Urgência e Emergência. Os conceitos frente às normas administrativas e legais e suas implicações na clínica médica.

Abstract

The emergency and the urgent situation present distinct concepts for those who provide medical service, for those who receive it, for those who pay for it and for those who legislate on the matter. Conceptual distinctions found in prepaid health plan legislation and in administrative regulations require that the health professional, in his requests for exams, procedures, and hospitalizations, extensively describe the clinical situation, to prevent the situation where the patient is left with the burden of proving his need for prompt healthcare to the health care provider or in court. This is because Federal Law 9.656 restricted the concept of urgency to situations of personal accidents and gestational complications and excluded situations of intense suffering from emergencies. It expanded, however, the concept of emergencies so that the health plan has to cover cases where there is a risk of irreparable damage to the patient. It provided an extended definition for immediate treatment, which could be offered within 24 hours. The studied jurisprudence indicated the importance of medico-legal documents for characterizing the clinical condition of the patient and guaranteeing his rights with respect to his health plan contract.