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The direction of the health operator Prevent Senior induced a competition between doctors to boost the prescription of the covid kit, according to a dossier with alleged irregularities practiced by the company delivered to Covid’s CPI. The document, to which the UOL obtained access, was prepared by 12 company professionals, six still in the network and six former employees. The events took place during 2020, at the height of the pandemic, the accusations indicate.

A Prevent Senior denies the allegations, adding that they are “systematic and untrue” (read below).

The covid kit is composed of a series of drugs without proven efficacy in the treatment of the disease, and may even cause serious side effects in certain people, depending on comorbidities and the general health condition.

At Prevent, the kit was prescribed to patients with flu-like symptoms, although without a diagnosis of covid-19, according to the doctors who prepared the dossier. Reports indicate that the methodology consisted of prescribing the drugs without the patients’ consent, a fact that is investigated by the CPI.

According to the complaint, Prevent professionals were “controlled by graphs that showed performance, inducing competitiveness among physicians, who began to have ‘goals’ for drug prescription”. These graphics were distributed internally in groups on WhatsApp by one of the directors of Prevent, the cardiologist Rodrigo Esper, as a way of trying to engage the team, points out.

In addition to the stimulus policy, the direction still made demands on doctors when the results were not pleasing, he says.

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For example, in a WhatsApp message identified as being dated May 10, 2020, Esper forwards a graphic titled “Protocol Inclusion: Tele x PS”. “Tele” refers to telescreening (virtual assistance) while PS refers to the Emergency Room of the Sancta Maggiore hospital, which belongs to the network.

In a message he later wrote: “Guys, we can’t lose focus. We’re back to bad yields. We can’t lose tone. We haven’t reached the peak of the epidemic yet and yields have fallen. I ask that all tutors on duty immediately talk to your teams and emphasize the importance of early treatment. This is very important! Thank you.”

On June 11 of last year, according to the dossier, Esper sent another graphic of similar content with the message: “Good afternoon, we are tending to (sic) drop in prescriptions. Let’s reinforce it with the group. Thank you.”

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On “peak days,” more than 250 kits were delivered to patients, the document says.

The dossier does not make it clear to which WhatsApp groups these messages were sent.

Starter kit would have been expanded later

Initially, Prevent’s covid kit consisted of 400 mg of hydroxychloroquine (indicated for some rheumatologic diseases and malaria) together with 500 mg of azithromycin (an antibiotic), the complaint states.

Afterwards, with the suspension of research promoted by Prevent on the effectiveness of the use of hydroxychloroquine in association with azithromycin, doctors would have been forced to promote the “Prevent kit”. This would have been a kind of expanded covid kit.

According to photos of the bags distributed to patients to which the article had access, a copy of the kit still contained azithromycin and hydroxychloroquine, but also ivermectin (antiparasitic), steroids, vitamins and a powdered protein food supplement.

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According to the WHO (World Health Organization) and studies carried out in several countries, so far, there is no medicine with proven efficacy against covid-19. Some drugs, however, are used in hospitals in order to lessen the impact of post-contamination symptoms, such as fever, respiratory problems, among others.

Messages sent to teams in June also show that Prevent instituted a sort of update to the covid kit, which was internally called “prevent kit”, and started to use it in order to give more “dynamism” to patient admissions.

Attempt to convince doctors

The dialogues reproduced by the dossier show that Prevent Senior’s top management allegedly sought, with a motivational approach, to convince health professionals to prescribe the drugs in the covid kit.

Also according to the dossier, in the health operator’s view, doctors could not “let go of the opportunity” to treat the disease “as soon as possible”. A sort of goal was established, according to a message sent by one of Prevent’s directors on April 12, 2020.

“Hit the target. The second day of symptoms is what we want. And the best part: the prescription is in your hand. And we are with you”, says an excerpt of the message.

The second day of symptom onset, which would be ideal for prescribing the covid kit according to Prevent’s protocols, even gained a nickname: “Golden day”. “Indicate the treatment and let us do the rest.”

Then the same director made an observation. “People, reinforce it with the teams. It’s important that we don’t miss the chance to treat. And treat early. And also reinforce the importance of filling out the TeleAlert spreadsheet.”

Retaliation

The complaint filed with the CPI states that the guidelines issued by the executive management and the medical clinic should be interpreted as orders, because if they were not complied with, the consequence was dismissal. According to reports, the dossier says, the atmosphere was one of “threats and hostility”.

“Given the policy of pejotization adopted by the company, the guidelines are transmitted to doctors by the WhatsApp application, since this informal methodology, in theory, would reduce the risk of possible lawsuits”, he quotes.

In testimony to Covid’s CPI on Wednesday (22), the executive director of Prevent Senior, Pedro Benedito Batista Júnior, said that no professional was fired for refusing to apply this “early treatment”. However, at another time, when asked about the same issue, he stated that “doctors were excluded from the company for serious ethical and moral failures, such as invasion of medical records and inadequate treatment of patients, many of them with complaints about compliance”.

Sept.22.2021 - The executive director of the Prevent Senior health care provider, Pedro Benedito Batista Júnior, in testimony at Covid's CPI.  - Edilson Rodrigues/Agência Senado - Edilson Rodrigues/Agência Senado

Sept.22.2021 – The executive director of the Prevent Senior health care provider, Pedro Benedito Batista Júnior, in testimony at Covid’s CPI.

Image: Edilson Rodrigues/Senate Agency

Prevent rebuts and asks for PGR investigation

In note, a Prevent Senior he denied the “systematic and deceitful accusations made anonymously to Covid’s CPI and to the press.” He also stated that he asked on Monday (20) that the PGR (Attorney General’s Office) investigate the accusations made public.

“Strangely, before the charges were brought to the Senate committee, a lawyer representing this group of doctors insinuated that the complaints would not be referred to the CPI if an agreement were reached. Due to the strangeness of the approach, Prevent Senior will take all measures legal courts to clarify the facts and repair the damage to its image,” he added.

Batista Júnior denied that the company had concealed deaths by covid-19, refuted the commission’s accusation that it carried out a “clinical study” to guide the application of the so-called covid kit and held doctors linked to the operator responsible for alleged manipulation of data and improper disclosure of medical records patients.

However, Batista Júnior confirmed that there was guidance for doctors to modify the ICD (diagnostic code) of patients who were admitted with covid-19, after 14 or 21 days, depending on the case of each one.

He claimed that the measure was taken to identify patients who would no longer pose a risk of transmission of the new coronavirus. CPI senators, however, saw an attempt to manipulate and underreport cases and deaths.

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