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Doctors who formally violated legal requirements but saved the lives and health of their child patients were acting in good faith, fulfilling their primary duty to provide qualified medical assistance.

This was the decision of the Panevėžys Regional Court, which examined the appeal of the National Health Insurance Fund, in which the institution demanded that the Republican Panevėžys Hospital compensate the Mandatory Health Insurance Fund (PSDF) almost 5,500 EUR in damages for an illegally prescribed medicinal product to two patients.

The Regional Court stated that the decision of the Panevėžys Hospital's medical professionals to prescribe the drug to two children treated in the hospital, in violation of the rules for prescribing medicinal products, was an action taken under conditions of necessity.

The case ended up in court after the Šiauliai Territorial Health Insurance Fund (TLK) conducted an inspection of the Republican Panevėžys Hospital. During the inspection, the auditors found that the hospital had violated the regulatory acts governing the use and prescription of centrally reimbursed medicinal products in two instances because, firstly, the medicinal product "Octagam" was prescribed to patients by a doctor of an inappropriate specialty, and secondly, the diagnosis for which "Octagam" was prescribed is not included in the cases for which this drug can be prescribed.

The Šiauliai TLK assessed that by illegally using the drug "Octagam," the Panevėžys Hospital caused almost 5,500 EUR in damage to the PSDF budget, as this amount corresponds to the purchase price of the drug.

Two child patients treated in the Pediatric Intensive Care Unit of the Republican Panevėžys Hospital in 2022 were diagnosed with "Multisystem inflammatory syndrome associated with Covid-19." The young patients' illness corresponded to a syndrome similar to Kawasaki disease (mucocutaneous lymph node syndrome), which is treated with intravenous human immunoglobulin "Octagam."

The consilium of doctors at Panevėžys Hospital, based on the knowledge of medical science and practice specialists, decided to apply a treatment algorithm identical to that for Kawasaki syndrome to the children, i.e., they prescribed intravenous human immunoglobulin "Octagam" to the children.

Formally, this drug could not have been prescribed to the patients because the diagnosis given to the children treated at Panevėžys Hospital (Multisystem inflammatory syndrome associated with Covid-19) was not listed in the List of Centrally Reimbursed Medicines under the diagnoses for which intravenous human immunoglobulin "Octagam" can be prescribed.

It is noteworthy that this List of Centrally Reimbursed Medicines was approved back in 2014, when Covid-19 disease did not exist at all, and there was no medical science data on the severe immunological manifestations of Covid-19 in children.

The Regional Court concluded that the mere formal violation of this list of medicines, which did not correspond to the achievements of medical science and practice, diagnostic and treatment recommendations, committed in the absence of a new Covid-19 methodology approved by legal acts and with doctors acting under exceptional pandemic conditions, provides grounds for exempting the Republican Panevėžys Hospital from civil liability.

In the court's opinion, the prescription of intravenous human immunoglobulin "Octagam" to the children treated in the hospital was the only way to avoid greater harm to their health and lives than the damage caused to the PSDF budget by formal violations.

The Regional Court agreed with the opinion of the court of first instance that the formal violations of the Panevėžys Hospital doctors were also caused by the inaction of the Territorial Health Insurance Fund itself, as a public administration entity with delegated powers, in the area within its competence.

The court noted that the Law on Health Insurance stipulates the duty of the National Health Insurance Fund to take care of the inclusion and exclusion of personal health care services in the list of personal health care services reimbursed from the PSDF budget, taking into account the effectiveness of these services, based on medical scientific evidence.

The ruling of the Panevėžys Regional Court takes effect immediately but can be appealed on cassation grounds to the Supreme Court of Lithuania within three months.

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