AC Camargo cancer hospital renews contract with more restricted services to the SUS

The AC Camargo hospital renewed its contract with the City of São Paulo for another 12 months and will continue to serve cancer patients from the SUS, but under more restricted conditions than before.

Last August, the Sheet revealed that the institution, with 70 years of tradition in cancer treatment, had decided not to renew the contract with the municipality due to the discrepancy in the SUS table. The state government even announced that it would provide additional funding, but this did not happen.

The agreement with the municipality was signed on December 9. The number of new vacancies increased from 96 to 124, but they are now focused on five types of cancer: lung, brain, eye, bone marrow and liver (in the last two, treatments involve transplants). The previous list also included tumors of the head and neck and abdomen.

The new contract provides for an amount of resources of R$ 54 million, R$ 19 million above the amount paid by the city hall in 2022 (R$ 35 million). The justification is that, in addition to the increase in vacancies, 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 institution says it 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 reduction in the deficit also occurs because the institution discharged nearly 2,000 SUS patients from oncology. In early 2022, there were 6,500; now there are 4,498 enrolled.

According to Victor Piana de Andrade, CEO of ACCamargo Cancer Center, the hospital had 130,000 SUS patients throughout its history. “Since 1953, we opened the medical records and never closed them. We did our homework, saw who had been cured for ten years, who had lost their bond more than five years ago, and we discharged the patients.”

The contract also stipulates that SUS patients will remain at the institution until discharge from cancer, but any urgent and emergency care they need will be carried out by the UPA Vergueiro, located close to the institution.

Andrade says that all patients have already been informed about the changes and that the UPA medical team underwent training to recognize, through signs, symptoms and tests, which emergency situations are related to cancer and which are not.

“When it is an oncological issue, the UPA transfers that patient to the AC, we admit and take care of him here. When it is not, the UPA gives the normal destination that it would give to any other patient.”

He says that, before, there were situations in which patients at the institution fell off a motorcycle, suffered a burn, had worsening kidney failure or complications from diabetes, for example, and went straight to the emergency room at AC Camargo. Due to lack of vacancies in general hospitals, the hospital ended up admitting them.

According to the Atlas of Cancer Care Centers, by the Oncoguia Institute, 53% of the public resources received by AC Camargo in 2021 went to oncology. The rest went to treat other health issues of the cancer patient.

“We felt harmed because our mission is oncology, our resource is not infinite and I need to use it for the oncology cause”, says Andrade.

According to the CEO, the alternative presented to the city hall to maintain the agreement was that AC Camargo would continue to take care of patients —with surgeries, radio and chemotherapy—, but, when the cancer treatment was finished, they would be referred 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 finished, Icesp returns them. them for the municipality to continue taking care of.”

According to Andrade, this situation of the hospital taking on non-oncological care for patients was worse than the discrepancy in the SUS table, from the point of view of the institution’s financial sustainability.

“It’s not the oncological treatment, the chemotherapy, the radiotherapy, the big problem. It’s the prolonged hospital stay. And when we do that for non-oncological cases, there’s a conflict with the foundation [Antonio Prudente, mantenedora do hospital]which is aimed at cancer.”

Regarding the fact that the new vacancies are restricted to five types of cancer, Andrade says that AC Camargo presented the Municipal Health Department with a list of tumors that could be treated by the institution, and it was the city hall that decided which of them would enter the new contract.

In a note, the Municipal Health Department says that option was given because the care offered by the hospital in neuro-oncology, pneumological oncology, ocular oncology and onco-hematology are the only references of the municipal network in these areas.

The folder also informs that it has used all the necessary efforts to guarantee the maintenance of the treatment of cancer patients in the municipal network. He also remembers that, in May 2022, the Bruno Covas Oncological Center was inaugurated, which offers highly complex treatment, including robotics, unprecedented in a municipal hospital of the SUS.

“The unit has outpatient capacity to treat 10,000 patients per month, in addition to performing 8,000 radiological exams and 450 surgeries,” he said. Asked about the current queue of SUS patients waiting for diagnoses and treatments in the municipality, the secretariat did not respond.

Last year, among the nearly 2,000 people who were discharged from cancer at AC Camargo was Luciana Magri, 48, from Praia Grande (São Paulo coast), with a neuroendocrine tumor and metastases in the lung, liver and pancreas, who was undergoing palliative care. A patient at the hospital since 2007, she received the notice by email.

After filing a lawsuit, she won, in the first instance, the right to remain being attended at AC Camargo and compensation for moral damages of R$ 5,000. The hospital appealed against the decision arguing, among other things, that, because 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 lives.

“It has been an exhausting process. The oncology doctor 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 reassessment, based on clinical and institutional protocols, and the previous decision to discharge cancer was considered correct.