The twins and 4 million euro treatment in the public health system

Written By Manuel Poças

A couple of days before Christmas, the Portuguese Socialist Party rejected the petitions for the parliamentary hearings concerning the twins’ case.

During 2019 and 2020, two Brazilian twins of Portuguese descendancy, who were, at the time, 15 months old, accessed the Portuguese public services, requested, and received a very expensive medical treatment costing the state 4 million euros. 

Given the strangeness of the process by which the twins were able to access the treatment, some figures started raising questions about how it all went down. As a result, eventually, it became one of the most mediatic judicial cases in Portugal.

Even though it all happened almost 4 years ago, the situation started being investigated by the Public Ministry only at the beginning of November. According to the intelligence retrieved and released by one of the main television channels in Portugal (TVI), there are 5 mysteries around this case that raise suspicions of possible corruption.

First and foremost, Portuguese nationality was obtained in record time. In order for the twins to be able to come to Portugal and receive the treatment, they needed Portuguese nationality. This is, most of the time, a long process. To provide an example, a girl who was pregnant, whose father was Portuguese, and who came to Portugal for her master’s degree, only got her nationality 8 months after initiating the process.

The twins, on the other hand, got their nationality in 13 or 14 days. Even though there are some cases that are processed faster than others, legal experts who were contacted by the media commented on the strangeness of the quick timeframe.

Second, the special request for the expensive medicine was approved in two days. Note that the medicine Zolgensma is known as ‘the most expensive medicine in the world’ and has a price of around 2 million euros.

At the time, the medicine, which was used by the twins, was not on the market yet. For that reason, the parents had to ask for special authorization of utilization. According to the National Index of Access to Hospital Medicines, this type of special authorization takes an average of 17 days to be accepted. In the case of the twins, it took only two days.

Third, the special request was approved on a Saturday. Apart from taking only two days, the special authorization of utilization requested by the twins’ parents was approved by Infarmed (official entity that regulates the utilization of medicine, among other things) during a weekend. According to the former president of Infarmed, the entity is closed on Saturdays and Sundays. Although it may exceptionally operate if it is a life or death situation, this was not the case.

Fourth, ‘the most expensive medicine in the world’ does not add much in terms of efficacy. One of the letters that reached the Portuguese authorities and that led to the development of the twins’ process mentioned the medicine as being ‘the only hope for a cure’. However, the twins suffer from spinal muscular atrophy and, according to experts, there is no cure for such illness.

Moreover, the official studies made by the relevant authorities state that there is no therapeutic advantage to taking Zolgensma. The only advantage is convenience. Contrary to other medicines, Zolgensma is only administered once throughout the life of the patient.

Fifth, the twins’ parents requested and received four very expensive electric wheelchairs. According to all the invoices, which were analyzed by TVI, the Hospital ordered and paid four wheelchairs for the twins. Each costs around 58 thousand euros. Until today, no other Portuguese children, independently of the case and diagnostic, got one of these chairs. The twins got four, and two of them are still to be taken from the hospital.

How could this all be? How could the Portuguese National Health Service spend more than 4 million euros on a treatment under such circumstances? Note that the twins came to Portugal to receive the treatment, which was subsidized by the National Health Service, and immediately returned to Brazil.

According to the intelligence retrieved by TVI, the mother of the twins confirmed the existence of Presidential influence. She stated: “We used our contacts. (..) I knew the President’s Daughter-in-Law, who knew the Minister of Health that sent an email to the Hospital”.

The Portuguese President, Marcelo Rebelo de Sousa, affirmed at first that he had nothing to do with the process. However, he ended up saying that in 2019 he got an email from his son, Nuno Rebelo de Sousa, about the twins’ cases at Santa Maria Hospital to which he argues he merely forwarded the email to the right institutions. 

It’s now public knowledge that his son was highly involved in the case. Notwithstanding, he cannot be the only one to have led to this result. 

For that reason, and in order to understand how this could all be, apart from the investigation of the Public Ministry, the opposing political parties requested parliamentary hearings with the twins’ parents, the son of the Portuguese President of the Republic, the former Secretary of State of Health (who was in office between 2019 and 2022), and the former Minister of Health (in office between 2018 and 2022).

However, a couple of days before Christmas, the Socialist Party rejected the hearings. The opposing parties accuse it of keeping the Portuguese citizens from the truth, blocking public interest.

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