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Justice forces health plan to pay treatment for child with EBF in Joinville

The 2nd Civil Chamber of the Santa Catarina Court of Justice has ruled that a health plan will cover the treatment of a boy with spinal muscular atrophy (AME), provide him with a wheelchair and also a device called a suropodalic orthosis, used for the feet. and ankles.

The orthosis supports, aligns, prevents and corrects deformities, and improves the functional ability of a person with special needs. The boy and his family live in Joinville, in the north of the state.

The court of origin partially granted emergency relief and guaranteed the physiotherapeutic and therapeutic treatment for the child, under penalty of a daily fine of R $ 500. However, it did not include the wheelchair and the orthosis.

The mother of the child with AME turned to TJ. She maintained that the child has progressive loss of muscle strength and loss of functional capacity, and therefore needs the required equipment.

Otherwise, according to medical reports, there is a high possibility of irreversible injuries. The health plan, in turn, argued that the equipment is not provided for in the contract.

For the rapporteur, Judge Rubens Schulz, there is sufficient documentary evidence to demonstrate the urgent need for the wheelchair for its displacement and also for the orthosis indicated by the doctor. “Even though there is no danger of death,” explained Schulz, “the danger of irreversible injury is unquestionable, as continuity of treatment is essential for improving the infant's quality of life. Each day of waiting makes the clinical condition worse and may even make it irreversible. ”

Schulz emphasized that in the confrontation of two essentially divergent interests, such as the health plan's patrimony and the child's right to life, their most important and important good, the right to life, must prevail. In addition to the rapporteur, judges Jorge Luis Costa Beber and André Luiz Dacol participated in the trial. The session took place on October 31st. The decision was unanimous.

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