademar Campos, 76, who since February has been seeking oncological care after being diagnosed with prostate cancer, as well as in all cases of patients questioned by the Sheetand always scheduled for more than 60 days after detection of the disease.

Also retired, Maurício Artuzo, 69, from the east side, was diagnosed with prostate cancer on March 24 — despite the fact that the first signs were identified in November 2022. The referral to an oncologist was only confirmed this Thursday (1st) — the consultation will be on July 7th.

Twenty days earlier, the Municipal Health Secretariat said that the consultation would be scheduled by the central regulation according to clinical and chronological priority, according to vacancies offered by the Oncology Services of the State Health Secretariat.

Also in a note, the state secretariat stated that there was no queue for oncology regulation in the state.

Tired of waiting for the phone call with the dreamed appointment date, the chef Cleiton de Abreu Chiari, 48, managed by his own means to attend to his father, Roberto Chiari, 76, at the Hospital de Câncer de Barretos, about 423 km from São Paulo. Paulo, but with the hope that he can be treated closer to home, in the east zone — with a diagnosis of prostate cancer, after several consultations, in March he was urgently asked to see an oncologist. This Thursday (1st), the secretariat said that the elderly person will be attended to on July 5th.

According to physician Fernando Maluf, oncologist and founder of Instituto Vencer o Cancer, delays in diagnosis and treatment worsen the prognosis, regardless of the tumor.

A 2017 study by the Oncology Observatory showed that in Brazil, in general, 20.4% of cases took, on average, more than 60 days to start treatment after diagnosis.

For the specialists heard by the report, the situation will only change with management improvement, computerization of the entire health system to reduce waste, budget to hire more professionals, equipment and capacity for hospital procedures, among others.

“The worst thing is for people to know that they have cancer, but that nothing is being done”, says doctor Maluf.

What does Law 12,732 of 2012 say

The patient with malignant neoplasm has the right to undergo the first treatment in the Unified Health System (SUS), within a period of up to 60 (sixty) days from the day on which the diagnosis is signed in a pathological report or in a shorter period, according to the therapeutic need of the case recorded in a single medical record

• For the purpose of complying with the deadline stipulated in the caput, the first treatment of the malignant neoplasm will be considered effectively started, with the performance of surgical therapy or with the beginning of radiotherapy or chemotherapy, according to the therapeutic need of the case.
• Patients affected by painful manifestations resulting from malignant neoplasm will have privileged and free treatment, regarding access to prescriptions and dispensation of opiate analgesics or related
• In cases where the main diagnostic hypothesis is that of malignant neoplasm, the tests necessary for elucidation must be carried out within a maximum period of 30 (thirty) days, upon reasoned request of the responsible physician
• Failure to comply with this Law will subject managers directly and indirectly responsible to administrative penalties

how to get help

Patients with a diagnosis of cancer who have difficulty obtaining medical care can go to court to try to enforce the 60-day law

São Paulo Public Defender’s Office

Rua Boa Vista, 150, downtown

• Click here to book online, on weekdays, from 8 am to 6 pm
• By phone 0800 773 4340, on weekdays, from 7am to 7pm

Other places offering legal advice

• Click here and see a series of legal support entities listed by OAB-SP in all regions of the capital