The procedure for reimbursement of expenditures for the acquisition of medical products by a Gaucher disease patient complies with the Satversme
The Constitutional Court has adopted a decision in the case, in the frameworks of which it examined compliance of norms that provide for procedures of reimbursement of expenditures for acquisition of medical products with the Satversme (Constitution) of the Republic of Latvia (case No. 2009-12-03 “On Compliance of the Words “the Reimbursement of Expenditures for the Acquisition of Medical Products and Medical Devices” of the Second Sentence of Para 92, the Words “Except for the Case Referred to in Sub-Paragraph 100.1” of Para 94, the Words “not More than LVL 10 000 for One Patient within a Time Period of 12 Months” of Para 100 and the Second Sentence of Para 100.1 of the 31 October 2006 Cabinet of Ministers Regulations No. 899 “Procedures for the Reimbursement of Expenditures for the Acquisition of Medical Products and Medical Devices Intended for Out-patient Medical Treatment” with Article 93 and Article 110 of the Satversme (Constitution) of the Republic of Latvia”).
The applicant – Department of Administrative Cases of the Supreme Court – addressed the Constitutional Court when the first was examining a case on reimbursement of expenditures for the acquisition of medical products for a treatment course from 17 December 2007 to 16 December 2008 of a child who has been diagnosed the Gaucher disease. According to the applicant, the contested norms do not comply with Article 93 of the Satversme that guarantees the right to life, and Article 110 of the Satversme that provides for special support for disabled children. The contested norms establish that reimbursement of expenditures for the acquisition of medical products shall be granted in the frameworks of funding allocated for this purpose, and the amount of the compensation shall not exceed 10 000 lats per patient in the period of 12 months. If planned expenditures are higher, then the maximum amount of reimbursement per one package of medical products is established, whilst the difference is covered by the patient.
The Constitutional Court has established that the contested norms do not infringe the right to life. No duty of the State to provide everyone with free necessary medical products follows from the right to life.
The right to life is generally protected by establishing criminal and civil liability for killing a person, the killing of a patient included, if the death is caused by a doctor or a pharmaceutical chemist acting intentionally or through carelessness. However, in the case under review, the patient is not a victim of malicious activities or carelessness of doctors or pharmaceutical chemists, and his case is a hereditary genetic patalogy. The case contains no materials that would prove that the State could take certain measures to prevent the respective disease.
Moreover, in the case under review, no irreversible consequences would immediately occur if the person does not take the medicine. When the respective medical products were not yet invented, patients who were diagnosed the Gaucher disease already in childhood could reach mature years.
When examining the case, the Constitutional Court concluded that in 2009 and 2010 financing was allocated for treating children who are diagnosed rare diseases by providing in the laws on the State budget of the respective years that resources to fully cover the acquisition of necessary medical products shall be granted to treatment institutions, not to the patient. It is indicated in the judgment that taking into account high costs of medical products and economic possibilities of the State, it is not proportionate to ensure reimbursement of expenditures for the acquisition of expensive medical products to be used when undergoing outpatient treatment because this does not allow constant supervision of the patient by medical personnel who could differentiate doses of medical products in the result of an examination. In other states, too, patients receive medicaments to cure the Gaucher disease when undergoing inpatient treatment.
The Constitutional Court has recognized that the contested norms comply with Article 93 and 110 of the Satversme. However, the question whether, in the case under review, the action of public institutions when refusing reimbursing expenditures for the acquisition of medical products from 17 December 207 to 16 December 2008 was lawful, shall be solved in the frameworks of the particular proceedings of the administrative case. The result of the proceedings, however, cannot influence compliance of the contested norms with the Satversme.
The judgment of the Constitutional Court is final and not subject to appeal. The Judgment shall come into force on the date of publishing it in the newspaper “Latvijas Vēstnesis”.
Linked case: 2009-12-03