Portuguese prosecutors indict four in Lisbon twin sisters Zolgensma treatment case

Indictments and formal charges

Portugal's Public Prosecution Service has formally indicted four defendants in the criminal investigation regarding the administration of the rare disease drug Zolgensma to Portuguese-Brazilian twin sisters at Lisbon's Santa Maria Hospital. According to a statement released on 28 September 2026 by the Lisbon Regional Department of Investigation and Criminal Action (DIAP), prosecutors Helena Almeida and Maria Leonor Cardiga concluded the inquiry assisted by the Judiciary Police. Three defendants (former Secretary of State for Health António Lacerda Sales, former Santa Maria clinical director Luís Pinheiro, and Nuno Rebelo de Sousa, son of former President Marcelo Rebelo de Sousa) are charged as co-perpetrators of prevarication in apparent concurrence with abuse of power. The fourth defendant, the children's mother Daniela Martins, faces charges of qualified fraud.

“The defendants always acted freely, voluntarily, and consciously in execution of a common plan outlined by António Lacerda Sales and Nuno Rebelo de Sousa, which Luís Pinheiro later joined, in order to benefit the two children.”

Allegations of influence and state costs

Prosecutors allege that Nuno Rebelo de Sousa leveraged the influence of his father's position to expedite access to treatment, bypassing standard National Health Service (SNS) waiting lists for other patients. The children, born in Brazil in summer 2018, did not reside in Portugal and lacked SNS user numbers when their appointments were scheduled. Zolgensma, a gene-therapy medication used to treat spinal muscular atrophy, cost between 1.9 million and 2.0 million euros per dose, resulting in four million euros in total medication costs covered by the Portuguese state. The case became public in November 2023 following a TVI investigative broadcast, which led to a parliamentary inquiry. Former President Marcelo Rebelo de Sousa has repeatedly denied any involvement or interference in the medical authorization process.

Single dose lower estimate1.9

Single dose upper estimate2

Total cost for both children4

Single dose lower estimate

1.9 €M

Single dose upper estimate

2 €M

Total cost for both children

4 €M

Data from the article text

Chronology of medical assistance

The twins received their diagnosis of spinal muscular atrophy on 9 September 2019 in Brazil at nine months of age. Following the diagnosis, Daniela Martins initiated inquiries to multiple Portuguese medical centers. A doctor at Santa Maria Hospital responded unofficially on 14 October 2019, confirming that the case had been forwarded to the hospital board of directors. By December 2019, when the children were 17 months old, they underwent their initial neuropediatric consultation and subsequently received the Zolgensma infusions in Lisbon. Age was considered a crucial clinical parameter, as the medication carried clinical criteria prioritizing administration in infants and children under two years old.

Defense statements and procedural steps

Following the announcement of the indictment, Daniela Martins issued a written statement asserting that her daughters obtained Portuguese citizenship lawfully and that the investigation found no illicit priority in their nationality registration. Martins clarified that her qualified fraud charge does not concern the multi-million euro medication itself, but rather specialized wheelchairs and support equipment provided by the SNS.

“I am the mother of two girls with a serious illness. Since they were born, I did and will continue to do everything legitimately within my power to provide them with treatment, autonomy, quality of life and a future.”

Martins previously lodged a formal complaint against TVI for broadcasting her children's images during its reporting. Following the formal closure of the investigation, the four defendants hold the procedural right to request the opening of an instructional phase (abertura de instrução) to contest the charges before the court determines whether to proceed to trial.