The 506% that alarmed medicine and the 2025 data nobody published

In 2024, the National Council of Justice (CNJ) registered 74,358 new lawsuits related to damages in healthcare services, compared to 12,268 in 2023: a 506% increase in a single year. The news spread across the country as evidence of a medical error epidemic. Law firms published warnings. Insurance companies used the data to urgently sell policies. Fear arrived before interpretation.

But the number has a technical explanation that the press did not prioritize: in 2023, the CNJ itself reclassified the procedural category. The old term "medical error" was replaced by "material and/or moral damages resulting from the provision of healthcare services," a much broader umbrella that now includes lawsuits against doctors, public and private hospitals, health plans, clinics, and laboratories in the same count. A significant portion of the 506% jump reflects this methodological change, not a proportional increase in medical failures.

The data that gained more traction in 2025 points in the opposite direction: for the first time since the beginning of the historical series, the judicialization of public health showed a decrease. According to the CNJ's Procedural Statistics Panel, new public health lawsuits fell by 6% between 2024 and 2025, from 377,000 to 354,000 new cases. Previously, the growth rate was almost 18% per year. The curve has turned.

What healthcare judicialization truly is: systemic, not medical

Most healthcare judicialization in Brazil is not about holding doctors accountable for clinical error: it's about forcing the system to fulfill its obligation to provide medications, treatments, and beds. The Diagnosis of Judicialization of Public and Supplemental Health published by the CNJ in partnership with the United Nations Development Programme (UNDP) in November 2025, with data from August 2024 to July 2025, shows that the most judicialized issues in state courts are consultations, surgeries, and ICU beds, not complaints of inappropriate conduct by healthcare professionals.

The cost of this is concrete: the Ministry of Health spent approximately R$3.2 billion in 2024 just to comply with judicial decisions in healthcare. Judicialization accounts for approximately 33% of public spending on medicines in the country, according to research by the Institute of Applied Economic Research (Ipea). This is the true scale of the problem: not a wave of doctors being sued for error, but a public system that fails to deliver on its constitutional promises, and whose patients have learned to seek redress through the Judiciary.

As of December 2025, there were over 895,000 health lawsuits pending in the country, making it the third-largest category in terms of volume of cases against public authorities, surpassed only by social security and public servants. São Paulo alone accounted for almost 93,000 lawsuits in supplemental health, a number higher than the combined total of cases in Bahia and Rio de Janeiro.

• 6% decrease in public health cases in 2025

  For the first time in the CNJ's historical series, new public health lawsuits decreased, from 377,000 to 354,000 cases, after years of nearly 18% annual growth.
• R$3.2 billion spent to comply with judicial decisions in 2024

  The Ministry of Health paid this amount to comply with court orders for access to medicines and treatments, demonstrating that the central problem is systemic, not related to medical conduct.
• 16% of STJ lawsuits involve only the doctor as defendant

  In lawsuits reaching the STJ, 46% have only legal entities like hospitals and clinics as defendants. In 38%, doctors who respond as legal entities. Only 16% involve the professional exclusively as an individual.
• 89.8% of CFM inquiries are dismissed

  Of the inquiries opened after ethical complaints in the Regional Councils, the vast majority do not result in an ethical-professional process. Being reported is not being convicted.

What is an obligation of means and why this concept changes everything

In medicine, professional activity is legally classified as an obligation of means, not of result: the physician commits to applying all available technical resources with competence and ethics, but cannot guarantee a cure or the outcome expected by the patient. For civil liability to exist, it is necessary to demonstrate negligence, imprudence, or malpractice, as well as a direct causal link between the conduct and the damage. A poor outcome without inappropriate conduct does not legally constitute medical error.

The most debated exception is aesthetic plastic surgery, where some courts understand there to be an obligation of result, an understanding that is still not uniform in the country. For all other specialties, consolidated jurisprudence protects the physician who acted with technical diligence, even in the face of a negative outcome. The problem is that most lawsuits are filed without the patient or family having consulted a Medical Law specialist beforehand, and the action is only filtered during the process, with real emotional cost for the professional even if it ends in dismissal or acquittal.

What actually leads to lawsuits: real complaint patterns

Studies on the profile of ethical complaints in Brazil show that the main complainant is the patient or family member themselves, and the most frequent complaint is negligence, followed by communication problems. An analysis of complaints in a Brazilian state between 2001 and 2016, published in the Ibero-American Journal of Bioethics, identified negligence as the main complaint in 31.87% of cases. This data is important because negligence, in procedural practice, often translates into a lack of record: the doctor acted correctly, but there is no documentary evidence of it.

What Medical Law specialists consistently observe is that many lawsuits stem from communication failures, not inadequate clinical conduct. The patient who was not clearly informed about the risks of the procedure, the family member who did not receive an explanation about the expected progression of a serious illness, the absence of a record in the medical chart that risks were discussed: these are the points where the relationship breaks down and the lawsuit begins. The technique may have been impeccable, but the documented dialogue failed.

The medical record as an instrument of protection, not bureaucracy

A well-prepared medical record is the most important protection a doctor has against any process, both ethical and legal. Most successful defenses in cases of alleged medical malpractice have been built on clear, complete, and chronologically coherent medical records. And most convictions or penalties have resulted from incomplete, illegible, or missing records that should have existed. The same care, documented in different ways, can have radically different outcomes in court.

The CFM resolution determines that medical records must be kept for at least 20 years after the last consultation, and 5 years beyond the age of majority for patients treated in childhood. The obligation to provide a copy to a patient who requests it is absolute. Denying access to medical records is an ethical violation explicitly provided for in the Code of Medical Ethics.

• Document the risk discussion

  Record in the patient's chart that the risks, benefits, and alternatives were explained and that the patient understood. The Informed Consent Form is important, but documenting the dialogue in the chart is complementary and equally valuable in the process.
• Record the clinical reasoning, not just the conduct

  Note the hypotheses considered, tests ordered and why, treatments discarded and why. A chart that documents the decision-making process is much more defensible than one with only a diagnosis and prescription.
• Record structural conditions when relevant

  If the clinical decision was conditioned by the absence of an available exam, overcrowding, or lack of resources, record it. This contextualizes the conduct within the reality of the service and can be crucial for defense.

What happens when a notification arrives

Receiving a notification from the CRM (Regional Medical Council) or a court summons does not mean conviction, and the procedural path has clear stages with opportunities for defense at each of them. Ethically, after a complaint to the CRM, an inquiry is opened. The physician is notified and has a deadline to present a written defense. A councilor analyzes the case and produces a report. This report goes to the Inquiry Chamber, which decides whether or not to open an Ethical-Professional Process (PEP). According to CFM data, 89.8% of inquiries are dismissed at this stage.

In the judicial field, the process is usually long. The CNJ's 2025 diagnosis shows that the average time until the first judgment on the merits is about 304 days after filing. This delay, although exhausting, acts as a filter: throughout the process, actions without technical foundation tend to be closed before reaching a final judgment. The cited physician can appoint a medical technical assistant to prepare an expert report on the conduct, and this report has significant weight in the decision.

A detail with direct practical consequence: keeping one's address and contact information updated with the CRM is a physician's obligation. Notifications sent to an outdated address result in missed deadlines, which compromises any defense regardless of the merits of the case.

The real cost of fear: defensive medicine and flight from specialties

Defensive medicine, a practice in which physicians prescribe unnecessary tests and procedures primarily to protect themselves from lawsuits, is estimated to cost billions annually in Brazil, without proportional benefit to the patient. It's not just a financial problem: unnecessary tests expose patients to radiation, invasive procedures, anxiety, and incidental diagnoses that trigger cascades of investigations that should never have started.

Fear also contributes to the phenomenon that specialists call "flight from high-risk specialties": physicians who avoid obstetrics, general surgery, or emergency medicine due to the fear of litigation, migrating to specialties with less procedural exposure. For a country with an existing deficit of specialists in these critical areas, this has concrete consequences for public health. Data from 2025, which for the first time show a decrease in public health litigation, suggest that the system is beginning to adjust. But as long as fear is disproportionate to reality, it will continue to guide career and clinical practice decisions that harm the system as a whole.

Frequently Asked Questions

Direct answers to the most common questions about judicial and ethical processes in medicine.