Amparo for repeated surgery postponement due to lack of hospital bedsAmparo por reprogramación de cirugía ante falta de camas hospitalarias

“…**II.- Purpose of the remedy (amparo).** The petitioner comes before this Chamber, alleging that since April twenty-third of the previous year, surgery was scheduled at the respondent Hospital in order to operate on a benign tumor in her left salivary gland. She states that on four occasions the surgery has been rescheduled with the justification that there are no gurneys available, such that as of the date of filing this amparo, she has not been operated on.

**III.- On the right to health.** The right to life recognized in Article 21 of the Constitution is the cornerstone upon which the rest of the fundamental rights of the inhabitants of the republic rest. Likewise, the right to health finds its basis in that provision of the political charter, since life is inconceivable if minimum conditions for an adequate and harmonious psychic, physical, and environmental balance are not guaranteed to the human person. Evidently, any delay by the hospitals, clinics, and other healthcare units of the Caja Costarricense del Seguro Social can negatively impact the preservation of the health and life of its users. Public entities, bodies, and officials owe themselves to the users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence.

**IV.- Efficiency, Effectiveness, Continuity, Regularity, and Adaptation in Public Health Services.** The public bodies and entities that provide public health services have the imperative and unpostponable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those who demand immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling such obligation. From this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social are under the duty to adopt and implement organizational changes, to hire medical or auxiliary staff, and to acquire the materials and technical equipment required to provide efficient, effective, and prompt services. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious care for patients, the problem of “waiting lists” for surgical interventions and the application of certain specialized examinations, or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and swift manner. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics belonging to it are under the duty and, consequently, are personally responsible—under the terms of Article 199 and following of the Ley General de la Administración Pública—for adopting and implementing all administrative and organizational measures and actions to definitively put a stop to the delayed provision—which, on occasions, becomes negligent due to its consequences—of health services, a situation that constitutes, clearly, an unequivocal lack of service that can give rise to the patrimonial administrative liability of that entity for the unlawful injuries caused to the administered parties or users (Articles 190 and following of the Ley General de la Administración Pública).

**V.- Specific Case.** As has been duly accredited, surgery was scheduled for the petitioner on April twenty-third, two thousand eight, for the purpose of removing a benign tumor in her left salivary gland. However, since that day, her surgery has been repeatedly rescheduled on the grounds that there are no beds available. For their part, the respondent authorities reported that the Hospital has been experiencing a serious problem regarding the high demand for scheduled surgeries and the number of existing gurneys. This Chamber considers that while there is a shortage of gurneys at the Hospital, this does not justify that, after more than nine months have elapsed since the surgery was scheduled, it has not yet been carried out. The jurisprudence of this Court has been reiterated, emphatically stating that the lack of human and material resources, as well as budget, is not a valid argument to exempt the authorities from providing efficient health service. On the other hand, it should be noted that this is not a case where the protected party was placed on a waiting list, but rather that her surgery was already scheduled and rescheduled on three occasions after the first time. In this sense, this Court verifies the violation of the petitioner's right to health, since the time elapsed without the authorities having been able to coordinate the corresponding actions and adopt the necessary measures to operate on the protected party within the dates scheduled for that purpose is clearly excessive and violates her fundamental rights.

**VI.-** In another vein, according to the report rendered under oath by the respondent authorities, the last rescheduling of the patient's surgery is set for February seventeenth, two thousand nine, for which reason it is appropriate to order the medical authorities of the Hospital Max Peralta de Cartago to perform the surgery on that day, as scheduled, in order to avoid causing further harm to the protected party.” The appellant comes before this Chamber, alleging that since April twenty-third of the previous year, surgery was scheduled for her at the respondent Hospital in order to operate on a benign tumor in her left salivary gland. She states that on four occasions her surgery has been rescheduled with the justification that there are no stretchers (camillas), such that as of the date of filing of the amparo, she has not been operated on.

**III.- On the right to health.** The right to life recognized in Article 21 of the Constitution is the cornerstone upon which the rest of the fundamental rights of the inhabitants of the republic rest. Likewise, in that provision of the political charter the right to health finds its footing, since life is inconceivable if the human person is not guaranteed minimum conditions for an adequate and harmonious psychic, physical, and environmental balance. Evidently, any delay by the hospitals, clinics, and other health care units of the Caja Costarricense del Seguro Social can negatively impact the preservation of the health and life of its users. Public entities, bodies, and officials owe themselves to users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence.

**IV.- Efficiency, Effectiveness, Continuity, Regularity, and Adaptation in Public Health Services.** The public bodies and entities that provide public health services have the imperative and non-deferrable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those who demand immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling such obligation. From this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social are under the duty to adopt and implement organizational changes, to hire medical or auxiliary personnel, and to acquire the materials and technical equipment required to provide efficient, effective, and rapid services. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious patient care, the problem of “waiting lists” for surgical interventions and the application of certain specialized examinations or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and expeditious manner. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics belonging to it are under the duty and, consequently, are personally responsible—under the terms of Article 199 et seq. of the Ley General de la Administración Pública—to adopt and implement all administrative and organizational provisions and measures to put a definitive stop to the delayed provision—which, on occasion, becomes omitted due to its consequences—of health services, a situation that constitutes, by all lights, an unequivocal failure of service that may give rise to the patrimonial administrative liability of that entity for the anti-juridical injuries caused to the administered parties or users (Article 190 et seq. of the Ley General de la Administración Pública).

**V.- Specific Case.** As has been duly accredited, surgery was scheduled for the appellant on April twenty-third, two thousand eight, for the purpose of removing a benign tumor in her left salivary gland. However, since that date, her surgery has been repeatedly rescheduled on the grounds that there are no beds available. For their part, the respondent authorities reported that the Hospital has been experiencing a serious problem regarding the high demand for scheduled surgeries and the number of stretchers (camillas) available. This Chamber considers that, although there is a shortage of stretchers (camillas) at the Hospital, that does not justify the fact that more than nine months after the surgery was scheduled, it has not yet been carried out. The jurisprudence of this Court is reiterated, having emphatically stated that the lack of human and material resources, as well as of budget, is not a valid argument that exempts the authorities from providing an efficient health service. On the other hand, it should be noted that this is not a case where the protected party was placed on a waiting list, but rather that her surgery was already scheduled and rescheduled on three occasions after the first time. In this regard, this Court verifies the injury to the appellant’s right to health, since the time elapsed without the authorities having been able to coordinate what is required and to adopt the necessary measures to operate on the protected party within the dates scheduled for that purpose is by all lights excessive and violative of her fundamental rights.

**VI.-** In another vein, according to the report rendered under oath by the respondent authorities, the latest rescheduling of the patient’s surgery is set for February seventeenth, two thousand nine, for which reason it is appropriate to order the medical authorities of the Hospital Max Peralta in Cartago to carry out the surgery on that day, as scheduled, so as not to cause further harm to the protected party.”

“…II.- Objeto del recurso. La recurrente acude a esta Sala, acusando que desde el veintitrés de abril del año anterior, se le programó cirugía en el Hospital recurrido, a fin de operarse de un tumor benigno en su glándula salival izquierda. Señala que en cuatro ocasiones se le ha reprogramado la cirugía con la justificante de que no hay camillas, de tal forma que a la fecha de interposición del amparo, no ha sido operada.

III.- Sobre el derecho a la Salud. El derecho a la vida reconocido en el numeral 21 de la Constitución es la piedra angular sobre la cual descansan el resto de los derechos fundamentales de los habitantes de la república. De igual forma, en ese ordinal de la carta política encuentra asidero el derecho a la salud, puesto que, la vida resulta inconcebible si no se le garantizan a la persona humana condiciones mínimas para un adecuado y armónico equilibrio psíquico, físico y ambiental. Evidentemente, cualquier retardo de los hospitales, clínicas y demás unidades de atención sanitaria de la Caja Costarricense del Seguro Social puede repercutir negativamente en la preservación de la salud y la vida de sus usuarios. Los entes, órganos y funcionarios públicos se deben a los usuarios con una clara e inequívoca vocación de servicio, puesto que, esa ha sido la razón de su creación y existencia.

IV.- Eficiencia, Eficacia, Continuidad, Regularidad y Adaptación en los Servicios Públicos de Salud. Los órganos y entes públicos que prestan servicios de salud pública tienen la obligación imperativa e impostergable de adaptarlos a las necesidades particulares y específicas de sus usuarios o pacientes y, sobre todo, de aquellos que demandan una atención médica inmediata y urgente, sin que la carencia de recursos humanos y materiales sean argumentos jurídicamente válidos para eximirlos del cumplimiento de tal obligación. Desde esta perspectiva, los servicios de las clínicas y hospitales de la Caja Costarricense de Seguro Social están en el deber de adoptar e implementar los cambios organizacionales, de contratar el personal médico o auxiliar y de adquirir los materiales y equipo técnico que sean requeridos para brindar prestaciones eficientes, eficaces y rápidas. Los jerarcas de las Clínicas y Hospitales no pueden invocar, para justificar una atención deficiente y precaria de los pacientes, el problema de las “listas de espera” para las intervenciones quirúrgicas y aplicación de ciertos exámenes especializados o de la carencia de recursos financieros, humanos y técnicos, puesto que, es un imperativo constitucional que los servicios de salud pública sean prestados de forma eficiente, eficaz, continua, regular y célere. Los jerarcas de la Caja Costarricense de Seguro Social y los Directores de Hospitales y Clínicas que les pertenecen están en el deber y, por consiguiente son los personalmente responsables -en los términos del artículo 199 y siguientes de la Ley General de la Administración Pública-, de adoptar e implementar todas las providencias y medidas administrativas y organizacionales para poner coto definitivo a la prestación tardía –la cual, en ocasiones, deviene en omisa por sus consecuencias- de los servicios de salud, situación que constituye, a todas luces, una inequívoca falta de servicio que puede dar lugar a la responsabilidad administrativa patrimonial de esa entidad por las lesiones antijurídicas provocadas a los administrados o usuarios (artículos 190 y siguientes de la Ley General de la Administración Pública).

V.- Caso Concreto. Tal y como ha quedado debidamente acreditado, a la recurrente se le programó cirugía para el veintitrés de abril del dos mil ocho, con el fin de eliminarle un tumor benigno en su glándula salival izquierda. Sin embargo, desde ese día, se le ha venido reprogramando la cirugía con el argumento de que no hay camas disponibles. Por su parte las autoridades recurridas informaron que en el Hospital se ha estado dando un grave problema en cuanto a la gran demanda de cirugías programadas y la cantidad de camillas existentes. Considera esta Sala que si bien existe un faltante de camillas en el Hospital, ello no da razón para que luego de más de nueve meses transcurridos desde que se programó la cirugía, esta no se haya llevado a cabo. Es reiterada la Jurisprudencia de este Tribunal la cual ha señalado enfáticamente que la carencia de recursos humanos y materiales, así como de presupuesto, no es argumento válido que exima a las autoridades de brindar un servicio de salud eficiente. Por otro lado, nótese que no se trata de que a la amparada se le haya puesto en lista de espera, sino que su cirugía ya se encontraba programada y reprogramada en tres ocasiones luego de la primera vez. En este sentido este Tribunal verifica la lesión al derecho a la salud de la recurrente toda vez que el tiempo transcurrido sin que las autoridades hayan sido capaces de coordinar lo correspondiente así como de adoptar las medidas necesarias a fin de operar a la amparada dentro de las fechas programadas al efecto, resulta a todas luces excesivo y violatorio de sus derechos fundamentales.

VI.- En otro orden de ideas, según el informe rendido bajo juramento por las autoridades recurridas, la última reprogramación de la cirugía de la paciente está para el diecisiete de febrero del dos mil nueve, razón por la cual, corresponde ordenar a las autoridades médicas del Hospital Max Peralta de Cartago, realizar a la cirugía ese día, tal y como esta programado, para con ello, no causar mayor perjuicio a la amparada.”