Hasil untuk "Medical legislation"

Kadriye Kart Yaşar

Throughout history, the physician’s legal and ethical approach to his/her patient has been debated, as has his/her professional competence. The treatment contract between the physician and the patient imposes certain duties and obligations on the physician. The physician’s professional competence, knowledge, and medical license are the grounds for the obligations of care and personal performance. In other words, the physician must both be medically successful and observe the rights of his/her patient. This study was designed to inform and raise awareness among physicians about legal responsibilities, of which they are often not consciously aware. Relationships that give rise to rights and responsibilities within the scope of patient -physician law are based on contract, tort, or public service. For this reason, the physician-patient relationship (PPR) has two important legal bases: the Law of Obligations and Administrative Law. In the study, the legal regulations in our country have been briefly compiled, and examples of legal liability in different countries, based on this legislation, have also been addressed. The relationship between the physician and the patient, based on contract and tort, is regulated by the Law of Obligations, whereas the public service relationship is regulated by the Administrative Law in our country. Under the power-of-attorney contract, which is the legal basis for the PPR, physicians face compensatory, criminal, and disciplinary liability for their medical acts. Therefore, physicians must act with medical, ethical, and legal responsibility towards their patients.

Александр Александрович Лебедев, Людмила Салчаковна Эрдыниева

The article considers issues related to the formation and extraction of profit from the implementation of medical activities by economic entities in the healthcare sector. The issues of administrative influence of the state on the activities of medical organizations of various forms of ownership that carry out entrepreneurial activities in the medical services market are analyzed. Legislative, organizational, economic aspects of medical activities are considered for the purpose of forming and extracting profit in accordance with legislatively established sources of financing in the healthcare sector. The methodological basis of the study is general scientific and specific scientific methods, such as formal-legal, analytical, system analysis, statistical, economic. The scientific novelty of the work lies in the conclusions proposed by the author based on the results of the study. Based on the analysis of the norms of the current legislation, it is concluded that at the current time, profit from medical activities can be extracted by economic entities in the healthcare sector when providing consumers with paid medical services. The author expresses the point of view that the principles of financial support in the sphere of public health protection, currently established within the framework of compulsory medical insurance and budget financing, do not provide for the possibility of making a profit from medical activities, which is the result of the social policy pursued by the state in the sphere of public health protection.

Taisiya V. Yudina, Marina M. Khairlapova

The article examines the relationships between salt producers and workers in the salt industry concerning insurance issues. Protecting the life and health of workers in the early 20th century was an intractable problem for Russian enterprises, and the number of accidents, caused by poor sanitary and technical conditions, was increasing. However, the owners did not pay due attention either to the improvement of sanitary and technical conditions or to occupational safety. The level of workers’ understanding of occupational safety remained very low. Using the comparative historical method, the authors were able to identify trends in the development of state policy on the “labour problem” in the salt fields of the Astrakhan Province. The study demonstrates that the legislation in the salt industry was the main lever regulating the relationships between salt producers and workers in matters of the working and living conditions of the latter. The mechanism of operation of certain articles of the law of June 2, 1903 in the salt industry is presented using concrete examples. In addition, the paper looks at compliance with the law of June 23, 1912 on insuring workers against accidents in the salt fields of the Astrakhan Province. The authors conclude that the insurance system of the Russian Empire, which took shape in the early 20th century, showed positive results. In compliance with the state legislation, in case of occupational accidents resulting in injury or death of workers, salt producers of the Astrakhan Province paid benefits and onetime remunerations to workers or their family members, which allowed those affected to receive medical treatment and maintain an acceptable standard of living.

Mehrab Valizadehderakhshan, A. Shahbazi, Masoud Kazem-Rostami et al.

Cannabis plant has long been execrated by law in different nations due to the psychoactive properties of only a few cannabinoids. Recent scientific advances coupled with growing public awareness of cannabinoids as a medical commodity drove legislation change and brought about a historic transition where the demand rose over ten-fold in less than five years. On the other hand, the technology required for cannabis processing and the extraction of the most valuable chemical compounds from the cannabis flower remains the bottleneck of processing technology. This paper sheds light on the downstream processing steps and principles involved in producing cannabinoids from Cannabis sativa L. (Hemp) biomass. By categorizing the extraction technology into seed and trichome, we examined and critiqued different pretreatment methods and technological options available for large-scale extraction in both categories. Solvent extraction methods being the main focus, the critical decision-making parameters in each stage, and the applicable current technologies in the field, were discussed. We further examined the factors affecting the cannabinoid transformation that changes the medical functionality of the final cannabinoid products. Based on the current trends, the extraction technologies are continuously being revised and enhanced, yet they still fail to keep up with market demands.

Abby L. Nerlinger, Debra L. Best, Anita Shah

D. Czarnecki, Danielle Bessett, Hillary J. Gyuras et al.

This study examines an underexplored source of medical uncertainty: the political context of care. Since 2011, Ohio has passed over 16 abortion-restrictive laws. We know little about how this legislation affects reproductive health care outside of abortion clinics. Drawing on focus groups and interviews with genetic counselors and obstetrician-gynecologists, we examine how abortion legislation impacts their work. We find that interpretation and implementation of legislation is not straightforward and varies by institution and region of the state. An ever-changing legislative landscape combined with uneven implementation of restrictions into policy produces uncertainty in reproductive health care. We also found uncertainty about the legal consequences of abortion in restrictive contexts, with obstetrician-gynecologists reporting greater concerns given their proximity to care provision. We argue that uncertainty can result in stricter interpretations of regulations than necessitated by the law, thereby amplifying the impacts of an already restrictive context for abortion care.

L. Aiken, D. Sloane, Jeannie P. Cimiotti et al.

Priyamvada Paudyal, Sharada Prasad Wasti, Pimala Neupane et al.

Introduction: Migrant workers support low- and middle-income economies through remittances, often bearing considerable health risks with long-term consequences. This study aims to understand the health and wellbeing issues of Nepalese migrant workers in Gulf Cooperation Council (GCC) countries, a major destination for low-skilled Nepalese workers. Methodology: We conducted a mixed-methods study in Dhading district of Nepal. A pilot survey was carried out with returnee migrants from GCC countries to understand key health and wellbeing issues faced by workers. In addition, in-depth interviews were conducted with a subset of these returnee migrants and their families, and related stakeholders. These aimed to understand broader societal and policy implications in relation to labour migration. Quantitative data from the survey were analysed using descriptive statistics and thematic analysis was used for qualitative interviews. Results: 60 returnee migrants (58 males, 2 females) took part in the survey (response rate, 100%). Median age of the survey participants was 34 (IQR, 9) years and 68% had completed school level education. Returnee migrants reported suffering from various physical and mental health issues during their stay in GCC countries including cold/fever (42%), mental health problems (25%) and verbal abuse (35%). 20 participants took part in the qualitative study:10 returnee migrants (8 males, 2 females), four family members (female spouses) and six key stakeholders working in organizations related to international migration. Interview participants reported severe weather conditions resulting in physical health problems (e.g. pneumonia, dehydration and kidney disease) as well as mental health issues (including anxiety, loneliness and depression). Participants raised concerns about the usefulness and appropriateness of pre-departure training, and the authenticity of medical tests and reports in Nepal. Female migrants reported facing stigma after returning home from abroad. Language difficulties, alongside issues related to payment, insurance and support at work were cited as barriers to accessing healthcare in destination countries. Conclusion: Our study shows that Nepalese migrant workers experience severe weather conditions and suffer from various physical and mental health issues, including workplace abuse and exploitation. The study highlights an urgent need for strategies to enforce compulsory relevant pre-departure orientation and appropriate medical screening in Nepal, and fair employment terms and full health insurance coverage in destination countries. Greater collaboration between the Nepalese government and GCC countries is needed to ensure necessary legislation and regulatory frameworks are in place to safeguard the health and wellbeing of migrant workers.

S Singh

Ethical guidance in research is underpinned by the need to show respect for study participants by upholding autonomy in participant decision-making, and confidentiality and protection of individual rights, privacy and interests, yet decision-making could also be influenced by the participant’s sociocultural and belief systems. This calls for a more Africanised approach to research ethics where these values and beliefs are upheld. While national and international ethics guidelines do exist, there is little evidence that such a paradigm shift in research ethics is adequately interrogated in the teaching and learning curricula in higher education, where research skills are developed and nurtured. Critical reflection is used to highlight opportunities to stimulate learning and debates underpinned by humanised pedagogy in higher education.

Vladimir V. Gonchar, Vladimir D. Povolotsky

The article examines Japanese medical practice in the territory of the Chinese Eastern Railway (CER or KVZhD) during its construction and operation. The archival material made it possible to find that the Japanese community was eager to take responsibility for providing medical care to its subjects independently. They achieved this by attracting national physicians whose activities were built on the principles of private medical practice. The provision of medical care followed the principles of Western medicine, although traditional medicine methods were not excluded. The Russian authorities allowed Japanese doctors to maintain their practice in the Russian-controlled territories, but medical care was provided only to their compatriots, as well as to the Chinese and Korean population. However, the activities of Japanese doctors were treated with distrust and wariness in Russian society, both due to the migrants’ low level of education and due to the existing narrative about the so-called “Yellow Peril.” Another aspect of the activities of Japanese physicians in Manchuria was the familiarization of the local population with European medicine methods. To achieve this, private, public, and charitable Japanese medical institutions were established. The difficult epidemiological situation in Manchuria, sanitary problems, socio-economic problems, requirements of Russian legislation, inter-faith divisions, and language barriers raised issues for the territorial communities’ leaders on increasing the availability and quality of health care for their compatriots. The initiatives and proposals of the Japanese community to open public hospitals in Manchuria, centralized medical examinations, strict sanitary procedures, and quarantine measures were supported by the Japanese central authorities. They were considered not only as elements of civilization and colonial ambitions but also as a means of social control not only over Japanese subjects.

Л. Стрижак, І. Анікін

Assessment of renal function in newborns is extremely important and at the same time challenging due to the unique body structure, increased vulnerability and rapid growth of the latter. However, for the early detection of acute kidney injury (АКI), rational dosing of drugs and safe drug therapy, the identification of early markers of renal dysfunction is essential. The objective is to evaluate the prognostic value of serum biomarkers for the early diagnosis of АКI in newborns with hypoxic-ischemic encephalopathy against the background of therapeutic hypothermia and preventive use of methylxanthines. Materials and Methods. A single-center, prospective, randomized trial involving 44 neonates with АКI requiring therapeutic hypothermia and prophylactically receiving caffeine citrate or theophylline to prevent АКI progression was conducted in from 2019 to 2022 on the basis of the NICU of Zaporizhzhia Regional Clinical Children's Hospital. Laboratory analysis of blood serum samples was performed on day 1, day 3 and 5 from birth, creatinine (Cr) and cystatin C (CysC) levels and their associations with the development of АКI were determined according to the neonatal criteria of the 2012 KDIGO guideline. Statistical analysis was performed using Statistica 13.0 program, TIBCO Software Inc. (license number JPZ804I382130ARCN10-J) and Microsoft Excel 2013 (license number 00331-10000-00001-АА404). The probability of the difference in absolute values of mean values was determined using non-parametric methods of statistical analysis: the Mann-Whitney U-Test for unrelated groups and the Wilcoxon signed-rank t test for related groups. Statistical significance was defined as p < 0.0500. The study was performed in accordance with the moral and ethical standards established by the IGH / GCP guidelines, the World Medical Association Helsinki Declaration, adopted in 1964 and amended in 1975, 1983, 1989, 1996 and 2000, The European Convention of Human Rights and Biomedicine and the legislation of Ukraine. The protocol was approved by the Medical Ethics Commission at Zaporizhzhia State Medical University. The study was performed as part of the research project "Optimization of diagnostics and intensive care of polyetiologic lesions of the brain, gastrointestinal tract, and kidneys in newborns and older children" (State registration number O118U007142) of the Pediatric Surgery and Anesthesiology Department of the State Institution "Zaporizhzhia State Medical University of the Ministry of Health of Ukraine." Results and their discussion. In general, AKI according to KDIGO developed in 5.00 (11.36 %) neonates out of 44.00 (100.00 %), stage 0 was found in 39.00 (88.64 %). 4.00 (9.09%) newborns had stage I, and 1 (2.27%) developed stage II; the data obtained were similar: p = 0.7872; U = 230.00. None of the patients progressed to stage III. In the newborns with preserved renal function during the study there was a decrease in Cr and a predictable, by this marker, increase in GFR. A statistically significant increase in Cr level and decrease in GFR was found in the newborns with renal dysfunction on days 3 and 5 of the study. Cr level progressed from baseline 1.07 (0.87; 1.10) mg/dl to 1.13 (0.86; 1.25) mg/dl on day 3 and to 1.40 (1.15; 1.82) mg/dl on day 5, while GFR decreased from 19.76 (19.07; 22.90) ml/min/1.73m2 to 17.97 (13.84; 24.42) ml/min/1.73m2 on day 3 and was 12.38 (11.12; 17.54) ml/min/1.73m2 on day 5, with p < 0.0500. CysC progressively decreased in the neonates without AKI from 2.50 (2.20; 2.60) ng/ml to 2.25 (2.08; 2.49) ng/ml, p = 0.0095; while in the neonates with AKI the level of this marker did not change and was 2.56 (2.41; 2.70) ng/ml on day 1 and 2.42 (1.89; 2.45) ng/ml on day 5, p = 0.2963. As this marker changed, eGFR (CysC) increased progressively in the cohort of patients without kidney damage but did not change in the other group. The diuresis rates in the newborns of both groups did not differ, being ≥ 1.5 ml/kg/h, which is probably due to methylxanthine therapies, p ≥ 0.0500. Conclusions. CysC assessment did not provide additional information on the development of acute kidney injury in neonates (nAKI) in the first 5 days of life, which would have allowed a quick decision to change the intensive care program. Further studies involving newborns who did not receive prophylactic therapy are needed.

Annie Sigognault Flochlay, E. Thomas, O. Sparagano

The poultry red mite, Dermanyssus gallinae, has been described for decades as a threat to the egg production industry, posing serious animal health and welfare concerns, adversely affecting productivity, and impacting public health. Research activities dedicated to controlling this parasite have increased significantly. Their veterinary and human medical impact, more particularly their role as a disease vector, is better understood. Nevertheless, red mite infestation remains a serious concern, particularly in Europe, where the prevalence of red mites is expected to increase, as a result of recent hen husbandry legislation changes, increased acaricide resistance, climate warming, and the lack of a sustainable approach to control infestations. The main objective of the current work was to review the factors contributing to this growing threat and to discuss their recent development in Europe. We conclude that effective and sustainable treatment approach to control poultry red mite infestation is urgently required, included integrated pest management.

Seda İrem Çakırca Yüceoğlu

Vaccine hesitation, described by theWHOas “delay orrefusal in the acceptance of vaccines notwithstanding the availability of vaccine services” and vaccine refusal, defined as the rejection of all vaccines, have been documented in more than 90% of the world’s countries. In Turkey, some parents are increasingly rejecting vaccination of infants. These vaccines are essential to prevent the emergence of preventable diseases, especially in infants, and to prevent deaths caused by these diseases. The discussion of making vaccinations compulsory after the Covid-19 pandemic made it important to reexamine the necessity of infancy vaccinations. In its Halime Sare Aysal decision regarding infancy vaccination in 2015, the Constitutional Court found legal representatives of infants who refuse to consent to infancy vaccination practices to be a violation of rights. However, contrary to the Constitutional Court decision’s reasoning, when the issue of whether to give consent that will make the medical intervention lawful is taken into consideration within the framework of the scope of limitation of the right of custody and “best interests of the child,” mandatory vaccination debates will cease to be a typical constitutional law debate. In the first part of this study, the regulation of infancy vaccination practices in comparative law will be discussed. Furthermore, in the second part, the legislation regarding infancy vaccination practices in Turkey and the position of the national and supranational judiciary will be examined. In the last part, the refusal of the legal representative of the infant to consent to medical intervention will be analyzed in the context of limiting or removing the right of custody on the basis of the best interests of the child.

Izabel Vianna Villela, Miriana da Silva Machado

New Approach Methodologies (NAMs) are any non-animal-based approaches that can provide information in the context of chemical hazard and safety assessment. The goal is to develop information with equivalent or better scientific quality and relevance than that provided by traditional animal models. Starting with ethical issues, these approaches are gaining regulatory relevance in different global agencies. Since 2008, with the enactment of the Arouca Law—the first Brazilian legislation dedicated to laboratory animals, NAMs are gathering pace in Brazil’s regulations. Specific regulations from different sectors include the acceptance of these new methods. However, some regulation is controversial about what is needed to address specific toxicological endpoints. The resulting regulatory uncertainty induces companies to keep on adopting the traditional methods, slowing NAM’s development in the country. This work brings a perspective on the regulatory acceptance of NAMs in Brazilian Legislation for the registration of pharmaceuticals, medical devices, food/supplements, and agrochemical products. This text discusses the main issues of NAM adoption for each specific regulation. Therefore, legal acceptance of NAMs results in Brazil is still a process in progress. A collective effort including regulators, industry, contract research organizations (CROs), and the academic environment is needed to build regulatory confidence in the use of NAMs.

Pimonov V.A., Delibalt V. V., Dvoryanchikov N.V. et al.

Psychological, medical and educational committees (PMECs) represent a unique type of work carried out by their interdisciplinary teams of specialists and aimed at children and adolescents. Being a part of the educational system, PMECs also belong to the system of prevention of crime among minors. However, existing legislation needs serious reconsideration within the context of activity arrangement of the committees, as well as harmonization of the problem domain thesaurus. The article analyzes controversial issues in legislative regulation of PMEC’s activities in the context of defining specific educational conditions when referring minors to the system of specialized open and closed teaching and educational facilities. We proposed and substantiated the list of documents required for a child being referred to the examination by a PMEC. On the basis of the analysis we justify the recommendations for closing the legislative gaps in regulation of PMECs, which are relevant both to the educational system and to the system of prevention of lawbreaking among minors – all with the inter-agency cooperation in mind.

LV V Puzyreva, AV V Mordyk, TL L Batishcheva

Aim - to identify the main social and medical problems of a patient with tuberculosis (TB) and his family that are connected with the economic changes in the country. Materials and methods. We conducted a solid sociological study involving 200 new TB cases during hospital treatment. The analysis of the obtained data was performed. Results. Only one third of the patients were married, even fewer were officially employed. About half of the patients had unrecorded employment, which caused some problems. These patients showed decreased motivation for long-term hospital and sanatorium treatment, as they were afraid of losing their jobs. For the majority of the patients, their professional activity is associated or was associated with unfavourable factors. Some of the respondents blamed their employers for the onset of the disease. The main reason of dissatisfaction of the patients was carelessness of health workers. Furthermore, every third patient with tuberculosis demanded from the phthisiatrician to recognize a disability category in order to improve their financial situation. Conclusion. Changes in the labour legislation have caused the emergence of private organizations that do not comply with requirements for protection of employees, which can affect their health.

Cristianne Maria Famer Rocha, Letícia Lassen Petersen, Lígia Daiane Fink dos Santos

O presente artigo aborda os obstáculos à regulação econômica do comércio de medicamentos no Brasil. A delimitação temática recai sobre o caso italiano de prática de conluio por parte de duas empresas do ramo farmacêutico para fraudar o sistema de saúde e a existência de indícios da mesma prática no Brasil. A prática do crime contra a ordem econômica e financeira respingou na própria organização do sistema público de saúde italiano e as empresas foram consideradas culpadas pela prática criminosa. O caso retoma a discussão da necessidade de intervenção estatal na economia – do ponto de vista tanto da regulação do mercado quanto da fiscalização do que é efetivamente ofertado à população pelo comércio –, com vistas à promoção da dignidade da pessoa humana, o que inclui a proteção da saúde pelo Estado. A pesquisa tem por objetivo sistematizar o caso italiano de duplicidade no registro de patente, paralelamente abordando a regulação econômica do registro dos medicamentos no Brasil e a criminalização do conluio nessa seara, para, então, testar a hipótese de pesquisa de que a mesma conduta empresarial de duplo registro da patente também foi adotada no Brasil. O método hipotético dedutivo conduz a realização da pesquisa, oferecendo ao leitor a sistematização do caso escolhido e conceitos com base em pesquisa bibliográfica e documental (livros, jornais de repercussão internacional, revistas científicas, artigos científicos, bulas dos medicamentos envolvidos e legislação brasileira sobre a matéria) para, assim, dialogar acerca dos fatos.

. Sukendar, Agus H. Rahim, Samuel Hutabarat

Informed consent atau tindakan medis merupakan salah satu upaya pengembangan usaha kesehatan untuk meningkatkan pelayanan kesehatan pada masyarakat. Sebelum dilakukan tindakan pembedahan, dalam keadaan yang wajar memerlukan persetujuan dari pihak pasien. Persetujuan ini dapat berupa persetujuan lisan atau persetujuan tertulis, hal ini tergantung dari besar dan kecilnya resiko dari pembedahan yang dilakukan. Hal seperti ini sudah diatur dalam perundang- undangan praktek kedokteran nomer 29 Tahun 2009 dan Undang-undang Rumah Sakit nomor 44 tahun 2004 dan Undang-Undang Kesehatan Nomor 36 Tahun 2009 dan peraturan internal rumah sakit (Hospital by Laws). Kesalahan dan kelalaian dalam melaksanakan profesi kedokteran merupakan masalah penting, karena dapat menyebakan kecacatan. Baik cacat sementara maupun cacat permanen, bahkan sampai menimbulkan kematian. Hal tersebut dapat merusak kepercayaan masyarakat terhadap profesi kesehatan .Sehingga pasien tidak melulu mengharapkan hasil yang baik dan sehingga setelah pembedahan tidak terjadi adanya konflik / kesalahpahaman yang akan menimbulkan adanya tuntutan. Berdasarkan uraian tersebut, penulis tertarik untuk melakukan penelitian yang berjudul TANGGUNG JAWAB RUMAH SAKIT ATAS KELENGKAPAN INFORMED CONSENT PADA SAAT OPERASI DI RS PREMIER JATINEGARA JAKARTA. Adapun perumusan masalah yang ada adalah bagaimana pengaturan tentang informed consent dikamar operasi sebelum melakukan tindakan pembedahan dilaksanakan di Rumah Sakit Premier Jatinegara, dan bagaimana dampak dan akidah hukum terhadap dokter atas kelengkapan informed consent di Rumah sakit Premier jatinegara. Metode dalam penelitian ini adalah yuridis normatif. Pendekatan yuridis normatif ini dalam menganalisa dan meninjau masalah digunakan prinsip dan asas-asas hukum. Penelitian ini menentukan pada segi-segi yuridis dan melihat pada Perundang-undangan yang berkaitan dengan pelaksanaan pemberian tindaklan medis / informed consent.

T. Pilling, P. Govender

Background: Numerous studies internationally highlight the devastating effects of firework-related injuries and the costs involved in treating these injuries, in addition to the calls to alter legislation to prevent these injuries from occurring. There has, however, been a paucity of research studies in the South African context that describes the complexity of the injuries sustained. The aim of this study was thus to profile the firework-injured hand and to review the management from a surgical and rehabilitation perspective. Methods: A retrospective file audit was conducted on patients who had sustained firework injuries between 2009 and 2014 (n = 65) in two hospitals in KwaZulu-Natal (KZN), South Africa. Results: The firework-injured hand has a varied profile, which appears to be dependent on the blast capacity. The thumb, index and middle fingers were predominantly affected at the level of the distal phalanges and distal interphalangeal joints resulting in amputation due to severe soft tissue injury and resultant fractures. Hand Injury Severity Scores indicated a large percentage of cases within the severe category. Medical and surgical interventions occurred within the first three to six hours post-injury and involved washout, cleaning, debridement and suturing. Formalisation of amputation was the predominant course of action. Rehabilitation was focused on assessment and hand therapy to ensure functional outcomes. Conclusions: From this study, the authors conclude that the firework-injured hand should be managed according to the resultant diagnosis, be it an amputation, fracture, or soft tissue injury, whilst managing the symptoms of oedema, pain and stiffness, which will all impact on hand function outcomes.

Paulo Roberto do Nascimento Martins, Bernardo Franke Dahinten, Augusto Franke Dahinten

O presente artigo tem como objetivo introduzir e analisar algumas das questões mais polêmicas relacionadas às indicações de Órteses, Próteses e Materiais Especiais (OPMEs) no âmbito dos contratos de planos de saúde. No texto, são exibidos elementos normativos atinentes a esse contexto, bem como decisões judiciais emblemáticas acerca da temática. O escopo é defender, de forma fundamentada, que a indicação de próteses e órteses pelo profissional assistente não pode ser vista como a única opinião válida, tampouco como necessariamente a mais correta, haja vista a existência de interesses outros que não a mera saúde do paciente e que também estão frequentemente em jogo. Ao final, é explicado que, à luz da normatização atualmente vigente no Brasil no âmbito da saúde suplementar, ao médico assistente cabe (apenas) indicar as características dos materiais necessários, cabendo à operadora de planos de saúde a escolha da marca e do fabricante. Enquanto os magistrados não se conscientizarem dessas normas, este sério problema não se resolverá.