The AC Camargo hospital has renewed its contract with the city of São Paulo for another 12 months and will continue to serve the cancer patients of the SUS, but under more limited conditions than before.
Last August, the Sheet revealed that the body, with a 70-year tradition in cancer care, had decided not to renew its contract with the municipality due to the discrepancy in the SUS schedule. The state government even announced that it would provide additional funding, but this did not happen.
The agreement with the municipality was signed on 9 December. The number of new vacancies has risen from 96 to 124, but they are now focused on five types of cancer: lung, brain, eye, bone marrow and liver (the last two treatments involve transplants). The previous list also included head and neck and abdominal cancers.
The new contract provides for an amount of resources of R$ 54 million, R$ 19 million more than what was paid by the city hall in 2022 (R$ 35 million). The justification is that, in addition to the increase in vacant posts, the cost of the first year of treatment is much higher than in subsequent years.
In the previous model, the hospital’s deficit with SUS services reached R$ 98.5 million. To close the accounts, the institute claims to have used resources from private services. Now, the deficit is R$ 9 million. The hospital’s net revenue in 2021 was BRL 1.32 billion.
The shortfall also occurs as the institution discharged nearly 2,000 SUS patients from oncology. At the beginning of 2022 there were 6,500; now there are 4,498 members.
According to Victor Piana de Andrade, CEO of ACCamargo Cancer Center, the hospital has had 130,000 SUS patients throughout its history. “Since 1953, we’ve opened medical records and never closed them. We’ve done our homework, seen who has been cured for ten years, who has lost their bond more than five years ago, and we’ve discharged patients.”
The contract also stipulates that SUS patients will remain at the institution until they are discharged from the cancer, but any urgent and emergency care they will need will be carried out by UPA Vergueiro, located near the institution.
Andrade says all patients have already been informed of the changes and that the UPA medical team is trained to recognize, through signs, symptoms and tests, which emergency situations are related to cancer and which are not.
“When it’s an oncological problem, UPA transfers that patient to the AC, we hospitalize and treat him here. When it’s not, UPA gives the normal destination it would give any other patient.”
He says that, before, there have been situations where patients at the institution have fallen off a motorcycle, suffered a burn, had worsening kidney failure or complications from diabetes, for example, and gone straight to the first aid of the AC Camargo. Due to lack of vacancies in general hospitals, the hospital ended up admitting them.
According to the Oncoguia Institute’s Atlas of Cancer Care Centers, 53% of the public resources received by AC Camargo in 2021 went to oncology. The rest went to treat the cancer patient’s other health problems.
“We felt damaged because our mission is oncology, our resource is not infinite and I need to use it for the cancer cause,” Andrade says.
According to the CEO, the alternative presented to the municipality to maintain the agreement was that AC Camargo would continue to take care of the patients —with surgery, radio and chemotherapy—, but, once the cancer treatment was over, they would be directed to other institutions.
“It is a model that the state already adopts. Many small municipalities cannot take care of cancer, patients come to Icesp (Cancer Institute of the State of São Paulo), for example, and, when the treatment is over, l ‘Icesp gives them back. of them so that the municipality continues to take care of them”.
According to Andrade, this situation of the hospital assuming non-cancer care for patients was worse than the discrepancy in the SUS table, from the point of view of the financial viability of the institution.
“It’s not the cancer treatment, the chemotherapy, the radiation therapy, that’s the big problem. It’s the extended hospital stay. And when we do it for non-cancer cases, there’s a conflict with the foundation.” [Antonio Prudente, mantenedora do hospital]that targets cancer.”
Regarding the fact that new vacancies are limited to five types of cancer, Andrade says AC Camargo has submitted a list of cancers that could be treated by the institution to the municipal health department, and it was the city hall that decide which of them would enter the new contract.
In a note, the Municipal Health Department states that the option was given because the treatments offered by the hospital in neuro-oncology, pulmonary oncology, ocular oncology and onco-hematology are the only references of the municipal network in these areas.
The dossier also informs that all the necessary efforts have been made to ensure that the treatment of cancer patients is maintained in the municipal network. He also recalls that, in May 2022, the Bruno Covas Oncological Center was inaugurated, offering highly complex care, including robotics, unprecedented in a municipal hospital in the SUS.
“The unit has an outpatient capacity to treat 10,000 patients a month, as well as perform 8,000 x-ray exams and 450 surgeries,” he said. When asked about the current queue of SUS patients waiting for diagnosis and treatment in the municipality, the secretariat did not reply.
Last year, among the nearly 2,000 people discharged from cancer at AC Camargo was Luciana Magri, 48, from Praia Grande (São Paulo coast), with a neuroendocrine tumor and metastases to the lung, liver and pancreas , who was undergoing palliative care . You have been a patient in the hospital since 2007, you received the notification by e-mail.
After filing a lawsuit, she won, in the first instance, the right to remain assisted at AC Camargo and compensation for moral damages of R $ 5,000. The hospital appealed the decision arguing, among other things, that since Luciana is in palliative care, Luciana no longer needs to be linked to the institution and that she could be assisted in the municipality where she resides.
“It was an exhausting process. The oncologist who continues to see me is the same one who discharged me. An animosity has been created that is difficult for me from a psychological point of view,” he says.
According to ACCamargo, the patient’s medical record underwent a careful review, based on clinical and institutional protocols, and the previous oncology discharge decision was deemed correct.
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