LSG Darmstadt rejects claims, among other things, for pure pain
There have been high hurdles with the possibility of prescribing cannabis since March 2017 at the expense of the statutory health insurers. According to a rush decision of the Hessian State Social Court (LSG) in Darmstadt announced on Thursday, November 16, 2017, severe pain in particular cannot justify a claim. After a further decision, the same applies to a non-inflammatory pain syndrome (fibromyalgia). In contrast, a man with chronic abdominal pain was successful. (Ref .: L 8 KR 255/17 B ER, L 8 KR 366/17 B ER and L 8 KR 288/17 B ER)
As of March 10, 2017, a new regulation was introduced into the Social Security Code that enables the prescription of cannabis at the expense of the statutory health insurance companies. The prerequisite is that this promises at least relief for a "serious illness". In addition, there must be no conventional medical alternatives or these should not be reasonable for the patient in the opinion of the doctor, for example due to severe side effects. The health fund may then reject an appropriately justified application "only in justified exceptional cases".
According to the LSG Darmstadt, a pure pain syndrome is not sufficient for a prescription of cannabis as a pain reliever. Rather, it is necessary that the pain is based on a "serious clinical picture"; this must "be documented by medical reports" (urgent decision of October 4, 2017, file number: L 8 KR 255/17 B ER).
The prescription for a patient with fibromyalgia (so-called soft tissue rheumatism, a muscle pain in the vicinity of joints) did not apply to the LSG. According to the current study situation, cannabis has no soothing effect (urgent decision of October 16, 2017, Az: L 8 KR 366/17 B ER). In both cases, the Darmstadt judges also complained that the doctors had not sufficiently examined conventional medical alternatives.
In the third case, a man had severe chronic abdominal pain that severely restricted his life. The reason was repeated inflammation of the pancreas and the operative establishment of a connection between the pancreas and the small intestine. Even morphine could only relieve the pain slightly. The doctor prescribed a cannabis mouth spray for the man. This at least brings the prospect of relief, there is no conventional medical alternative, said the LSG Darmstadt. Therefore, the health insurance company must pay for the prescribed cannabis oral spray (urgent decision of September 28, 2017, file number: L 8 KR 288/17 B ER).
The LSG Rhineland-Palatinate in Mainz had previously been more generous. Here, the plaintiff suffered, among other things, from psoriasis arthropathy associated with painful joint changes and stiffening. Similar to the first two cases of the LSG Darmstadt, the health insurance company also said that the doctor had not ruled out numerous alternative treatment options for a reason. The LSG Mainz nevertheless gave the patient the cannabis prescribed for pain relief. The doctor had endorsed this therapy, the health insurance company should therefore only reject it in exceptional cases (urgent decision of July 27, 2017, file number: L 5 KR 140/17 B ER, JurAgentur announcement of August 29, 2017). mwo