Opinion – Rômulo Saraiva: Specialist doctor for STF minister, but not in the INSS environment

It is common sense that a specialized professional is usually better able to assess the problem compared to the one who solves everything. In the medical field, it is no different.

It is for no other reason that those who are sick usually go to the specialist. In the Federal Supreme Court this reasoning does not prosper.

The decision given by Minister Dias Toffoli in the judgment of the extraordinary appeal 635.109/EC removes the Federal Public Ministry’s claim that the medical expertise promoted by the INSS would be carried out by a professional specialized in the area of ​​the respective disease.

According to the STF minister, the more extensive the general medical knowledge, the better the quality of the evaluation. If Toffoli really believes this, he is acting against what he wrote in his decision.

In March, when dealing with an esophageal hernia, in the “do as I say but not as I do” style, the minister insisted on consulting and operating with Antônio Macedo, a specialist physician renowned in the world for surgery on the digestive system, an area that affects the minister’s health problem.

With this judgment, INSS policyholders will not have the same luck as the minister in being evaluated by a specialist doctor.

For Toffoli, within the social security agencies there is no problem with the insured person with different health problems being analyzed by a general practitioner or even a specialty other than the pathology that justifies the request for the social security benefit.

In the public civil action, filed by the Federal Public Prosecutor’s Office, the objective was to give the worker the right of an assessment in the social security expertise with greater precision.

Carrying out medical expertise, without requiring any technical qualification from the professional, is, according to the Public Prosecutor’s Office, “insufficient to verify, with the rigor that the measure requires, the real conditions of the beneficiary to return to work or not”, which may increase the risk of be wrongly denied the benefit.

If the decision were successful, the INSS would have to hire more doctors, since in the current model it is optional for the worker to be evaluated by a specialist or not.

The number of medical experts registered with the INSS no longer absorbs the demand, especially for disability benefits.

Currently, the federal medical expertise has about 3,400 professionals. The last strike, in May, generated an accumulation of 1 million people waiting for expertise, with one of the points of the wall movement being the requirement for a public tender for the category.

If haste is the enemy of perfection, the volume of pending issues can also affect the quality of expertise, especially from now on, as the decision relieves the INSS from worrying about assistance by a specialist, which could increase the chance of error in the evaluation.

By denying the class action, Toffoli endorses the argument that the precarious structure of the INSS would not accommodate so many specialists: “always requiring the appointment of a specialist for each pathology alleged by the insured would imply, in most cases, the need to carry out several expert examinations in the same process, because, in most cases, there are numerous complaints of pathologies of different natures”.

The minister recalled that there are 54 specialties officially recognized by the Brazilian Medical Association and, therefore, it would be unfeasible to compose a body of experts with at least one representative from each of them.

The determination of the working capacity of the beneficiaries must be judicious, even in cases of association of diseases as the basis for requesting the benefit.

The mere establishment of an administrative process for expert evaluation is not reasonable, but rather that in this process it is ensured that the beneficiaries will be evaluated by professionals with expertise in the areas of their disabilities, such as ophthalmologists, orthopedists, psychiatrists, neurologists, etc.

Regardless of the fact that the INSS does not have a satisfactory number of experts, or an adequate physical structure that can expand the expert ceremony, the insured person must not be harmed by these historical ills of the autarchy.

Like Minister Toffoli, who sought out a renowned specialist to deal with his esophageal problem, the insured would also like to be assisted in the federal public service by a professional specialized in his respective health problem.

This gives the insured greater security and can avoid injustices, such as having the benefit unfairly denied due to a bad medical evaluation.