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Res. 02265-2009 Sala Constitucional · Sala Constitucional · 2009
OutcomeResultado
The Constitutional Chamber granted the amparo appeal for violation of the right to health, finding that the CCSS had not effectively provided the prescribed infliximab despite purchase authorization.La Sala Constitucional declaró con lugar el recurso de amparo por violación al derecho a la salud, al verificarse que la CCSS no había entregado efectivamente el medicamento infliximab prescrito pese a la autorización de compra.
SummaryResumen
The Constitutional Chamber heard an amparo appeal against the Costa Rican Social Security Fund for denying the supply of injectable infliximab, prescribed by the treating physician for the appellant's illness. The CCSS argued that the drug was not on the Official Medicines List and that the Local Pharmacotherapy Committee rejected the request for not meeting technical-scientific criteria. However, the Central Pharmacotherapy Committee later authorized the purchase on January 28, 2009, but as of February 3, 2009, formal notification had not been issued and the product had not been acquired. The Chamber found that the delay in effective delivery of the medication, despite the authorization, violated the fundamental right to health, protected by Article 21 of the Constitution and various international instruments. Consequently, it granted the appeal and ordered the CCSS to pay costs, damages, and losses, reaffirming the State's obligation to ensure access to necessary medical treatments.La Sala Constitucional conoció de un recurso de amparo contra la Caja Costarricense de Seguro Social por la denegatoria de suministro del medicamento infliximab inyectable, recetado por el médico tratante para la enfermedad del recurrente. La CCSS argumentó que el medicamento no estaba en la Lista Oficial de Medicamentos y que el Comité Local de Farmacoterapia no aprobó la solicitud por no cumplir criterios técnico-científicos. Sin embargo, posteriormente el Comité Central de Farmacoterapia autorizó la compra el 28 de enero de 2009, pero al 3 de febrero de 2009 aún no se había formalizado la notificación ni adquirido el producto. La Sala determinó que la demora en la entrega efectiva del medicamento, pese a la autorización, configuró una lesión al derecho fundamental a la salud, protegido por el artículo 21 constitucional y diversos instrumentos internacionales. En consecuencia, declaró con lugar el recurso y condenó a la CCSS al pago de las costas, daños y perjuicios, reafirmando la obligación estatal de garantizar el acceso a tratamientos médicos necesarios.
Key excerptExtracto clave
In accordance with the foregoing, it is not possible for this Court to verify whether the medication prescribed to the appellant since early December of the previous year has been provided, thereby confirming the alleged violation of the appellant's fundamental right to health by the respondent authorities of the Costa Rican Social Security Fund, and it is appropriate to grant the appeal, as hereby ordered.De conformidad con lo expuesto, no es posible para este Tribunal, constatar si a la fecha se ha dado el medicamento prescrito al amparado desde principios de diciembre del año anterior con lo que se verifica la lesión la lesión acusada al derecho fundamental a la salud del amparado respecto de las autoridades recurridas de la Caja Costarricense de Seguro Social y lo procedente es declarar con lugar el recurso, como en efecto se dispone.
Pull quotesCitas destacadas
"No está de más reiterar el carácter trascendental de la tutela constitucional al derecho a la salud, a través del ordinal 21 de la Constitución Política que establece la inviolabilidad de la vida humana, habida cuenta que esta última depende en gran medida del respeto a aquel derecho."
"It is worth reiterating the transcendental nature of the constitutional protection of the right to health, through Article 21 of the Political Constitution, which establishes the inviolability of human life, given that the latter depends largely on respect for that right."
Considerando IV
"No está de más reiterar el carácter trascendental de la tutela constitucional al derecho a la salud, a través del ordinal 21 de la Constitución Política que establece la inviolabilidad de la vida humana, habida cuenta que esta última depende en gran medida del respeto a aquel derecho."
Considerando IV
"La preponderancia de la vida y de la salud, como valores supremos de las personas, está presente y señalada como de obligada tutela para el Estado, no sólo en la Constitución Política, sino también en diversos instrumentos internacionales..."
"The preponderance of life and health, as supreme values of individuals, is present and indicated as mandatory protection for the State, not only in the Political Constitution but also in various international instruments..."
Considerando IV
"La preponderancia de la vida y de la salud, como valores supremos de las personas, está presente y señalada como de obligada tutela para el Estado, no sólo en la Constitución Política, sino también en diversos instrumentos internacionales..."
Considerando IV
Full documentDocumento completo
“I.- Purpose of the amparo action (recurso de amparo). The petitioner claims that the institutional provision of the injectable medication infliximab, for the treatment of his illness, was not authorized by the Caja Costarricense de Seguro Social, which he considers contrary to his right to health.” “… IV.- On the constitutional protection (tutela constitucional) of the right to health. It bears reiterating the transcendental nature of the constitutional protection of the right to health, through Article 21 of the Political Constitution, which establishes the inviolability of human life, considering that the latter depends to a great extent on respect for that right. Article 21 of the Political Constitution establishes that human life is inviolable, and from this the right to health of every citizen has been derived, it being ultimately the responsibility of the State to ensure public health by preventing it from being attacked. The preponderance of life and health, as supreme values of persons, is present and indicated as requiring mandatory protection from the State, not only in the Political Constitution, but also in various international instruments signed by the country, such as the Universal Declaration of Human Rights, the American Convention on Human Rights, the American Declaration of the Rights and Duties of Man, and the International Covenant on Civil and Political Rights. What must be clear is not only the relevance of the values for which the petitioner seeks protection, but also the degree of commitment that the Costa Rican State has acquired to defend them in an unquestionable and unconditional manner.
V.- On the merits. In the specific case, from the evidence in the record, as well as from what was reported under oath by the respondent authorities, it is established that as of December 11, 2008, it was decided to prescribe the medication infliximab for the petitioner. As it involves a treatment outside the Official List of Medications (Lista Oficial de Medicamentos, LOM), the request for infliximab was submitted to the Local Pharmacotherapy Committee (Comité Local de Farmacoterapia), whose members considered that it did not meet the scientific technical criteria, since the proceeding did not fulfill the institutional requirements that regulate the prescription and dispensing of LOM medications. However, despite the determination that the protected party was not a candidate for the application of the medication and the case was elevated to the Central Pharmacotherapy Committee (Comité Central de Farmacoterapia), upon receiving information that the petitioner presented an allergic reaction to one of the prescribed medications, the Central Pharmacotherapy Committee authorized, on January 28, 2009, the purchase of the medication infliximab; given that as of the date on which the General Director of Hospital San Juan de Dios submitted the report to this Chamber, February 3, 2009, the minutes of the Local Pharmacotherapy Committee have not been ratified and the communication of the resolution has not yet been sent; which means that formal notification is awaited before proceeding to acquire the product. In accordance with the foregoing, it is not possible for this Court to verify whether, to date, the medication prescribed to the protected party since early December of the previous year has been provided, thereby confirming the alleged harm to the fundamental right to health of the protected party with respect to the respondent authorities of the Caja Costarricense de Seguro Social, and it is appropriate to grant the amparo action, as is hereby ordered.” The appellant claims that the supply of the injectable medication infliximab, at institutional expense of the Caja Costarricense de Seguro Social, for the treatment of his illness was not authorized, which he considers contrary to his right to health.” “… IV.—On the constitutional protection of the right to health. It is worth reiterating the transcendental nature of the constitutional protection of the right to health, through Article 21 of the Political Constitution, which establishes the inviolability of human life, given that the latter depends to a large extent on respect for that right. Article 21 of the Political Constitution establishes that human life is inviolable, and from this the right to health of every citizen has been derived, it being ultimately the State’s responsibility to safeguard public health by preventing it from being attacked. The preponderance of life and health, as supreme values of individuals, is present and indicated as requiring mandatory protection by the State, not only in the Political Constitution, but also in various international instruments signed by the country, such as the Universal Declaration of Human Rights, the American Convention on Human Rights, the American Declaration of the Rights and Duties of Man, and the International Covenant on Civil and Political Rights. The relevance not only of the values for which the petitioner seeks protection must be clear, but also the degree of commitment that the Costa Rican State has acquired to defend them in an unquestionable and unconditional manner.
V.—On the merits. In the specific case, from the evidence in the record, as well as from what was reported under oath by the respondent authorities, it is established that as of December 11, 2008, it was decided to prescribe the medication infliximab to the appellant. Because this was a treatment outside the Official List of Medications (Lista Oficial de Medicamentos, LOM), the request for infliximab was submitted to the Local Pharmacotherapy Committee, where its members considered that it did not meet the scientific technical criteria, since the request did not fulfill the institutional requirements governing the prescription and dispensing of LOM medications. However, despite the fact that it was determined that the protected party was not a candidate for the application of the medication, and the case was referred to the Central Pharmacotherapy Committee, upon receiving information that the appellant presented an allergic reaction to one of the prescribed medications, the Central Pharmacotherapy Committee authorized the purchase of the medication infliximab on January 28, 2009; given that, as of the date on which the Director General of Hospital San Juan de Dios submitted her report to this Chamber, February 3, 2009, the minutes of the Local Pharmacotherapy Committee have not been ratified and the communication of the resolution has not yet been sent; meaning that formal notification is awaited in order to proceed with acquiring the product. In accordance with the foregoing, it is not possible for this Court to verify whether, to date, the medication prescribed since early December of the previous year has been provided to the protected party, thereby confirming the alleged injury to the fundamental right to health of the protected party by the respondent authorities of the Caja Costarricense de Seguro Social, and it is appropriate to grant the appeal, as is hereby ordered.”
“I.- Objeto del recurso. Acusa el recurrente que no se autorizó el suministro con cargo institucional de la Caja Costarricense de Seguro Social del medicamento infliximab inyectable, para el tratamiento de su enfermedad, lo que estima contrario a su derecho a la salud.” “… IV.- Sobre la tutela constitucional al derecho a la salud. No está de más reiterar el carácter trascendental de la tutela constitucional al derecho a la salud, a través del ordinal 21 de la Constitución Política que establece la inviolabilidad de la vida humana, habida cuenta que esta última depende en gran medida del respeto a aquel derecho. La Constitución Política en su artículo 21 establece que la vida humana es inviolable y a partir de ahí se ha derivado el derecho a la salud que tiene todo ciudadano, siendo en definitiva al Estado a quien le corresponde velar por la salud pública impidiendo que se atente contra ella. La preponderancia de la vida y de la salud, como valores supremos de las personas, está presente y señalada como de obligada tutela para el Estado, no sólo en la Constitución Política, sino también en diversos instrumentos internacionales suscritos por el país como la Declaración Universal de Derechos Humanos, la Convención Americana sobre Derechos Humanos, de la Declaración Americana de los Derechos y Deberes del Hombre y el Pacto Internacional de Derechos Civiles y Políticos. Debe quedar clara no sólo la relevancia de los valores para los cuales el actor reclama tutela, sino también el grado de compromiso que el Estado costarricense ha adquirido en cuanto a acudir de manera incuestionable e incondicional en su defensa.
V.- Sobre el fondo. En el caso en concreto, de las pruebas que constan en autos, así como de lo informado bajo juramento por las autoridades recurridas, se tiene que desde el 11 de diciembre de 2008 se decidió indicarle al recurrente el medicamento infliximab. Por tratarse de un tratamiento fuera de la Lista Oficial de Medicamentos (LOM), la solicitud de infliximab se elevó ante el Comité Local de Farmacoterapia, donde sus miembros consideraron que no cumplía con los criterios técnicos científicos, pues la gestión no llenaba los requisitos institucionales que regula la prescripción y despacho de medicamentos LOM. No obstante, pese a que se determinó que el amparado no era candidato a la aplicación del medicamento y se elevó el caso al Comité Central de Farmacoterapia, al tenerse información de que el recurrente presentaba una reacción alérgica a uno de los medicamentos indicados, el Comité Central de Farmacoterapia autorizó el 28 de enero de 2009, la compra del medicamento infliximab; siendo que a la fecha en que la Directora General del Hospital San Juan de Dios rinde el informe a esta Sala, el 03 de febrero de 2009, el acta del Comité Local de Farmacoterapia no ha sido ratificada y la comunicación de la resolución aun no ha sido enviada; lo que hace que se esté en espera de la notificación formal para proceder a adquirir el producto. De conformidad con lo expuesto, no es posible para este Tribunal, constatar si a la fecha se ha dado el medicamento prescrito al amparado desde principios de diciembre del año anterior con lo que se verifica la lesión la lesión acusada al derecho fundamental a la salud del amparado respecto de las autoridades recurridas de la Caja Costarricense de Seguro Social y lo procedente es declarar con lugar el recurso, como en efecto se dispone.”
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