To ensure the continuity of services provided by the Regional Hospital of São Jerônimo and reorganize healthcare services in neighboring cities, the Center for Autocomposition and Resolution – MEDIAR, of the Public Ministry of Rio Grande do Sul (MPRS), conducted an autocomposition procedure with municipalities in the Carboniferous Region of the State, through which 35 consensuses were consolidated to instrumentalize the solution of the problem. The procedure was completed in a meeting held this Friday, September 18, at the headquarters of the MPRS, in Porto Alegre.
According to MEDIAR, the hospital provided services for urgent and emergency care classified as low complexity, which could be provided by the primary care of the patients' originating municipalities. This situation created a burden on the institution, which served residents of Arroio dos Ratos, Barão do Triunfo, Butiá, Charqueadas, Eldorado do Sul, General Câmara, Minas do Leão, São Jerônimo and Triunfo without receiving the corresponding financial compensation for the services provided.
To address the problem, 21 meetings were held, starting in May 2025. The proposed solution provided that municipal administrations choose to either finance the services provided by the hospital or strengthen their own primary care structures to absorb local demand.
The majority of municipalities chose to invest in their health networks, reducing the dependence on services offered by the São Jerônimo institution. Among the consensuses, there is the forecast that the São Jerônimo City Hall will remit R$ 200,000 per month to the city hospital, with R$ 170,000 in financial contribution and R$ 30,000 through the remission of the Service Tax (ISS).
The work was conducted by the mediators of MEDIAR, with the participation of Public Prosecutor Fernando Sgarbossa, appointed for mediation, and also of Public Prosecutors Anita Spies da Cunha, Gabriela Cristina Silva, Deus, Guilherme Vicari, Laura de Castro Silva Mendes and Loren Tazioli Engelbrecht Zantut.
In the implementation phase of the consensuses, the prosecutors of the involved jurisdictions may monitor the effective implementation of the measures adopted by the municipalities that opted to strengthen the primary care network. The objective is to ensure that the reorganization of services is concretized and that the hospital ceases to support the regional demand alone.
Public Prosecutor Fernando Sgarbossa highlights that the problem had the potential to affect more than 140,000 inhabitants of the nine involved municipalities. "Given the demand from six distinct prosecutor's offices and following the usual flows, any rapid solution would be unfeasible without the essential assistance of MEDIAR. The agreement with MEDIAR proved itself in the accompaniment of the use of mediation techniques by colleagues in the numerous hours of work, meetings and sessions, with intense deepening of several points of the intricate issue. Mayors, municipal health secretaries, municipal and state procuracies, state health secretary, the State Audit Court, municipal and state legislatures, and other health sector actors participated and built, following the MEDIAR guidelines, the possible consensus and the necessary solution."
According to Public Prosecutor Paulo Valério Dal Pai Moraes, technical coordinator of MEDIAR, the initiative will directly benefit the population. "The impact is direct and positive for public health. Citizens will no longer need to travel to São Jerônimo, as they will be served in their own communities, through strengthened local structures. This is the role of the Public Prosecutor's Office, and this work reflects a successful result based on dialogue."
