SN: pomoc zagrożonemu pacjentowi jest ważniejsza niż limity budżetowe

Sąd Najwyższy orzekł, że NFZ ma refundować zabiegi niezbędne ze względu na zagrożone zdrowia lub życie (I CSK 161/13). Kwestia wynikła w sprawie Fresenius Nephrocare Polska, świadczeniodawcy zzakresu dializoterapii i leczenia chorób nerek.

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table.MsoNormalTable\{mso-style-name:Standardowy;\mso-tstyle-rowband-size:0;\mso-tstyle-colband-size:0;\mso-style-noshow:yes;\mso-style-priority:99;\mso-style-parent:"";\mso-padding-alt:0cm 5.4pt 0cm 5.4pt;\mso-para-margin-top:0cm;\mso-para-margin-right:0cm;\mso-para-margin-bottom:10.0pt;\mso-para-margin-left:0cm;\line-height:115%;\mso-pagination:widow-orphan;\font-size:11.0pt;\font-family:"Calibri","sans-serif";\mso-ascii-font-family:Calibri;\mso-ascii-theme-font:minor-latin;\mso-hansi-font-family:Calibri;\mso-hansi-theme-font:minor-latin;\mso-fareast-language:EN-US;}</style><![endif]Firma domaga się od NFZ 895 tys. zł za 2162 zabiegi wykonane w trzech stacjach dializ na Podkarpaciu ponad limit z umowy z NFZ na 2010 rok. Opiewał on na nieco ponad 11 mln zł i okazał się zbyt niski.

Rzeszowskie sądy Okręgowy i Apelacyjny zasądziły żądaną kwotę. Wykazały, że nie było innych stacji dializ w rozsądnej odległości, a dowóz pacjentów rodzi zagrożenia. Narodowy Fundusz Zdrowia nie kwestionował liczby nadwykonań ani ich wyceny. Nie godził się natomiast na obciążenie go zabiegami wykonanymi ponad limit.

Sąd Najwyższy nie podzielił stanowiska Funduszu i uznał, że dializoterapia to świadczenie ratujące życie, za które NFZ musi zapłacić.

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