SGK o ilacı ödemeyi reddetti : Mahkeme 'Sosyal Devlet İlkesini' kabul etti
SGK Söz konusu ilacın 'Bedeli ödenecek ilaçlar listesinde yok' diyerek talebi reddetmesinin ardından Y.M.G.'nin ailesi yasal yollara başvurdu. İş Mahkemesi, Anayasa'daki 'Sosyal Devlet İlkesini' dikkate alarak ara kararında ilaç bedelinin kesinti yapılmaksızın dava sürecinde SGK tarafından karşılanmasına karar verdi. Aile avukatı Enbiya Yıldırım ise "Mahkemenin verdiği karar çok önemli. Bu karar ilacın SGK'nın geri ödeme kapsamına alınması için mücadele eden tüm aile ve hasta çocuklara ışık olacak" dedi. Dosya içeriğini dikkate alan mahkeme, Anayasa'daki 'Sosyal Devlet İlkesini' de dikkate alarak davacının ihtiyati tedbir talebini kabul etti. Dilekçede, "Müvekkilin ilacı kullanmaması durumunda ne yazık ki ölüm riskiyle karşı karşıya kalacaktır. 3 yaşında bir çocuğun maddi sebepler nedeniyle ölüm riski ile karşı karşıya kalması vicdanen ve hukuken kabul edilebilecek bir durum değildir" denildi.
DOKTORLAR 'İLACIN KULLANILMASI ZORUNLU' ŞEKLİNDE GÖRÜŞ BİLDİRDİ
Milliyet'in haberine göre; Avukat Enbiya Yıldırım'ın sunduğu dava dilekçesine göre Y.M.G.'nin 2018 tarihinde doğduğu ve doğduktan yaklaşık 1 ay sonra hastane hekimleri tarafından yapılan tetkikler sonucu 3 yaşındaki Y.M.G.'ye 'Kistik Fibrozis' tanısı konulduğu belirtildi. Hastalık dolasıyla Y.M.G.'nin halen hastanede tedavi gördüğü anlatılan dilekçede, doktorların "Bu hastalığın tedavisi için 'Ivacaftor' etkin maddeli ilacın kullanılması gerekiyor. Bu ilacın kullanılması zorunlu ve hayati derecede önem taşıyor" şeklinde görüş bildirdiği anlatılan dilekçede, hastanenin de aynı görüşte belge sunduğu ve söz konusu belgenin mahkemeye delil olarak sunulduğu kaydedildi.
SGK 'BEDELİ ÖDENECEK İLAÇLAR LİSTESİNDE YOK' DİYEREK TALEBİ REDDETTİ
Sosyal Güvenlik Kurumu'na (SGK) söz konusu ilacın bedelsiz olarak karşılanmasının talep edildiği anlatılan dilekçede SGK'nin söz konusu ilacın 'Bedeli ödenecek ilaçlar listesinde yok' diyerek talebi reddettiği ifade edildi.
Anayasa'da sağlık hakkının güvence altına alındığı ve sağlık hakkının devletin temel görevi olduğu hatırlatılan dilekçede, SGK'nin 'SUT kurallarının arkasına saklanarak' ilacın bedelini ödememesinin Anayasa'ya ve en temel hak olan yaşam hakkına aykırı olduğu öne sürüldü. Y.M.G.'nin Sağlık Uygulama Tebliği (SUT) kapsamındaki verilen başka ilaçlarının ilk etapta kullandığı anlatılan dilekçede, söz konusu verilen ilaçların bu hastalıkla iyileştirici etkisi olmadığının hekim raporlarında sabit olduğu vurgulandı.
"BİR ÇOCUĞUN MADDİ SEBEPLER NEDENİYLE ÖLÜMLE KARŞI KARŞIYA KALMASI KABUL EDİLEMEZ"
'Kistik fibrozis' hastalığının genetik yapılı ölümcül bir hastalık olduğu vurgulanan dilekçede, "Müvekkilin ilacı kullanmaması durumunda ne yazık ki ölüm riskiyle karşı karşıya kalacaktır. 3 yaşında bir çocuğun maddi sebepler nedeniyle ölüm riski ile karşı karşıya kalması vicdanen ve hukuken kabul edilebilecek bir durum değildir" denildi. İlaçların yurt dışından getirildiği, pahalı olması nedeniyle Y.M.G.'nin ailesinin maddi durumunun ilaç bedellerini karşılamaya yetmeyeceği anlatılan dilekçede, mahkemeden dava sonuçlanıncaya kadar ihtiyati tedbir kararının verilmesi ardından da davanın kabul edilmesi talep edildi.
MAHKEME SOSYAL DEVLET İLKESİNİ DİKKATE ALARAK TALEBİ KABUL ETTİ
Anadolu 18. İş Mahkemesi'nce yapılan ön inceleme duruşmasında ise 3 yaşındaki Y.M.G. avukatı Enbiya Yıldırım aracılığıyla 'davacı', SGK ise 'Davalı' sıfatıyla yer aldı. Ara kararını açıklayan mahkeme, davacı avukatının sunmuş olduğu raporu dikkate aldı. Ara kararında ilaç bedelinin ailenin mevcut ekonomik duruma göre yüksek olduğuna ve ailenin bu bedeli karşılayamaması durumunun söz konusu olup ilacın kullanılmasının sağlık açısından zaruri olduğuna kanaat getirdi. Dosya içeriğini dikkate alan mahkeme, Anayasa'daki 'Sosyal Devlet İlkesini' de dikkate alarak davacının ihtiyati tedbir talebini kabul etti. Mahkeme, dava sonuçlanıncaya kadar davacının mevcut hastalığı nedeniyle kullanmak zorunda olduğu ilaç bedelinin kesinti yapılmaksızın SGK tarafından tedbiren karşılanmasına karar verdi.
"BU KARAR HASTA ÇOCUKLARA IŞIK OLACAK"
Kararı değerlendiren aile avukatı Enbiya Yıldırım, yaşanan süreci anlattıktan sonra "Mahkemede öncelikle bu ilaçların bedelsiz olarak SGK tarafından karşılanmasını talep ettik. Mahkememiz bu olumlu kararı bir hafta içerisinde tedbir olarak verdi. Bu dava aşaması sürecinde bu ilaçların bedelleri ücretsiz bir şekilde SGK tarafından temin edilecektir" dedi. Söz konusu ilacın yurt dışından temin edildiğini belirten Avukat Yıldırım, "Mahkemenin verdiği karar çok önemli. Bu karar ilacın SGK'nın geri ödeme kapsamına alınması için mücadele eden tüm aile ve hasta çocuklara ışık olacak" ifadelerini kullandı. Yıldırım, kararı aileyle paylaştığında Y.M.G.'nin ailesinin çok umutlu ve sevinçli olduğunu söyledi.
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