Iuri Archuadze v. Ministry of Health and Social Affairs; Municipality of Gori

Case no. #bs-758-730(k-08)
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The applicant, Iuri Archuadze, suddenly developed a life threatening jaw condition and went to the Tbilisi State Medical Institute where he had an immediate surgical operation, and, following post-surgical complications, was taken to the intensive therapy department.  In total, the cost of the treatment was 9263,71 GEL, but the applicant was only reimbursed 205,94 GEL from the state medical aid program.

The applicant applied to the Gori Municipality for reimbursement of the costs, and he was rejected. He then applied to the Ministry of Health and Social Affairs, but again his application for reimbursement was refused.  He brought suit to Tbilisi City Court against the Ministry of Health and Social Affairs and Municipality of Gori, alleging, amongst other things, that the state protected a right for free of charge medical service “when without its’ urgent realization the death, invalidism or significant health deterioration of patient was inevitable.”

Tbilisi City Court dismissed his claims, and the Circuit Court affirmed.  The applicant submitted a cassation application requesting to void the Circuit Court judgment.

The Cassation Court found that the applicant’s cassation claim should not be satisfied.

The Court agreed with the applicant’s argument that paragraph 1 of article 37 of Georgian constitution required that free of charge medical services must made in certain circumstances, and such circumstances were established by law.  However, the applicant had failed to indicate a law or sub-law establishing circumstances where full reimbursement was required for his case.

The Court noted that article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) set forth an obligation to take all the necessary measures to ensure medical aid and medical treatment, but held that this obligation did not require for the State to provide free of charge medical aid. The Court determined that paragraph one of article 12 of the Georgian law on patient’s rights, which reflected the obligation set forth in article 12 of the ICESCR, provided that in emergency situations medical providers must offer care regardless of ability to pay; in non-emergencies, this obligation was relaxed. However, this law ensured the patient’s right for medical service, which meant only that medical services existed but not their use free of charge.

As the applicant had not identified any other laws which would allow him to receive free of charge medical aid, the Court overturned the Circuit Court’s decision.

“The Cassation Court agrees with the Circuit Court’s interpretation that paragraph 1 of article 37 of Georgian Constitution sets forth in which circumstances can free of charge medical service be used and such circumstances should be established by law.” Page 6

“The Cassation Court agrees with the Circuit Court’s interpretation that article 12 of the International Covenant on Economic, Social and Cultural Rights, according to which the member states accept an obligation to undertake all the measures which are necessary for creating such conditions to ensure medical aid and patient’s treatment for all and cannot agree on the cassation applicant’s interpretations that, by this covenant, member states recognize an obligation for the availability of medical aid free of charge. .” Page 6

“According to article 12 of the aforementioned law the state protects the right of the patient to medical service when, without its urgent realization, the death, invalidism or significant health deterioration of the patient is inevitable. By paragraph 2 of the same article if patient is in urgent need of medical service without which the death, invalidism or significant health deterioration of the patient is inevitable and a medical service provider has no ability to serve the patient, one is obliged to provide full information to patient and his relative or his guardian under law on where to obtain urgent medical service. In accordance with the mentioned norm the patient’s right to medical service is ensured, which means the obligation is for the existence medical standard and not for their use free of charge.” Page 6

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