A session of Administrative court Turgovishte determined the requirements of NHIS to hospitals for two specialists per clinical path as unlawful. The requirements in question were introduced on 12.01.2010 with a letter from the acting Director of NHIS Alexander Ognyanov also signed by the Chairman of BDA. Then CZPZ pointed out that the introduction of such a requirement was unlawful and we advised the hospitals to seek their rights in court.  
The administrative lawsuit was filed after a claim from MBAL Popovo EOOD because of the refusal of the director of LHIS to engage in a contract for clinical paths numbers 217, 218, 222 and 223 because of the ' lack of two specialist orthopedists.' The motives of the court point out that neither the common nor the special conditions for signing contracts between NHIS and health institutions contain the requirement for the presence of two specialists. The court also assumed that it was unacceptable that with joint instructions from NHIS and BDA the legislation be amended and that the letter in question from the Director of NHIS and the Chairman of GB of BDA can not be the basis for refusal to sign a contract with the providers of medical services. Therefore with decision No 40/13.05.2010 Administrative court Turgovishte overturned the refusal of the Director of LHIS to engage in a contract with MBAL Popovo EOOD for clinical paths with numbers 217, 218, 222 and 223 due to improper application of material law rules. The LHIS has been sentenced to pay the expenses for the case. After the decision is in power MBAL Popovo EOOD can separately request that NHIS to pay compensation for missed opportunities as a result of the unlawful refusal to sign a contract.

Dispensing medicines to cancer patients has been a traditional hole in the work of the health administration. What we bumped into a couple of days ago however gives to the ministry of health a role that has not been known so far. Untill now we reckoned that the ministry of health is a type of state administration. It turned out that it works as a health institution as well. What is it all about? A cancer patient receives treatment at a Sofia university hospital. The leading doctor, a recognized academic, prescribes the medicine Alimpta considering it the best for the treatment of the patient. A Protocol is prepared and all necessary documents according to the rules of Regulation 34 and they have been duly sent to the ministry of health. And there - a surprise - the administrative body decided that the patient is not suitable for treatment with Alimpta but with Taxoter instead. According to what criteria and with what justification neither the patient nor the doctor knows. It is true that the MH has created many commissions that include doctors. That however does not change in any way the fact that it is a matter of administration and an administrative body. No matter how competent the doctors in the commissions are it is the least doubtable that they can determine the treatment of a patient without even seeing him and knowing his actual situation. And if it is somehow acceptable that by certain criteria the commission can refuse treatment with a certain medicine then it is absolutely absurd for the administration to 'prescribe' another medicine. If that is possible then is it not better to close all cancer dispensary clinics and the commissions of MH prescribe medicines to all patients? In that way a lot of money will be saved from doctors' salaries who are obviously not necessary for the health administration.

More and more often in practice we bump into a problem not known so far - waiting lists for receiving medical care. There are a significant number of health institutions that can not accept immediately patients for planned treatment and they inscribe them for admission after a certain period of time - weeks and even months.  
The situation with the medicines for cancer patients is the most dramatic. There the patients are forced to wait for months on end without having any clarity about the reason, the period of waiting and if they will receive their life-saving medicines at all. After the doctor prescribes the medicine to the cancer patient the latter has no idea where his protocol is , if it has been sent to MH, if it has been through the relevant commissions, if it has been approved or not , when he will receive the medicines. The lack of any information (protocol, number etc.) does not allow the patient to check any of the circumstances described above. Everybody in a certain position of power or with a sizable amount of money, having in mind this complete lack of transparency, could receive the necessary medicines before anybody else who does not have these opportunities regardless of the fact that this someone else could have waited for much longer to receive his medicines.

A session of Sofia city Administrative Court sentenced the Ministry of health to pay out a compensation of 10 1000 leva to Teodora Zaharieva for non-property damages that she suffered because the ministry did not fulfil its obligation to provide the medicine Zometa. This medicine is necessary for treatment of metastasised breast cancer. The court has accepted as determined that the ministry of health did not fulfil its obligation under Regulation 34 to provide the medicine and thus the patient suffered damages and it refuted the objection of the lawyer of the ministry of health that it was the fault of the pharmacy of the dispensary clinic that the medicine was lacking.  
The prosecution also has expressed its opinion on the justifiability of the claim. It has been the ninth case in a row that a court sentences the ministry of health for lack of medicines for cancer patients. Unlike other lawsuits judge Lubka Stoyanova displayed high professionalism and the case was dealt with and decided in one session.

Today, 28.04.2010, at the NHIS a working meeting was held with representatives of patients organizations. Ms Teodora Zaharieva and Mr Ivan Dimitrov from Bulgarian Patients' Forum, Ms Jeny Adarska - NPO, Mr Vladimir Tomov - CPH and Mr Plamen Taushanov - Bulagaian Association for protection of patients took part in the discussion.  
The topic of the discussion is the introduction a prescription fee for medicines that are subject of Regulation 10 of NHIS - i.e. medicines that are designated only for home treatment and are reimbursed at 100 %.  
D-r Albena Zlatareva explained that the introduction of a prescription fee is needed only for the months till the end of calendar year otherwise within two months NHIS will collapse financially and might stop paying for medicines. This measure will lower the expenditure of NHIS with approximately 25 million leva.