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ÚS otevřel spor lékařky s pojišťovnou o překročení limitu na léky


 | 29.9.2011 | komentárov: 302

Pojišťovny by neměly penalizovat lékaře, pokud v odůvodněných případech překročí limit na předpis léků. Vyplývá to z nálezu Ústavního soudu (ÚS) ve sporu pražské lékařky Marty Böhmové a Zdravotní pojišťovny Ministerstva vnitra (ZPMV) ČR o sankci 5146 korun za překročení limitu na léky ve 2. čtvrtletí 2004. Případem se musí znovu zabývat Městský soud v Praze. Bude řešit, zda lékařka skutečně poskytovala nezbytnou a neodkladnou péči, což v původním řízení vůbec nezkoumal.

Obrazok Podle ředitele ZPMV Jaromíra Gajdáčka mají pojišťovny ze zákona povinnost uplatnit srážky, když lékař neodůvodněně překročí limit. Za rozhodnutím svých revizních lékařů tedy stojí. Předseda sdružení praktických lékařů Václav Šmatlák rozhodnutí ÚS vítá, podle něj se proti srážkám brání řada lékařů. Ministerstvo zdravotnictví vyčká s reakcí na konečné vyjádření všech soudních instancí.

Ústavní soud odkázal na letošní stanovisko Nejvyššího soudu, který v jiném případě rozhodl, že pojišťovny by měly platit náklady na nezbytnou a odůvodněnou péči i tehdy, kdy byl překročen limit. Lékaři ale musejí být schopni před soudem prokázat, že náklady byly nezbytné a neodkladné.
„Z tohoto hlediska samozřejmě lze doporučit lékařům a zdravotnickým zařízením, aby svou dokumentaci velmi pečlivě vedli tak, aby se nedostali do důkazní nouze a mohli prokázat, že v tom daném konkrétním případě a v daném časovém období šlo o náklady, které byly naléhavé, nezbytné, nutné,“ řekl novinářům soudce zpravodaj Vojen Güttler. Dnešního vyhlášení nálezu se nezúčastnila lékařka ani zástupci pojišťovny.


„Ústavní soud rozhodl o konkrétní srážce pro konkrétní lékařku. Provedli jsme ji na základě závazného opatření ministerstva zdravotnictví. Paní doktorka překročila limit o 80 tisíc korun, vše jsme zrevidovali a dali jí regulační srážku 5000 korun, což bylo minimum možného,“ řekl ředitel Gajdáček. Podle něj byla pojišťovna k lékařce „velmi vstřícná“, srážky prý uplatňuje jen ve „výjimečných případech“.

„Pokud je paní doktorka přesvědčena, že chybu neudělala a nemohla postupovat při léčbě jinak, tak je dobře, že se brání,“ řekl Šmatlák. Nemyslí si, že tento jeden případ spustí lavinu žalob, ale doufá, že pojišťovny „zpozorní a budou postupovat při srážení peněz uvážlivěji“. Podle Šmatláka se pojišťovny mnohdy nechtějí zabývat konkrétním případem, berou suchá čísla, a kdo přesáhne limit, dostane pokutu. „Neberou v úvahu, že lékař léčí pacienty,“ poznamenal.

Böhmová podala na pojišťovnu žalobu kvůli neoprávněnému majetkovému prospěchu a peníze chtěla zpět. Obvodní soud pro Prahu 10 nejprve lékařce vyhověl. Odvolací Městský soud v Praze rozsudek změnil a žalobu zamítl. Podle městského soudu pojišťovna vybrala srážku za překročení úhrad za léky v souladu s právními předpisy a není důvod sumu vracet lékařce.

Lékařka v úspěšné stížnosti nezpochybnila ústavnost určité regulace úhrad za péči. Zároveň ale tvrdila, že ve sporném období poskytovala pacientům jen nezbytnou a odůvodněnou péči, a to bez zbytečných nebo přehnaných nákladů. Lékařka se domnívá, že kvůli srážce vlastně zaplatila za léčení části pacientů ona sama místo jejich pojišťovny.
Podle Güttlera Městský soud v Praze zcela ignoroval argumenty, které lékařka uplatňovala ve smírčím řízení s pojišťovnou i v soudním sporu. „Bude tedy třeba, aby je znovu zvážil a eventuálně doplnil důkazy o tom, zda v daném případě opravdu bylo naléhavé a nezbytné to, co lékařka udělala a v důsledku čehož překročila léčebnou preskripci,“ uvedl Güttler.

zdroj: ČTK, zdn.cz, pôvodne tu
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