Subjective Moral Damages in Amparo Execution for Medical Delay — Reconsidering Restorative JusticeDaño moral subjetivo en ejecución de amparo por retraso en atención médica — Reconsideración de la justicia restaurativa

**Review of the Document** **Exp. 23-003432-1028-CA** **Res. 000571-F-S1-2025** **FIRST CHAMBER OF THE SUPREME COURT OF JUSTICE.** San José, at eleven hours forty-four minutes on the twenty-seventh of March of two thousand twenty-five.

Enforcement proceeding of the judgment issued by the Constitutional Chamber of the Supreme Court of Justice in an amparo action filed by LEONARDO GÓMEZ SALAZAR, attorney, holder of identity card number 108760664 and bar association number 17,049, in his capacity as special judicial representative of MARÍA DE LOS ÁNGELES CARMONA CASTILLO, homemaker, holder of identity card number 108300488 against the CAJA COSTARRICENSE DE SEGURO SOCIAL, with legal entity identification number 4-000-042147, represented by its unlimited-sum general judicial representative, Xinia Enid Calderón Umaña, attorney, holder of identity card number 111430399 and bar association number 27,700. The general judicial representative of the executed entity filed a cassation appeal challenging judgment number 2024000956 issued at 14 hours 50 minutes on May 6, 2024, by the Administrative and Civil Treasury Court of the Second Judicial Circuit of San José, composed of Judge Pablo Zeledón Hernández.

Reporting Judge Jorge Leiva Poveda **CONSIDERING** **I.** The Constitutional Chamber of the Supreme Court of Justice, through judgment number 2023013051 at 09 hours 45 minutes on June 2, 2023, granted the amparo action filed by Leonardo Gómez Salazar on behalf of María de los Ángeles Carmona Castillo against the Caja Costarricense de Seguro Social (CCSS). Said action, filed before that Chamber on May 16, 2023, originated from the violation of the fundamental right to health. This was because the protected party is a patient of the Gynecology service at Hospital Maximiliano Peralta Jiménez in Cartago. She was diagnosed with “uterine leiomyoma.” On November 15, 2022, she was placed on a waiting list at that hospital for a “total abdominal hysterectomy surgery.” However, as of the date the amparo was filed, she had not received the required medical care. Nor did she have a definite date for the surgery. Regarding this, said Chamber stated: “IV.- […] Thus, this Chamber considers that the action must be granted, since approximately 6 months and 15 days have elapsed since the protected party was placed on a waiting list for the surgery required as treatment for her pathology, a period that is disproportionate and violates the fundamental rights of the person under protection. Added to the above, as can be deduced from the report issued by the respondent authority, there is no definite date for the surgical intervention, maintaining uncertainty regarding the timeframe for its completion. Precisely, it is the duty of the Caja Costarricense de Seguro Social to effectively safeguard the right to health of all its users, which includes –evidently– the obligation to provide timely and diligent care and medical treatment that its patients need. Given the foregoing, the appropriate course is to grant the action, due to violation of the right to health.” (The underlining is supplied). It ordered the Director General and the Head of the Gynecology Service, both of said Hospital, to promptly and timely arrange the necessary actions and coordination so that, within a maximum period of three months, counted from the notification of that judgment, the protected party would undergo the suitable surgical procedure she needs. All of this, under the strict supervision and responsibility of her treating physician, provided there is no cause preventing it and all pre-operative and institutional requirements have been met. They were warned that, in accordance with the provisions of article 71 of the Ley de la Jurisdicción Constitucional, imprisonment of three months to two years, or a fine of twenty to sixty days, will be imposed on anyone who receives an order, issued within an amparo action, that must be complied with or enforced, and fails to comply with or enforce it, provided the offense is not more severely punished. Likewise, it ordered the CCSS to pay the costs, damages, and losses caused by the facts that served as the basis for that declaration, which, it ordered, shall be liquidated in the enforcement of sentence before the administrative contentious jurisdiction.

**II.** By means of a brief submitted to the Court on November 8, 2023, uploaded to the electronic judicial file that day at 13:01:02, images 01 through 25, attorney Leonardo Gómez Salazar, in his capacity as special judicial representative of María de los Ángeles Carmona Castillo, submitted the corresponding liquidation to the court. He requested that the following items be granted: 1) the executed entity be ordered to pay the costs of the judgment enforcement proceeding; 2) ₡181,500.00 for the personal costs of the amparo action; 3) ₡300,000.00 for subjective moral damages (daño moral subjetivo); and 4) the payment of statutory interest, from the moment the judgment becomes final until its effective payment. By resolution at 15 hours 48 minutes on the 17th of that month and year (images 26 and 27), the procedural judge, Giovanni Marchena Jara, admitted the claim. In a brief uploaded to the file on January 18, 2024, at 10:36:52, images 29 through 79, the unlimited-sum general judicial representative of the CCSS opposed the enforcement. She raised the defenses of lack of: right, active standing, and passive standing. In the now-challenged judgment, the Enforcement Judge, Pablo Zeledón Hernández, rejected said defenses. Consequently, he granted the liquidation in the following terms. He ordered the CCSS to pay: 1) ₡50,000.00 for subjective moral damages (daño moral subjetivo); 2) ₡181,500.00 for the costs of the amparo action; 3) he also imposed on the executed institution the recognition of legal interest on the granted sums from the date that resolution becomes final until its effective payment; and 4) finally, he ordered the CCSS to pay the costs of the judgment enforcement proceeding. In disagreement, the general judicial representative of the CCSS filed a cassation appeal. For its resolution, the brief uploaded to the virtual desk of this Chamber on February 12, 2025, at 13:25:51, signed by attorney Gómez Salazar, was considered.

**III.** In the first objection, page three of the brief, the appellant stated she was filing it based on the cassation ground of violation of substantive norms provided in article 138, subsection a) of the Código Procesal Contencioso Administrativo (CPCA): “A cassation appeal shall also proceed for violation of substantive norms of the legal system, in the following cases: / a) When improper valuation is attributed to the evidence or it has been precluded.” This, she said, was due to the improper valuation of the means of conviction in the record, specifically, the enforceable judgment of the constitutional amparo action. She alleged that article 196 of the Ley General de la Administración Pública (LGAP) was violated. The contested judgment, she noted, based its argument for granting the item of subjective moral damages (daño moral subjetivo) on a factual element, but without analyzing the aspects contained in the line of precedent from this Chamber (she alluded to ruling no. 297-F-S1-2024 of 17 hours 27 minutes on March 21, 2024), such as determining the extreme necessity of the patient's case from a medical viewpoint -urgency-, their consent to be on a waiting list, or the existence of physical harm. The resolution, she stated, mentioned conditions of the claimant; however, it did not determine whether or not it was related to an emergency from a medical viewpoint. The Judge indicated that only an enforceable constitutional judgment is needed to demonstrate a factual situation. She reproduced, in what is of interest, the considerations in section IV of the contested judgment regarding subjective moral damages (daño moral subjetivo). With a simple enforceable judgment, she alleged, the judicial authority was able to determine that the Administration caused the claimant “an emotional impairment (menoscabo emocional)”, without considering factors of restorative justice, urgency, and patient compliance. She copied the proven facts from the enforceable judgment. With them, she indicated, no moral damage whatsoever suffered by the patient is proven. They do not make any reference to the worsening of her condition nor that she suffered “an emotional impairment (menoscabo emocional)”. The Judge, with the simple enforceable judgment, in her words, she insisted, determined the existence of an injury in the patient, without specifying what type. She transcribed another fragment of what was considered in section IV of the challenged ruling concerning subjective moral damages (daño moral subjetivo). In the substantive analysis of the Constitutional Chamber's judgment, she alleged, it was considered that the amparo was granted because the claimant was subjected to a waiting list for a period of 06 months and 15 days, without mentioning whether or not there was a need for immediate follow-up. She reproduced what was stated in the ruling of said Chamber in section IV. The Constitutional Court determined that said waiting period -06 months and 15 days- was disproportionate and violated the fundamental rights of the person under protection. However, she added, the Chamber has also mentioned, on other occasions, that determining how much time is fair and necessary, from a medical viewpoint, to attend, generally, to sick persons who come to CCSS services exceeds the scope of its powers and that, for this, it depends on a specific technical-scientific evaluation or criterion on the urgency or not of the treatment each one requires. An evaluation or criterion that, in this case, is not in the amparo file to determine that a period of 06 months and 15 days is disproportionate and violative. Mrs. Carmona Castillo, she noted, was not denied access to health services or medical care by her represented entity. Contrary to this, she stated, at the time the amparo action was filed, it was clear that what the protected party sought was a hysterectomy procedure which, under no circumstances, was considered an emergency or pathology of an urgent or oncological nature, as was indicated at the time. The Enforcement Judge, she stated, took as a basis to grant the enforcement of judgment an element that was not mentioned by the Constitutional Chamber to grant the amparo action and which, therefore, could not serve as a basis to grant claims. She transcribed another part of what was stated in the indicated Considering IV of the contested judgment. He issued the ruling considering the elapsed waiting period excessive. However, she said, nowhere in what was indicated in resolution no. 20233013051 of the Constitutional Chamber does it focus on indicating an excessive waiting time and urgency. Contrary to this, from the viewpoint of the treating physician, technical report no. HMP–DG-1915-2023, which is in the amparo action file, refers to Mrs. Carmona's pathology as non-priority or non-urgent. The contested judgment, she asserted, directly violated article 196 of the LGAP, by having determined the existence of an injury and damage, with an enforceable judgment. What was required for this, she stated, was technical evidence to prove it, which is aggravated by the fact that the Judge indicated that “an emotional impairment (menoscabo emocional)” occurred (page five of the ruling) and its prolongation, by the simple act of having analyzed the enforceable judgment. The questioned resolution, she insisted, violated said norm, which provides that the damage must be effective, assessable, and individualizable, in relation to a person or group. The truth is, she pointed out, that, based on a judgment from an amparo action for placement on a waiting list, there is no evidence whatsoever of an effect on the internal sphere of the claimant. There is no evidence whatsoever of an injury suffered. Nor what type of injury, since this legal concept corresponds to damage resulting from a lack of equivalence between what is given and what is received. In an onerous transaction. Damage resulting from a crime where a person's body is diminished or transgressed. Or, an organic or functional disturbance of an individual. That is, the Judge, from a simple enforceable judgment, validated and determined the existence of an injury in the patient; without specifying which type of injury, without having technical evidence to prove it. This, she argued, results in the damage not being real or effective, violating said precept. She insisted, the Judge did not consider the factors of restorative justice, urgency, patient compliance, reiterated in the case law of this Chamber. She mentioned judgments (in order of citation) nos. 28-F-S1-2024 of 11 hours 05 minutes on January 11; 297-F-S1-2024 of 17 hours 27 minutes on March 21, both of the year 2024; 1502-F-S1-2022 of 11 hours 24 minutes on September 1; 1823-F-S1-2022 of 14 hours 26 minutes on August 4, two thousand twenty-two; and 2429-F-S1-2022, all three of the year 2022. She included a table where she set out, in her opinion, what was specified in each of those rulings. If the Judge, she added, had properly analyzed the evidence, he would determine that an enforceable judgment is insufficient to establish the appropriateness of subjective moral damages (daño moral subjetivo). Especially, and taking into consideration that placing a person on a waiting list is not “per se,” sufficient grounds to award compensation. Regarding this, she indicated, this Chamber established, in resolution no. 1502-S1-2022 of 11 hours 24 minutes on September 1, 2022, that, concerning compensations for amparo actions due to placement on waiting lists, it is irrational to impose on the tripartite contribution fund of social security, compensation on someone who has consented to a wait and received the required medical care. She repeated once more, this was pointed out to the jurisdictional authority. However, in her opinion, it denoted that there is an “animus” to condemn the CCSS at all costs (and, clearly, the contributors), without any support whatsoever from an evidentiary standpoint. If the Judge had adequately valued the evidence, she asserted, the argumentation of the ruling would be different. He would have determined that the evidence was insufficient to establish the existence of any type of damage. From the proven facts of the amparo judgment, she stated, it is not denoted that it refers to an issue of injury to the claimant. That is, if the amparo judgment did not mention any aspect related to an injury due to placement on a waiting list, the judicial authority was prohibited from hearing it and, above all, taking it as a starting point to determine compensation. Without technical evidence, and without the enforceable amparo judgment mentioning any aspect, from a medical viewpoint, she pointed out, he determined complex technical-medical elements to conclude the existence of damage, effective and individualized, with respect to the claimant. She affirmed that she cannot condone the Judge's view, since, from the series of elements that were taken into consideration, it does not follow from what was analyzed by the Constitutional Chamber to grant the amparo action. Especially, taking into account that he referred to highly technical aspects, from a medical viewpoint (with specialties such as gynecology, for example), which can only be verified with that type of (technical) evidence. The enforceable judgment of a constitutional court, she indicated, by itself, does not have a nuance of such magnitude as to conclude the existence of an injury, taking into consideration, she insisted, that there was no technical evidence on it. If the Judge had properly analyzed the evidence, she concluded, he would determine that an enforceable judgment is insufficient for the appropriateness of subjective moral damages (daño moral subjetivo).

**IV.** This Chamber will undertake the analysis of the extensive objection in the following manner. FIRST. After its detailed analysis, it is determined that it suffers from a contradiction that causes perplexity. On page five of the brief, she affirmed: “Note by the honorable First Chamber, that the High Constitutional Court determined that the waiting period of 6 months and 15 days was disproportionate and violated the fundamental rights of the person under protection […]”. However, on the next page -six- she stated: “As can be seen by the honorable First Chamber, Judge Zeledón Hernández ruled considering the elapsed waiting period excessive, however, nowhere in what was indicated in Resolution No. 20233013051 of the Constitutional Chamber does it focus on indicating an excessive waiting time and urgency, contrary to this, from the viewpoint of the treating physician, technical report No. HMP–DG- 1915-2023 that is in the amparo, it refers to Mrs. Carmona's pathology as non-priority or non-urgent.” (The highlighting is from the original). That is, at first she affirmed that the Constitutional Chamber determined that the waiting period for the required surgery, which at the time the enforceable judgment was issued was six months and fifteen days, was disproportionate and violated the fundamental rights of the protected party, which is why the amparo action was granted. However, later she indicated that the Enforcement Judge, by considering the waiting period suffered by the claimant excessive, in order to determine the appropriateness of subjective moral damages (daño moral subjetivo), violated the enforceable ruling, since the Constitutional Chamber did not indicate that the waiting time was excessive. The contradiction is evident. In this sense, as noted in Considering I of this judgment, it is insisted, the Constitutional Chamber granted the amparo action filed in favor of Mrs. María de los Ángeles Carmona Castillo, as determined from the considerations in section IV of the enforceable ruling, by considering that the period she had been waiting up to that moment for the required surgery, of six months and fifteen days, was indeed disproportionate and violated her fundamental right to health. That is, the Enforcement Judge, adhering to what was resolved in the constitutional venue, as will be developed later, ordered that the waiting period suffered by the protected party was excessive. Furthermore, according to the response to the claim -image 30- and the evidence provided by the CCSS itself, visible in images 40 through 79, it is determined that, in compliance with what was ordered by the Constitutional Chamber, Mrs. María de los Ángeles underwent surgery at the Hospital Dr. Maximiliano Peralta Jiménez in Cartago, on September 13, 2023. That is, ultimately, she had to wait approximately 10 months for the required surgery. Which, according to what was resolved by the Constitutional Chamber, is harmful to her fundamental right to health.

**V.** SECOND. In order to have a full understanding of what will be said, it is appropriate to reproduce what was resolved by the Enforcement Judge in section IV of the contested judgment regarding subjective moral damages (daño moral subjetivo): “IV.- […] This Judge considers that in the specific case under analysis, regarding subjective moral damages (daño moral subjetivo), it is not difficult to determine without further proof than the provided enforceable judgment, it has been weighed that the [sic] plaintiff went to the medical center, and was placed on the waiting list on November 15, 2022, however, on the date the amparo action was filed, the [sic] plaintiff had not been operated on. The elapsed waiting period was weighed by the Constitutional Chamber, and was considered excessive and injurious to the right to health. Regarding the arguments of the CCSS to reject the liquidated moral damages (daño moral), they must be [sic] rejected, as it seeks to change the bases established in the constitutional ruling being executed, it seeks to re-discuss the issue that was analyzed by the Constitutional Chamber, effectively the Constitutional Court found abnormal functioning, where the plaintiff's health was neglected, it declared that there was a violation of the right to health, therefore, it is not admissible to re-discuss the same facts for which the CCSS was condemned, since they were held as true in the judgment being executed. It has been weighed that there exists an emotional impairment (menoscabo emocional), in the fact that occurred, when the [sic] plaintiff was faced with the prospect of a prolonged wait for her medical care, and therefore, had to resort to the Constitutional Chamber to remedy the grievance of an excessive delay in the provision of medical services; the fact that by order of the Constitutional Court, medical care was more immediate, does not erase the emotional impairment (menoscabo emocional) suffered by the plaintiff, in the face of a true dysfunction in the provision of health services, the thesis of the CCSS is not admissible, understanding that we are in a judgment enforcement proceeding, where the aim is to establish the amounts of the bases set by the Constitutional Chamber, it is not appropriate to proceed to make assessments of the merits of the constitutional proceeding, the executed judgment considered the waiting time set for the claimant's medical care excessive, it was determined in the constitutional proceeding that urgency existed, so much so that medical care was ordered within a period no longer than three months, therefore the CCSS's argument, which seeks to vary the bases set in the executed judgment, must be rejected. The elapsed waiting time in medical care is considered disproportionate, violating her Right to Health, such that the Constitutional Chamber had to order her care, in accordance with the principles of good public service and respect for the right to health, it is logical to deduce in re ipsa that it must have caused an emotional effect in the internal sphere of the claimant, and suffering resulting from the impotence in the face of the excessive and unjustified delay by the administrative authorities which prolonged her care, it clearly adds compensable worry, sadness, and anger, due to the inoperativeness of the service that is charged to her in advance and compulsorily (nexus of causation). It is clear that there is no consent to the delay in her medical care because she resorted to the Constitutional Chamber to obtain the health service within a reasonable timeframe, and to this enforcement venue, to find redress for the injury suffered, which forced her to activate the judicial system to receive a service that functions abnormally. In addition to the foregoing, it is considered that restorative justice operated with respect to the order to provide the health service, but not with respect to the other, different order regarding costs, damages, and losses, so the right regarding these unpaid aspects subsists. Therefore, and based on the principles of proportionality and reasonableness, subjective moral damages (daño moral subjetivo) is appropriate, in the sum of FIFTY THOUSAND COLONES, the indicated amount is considered adjusted to the results of the proceeding, it is supported by the principles of sound rational critique. The amount proposed by the claimant is rejected, as it is considered excessive, according to the results of the proceeding. The defense of lack of right and lack of passive standing is rejected.” (The highlighting and underlining are from the original).

**VI.** THIRD. Regarding what was argued by the appellant, it must be remembered that, in judgment enforcement proceedings in general and, mainly, those issued by the Constitutional Chamber, what is executed must necessarily be constrained to what was resolved in the amparo judgment subject to enforcement. This Chamber has indicated that the judgment enforcement proceeding seeks to materialize the -abstract- condemnation imposed on the losing party. If aspects different from -or contrary to- the pronouncement giving rise to the enforcement are granted, or against persons who were not condemned, res judicata is violated. See, among other rulings from this deciding body, nos. 383-2019 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-925036) and 309-2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1024927). Consequently, the supervisory role of this Chamber is constrained to an objective comparison between the enforceable judgment and the appealed resolution. In this sense, consultations can be made of, among many others, resolutions nos. 82-A-S1-22 of 10 hours 06 minutes on January 26 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1072742) and 1984-F-S1-2022 of 11 hours 18 minutes on September 8, both of the year 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112319).

**VII.** FOURTH. As noted in Considerings I and IV of this judgment, the Constitutional Chamber, in the executed judgment, granted the amparo action filed in favor of the protected party, as it was proven that on November 15, 2022, she was placed on a waiting list for total abdominal hysterectomy surgery and that, at the time the constitutional judgment was issued, she did not have a definite date for said surgical procedure. Therefore, that Chamber considered the period elapsed up to that moment, of six months and fifteen days, was disproportionate and violated her fundamental rights. Therefore, it granted the amparo action and ordered both the Director General of the Hospital and the Head of Gynecology to promptly and timely arrange the necessary actions and coordination so that, within a maximum period of three months, counted from the notification of the constitutional judgment, the protected party would undergo surgery. Which happened, as she was operated on on September 13, 2023. As can be clearly inferred, the Constitutional Chamber granted the action because it considered that the period the protected party had been on the waiting list was disproportionate and violated her fundamental right to health, considering her pathology. Precisely, the Enforcement Judge, it is insisted, adhering to what was resolved in the constitutional venue, considered: “[…] the fact that by order of the Constitutional Court, medical care was more immediate, does not erase the emotional impairment (menoscabo emocional) suffered by the [sic] plaintiff, in the face of a true dysfunction in the provision of health services, the thesis of the CCSS is not admissible, understanding that we are in a judgment enforcement proceeding, where the aim is to establish the amounts of the bases set by the Constitutional Chamber, it is not appropriate to proceed to make assessments of the merits of the constitutional proceeding, the executed judgment considered the waiting time set for the claimant's medical care excessive, it was determined in the constitutional proceeding that urgency existed, so much so that medical care was ordered within a period no longer than three months, therefore the CCSS's argument, which seeks to vary the bases set in the executed judgment, must be rejected. The elapsed waiting time in medical care is considered disproportionate, violating her Right to Health, such that the Constitutional Chamber had to order her care, in accordance with the principles of good public service and respect for the right to health, it is logical to deduce in re ipsa that it must have caused an emotional effect in the internal sphere of the claimant, and suffering resulting from the impotence in the face of the excessive and unjustified delay by the administrative authorities which prolonged her care, it clearly adds compensable worry, sadness, and anger, due to the inoperativeness of the service that is charged to her in advance and compulsorily (nexus of causation). It is clear that there is no consent to the delay in her medical care because she resorted to the Constitutional Chamber to obtain the health service within a reasonable timeframe, and to this enforcement venue, to find redress for the injury suffered, which forced her to activate the judicial system to receive a service that functions abnormally. In addition to the foregoing, it is considered that restorative justice operated with respect to the order to provide the health service, but not with respect to the other, different order regarding costs, damages, and losses, so the right regarding these unpaid aspects subsists. […]” (The highlighting and underlining are from the original). However, the appellant did not challenge said basis for determining the existence and quantification of that damage in due form, as required by the technique of cassation, in accordance with the provisions of article 139, subsection 3) of the CPCA. She limited herself to making a generic argument, without questioning, in a clear and precise manner, what was ordered by the Enforcement Judge. On the contrary, she alluded to other topics, not set forth by the judicial authority, such as restorative justice, urgency, and consent.

Likewise, the claimed damage cannot be inferred from the judgment; however, it is insisted once more, without questioning what was stated regarding its determination being "in re ipsa". This makes the argument futile for the purpose of varying what was decided.

VIII.Without prejudice to what was indicated in the previous section and, for greater abundance of reasons, it is necessary to point out the following. FIFTH. The appellant, insistently, alluded to the fact that what she called "restorative justice" operated in the sub júdice. In this regard, it is appropriate to note that this Chamber, in previous matters, recognized its applicability in matters of compensation for subjective moral damage (daño moral subjetivo) due to the infringement of the fundamental right to health (thus recognized by the Constitutional Chamber of the Supreme Court of Justice when granting the respective amparo appeal, due to the delay by the CCSS in providing the medical service required by the administered person), when the CCSS provides the service within the period ordered in the constitutional venue. In this respect, judgments no. 1502-S1-2022 of 11 hours 24 minutes on September 1st (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112330), 2429-F-S1-2022 of 14 hours 16 minutes on November 3rd (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1123608), both from the year 2022; 28-F-S1-2024 of 11 hours 05 minutes on January 11th (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396), 297-F-S1-2024 of 17 hours 27 minutes on March 21st (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250), 901-F-S1-2024 of 12 hours 31 minutes on July 4th (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1240015) and 937 of 14 hours 51 minutes on July 10th (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925); all from the year 2024, may be consulted. However, the current composition of this Chamber, after further study, considers it necessary to reconsider that position. Without a doubt, it is a vindication of the injured legal situation, due to a failure of service, that it be provided. Even more so, when it becomes necessary, as occurs with a pending health service. However, said reparation does not exclude, as the Enforcement Judge rightly indicated, that the harmed person has suffered effects in their moral and patrimonial sphere while the abnormal conduct persisted due to the administrative dysfunction. If effective detriments are demonstrated (precepts 196 and 197 of the LGAP) specific to the particular case and derived from its particular characteristics, inferring their existence, even through the "in re ipsa" intellectual process, despite the user having been jurisdictionally protected, their reparation proceeds. That is, corrective service provision does not exclude that the harmed person suffered effects in their moral and patrimonial sphere while the abnormal conduct persisted. If that occurred and was proven, it is mandatory to impose the corresponding compensatory consequence, if it was requested by the person whose legal sphere was damaged. This is in accordance with the principle of integral reparation of damage, which has constitutional and legal roots (constitutional canons 9, 41, 49; 190 and 197 of the LGAP).

IX.Within this line of thought, and regarding the existence and quantification of subjective moral damage, this Chamber, for a long time, has indicated that: "IV. [...] it comes from the injury to an extra-patrimonial right. That is, it does not directly impact the patrimony. It supposes an unjust disturbance of the emotional conditions. It does not require direct proof and is left to the equitable assessment of the Judge. If it is a matter of subjective moral damage, the courts are empowered to decree and quantify the condemnation. The legal nature of this type of damage does not oblige the liquidator to determine its existence because it corresponds to their internal sphere. That is not a problem for psychiatrists or doctors. Its existence or not must be understood because it belongs to the conscience. It is deduced through presumptions inferred from indicia, since the unlawful generating fact manifests the moral damage, as when the psyche, health, physical integrity, honor, intimacy, etc., are damaged, it is easy to infer the damage, which is why it is said that the proof of moral damage exists 'in re ipsa'. Nor should its value be proven because it has no concrete value. It is valued prudentially. It is not, then, about quantifying suffering, as it is invaluable, but about setting a monetary compensation for its injury, the only mechanism to which the law can resort, to thus repair, at least in part, its offense. For more detail on this aspect, one can consult, among others, of this collegiate body, rulings no. 112 already cited, no. 17 of 14 hours 30 minutes on February 21, 1996, and no. 41 of 14 hours 40 minutes on May 14, 1997. Its granting does not maintain a strict subjection to evidentiary factors (except those referring to the causal relationship), but to the prudence and objective discretion of the judge. However, its determination is subject to the principles of reasonableness and proportionality, which must be assessed by the competent authority in each case, so that its quantification is in accordance with Law and does not lead to excessive indemnifications that unjustifiably benefit one of the parties. That is, it must maintain a fair balance derived from the specific factual picture, a matter that must be weighed within the indicated limits." (Among many others, the judgment of this Chamber no. 468-F-S1-19 of 9 hours 45 minutes on May 30, 2019, may be consulted). According to what has been stated, once the existence of the moral damage and its causal link with the cause of action alleged by the plaintiff have been established - which is not objected to by the appellant - the determination of the quantum depends on the equitable assessment of the Judge; for which, the special circumstances of the case must be attended to, as well as the constitutional principles of reasonableness and proportionality." In this respect, judgment no. 1098-F-S1-2023 of 10 hours 09 minutes on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1170686), among many others, may be consulted. That is, it is regarding subjective moral damage that its demonstration is "in re ipsa", provided it is a consequence of a generating fact or unlawful cause.

X.In this dispute (lite), the Constitutional Chamber, as already indicated, determined the unlawful conduct of the CCSS by verifying the impairment of the fundamental right to health of Mrs. María de los Ángeles. The postponement of the required surgery was, at the time of the issuance of the constitutional judgment, six months and fifteen days; when it was performed, on September 13, 2023, the total wait was approximately 10 months, as indicated in section IV of this judgment. Such a situation -unlawful act-, according to the maxims of logic, experience, and correct human understanding, as was resolved, is an adequate cause of moral affliction, associated with anxiety, discomfort, frustration, and worry, due to the excessive waiting time -thus declared, it is insisted, in the constitutional venue- for a health situation that, "per se", is a cause of concern for the person suffering from it. According to correct human understanding and experience, it is insisted, one can infer, "in re ipsa", as the Enforcement Judge did, the existence of feelings such as those described above, without having the legal duty to bear them, as they derive from an abnormal functioning of the Administration, thus decreed, it is repeated once more, by the Constitutional Chamber. Ergo, different from what was indicated by the appellant, its existence is determined and, therefore, the appropriateness of its compensation.

XI.Similarly, this Chamber has stated: "VIII. [...] On other occasions, this cassation body has had the opportunity to highlight the necessary 'legal reasonableness' that this type of compensation must observe, for the verification of which compliance with a 'reasonableness of equality' must be confirmed, which the Constitutional Chamber has defined as '...the type of legal assessment that assumes that equal antecedents must have equal consequences, without arbitrary exceptions' (e.g., votes no. 5236-99 and 1354-2011). That is, to avoid inequitable and illegitimate treatments in the various matters in which compensation for moral damages is discussed, it is necessary to verify that the recognized amounts are not disproportionate, when compared with those established in other similar matters. In that vein, the Chamber considers that the sum granted adjusts to the intensity of the damage caused." Judgment no. 760-F-S1-2023 of 13 hours 24 minutes on May 29, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1157835). In the same sense, rulings nos. 1934-F-S1-2022 of 15 hours on August 12; 2654-F-S1-2022 of 10 hours 10 minutes on December 8 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1132117), both from the year 2022 and 1087-F-S1-2023 of 09 hours 36 minutes on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1173505), among others, may be consulted. In that vein, this Chamber considers the sum granted for the concept of subjective moral damage, ₡50,000.00, to be reasonable and proportionate, considering the circumstances of this case. Furthermore, it is quantitatively inferior to what has been recognized for similar effects. By way of example, the following precedents can be pointed out, where this deciding body did not consider unreasonable the sums granted for the delay in the provision of the public health service, nos. 429-F-S1-2024 of 10 hours 41 minutes on May 3rd (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1229475), where the Judge granted ₡500.00,00 and 937-F-S1-2024 of 14 hours 51 minutes on July 10th, both of the year 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925), establishing as compensation for moral damage, due to the delay in service provision, the sum of ₡200,000.00.

XII.SIXTH. Likewise, the appellant alleged that, in the case of the protected person (amparada), there was no urgency in performing the surgery. As stated in section I of this judgment, contrary to what was argued, it was the Constitutional Chamber itself, in the judgment under execution, that determined the urgency for the performing party (ejecutante) to undergo the required surgical procedure, ordering that it be carried out within three months from the notification of that ruling. Therefore, within the objective comparison that must prevail in this type of process -execution of a constitutional judgment- the issue of urgency is a precluded aspect, since, it is repeated, it was so determined and resolved by the Constitutional Court.

XIII.SEVENTH. Lastly, the challenger argued that the protected person conformed or consented to remaining on the waiting list. Different from what was alleged, in this dispute the existence of tacit or, even less, express consent by Mrs. Carmona Castillo cannot be considered. As the Enforcement Judge rightly indicated, the amparo appeal was filed in favor of Mrs. María de los Ángeles in time. So much so that the Constitutional Chamber admitted it for processing and, subsequently, granted it. This, regardless of the time elapsed between when the CCSS placed her on a waiting list and the filing of the amparo. Therefore, the performing party showed her disagreement with her permanence on the waiting list, and said jurisdictional body agreed with her.

XIV.In the second objection, page 11 of the appeal, the appellant announced that she was filing it on the cassation ground for violation of substantive norms provided for in subsection c) of canon 138 of the CPCA: "c) When a legal norm has been unduly applied or interpreted or has been omitted from application." She invoked as transgressed ordinances 73.1 of the Code of Civil Procedure (CPC) and 85 of the Tax Code of Norms and Procedures (Tax Code). Regarding the issue of the personal legal costs (costas personales) of the amparo appeal, she said, the Enforcement Judge pointed out: "[...] it has been weighed that the constitutional judgment established said right in favor of the performing party and that this right cannot be denied in the execution phase [...]". This, she pointed out, despite the non-existence of the issuance of an electronic invoice by any legal professional for professional services to file an amparo appeal. Even so, she noted, the amount for said petitionary item was granted, in accordance with article 73.1 of the CPC. She reproduced, in what is of interest, what was considered in section V of the questioned judgment, called "COSTS OF THE AMPARO". The judicial authority, she stated, relied on said precept to grant the amount for the concept of costs of the amparo appeal; despite no proof related to a professional service (issuance of an electronic invoice) having been presented. The objected judgment, she noted, unduly applied that provision, as it referred only to assessing part of its content, without thoroughly analyzing its literal text and even the teleological element. In this regard, she commented, this is a process of executing a constitutional judgment. The condemnation made by the Constitutional Chamber was in the abstract. Therefore, she indicated, the right to receive compensation for costs, damages, and losses must be executed and demonstrated in this venue. She reproduced said canon 73.1 of the CPC. Its content, she stated, establishes that the following will be considered costs: attorney's fees, compensation for time invested, and essential expenses of the process; but, the performing party did not provide any proof to demonstrate that an investment of money for attorney's fees had occurred. That is, she alleged, as there is a lack of proof regarding this, the Judge was compelled to grant no amount for the concept of costs of the amparo appeal, in the form of fees, as there is no proof that they have been paid, since there is no electronic invoice involved. Under the Judge's premise, she indicated, any person, through vicarious action, could file amparo appeals for the issue of waiting lists and, at the time of executing the judgment, would receive, as compensation, the costs of the appeal, which, in her view, would be absurd, since, to receive full compensation for an expense, it must be demonstrated. This, she pointed out, cannot be condoned, as no proof of that expense was presented. That is where the error of the judgment lies, as it granted the amount for the concept of costs of the amparo appeal as if they were for fees. It is important that the reasons why costs are awarded to a prevailing party in a judicial process be clear. Furthermore, she added, the magistrate of the Constitutional Chamber, Mr. Fernando Castillo Víquez, on multiple occasions has been clear in ordering both the CCSS, when the extra-procedural satisfaction of the Constitutional Chamber's condemnations is carried out, and the contentious-administrative jurisdiction, to ensure that the amounts granted effectively reach the hands of the protected persons. She transcribed, in what is of interest, what was stated in vote of the Constitutional Chamber no. 2016-012528. The questioned judgment, she concluded, should have rejected said item, since, as an electronic invoice was not provided, it was not demonstrated that any legal professional had provided a professional service and charged for it.

XV.Regarding what was stated in the previous section, it is necessary to point out the following. FIRST. As indicated, the appellant announced she was formulating the objection for violation, among others, of canon 85 of the Tax Code. However, in the development of the objection, she did not cite it. Therefore, she did not explain, with the required clarity and precision, how it was violated by the objected judgment. Consequently, this Chamber is barred from carrying out any analysis regarding said norm. SECOND. The Judge, in section V of the questioned judgment, concerning the costs of the amparo appeal, considered: "Regarding the personal costs of the amparo appeal, it has been weighed that the constitutional judgment established said right in favor of the performing party and that this right cannot be denied in the execution phase; in this instance the amount of the costs will be defined, but the bases of the judgment being executed cannot be varied as intended by the respondent CCSS representation. In accordance with numeral 193 of the Contentious Administrative Procedure Code, which, like article 73.1 of the Code of Civil Procedure, condemns the losing party to pay costs ex officio, what was requested is admissible, now, given that the amparo was filed on May 16, 2023, the provisions of numeral 46 of Executive Decree 41457-JP, which came into effect on February 1, 2019, are applicable, and which establishes an amount of ONE HUNDRED EIGHTY-ONE THOUSAND FIVE HUNDRED COLONES for said concept, therefore the personal costs of the amparo appeal are set up to said liquidated amount, rejecting the exception of lack of right and lack of active standing of the liquidated item." THIRD. On page 12 of the petition (libelo), the challenger stated: "Under the premise of Judge Zeledón Hernández, any person, through Vicarious Action, could file Amparo Appeals for the issue of waiting lists, and at the time of executing the judgment, would perfectly receive as compensation both costs of the appeal, which, respectfully, would be an absurdity [...]". Different from what was indicated, this Chamber, for a long time, has pointed out the difference between personal costs and attorney's fees, concluding that personal costs belong to the party, not the lawyer. In this regard, mutatis mutandis, the rulings nos. 432-F-S1-2017 of 09 hours 30 minutes on April 20, 2017 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-950854); 515-F-S1-2018 of 11 hours 20 minutes on May 30, 2018 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-892742); 28-F-S1-2024 of 11 hours 05 minutes on January 11 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396) and 297-F-S1-2024 of 17 hours 27 minutes on March 21 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250); both from the year 2024, may be consulted.

XVI.FOURTH. On pages 11, 12 and 13, the appellant indicated: "Regarding the issue of the personal costs of the Amparo Appeal, Judge Pablo Zeledón Hernández points out that [...] despite not fully having the issuance of an electronic invoice by any legal professional for Professional Services to file an Amparo Appeal, and even so, grants the amount for said petitionary item, in accordance with article 73-1 of the Code of Civil Procedure. In this regard, the judgment mentions the following: [...] That is, knowingly that no proof related to a professional service (the issuance of an electronic invoice) was presented, he grants this. [...] With the above, and given that the plaintiff party does not provide any proof that an investment of money for attorney's fees occurred, that is, as there is a lack of proof regarding this, the fact of the matter is that the judge was compelled to grant the amount for the concept of costs of the Amparo Appeal, in the form of fees for which there is no proof they have been paid, as there is no electronic invoice involved. [...] Therefore, it follows that the judgment should have rejected said item, since, as an electronic invoice was not provided, it was not demonstrated that any legal professional had provided a professional service and charged for it." (The highlighting is from the original). In this regard, it is necessary to state, the CPCA, in ordinance 193, expressly regulates the imposition of costs; as does canon 73.1 of the CPC. Therefore, it is the norm of the CPCA that is applicable to this dispute. However, this provision does not stipulate, as the one of the CPC does, what is considered costs. Ergo, this procedural principle, like those contained in ordinances 76.1 and 76.4 ibid, by virtue of the referral made by article 220 of the CPCA, is applicable to this dispute. In this sense, precept 73.1 of the CPC provides: "[...] Attorney's fees, compensation for time invested by the party in attending procedural acts where their presence was necessary, and other essential expenses of the process shall be considered costs." (The underlining is supplied). In this same vein, precepts 76.1 and 76.4 ibid indicate: "76.1 Right to fees and determination. Attorney's fees belong to the attorney, with the exceptions established by law. When the party is a lawyer and has acted personally, they shall have the right to them. Unless agreed otherwise, they shall be determined based on the work, the status, and the economic significance of the process, based on the provisions of Law No. 13, Organic Law of the Bar Association, of October 28, 1941, and the decree on attorney and notary fees. [...] 76.4 Contractual determination of attorney's fees. Lawyers and their clients may contractually determine the amount of the fees and their payment modalities respecting the limits imposed by the law and the respective decree. Said stipulation shall not affect the opposing parties in the process, for the purposes of determining personal costs." (Only the underlining is supplied). In light of the provisions of said norms, it is clear that, for cost purposes, attorney's fees must be calculated based on the legal limits and the rates established in the respective Decree, independently of any private agreement between the lawyer and their client. This implies that, in the liquidation of costs, it is not necessary for the performing party to demonstrate the agreement they have with their lawyer or the payment they may have made, as the regulations provide that the calculation of this item must be carried out according to the respective tariff or decree, to ensure an objective criterion in the liquidation of costs. Thus, if a party had legal representation in the processing of a case and obtained the payment of costs in their favor, the amount that will be recognized as attorney's fees shall necessarily be that established in the "Tariff of Fees for Professional Legal Services", according to the work performed. Consequently, it is not essential to provide an invoice or payment receipt in favor of the legal professional for the recognition of that item to proceed. In this dispute, the objecting party did not prove that Mrs. María de los Ángeles had lacked legal representation during the processing of the amparo process. On the contrary, it is on record that her special judicial representative in this execution process was the one who filed the amparo appeal on her behalf before the Constitutional Chamber. This allows inferring that said professional defended the interests of the protected person in the constitutional venue. Ergo, the lack of presentation of the invoice or payment receipt claimed by the appellant is not sufficient to diminish or dismiss the item of personal costs liquidated by the party and expressly recognized in the judgment under execution. It is reiterated, because the performing party had legal representation during the processing of the amparo and obtained the payment of costs in their favor. That is, they have the right to have the amount established by the applicable tariff for attorney's fees recognized as costs. Corollary, this Chamber does not observe the alleged legal violation and, consequently, the rejection of the objection shall be imposed.

XVII.In the third reason for disagreement, page 13 of the petition, the appellant announced she was filing it on the cassation ground for violation of substantive norms provided for in subsection d) of numeral 138 of the CPCA: "d) When the judgment violates the norms or principles of Constitutional law, among others, reasonableness, proportionality, legal certainty, and equality." Specifically, she invoked the postulate of reasonableness as infringed. In the questioned judgment, she stated, the Enforcement Judge determined the reasonableness of the compensation. She alleged that the performing party (besides not consenting to being on a waiting list by having resorted to the Constitutional Chamber, and that restorative justice did not mediate), sought compensation, not having an unhealthy desire. She transcribed, as pertinent, what was considered in section IV of the questioned judgment, regarding subjective moral damage. The Judge spoke of compensation for "the injury suffered," she noted, which forced the performing party to resort to filing the amparo appeal, but did not specify what the injury suffered was, whether physical or psychological. Furthermore, the judgment under execution (2024000956) does not reveal what the "alleged injury suffered" is. Nor is there proof in the file demonstrating that it occurred. Regarding the concept of injury, she reproduced, as pertinent, what was stated by the author Goldstein, Mabel, but did not indicate any work. The challenged judgment, she pointed out, left open the possibility to seek, unrestrictedly, double compensation: material compensation, upon receiving medical attention; and pecuniary compensation, without any proof thereof. The Judge was clear that the performing party sought an amount of ₡300,000.00 for subjective moral damage, plus compensation for costs. In total, the performing party petitioned for at least ₡481,500.00. The Judge, with his analysis, violated the principle of reasonableness. The spirit of the CCSS, in accordance with article 73 of the Political Constitution, she related, is to guarantee the fundamental rights to life and health; without which, the other guarantees enshrined in the Magna Carta cannot be fully exercised. Although, she noted, there are waiting lists, granting pecuniary compensation for placing a person on one of them, without a medical criterion of urgency, implies that the amounts destined to guarantee the two principal fundamental rights would be diminished, which, clearly, she said, is irrational, since the contributing persons to the Sickness and Maternity Insurance do so with the objective that a health service be provided and that resources be available to guarantee it. Not, she reiterated, so that compensation be granted for placing a person on a waiting list. The judge, she noted, distancing himself from the principle of reasonableness, determined that the fact that the medical procedure had been performed was insufficient to determine the existence of total restorative justice. Therefore, there must also be economic compensation. That is, it can be deduced from the foregoing that the Judge determined that a double compensation must always occur when a person is placed on a waiting list. However, she affirmed, the fact is that this generates a privilege and an unjust enrichment without any cause. The objective of the person who resorted to the Constitutional Chamber was to have a surgical procedure performed or to receive medical attention. Clearly, she added, they sought a restoration of their health, not to obtain compensation. This, she argued, could lead to a reduction in the resources of the health service, necessary for improvements in equipment, payment for medications, and instruments to adequately provide the health service, through professionals prepared for it. The Judge, she insisted, directly violated the principle of reasonableness by granting a compensatory item alleging that the performing party must receive monetary compensation, in addition to the substantive one already received: the performance of the required medical procedure. On this, she reiterated, he transgressed the principle of reasonableness, by not determining that compensation includes restoration. Which, she asserted, occurred through the judicial resolution, since the health service user received the required medical attention, making it contrary to law, especially to said principle, that, in addition to the restoration received, an extra amount be granted to her, having singularly overcome the situation of being on a waiting list. That is, granting her an amount for compensation, in addition to having performed the required medical procedure, gives her a privilege over the other insured parties, who were surpassed by the protected person. This was previously analyzed, she noted, by this Chamber in judgment no. 1502-S1-2022, which she reproduced in what was of interest. Also, in no. 297-F-S1-2024 of 17 hours 27 minutes on March 21, 2024, which she also copied as pertinent. That situation, she pointed out, which as can be inferred, was presented to the Judge, was directly disregarded and, even, a possible existence of some "animus" to condemn under any scenario is evidenced in some way. This, she reiterated, is contrary to the principle of reasonableness; since, in addition to diminishing the resources the institution has to provide the health service, it grants a privileged position to the person who received the required attention, at the expense of those who collaborate so that an adequate health service is provided. Therefore, she concluded, granting compensation for moral damage becomes a violation of the principle of reasonableness.

XVIII.

Regarding the preceding Whereas clause, the following must be clarified. FIRST. On page 14 of the complaint, the appellant stated: “[...] besides the final judgment (2024000956) it is not apparent what [sic] the ‘alleged injury suffered’ is, nor does the case file contain any proof demonstrating that it occurred.” (The highlighting and underlining are from the original). The appellant's assertion is a source of confusion. As noted in section I of this judgment, the final judgment is number 2023013051 of 09:45 hours on June 2, 2023, not number 2024000956, as the appellant erroneously indicated.

XIX.SECOND. The appellant forgot that this procedural instance does not correspond to an ordinary appeal (such as an appeal). Neither is it sufficient to express a series of general and merely argumentative disagreements. It is necessary to contrast the decision with the violation that, in her opinion, occurred. In this regard, numeral 139, subsection 3 of the CPCA provides a necessary material requirement, both for the admissibility of the appeal and for its subsequent evaluation on the merits. This is the statement of grounds for the appeal, which, due to the characteristics of cassation, must be clear and precise. In this sense, it must contain, as provided by the precept in question, the factual and legal basis of the case. Factual, to the extent that it shows disagreement with the facts that have been deemed proven or unproven (which leads to the weighing of evidence), or with the circumstances occurring in the violation of procedural rules. Legal, when it is an issue raised regarding the application, omission, or improper interpretation of any norm that makes up the legal system, including, of course, constitutional principles, or one that also operates by reflective or indirect effect, after the facts of the challenged judgment are modified. In both procedural and evidentiary violations, factual grounds may concur, together with legal grounds (always necessary), and in that sense, the referenced grounds must address both aspects, under penalty of inadmissibility. For its part, it must be clarified that the legal justification is exempted, by express legal mandate, from indicating those canons related to the value of the poorly assessed evidentiary element or elements. Likewise, it is unnecessary to cite the norms that the lower court wrongly used and mentioned to issue and reason its decision, because they appear in the appealed ruling itself. And of course, it is not at all indispensable to cite the precepts that establish the requirements, deadlines, and basic rules for the admission of the appeal. Rather than citing the latter, what is essential is that they are fulfilled and put into practice when drafting and filing the cassation appeal. Thus, the statement of grounds required by law can be understood, broadly speaking, as that technical-legal argumentation in which a series of articles, or legal rules are mentioned, interwoven or concatenated with each other and reasonably linked from a dual perspective: with the arguments of the appeal and with the judgment under challenge. To the extent that a set of legal norms (or if applicable, a single one) is cited, pertinent and clearly linked to the contested judgment (whether in its factual or legal basis) and the arguments of the appeal, there is a legal basis. Jurisprudential additions or occasional doctrinal citations will sometimes reinforce the allegations made, but, generally, they do not constitute their essence. As this Chamber has previously indicated when interpreting the referenced Article 139, “it is required that the appeal have a minimum legal basis... the reasons on which it bases its action must be explained, contesting the legal arguments of the appealed judgment and recording, at least, some normative reference that supports it” (Resolution no. 318-A-2008, of 14:25 on May 8, 2008). The statement of grounds is, therefore, alien to the confused deployment of norms and allegations; to the mixture of unintelligible arguments or the simple exposition of opinions on the merits or justice of the case, or rather, to the recounting of the errors considered to have been committed in the appealed judgment, without support in legal norms or criteria. Hence, if the appeal completely omits that technical-normative relationship to which reference has been made, or the one it makes is manifestly and evidently impertinent or unconnected to the case, it must be understood that it lacks “complete legal basis,” and therefore, fails to meet the necessary requirement established in numeral 139.3, which is sanctioned with outright rejection, pursuant to the provisions of Article 140, subsection c) of the same Code of Procedure. Likewise, this Chamber has repeatedly indicated that, for an appeal to pass the admission review, it requires, in addition to a sufficient statement of reasons, the corresponding mention and linkage with the challenged judgment of the applicable norms that are deemed violated. In this regard, one may consult, among other resolutions, nos. 677-A-S1-2021 of 09:40 on March 25, 2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1029345); 755-A-S1-2022 of 10:55 on March 29 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1082042); and 1663-A-S1-2022 of 10:05 on July 21 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112340), both from the year 2022.

XX.Along this line of thought, after a thorough study of the challenge under review, this Chamber determines that the appellant alleged two dissimilar hypotheses, but, due to the way they were structured, they are inseparable from each other. In this sense, on page 14 of the complaint, she indicated: “It is observed in the previously transcribed paragraph that the Judge speaks of compensation for ‘the injury suffered’ that forced the plaintiff to resort to filing the recurso de amparo, but does not specify what [sic] the injury suffered is, whether physical or psychological […]”. (The highlighting is from the original). If such is the case, this would constitute the cassation ground for violation of procedural rules provided for in subsection 1), point d), of canon 137 of the CPCA: absence of a statement of reasons. Then, on pages 15 and 16, she stated: “In addition to the above, the trial judge, departing from the principle of reasonableness, determines that the fact that the medical procedure was performed is insufficient to speak of full restorative justice, and that therefore there must also be financial compensation […] In that sense, the trial judge directly violates the principle of reasonableness, by awarding a compensatory amount arguing that the plaintiff should also receive monetary compensation, besides the one already substantively received: the performance of the required medical procedure. / In this regard, Judge Zeledón Hernández violates the principle of reasonableness, by not determining that compensation includes restoration, and this was achieved through the judicial resolution, since the health service user received the required medical attention, making it contrary to law, especially to said principle, that in addition to the restoration received, an additional amount is awarded […] it is evidenced somehow, a possible existence, it is reiterated, of an intent to convict under any scenario, which is reiterated, is contrary to the principle of reasonableness, given that this, besides depleting the resources available to the Institution to provide the health service, grants a privileged position to the person who received the required attention, at the expense of those who collaborate to provide adequate health service. / Therefore, granting compensation for moral damages becomes a violation of the principle of reasonableness.” (The highlighting is from the original). What has just been set forth would give rise to the declared cassation ground for violation of substantive norms, for the alleged violation of the constitutional principle of reasonableness. The outlined ambiguity conflicts with the technique of cassation, which requires that the grounds for the appeal be indicated clearly and precisely, with the factual and legal basis of the case (precept 139, subsection 3) of the CPCA). Ergo, the rejection of the objection under study is required.

XXI.THIRD. The appellant's arguments concerning the existence of restorative justice; as well as the lack of urgency in the appointment for the person protected by the recurso de amparo and the inappropriateness of granting compensation for subjective moral damages, were already analyzed in sections VIII through XIII of this judgment, and therefore, to avoid unnecessary reiterations, reference is made to what was expressed therein.

XXII.In the fourth and final reproach, page 16, the appellant announced that she was filing it under the cassation ground for violation of substantive norms provided for in subsection c) of Article 138 of the CPCA. She alleged improper application of canon 193 ibid. In the challenged judgment, she said, the Execution Judge awarded costs of the Sentence Execution. She considered that the enforcing party had sufficient reasons to litigate, having a right granted in abstracto. However, she noted, the indicated precept -193 ibid- establishes that the losing party will be exempted from paying costs when, due to the nature of the debated issues, there existed sufficient grounds to litigate. She transcribed, in relevant part, what was considered in section VI of the challenged judgment, called “COSTAS DE LA EJECUCIÓN E INTERESES” (EXECUTION COSTS AND INTEREST). The challenged judgment, she pointed out, was clear that the enforcing party requested, for subjective moral damages, an amount of ₡300,000.00, plus compensation for costs. She copied, as pertinent, the statements in section I of the appealed ruling. In total, she stated, the enforcing party sought, at least, ₡481,500.00. The Judge, she commented, improperly applied Article 193, subsection 2) of the CPCA, as said norm establishes that the losing party may be exempted from paying costs when, due to the nature of the issues debated, there existed sufficient grounds to litigate. Taking into consideration purely arithmetical aspects, and only the awarded amounts, they represent a total of ₡231,500.00. This implies that, she argued, of the total sought, the enforcing party obtained 48.07%, which entails, a contrario sensu, that she did not obtain 51.93% of what she sought to obtain. Consequently, she alleged, it is evident that her represented party had to litigate. She achieved, she added, that the enforcing party did not obtain the total of her claims. Therefore, she questioned, she does not understand how this was not even minimally appreciated by the Judge, who considered that the winning party had sufficient grounds to litigate, when he should have assessed that it was her represented party who had sufficient grounds to litigate. Especially when dealing with an execution of a judgment for a right granted in abstracto, facing a scenario of extreme petitions, which implied that this representation had to exercise defense of institutional interests. If the Judge had assessed the above, she stated, he would have determined that her represented party had grounds to litigate. Among different elements, she indicated, the following are present: 1) the total amount sought by the enforcing party was ₡481,500.00; ₡300,000.00 for moral damages and ₡181,500.00 for costs, for the elapsed period of six months and fifteen days, where, even medically, it was never classified as urgent; 2) of the total amount sought, 48.07% was awarded (₡50,000.00 for moral damages and ₡181,500.00 for costs), resulting in 51.93% of the total sought being rejected; 3) of the amount sought for subjective moral damages, the sum of ₡50,000.00 was awarded, representing 16.6% of what was initially requested; 4) this is a claim with an evident attempt to obtain amounts beyond what can be considered, parallel to reasonableness; 5) this Chamber, in judgment no. 1502-S1-2022, indicated that it is irrational to impose on the tripartite contribution fund for social security and on the other insured beneficiaries of those funds, an additional compensation on someone who has consented to the wait and received, through judicial protection, the required medical care. Additionally, it provided guidelines to determine whether or not compensation should be granted, such as whether the type of pathology of the patient refers to an emergency or not, or rather, conformity with being included on a waiting list, and even compensation “in natura”. That is, her represented party relied on positions developed by this Chamber to litigate in the proceeding, which was pointed out to the Judge, without him taking it into consideration. For the foregoing, she argued, it is evident that this representation had to litigate in the proceeding. Not satisfied with that, the Judge decided to award costs against her client, leaving her in a clear position of vulnerability and disadvantage, since defending, even the financial sustainability of the Institution, is clearly sufficient grounds to litigate. Not satisfied with that, she insisted, the Judge awarded costs against her represented party for the execution proceeding. Therefore, she indicated, it can be deduced, directly, clearly, and simply, that her represented party had sufficient grounds to litigate, given that the principles of legality, good faith, loyalty between parties, and preclusion were being effectively protected. If Article 193, subsection b) of the CPCA had been properly applied, she said, the Judge would have exempted her client from paying costs, given that it is evident and manifest, she concluded, in addition to being simple to verify, the fact that there were sufficient grounds to litigate.

XXIII.Regarding the statements in the preceding Whereas clause, it is necessary to indicate FIRST, the Execution Judge, in section VI of the challenged judgment, stated: “Pursuant to Articles 119.2, 193 of the Código Procesal Contencioso Administrativo, as in this Judge's opinion there are sufficient reasons for the plaintiff to have litigated in this proceeding, since she had a right granted in abstracto by the Sala Constitucional which she could come to enforce in this court, costs are awarded against the defendant [sic] CCSS, rejecting the objection of lack of right of the liquidated item. […]”. SECOND, after a detailed study of the grievance, it is determined that its core consists of the alleged violation, by erroneous application, of ordinal 193, subsection b) of the CPCA, since, in her view, due to the nature of the debated issues, her client had sufficient grounds to litigate. This is because, she indicated, the enforcing party sought payment of at least ₡481,500.00, distributed as follows: ₡181,500.00 for personal costs of the recurso de amparo and ₡300,000.00 for subjective moral damages. However, the Execution Judge, she said, only awarded a total of ₡231,500.00 (₡181,500.00 for personal costs of the recurso de amparo and ₡50,000.00 for subjective moral damages). That is, 48.07% of what was sought. In this regard, the foregoing would give rise to the announced cassation ground, provided for in subsection c) of precept 138 of the CPCA. However, she then alluded to two more dissimilar hypotheses, with all three being indivisible, given the way the objection was formulated. In this sense, on pages 17 and 18, she indicated: “Regarding this, and taking into consideration purely arithmetical [sic] aspects, and only taking into consideration the awarded amounts, these represent a total of ₡231,500.00 (two hundred thirty-one thousand five hundred colones), which implies that of the total sought, the plaintiff obtained 48.07%, which entails, a contrario sensu, that she did not obtain 51.93% of what she sought to obtain, which demonstrates that, in the first instance, my represented party indeed had to litigate this proceeding [sic] and even managed to ensure the plaintiff did not obtain the total of her claims, which is not understood how it was not even minimally appreciated by the trial judge, who considers that the winning party had sufficient grounds to litigate, when he should have assessed that it was my represented party who had sufficient grounds to litigate the [sic] sentence execution proceeding, especially when dealing with an execution of a judgment for a right granted in abstracto, where we were practically facing a scenario of extreme petitions, which imply that this representation undoubtedly had to exercise the defense of institutional interests. / If Judge Zeledón Hernández had assessed the above, he would have determined that my represented party had ample grounds to litigate the judicial proceeding, given that, among different elements, the following are present: […] The Sala Primera de la Corte Suprema de Justicia, in judgment No. 1502-S1-2022, indicates that it is irrational to impose on the tripartite contribution fund for social security and on the other insured beneficiaries of those funds, an additional compensation on someone who has consented to the wait and received through judicial protection the required medical care, and additionally, it provided guidelines to determine whether or not compensation should be granted, such as whether the type of pathology of the patient refers to an emergency or not, or rather, conformity with being included on a waiting list, and even compensation in natura, that is, my represented party relied on positions developed by the same Sala Primera to litigate the proceeding, which was pointed out to the trial judge, without him even taking it into consideration.” (The highlighting is from the original). In what has just been set forth, the appellant alluded to the cassation ground for violation of procedural rules, provided for in Article 137, subsection 1), point d) of the CPCA: absence of a statement of reasons. However, the argument is informal. The objecting party omitted to indicate the procedural norm violated, with a clear and precise explanation, just as the technique of cassation requires, as indicated in section XIX of this judgment, in accordance with the provisions of ordinal 139, subsection 3) ibid. On the other hand, on page 18, she added: “Therefore, it is evident that this representation had to litigate the proceeding, and not satisfied with that, the trial judge decides to award costs against my represented party, placing her in a clear position of vulnerability and disadvantage, given that defending even the financial sustainability of the Institution is clearly sufficient grounds to litigate, not satisfied with that, Judge Zeledón Hernández awards costs against my represented party for the execution proceeding.” (The highlighting is from the original). In what has just been set forth, she refers to the cassation ground for violation of substantive norms provided for in subsection d) of ordinal 138 of the CPCA. The demonstrated confusion, as indicated, conflicts with the technique of cassation, which, as has already been indicated, requires that the reproaches of the cassation appeal be formulated clearly and precisely (Article 139, subsection 3) of the CPCA); which entails the rejection of the grievance under study.

XXIV.THIRD. According to the statements in the statement of defense, images 29 to 38 of the electronic judicial file, the general judicial representative of the CCSS alleged and requested that her client should not be ordered to pay subjective moral damages. This, despite what was resolved by the Sala Constitucional, because, in her opinion, the person protected by the recurso de amparo was not denied access to health services, much less medical care. Furthermore, according to her, the diagnosis of the protected person was not urgent. The protected person, she stated, did not explain what the moral damage consisted of. That is, the enforcing party did not comply with the provisions of ordinals 163 and 180 of the CPCA. Likewise, she did not demonstrate the causal link between what appears in the case file and the factual situation on which she intends to base said damage. That is, she did not prove it. Nor are there technical criteria demonstrating its existence. Ergo, this item had to be rejected. For his part, the Execution Judge, in the challenged judgment, according to the transcription made in section V of this judgment, deemed the subjective moral damage appropriate, by virtue of its “in re ipsa” demonstration based on the facts that served as the basis for granting the recurso de amparo. In accordance with his prudent judgment and the principles of reasonableness and proportionality, he set the amount at ₡50,000.00. The foregoing means, contrary to what the appellant argued, that the opposition raised by the general representative of the CCSS was unsuccessful. The Judge, it is reiterated, determined the existence of subjective moral damage by virtue of the facts that served as the basis for granting the recurso de amparo, which was endorsed by this Chamber, as stated. Moreover, he set its amount, as indicated, according to his prudent judgment and under the protection of the indicated principles of reasonableness and proportionality, which was also shared by this Chamber. Likewise, the amount requested for personal costs of the recurso de amparo was awarded. Furthermore, the legal interest on the awarded amounts and the costs of the execution proceeding were granted, just as requested. As a corollary, contrary to what the appellant stated, and as was rightly resolved, awarding the payment of costs for the execution proceeding was required, as provided by canon 193 of the CPCA, as none of the grounds for exemption provided for in that norm were present. FOURTH. As noted in section XXI of this judgment, the appellant's arguments concerning the existence of restorative justice and the lack of urgency in the appointment for the person protected by the recurso de amparo, her having consented to the wait, and the inappropriateness of granting compensation for subjective moral damages were already analyzed in sections VIII through XIII of this judgment, and therefore, to avoid unnecessary reiterations, reference is made to what was expressed therein.

XXV.By virtue of the reasons set forth, the rejection of the filed appeal is required. In accordance with the provisions of Article 150, subsection 3) of the CPCA, as this Chamber does not consider that the appellant entity has sufficient grounds to appeal, for the reasons stated when analyzing each grievance, the payment of the costs of the cassation appeal shall be imposed, which must be settled in the sentence execution phase, in order to guarantee the right of defense of the executed party, with the respective hearing being granted on the settlement presented (Articles 41 and 153 of the Constitución Política).

XXVI.DISSENTING VOTE OF JUDGE ROJAS MORALES. I depart from the majority opinion, insofar as it deems it appropriate to order the defendant to pay subjective moral damages in the amount of ₡50,000.00. Regarding the damages caused by a ruling of the Sala Constitucional, when granting a recurso de amparo, it is worth bearing in mind that, given their nature, these types of judgments contain an abstract award, without any factual consideration; they do not prejudge, as it was not subject to analysis, their existence, nor their causal link or quantification. Said Court limits itself to determining the constitutional violation. When executing those aspects, the causal relationship between what is declared in abstracto and the specific matter must be established. Thus, the fact that the Sala Constitucional abstractly orders the payment of damages does not entail an automatic enforceable award, as the Execution Judge seems to understand incorrectly. It is up to the judges responsible for resolving the settlement to assess in each specific case whether there is sufficient merit to grant the requested compensation. In this direction, the following must be analyzed: the particular circumstances of the case, the position of the parties, the nature, object, and purpose of the compensation, as well as the constitutional principles of reasonableness and proportionality. Furthermore, when the matter concerns alleged subjective moral damage suffered by a person facing a lack of medical care, as in this case, examining additional facets becomes indispensable. First, the urgency factor must be assessed, as it is evident that a person who requires urgent care from the CCSS, for example: an administered person suffering from cancer which advances irremediably, is not in the same situation as someone who presents an ailment and has been prescribed a surgical intervention or a medical appointment without urgency; in both cases, the waiting time to receive the medical service does not have the same result. Likewise, the moral impact will not be of equal intensity. On the other hand, the inactivity of the patient due to the passage of time on the waiting list must be analyzed (canon 30, subsection ch) of the Ley de la Jurisdicción Constitucional -LJC- and 38 of the Código Procesal Contencioso Administrativo), which ceases when they turn to the Sala Constitucional via recurso de amparo or to the courts of justice to demand the medical care or treatment they need (administrative activity). It should be noted that the passage of time without taking action has clear consequences in the Costa Rican legal system regarding the expiration of the action, an aspect assessable ex officio. A financial advantage cannot be derived from inactivity, as this contradicts the principle of proportionality in the strict sense. Third, the satisfaction provided by a court order directing the performance of a medical act or the delivery of medication must be considered (even if it arises due to a precautionary measure). Indeed, the most recent case law of the Sala Constitucional has assessed the satisfaction generated from the notification of the course of the recurso de amparo. These are cases where, due to the recurso de amparo and regardless of the time elapsed between filing the appeal and receiving the administrative response, the respondent authority recognizes the required medical care for the administered person (granting a definite date for surgery or a medical consultation, providing the needed medication, rescheduling an appointment, etc.). Cases of the latest binding resolution erga omnes (according to ordinal 13 of the LJC), in which the Constitutional Judges have considered it inappropriate to award costs and damages, issuing resolutions even without an award on those aspects; these must be assessed by this Chamber when ruling on ongoing proceedings. In that sense, one may consult, among others, judgments numbers: 2024-000017 of 9:15 on January 9, 2024, 2024-000026 of 9:15 on January 9, 2024, and 2024-006673 of 9:15 on March 8, 2024. It is worth highlighting that providing the required medical service constitutes a manifestation of restorative justice, which this Deciding Body must assess. Compensation awarded in violation of the stated reasoning becomes unreasonable and disproportionate, especially when, in a universal social security system like Costa Rica's, such compensations are paid by all insured parties, including those displaced by the enforcing party. When examining the described aspects and the particular case of Mrs. María de los Ángeles Carmona Castillo, it becomes inappropriate to compensate the emotional impact awarded in the judgment. The record shows that on November 15, 2022, the Gynecology Service of the Hospital Maximiliano Peralta Jiménez de Cartago issued a hospitalization request for surgery for Mrs. María de los Ángeles, a date from which she entered the waiting list. On May 16, 2023, she filed a recurso de amparo before the Sala Constitucional, meaning she remained waiting for the intervention to be scheduled for approximately six months. The possibilities of social security in an area like General Surgery must be taken into account, where there are not enough specialists to serve the population, especially given that the number of people requiring intervention in that area is increasing. Moreover, it is worth noting that even though the Hospital Maximiliano Peralta Jiménez de Cartago issued the hospitalization order for surgery, it did not do so on an urgent basis (as indicated in technical report no. HMP-DG-1915-2023). In addition to the above, the Expediente Digital Único en Salud shows that the medical care requirement was satisfied for the enforcing party, since the surgery was performed on September 13, 2023, implying care within a reasonable period, given the noted conditions. Observe, the waiting time Mrs. María de los Ángeles endured to receive the needed care was about four months, counted from when she filed the recurso de amparo on May 16, 2023, until she underwent surgery on the following September 13. The period is even shorter if it is taken into account that the final judgment was notified on June 5, 2023. Periods that are inherently reasonable from the perspective of providing a non-urgent service and in light of the need to fulfill the preoperative requirements accompanying any surgical intervention.

It should be noted that, from the filing of the amparo, the enforcing party was never subjected to a prolonged or indefinite wait. She received medical attention within a more than reasonable period (even shorter than the waiting periods in private medicine). Without overlooking the fact that the surgery was scheduled for her on a non-urgent basis. The foregoing speaks to the non-existence of the liquidated damages. It is worth adding that, in cases such as the one under study, there is no doubt that the user's satisfaction has already been generated; therefore, it becomes contrary to law to grant additional compensation to that already received (medical assessment in singular derogation of the waiting list). The foregoing, far from causing the enforcing party moral harm, granted her a privilege over the other insured persons, which detracts from the claim for moral damages filed. It is irrational to impose on the tripartite contribution fund of the social security system and on the other insured persons benefiting from said funds, additional compensation on someone who has received the required medical attention through judicial protection. For the reasons indicated, the compensation granted does not conform to criteria of reasonableness and proportionality (established by the Constitutional Chamber itself). In merit of the foregoing, the undersigned considers that the appropriate course was to uphold the first and second grievances of the appeal filed and, consequently, to annul the contested judgment -only- insofar as it recognized the amount of ¢50,000.00 for subjective moral damages, and instead, ruling on the merits, to reject that claim.

POR TANTO

By majority vote, the appeal is declared without merit, with costs to be borne by the cassation appellant, Caja Costarricense de Seguro Social, which shall be settled in the judgment execution stage. Judge Rojas Morales dissents to uphold the appeal by virtue of restorative justice having been configured.

Luis Guillermo Rivas Loaiciga Rocío Rojas Morales Damaris Vargas Vásquez Jorge Leiva Poveda Carlos Guillermo Zamora Campos Documento Firmado Digitalmente -- Código verificador --  Regarding this, said Chamber indicated: "IV.- [...] Thus, this Chamber considers that the appeal must be granted, since approximately 6 months and 15 days have elapsed since the protected party was placed on the waiting list for the surgery required as treatment for her pathology, a period that is disproportionate and violates the fundamental rights of the protected party. In addition to the foregoing, according to the report rendered by the appealed authority, there is no certain date for performing the surgical intervention, maintaining uncertainty as to the timeframe for its performance. Precisely, it is the duty of the Costa Rican Social Security Fund to effectively safeguard the right to health of all its users, which includes—evidently—the obligation to provide timely and diligent care and medical treatment needed by its patients. Given the foregoing, the appropriate course of action is to grant the appeal, due to violation of the right to health." (The underlining is supplied). It ordered the General Director and the Head of the Gynecology Service, both of said Hospital, to promptly and timely arrange the necessary actions and coordination so that, within a maximum period of three months, counted from the notification of that judgment, the appropriate surgical procedure needed by the protected party be performed on her. All of this, under strict supervision and responsibility of her treating physician, provided there is no cause preventing it and all preoperative and institutional requirements have been met. They were warned that, in accordance with the provisions of Article 71 of the Constitutional Jurisdiction Law, imprisonment of three months to two years, or a fine of twenty to sixty days, shall be imposed on whoever receives an order that must be complied with or enforced, issued within an amparo appeal, and fails to comply with it or enforce it, provided the crime is not more severely punished. Likewise, it ordered the CCSS to pay the legal costs (costas), damages (daños y perjuicios) caused by the facts that served as the basis for this declaration, which, it ordered, shall be liquidated in the enforcement of the contentious-administrative judgment.

**II.** Through a brief submitted to the Office on November 8, 2023, uploaded to the electronic judicial file that day at 13:01:02, images 01 to 25, attorney Leonardo Gómez Salazar, in his capacity as special judicial representative of María de los Ángeles Carmona Castillo, submitted the corresponding liquidation to the court. He requested that the following items be accepted: **1)** that the executed entity be ordered to pay the legal costs (costas) of the judgment enforcement proceeding; **2)** ₡181,500.00 for the personal legal costs of the amparo appeal; **3)** ₡300,000.00 for subjective moral damages (daño moral subjetivo); and **4)** the payment of legal interest from the moment the judgment became final until its effective payment. By a ruling at 3:48 p.m. on the 17th of that same month and year (images 26 and 27), the procedural judge, Giovanni Marchena Jara, admitted the claim. In a brief uploaded to the file on January 18, 2024, at 10:36:52, images 29 to 79, the CCSS's general judicial representative without sum limit opposed the enforcement. She raised the defenses of lack of: right, active standing (legitimación activa), and passive standing (legitimación pasiva). In the judgment now challenged, the Enforcement Judge, Pablo Zeledón Hernández, rejected these preliminary objections. Consequently, he accepted the liquidation in the following terms. He ordered the CCSS to pay: **1)** ₡50,000.00 for subjective moral damages (daño moral subjetivo); **2)** ₡181,500.00 for the legal costs of the amparo appeal; **3)** he also imposed on the executed institution the recognition of legal interest on the granted sums from the finality of that resolution until their effective payment; and **4)** finally, he ordered the CCSS to pay the legal costs (costas) of the judgment enforcement proceeding. Disagreeing, the general judicial representative of the CCSS filed a cassation appeal (recurso de casación). For its resolution, the brief uploaded to the virtual office of this Chamber on February 12, 2025, at 13:25:51, signed by attorney Gómez Salazar, was considered.

**III.** In the **first** censure, page three of the brief, the appellant announced that she was filing it on the cassation ground of breach of substantive norms provided for in Article 138, subsection a) of the Contentious Administrative Procedure Code (Código Procesal Contencioso Administrativo, CPCA): "The cassation appeal shall also proceed for violation of substantive norms of the legal system, in the following cases: **/ a)** When an improper assessment is attributed to the evidence or it has been pretermitted." This, she said, was due to the improper assessment of the means of proof in the record, specifically, the final judgment of the constitutional amparo appeal. She alleged a violation of Article 196 of the General Public Administration Law (Ley General de la Administración Pública, LGAP). The impugned judgment, she noted, based its argument for awarding the item of subjective moral damages on a factual assertion, but without analyzing the aspects contained in the case law of this Chamber (she referred to ruling no. 297-F-S1-2024 at 5:27 p.m. on March 21, 2024), such as the determination of the extreme necessity of the patient's case from a medical point of view—urgency—, their consent to be on a waiting list, or the existence of physical harm (daño físico). The resolution, she stated, mentioned the executing party's conditions; however, it did not determine whether or not it relates to a medical emergency. The Judge pointed out that only a final constitutional judgment is needed to demonstrate a factual situation.

It reproduced, in what was of its interest, the matters considered in section IV of the challenged judgment, regarding subjective moral damage (daño moral subjetivo). With a mere final judgment (ejecutoria de una sentencia), it alleged, the judicial authority was able to determine that the Administration caused the petitioner “an emotional impairment (un menoscabo emocional),” without taking into account the factors of restorative justice, urgency, and the patient’s condition. It copied the proven facts from the final judgment. With them, it pointed out, no moral damage suffered by the patient is proven. They make no reference whatsoever to the aggravation of her condition or that she suffered “an emotional impairment.” The Judge, according to its words, it insisted, determined the existence of an injury (lesión) in the patient from the mere final judgment, without specifying what type. It transcribed another fragment of what was considered in section IV of the challenged ruling concerning subjective moral damage.

In the substantive analysis of the Constitutional Chamber's (Sala Constitucional) judgment, it alleged, it was considered that the amparo (amparo) was granted because the petitioner was placed on a waiting list for a period of 06 months and 15 days, without mentioning whether or not there was a need for immediate follow-up. It reproduced what was stated in said Chamber's ruling in section IV. The Constitutional Court determined that said waiting period—06 months and 15 days—was disproportionate and violated the protected person's fundamental rights. However, it added, the Chamber has also mentioned, on other occasions, that determining how much time is fair and necessary, from a medical point of view, to care for sick people who come to CCSS services in general exceeds the scope of its powers, and that, for this purpose, it depends on a precise technical-scientific evaluation or criteria regarding the urgency or not of the treatment each one requires. An evaluation or criteria that, in this case, does not appear in the amparo case file to determine that a period of 06 months and 15 days is disproportionate and a violation. To Mrs. Carmona Castillo, it noted, her client did not deny access to health services, to medical care. Contrary to that, it explained, at the time of filing the amparo appeal, it was clear that what the petitioner sought was a hysterectomy (histerectomía) procedure that, under no circumstances, was considered an emergency or a pathology of an urgent or oncological nature, as was indicated at the time. The Execution Judge, it stated, took as a basis for granting the enforcement of judgment an element that was not mentioned by the Constitutional Chamber to grant the amparo appeal and that, therefore, could not serve as a basis for granting claims. It transcribed another part of what was stated in the indicated Considering IV of the challenged judgment. It issued the ruling considering the elapsed waiting period to be excessive. However, it said, nowhere in what was indicated in resolution no. 20233013051 of the Constitutional Chamber is there a focused indication of an excessive waiting time and urgency. Contrary to that, from the point of view of the treating physician, technical report no. HMP–DG-1915-2023, which is in the amparo appeal case file, refers to Mrs. Carmona’s pathology as non-priority or urgent. The challenged judgment, it asserted, directly violated Article 196 of the LGAP, by having determined the existence of an injury and damage with a final judgment. For that, it explained, technical proof that so accredited it was required, which is aggravated by the fact that the Judge indicated that “an emotional impairment” occurred (page five of the ruling) and its prolongation, with the simple act of having analyzed the final judgment. The questioned resolution, it insisted, violated said norm, which provides that the damage must be effective, assessable, and individualizable, in relation to a person or group. The truth, it pointed out, is that, based on a judgment from an amparo appeal for placement on a waiting list, there is no proof whatsoever of an affectation to the internal sphere (fuero interno) of the executing party. There is no proof whatsoever of an injury suffered. Nor what type of injury, since said legal concept corresponds to damage resulting from a lack of equivalence between what is given and what is received. In an onerous contract. Damage resulting from a crime where a person's body is diminished or transgressed. Or, an organic or functional disturbance (perturbación orgánica o funcional) of an individual. That is, the Judge, from a mere final judgment, validated and determined the existence of an injury in the patient; without specifying what type of injury, without having technical proof that so accredited it. This, it argued, entails that the damage is neither real nor effective, thereby violating said precept. It insisted, the Judge did not take into account the factors of restorative justice, urgency, and the patient's condition, reiterated in this Chamber's jurisprudence. It mentioned the judgments (according to the order of citation) nos. 28-F-S1-2024 at 11 hours 05 minutes on January 11; 297-F-S1-2024 at 17 hours 27 minutes on March 21, both of the year 2024; 1502-F-S1-2022 at 11 hours 24 minutes on September 1; 1823-F-S1-2022 at 14 hours 26 minutes on August 4, two thousand twenty-two; and 2429-F-S1-2022, the latter three of the year 2022. It included a table where it set forth, in its judgment, what was specified in each of those rulings. If the Judge, it noted, had properly analyzed the evidence, he would determine that a final judgment is insufficient to establish the merit of a subjective moral damage claim. Especially, and taking into consideration that placing a person on a waiting list is not “per se” sufficient reason to grant compensation (indemnización). On this, it indicated, this Chamber established, in resolution no. 1502-S1-2022 at 11 hours 24 minutes on September 1, 2022, that, regarding compensation for amparo appeals for placement on waiting lists, it is irrational to impose on the tripartite contribution fund of social security an indemnity on a person who has consented to a wait and received the required medical care. It reiterated once more, this was pointed out to the jurisdictional authority. However, in its judgment, it denoted that there exists an “animus” to condemn the CCSS at all costs (and, of course, the contributors), without any support whatsoever from an evidentiary point of view. If the Judge had adequately assessed the evidence, it asserted, the reasoning of the ruling would be different. It would have determined that the evidence was insufficient to establish the existence of damage of any type. From the proven facts of the amparo appeal judgment, it explained, it is not denoted that it refers to a matter of injury to the executing party.

That is, if the ruling on the amparo appeal did not mention any aspect related to an injury caused by placement on a waiting list, the judicial authority was barred from hearing it and, above all, from taking it as a starting point to determine compensation. Without technical evidence, and since the final ruling of the amparo appeal did not mention any aspect, from a medical standpoint, it pointed out, it determined complex technical-medical elements to conclude the existence of effective and individualized harm with respect to the enforcement claimant. The Judge's opinion cannot be endorsed, it affirmed, because the series of elements that were taken into consideration do not derive from what was analyzed by the Sala Constitucional to grant the amparo appeal. Especially, taking into account that it referred to highly technical aspects, from a medical standpoint (with specialties such as gynecology, for example), which can only be verified with such (technical) evidence. The final ruling of a constitutional judgment, it indicated, on its own, does not have a nuance of such magnitude as to conclude the existence of an injury, taking into consideration, it insisted, that there was no technical evidence on the matter. If the Judge had duly analyzed the evidence, it concluded, he would determine that a final ruling is insufficient for the granting of subjective moral harm (daño moral subjetivo).

**IV.** This Chamber will address the analysis of the extensive criticism in the following manner. **FIRST**. After its detailed analysis, it is determined that it suffers from a contradiction that causes perplexity. On page five of the brief, it affirmed: *“Let it be noted by the honorable Sala Primera, that the High Constitutional Court determined that the waiting period of 6 months and 15 days was disproportionate and violated the fundamental rights of the protected party* […] *”.* However, on the following page—six—it stated: *“As can be seen by the honorable Sala Primera, Judge Zeledón Hernández issues a judgment considering the elapsed waiting period excessive, however, nowhere in what is indicated in Resolution No. 20233013051 of the Sala Constitucional is there a focus on pointing out an excessive waiting time and urgency, contrary to that, from the point of view of the treating physician, technical report No. HMP–DG- 1915-2023 which is in the amparo file, refers to Mrs. Carmona’s pathology as non-priority or non-urgent.”* (The emphasis is from the original). That is, at first it affirmed that the Sala Constitucional determined that the waiting period for performing the required surgery, which at the time the final ruling was issued was six months and fifteen days, was disproportionate and violated the fundamental rights of the amparo petitioner, which is why the amparo appeal was granted. However, later it indicated that the Enforcement Judge, by considering the waiting period suffered by the enforcement claimant excessive, in order to determine the granting of subjective moral harm (daño moral subjetivo), transgressed the final ruling, since the Sala Constitucional did not indicate that the waiting time was excessive. The contradiction is evident. In this regard, as noted in Recital I of this judgment, it is insisted, the Sala Constitucional granted the amparo appeal filed on behalf of Mrs. María de los Ángeles Carmona Castilla, as determined from what was considered in section IV of the final ruling, upon deeming that the waiting period she had endured up to that moment for the required surgery to be performed, of six months and fifteen days, was indeed disproportionate and violated her fundamental right to health. That is, the Enforcement Judge, adhering to what was resolved at the constitutional level, as will be developed further on, held that the waiting period suffered by the amparo petitioner was excessive. Furthermore, according to the answer to the complaint—image 30—and the evidence provided by the CCSS itself, visible in images 40 through 79, it is determined that, in compliance with what was ordered by the Sala Constitucional, Mrs. María de los Ángeles underwent surgery at the Hospital Dr. Maximiliano Peralta Jiménez in Cartago, on September 13, 2023. That is, ultimately, she had to wait approximately 10 months for the surgery she required to be performed. Which, according to what was resolved by the Sala Constitucional, is harmful to her fundamental right to health.

**V.** **SECOND.** In order to have a complete understanding of what will be said, it is appropriate to reproduce what was resolved by the Enforcement Judge in section IV of the contested judgment regarding subjective moral harm (daño moral subjetivo): *“IV.-* […] *This Judge considers that in the specific case under analysis, regarding subjective moral harm, it is not difficult to determine without further evidence than the final ruling provided, it has been weighed that the claimant* [sic] *went to the medical center, and entered the waiting list on November 15, 2022, however, by the date of filing the amparo appeal, the claimant party had not been operated on* [sic]*. The elapsed waiting period was weighed by the Sala Constitucional, and it was considered excessive and injurious to the right to health. Regarding the CCSS’s arguments to reject the liquidated moral harm, they must* [sic] *be rejected, since it intends to change the bases established in the constitutional ruling being enforced, it intends to re-discuss the issue that was analyzed by the Sala Constitucional, indeed the Constitutional Court found abnormal functioning, where the health of the claimant was neglected, it declared that there was a violation of the right to health, therefore, it is not admissible to re-discuss the same facts for which the CCSS was condemned, since they were held as true in the judgment being enforced.”* It has been weighed that there is an emotional impairment (menoscabo emocional) in the fact that occurred when the claimant [sic] found himself facing the prospect of a prolonged wait for his medical care, and therefore, had to resort to the Sala Constitucional to repair the grievance of an excessive delay in the provision of medical services; the fact that, by order of the Constitutional Court, the medical care was more immediate does not erase the emotional impairment (menoscabo emocional) suffered by the claimant in the face of a true dysfunction in the provision of health services. The thesis of the CCSS is not admissible, understanding that we are dealing with a sentence execution process, where it is sought to establish the amounts of the bases set by the Sala Constitucional. It is not appropriate to assess the merits of the constitutional proceeding; the executed sentence considered the waiting time fixed for the executor's medical care excessive. It was determined in the constitutional process that urgency existed, so much so that medical care was ordered within a period not exceeding three months. Therefore, the argument of the CCSS that seeks to vary the bases set in the executed sentence must be rejected. The elapsed waiting time for medical care is considered disproportionate, violating his Right to Health, so the Sala Constitucional had to order his care. In accordance with the principles of good public service and respect for the right to health, it is logical to deduce in re ipsa that it must have caused an emotional affectation in the executor's inner self, and suffering resulting from helplessness in the face of the excessive and unjustified delay by the administrative authorities, which prolonged his care, clearly adding compensable worry, sadness, and anger, due to the ineffectiveness of the service for which he is charged in advance and mandatorily (causal link). It is clear that there was no consent to the delay in his medical care, since he resorted to the Sala Constitucional to obtain the health service within a reasonable time, and to this execution venue to find redress for the injury suffered, which forced him to activate the judicial system to receive a service that functions abnormally. In addition to the foregoing, it is considered that restorative justice operated with respect to the order to provide the health service, but not with respect to the other distinct condemnation for costs, daños y perjuicios, so the right to these unpaid elements subsists. For the foregoing reasons, and based on the principles of proportionality and reasonableness, the subjective non-material damage (daño moral subjetivo) is appropriate in the sum of FIFTY THOUSAND COLONES, an amount considered adjusted to the results of the process and supported by the principles of sound rational criticism. The amount proposed by the executing party is rejected, as it is considered excessive according to the results of the process. The defense of lack of right and lack of passive standing (legitimación pasiva) is rejected.” (The highlighting and underlining are from the original).

VI.THIRD. Regarding what was argued by the appellant, it must be remembered that, in sentence execution processes in general and, principally, those issued by the Sala Constitucional, what is executed must necessarily be limited to what was resolved in the amparo judgment object of enforcement. This Chamber has indicated that the sentence execution process seeks to materialize the –abstract– condemnation imposed on the losing party. If aspects different –or contrary– to the pronouncement giving rise to the execution are granted, or against persons who were not condemned, res judicata is violated. See, among other decisions of this deciding body, nos. 383-2019 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-925036) and 309-2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1024927). Consequently, the oversight function of this Chamber is constrained to an objective comparison between the executed judgment and the appealed decision. In this sense, one may consult, among many others, decisions nos. 82-A-S1-22 of 10 hours 06 minutes on January 26 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1072742) and 1984-F-S1-2022 of 11 hours 18 minutes on September 08, both from the year 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112319).

VII.FOURTH. As noted in Considerandos I and IV of this judgment, the Sala Constitucional, in the sentence being executed, upheld the amparo appeal filed on behalf of the protected party, having verified that on November 15, 2022, she was placed on a waiting list for total abdominal hysterectomy surgery and that, at the time the constitutional judgment was issued, she did not have a certain date for the completion of said surgical procedure. Therefore, said Chamber considered that the elapsed period up to that moment, of six months and fifteen days, was disproportionate and a violation of her fundamental rights. Therefore, it upheld the amparo appeal and ordered both the General Director of the Hospital and the Head of Gynecology to promptly and timely arrange the actions and coordinations necessary so that, within a maximum period of three months counted from the notification of the constitutional judgment, the surgery be performed on the protected party. Which is what happened, since on September 13, 2023, she was operated on. As can be clearly inferred, the Sala Constitucional upheld the appeal because it considered the time the protected party had been on the waiting list was disproportionate and violated her fundamental right to health, considering her pathology. Precisely, the Execution Judge, it is insisted, adhering to what was resolved in the constitutional venue, considered: “[…] the fact that, by order of the Constitutional Court, the medical care was more immediate does not erase the emotional impairment (menoscabo emocional) suffered by the claimant [sic] in the face of a true dysfunction in the provision of health services. The thesis of the CCSS is not admissible, understanding that we are dealing with a sentence execution process, where it is sought to establish the amounts of the bases set by the Sala Constitucional. It is not appropriate to assess the merits of the constitutional proceeding; the executed sentence considered the waiting time fixed for the executor's medical care excessive. It was determined in the constitutional process that urgency existed, so much so that medical care was ordered within a period not exceeding three months. Therefore, the argument of the CCSS that seeks to vary the bases set in the executed sentence must be rejected.

The time elapsed waiting for medical care is considered disproportionate, violating his Right to Health, which is why the Constitutional Chamber had to order his care, in accordance with the principles of good public service and respect for the right to health. It is logical to deduce *in re ipsa* that it must have caused an emotional affectation in the inner self of the petitioner, and a suffering resulting from the impotence in the face of the excessive and unjustified delay by the administrative authorities, which prolonged his care. This clearly adds compensable worry, sadness, and anger, due to the <span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; text-decoration:underline; vertical-align:sub">malfunctioning of the service that is charged to him in advance and on a mandatory basis</span> (causal link). It is clear that there is no consent to the delay in his medical care, given that he went to the Constitutional Chamber to obtain the health service within a reasonable timeframe, and to this enforcement court to find compensation for the injury suffered, which forced him to activate the judicial system to receive a service that <span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; text-decoration:underline; vertical-align:sub">functions abnormally</span>. In addition to the foregoing, it is considered that restorative justice operated with respect to the order to provide the health service, but not with respect to the other, different order regarding costs and damages, such that the right subsists regarding these unpaid items. [<span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">…</span>]<span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span> (The bolding and underlining are from the original). However, the appellant did not properly challenge that basis for determining the existence and quantification of that damage, as the technique of cassation requires, in accordance with the provisions of article 139, subsection 3) of the CPCA. She limited herself to making a generic argument, without questioning, in a clear and precise manner, what the Enforcement Judge had ordered. On the contrary, she alluded to other issues, not raised by the judicial authority, such as restorative justice, urgency, and consent. As well as that the damage claimed cannot be inferred from the judgment; however, it is insisted once again, without questioning what was stated regarding its determination being “*in re ipsa*”. This makes what was argued futile for the purpose of varying what was decided.

**VIII.** Notwithstanding the foregoing section and, as an abundance of reasons, the following must be pointed out. **FIFTH.** The appellant insistently alluded to what she termed “restorative justice” operating in the sub judice. In this regard, it is necessary to point out that this Chamber, in previous matters, recognized its applicability in matters of compensation for subjective non-pecuniary damage (daño moral subjetivo) for the infringement of the fundamental right to health (as recognized by the Constitutional Chamber of the Supreme Court of Justice upon granting the respective amparo appeal, due to the delay by the CCSS in providing the medical service required by the administered person), when the CCSS provides the service within the period ordered in the constitutional venue. In this regard, see judgments nos. 1502-S1-2022 of 11:24 a.m. on September 1 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112330</span>), 2429-F-S1-2022 of 2:16 p.m. on November 3 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1123608</span>), both from the year 2022; 28-F-S1-2024 of 11:05 a.m. on January 11 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396</span>), 297-F-S1-2024 of 5:27 p.m. on March 21 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250</span>), 901-F-S1-2024 of 12:31 p.m. on July 4 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1240015</span>), and 937 of 2:51 p.m. on July 10 (<span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925</span>); all from the year 2024. However, the current composition of this Chamber, after further study, considers it necessary to reconsider that position. Without a doubt, it constitutes a vindication of the injured legal situation, due to a failure of service, that the service be provided. Even more so when it is necessary, as occurs with a pending health service. However, such reparation does not exclude, as the Enforcement Judge rightly indicated, that the injured person suffered impacts on their moral and patrimonial sphere while the abnormal conduct persisted due to the administrative dysfunction. If effective impairments are demonstrated (precepts 196 and 197 of the LGAP) specific to the particular case and derived from its particular characteristics, with their existence being inferred even through the “*in re ipsa*” intellectual process, despite the user having been jurisdictionally protected, their reparation is appropriate. That is, the service rectification does not exclude that the injured person suffered impacts on their moral and patrimonial sphere while the abnormal conduct persisted. If that occurred and was so accredited, it becomes obligatory to impose the corresponding compensatory consequence, if requested by the person whose legal sphere was damaged. This is in accordance with the principle of integral reparation of damage, which has constitutional and legal roots (canons 9, 41, 49 of the Constitution; 190 and 197 of the LGAP).

**IX.** Along this line of thought, and regarding the existence and quantification of subjective non-pecuniary damage (daño moral subjetivo), this Chamber, for a long time, has indicated that: “**IV.** [...] <span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">comes from the injury to an extra-patrimonial right. That is, it does not impact the patrimony directly. It supposes an unjust disturbance of the psychological conditions. It does not require direct proof and is left to the equitable assessment of the Judge. If it is a matter of subjective non-pecuniary damage (daño moral subjetivo), the courts are empowered to decree and quantify the award. The legal nature of this type of damage does not obligate the liquidator to determine its existence because it corresponds to its internal sphere. That is not a problem for psychiatrists or doctors. Its existence or non-existence must be understood because it belongs to the conscience. It is deduced through presumptions inferred from indicia, since the unlawful generating event reveals the non-pecuniary damage (daño moral), for when the psyche, health, physical integrity, honor, intimacy, etc., are harmed, it is easy to infer the damage, which is why it is said that proof of non-pecuniary damage (daño moral) exists </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">in re ipsa</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">. Its value also need not be proven because it has no concrete value. It is valued prudentially.</span> It is not, then, a matter of quantifying the suffering, since it is inestimable, but rather of fixing monetary compensation for their injury, the only mechanism to which the law can resort, in order to at least partially repair the offense. For greater detail on this aspect, one may consult, among others, from this collegiate body, rulings no. 112 already cited, no. 17 of 14:30 on February 21, 1996, and no. 41 of 14:40 on May 14, 1997. Its granting is not closely tied to evidentiary factors (except those referring to the causal link), but rather to the prudence and objective discretion of the judge. However, its determination is subject to the principles of reasonableness and proportionality, which must be assessed by the competent authority in each case, so that its quantification is in accordance with the Law and does not lead to excessive compensation that unjustifiably benefits one of the parties. That is, it must maintain a fair balance derived from the specific factual scenario, a matter that must be weighed within the indicated limits.” (Among many others, one may consult the ruling of that Chamber no. 468-F-S1-19 of 9:45 on May 30, 2019). In accordance with the foregoing, once the existence of the non-material damage (daño moral) and its causal link to the cause of action alleged by the plaintiff has been established—which is not contested by the appellant in cassation—the determination of the amount depends on the equitable assessment of the Judge; for which, attention must be paid to the special circumstances of the case, as well as to the constitutional principles of reasonableness and proportionality.” In this regard, one may consult, among many others, ruling no. 1098-F-S1-2023 of 10:09 on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1170686). That is, it is regarding subjective non-material damage (daño moral subjetivo) that its demonstration is “in re ipsa,” provided it is the consequence of an unlawful generating event or cause.

**X.** In this litigation, the Constitutional Chamber (Sala Constitucional), as has already been indicated, determined the unlawful conduct of the CCSS upon verifying the breach of the fundamental right to health of Mrs. María de los Ángeles. The postponement of the required surgery was, at the time the constitutional ruling was issued, six months and fifteen days; when it was performed, on September 13, 2023, the total wait was approximately 10 months, as indicated in Section IV of this ruling. Such a situation—an unlawful act—according to the maxims of logic, experience, and correct human understanding, as was resolved, is the adequate cause of a non-material affliction (aflicción moral), associated with anxiety, discomfort, frustration, and worry, due to the excessive waiting time for care—so declared, it is insisted, in the constitutional venue—for a health situation that, “per se,” is a cause of worry for the person suffering from it. In accordance with correct human understanding and experience, it is insisted, one can infer, “in re ipsa,” as the Enforcement Judge (Juez de Ejecución) did, the existence of feelings such as those described above, without her having the legal duty to bear them, as they derive from an abnormal functioning of the Administration, so decreed, it is repeated once more, by the Constitutional Chamber. Ergo, contrary to what was indicated by the appellant, its existence is determined and, therefore, the appropriateness of its compensation.

**XI.** Likewise, this Chamber has stated: “**VIII.** […] On other occasions, this cassation body has had the opportunity to highlight the necessary “legal reasonableness” (razonabilidad jurídica) that this type of compensation must maintain, for the verification of which the observance of a “reasonableness of equality” (razonabilidad de igualdad) must be verified, which the Constitutional Chamber has defined as “…the type of legal assessment that proceeds from the premise that equal antecedents must have equal consequences, without arbitrary exceptions” (e.g., Votos no. 5236-99 and 1354-2011). That is, to avoid inequitable and illegitimate treatment in the various cases where compensation for non-material damage (daños morales) is discussed, it is necessary to verify that the amounts recognized are not disproportionate, when compared with those that have been established in other similar cases. In that order of ideas, this Chamber considers that the sum granted conforms to the intensity of the damage caused.” Ruling no. 760-F-S1-2023 of 13:24 on May 29, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1157835). In the same vein, one may consult, among others, rulings nos. 1934-F-S1-2022 of 15:00 on August 12; 2654-F-S1-2022 of 10:10 on December 8 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1132117), both from the year 2022, and 1087-F-S1-2023 of 09:36 on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1173505). In that order of ideas, this Chamber considers the sum granted for subjective non-material damage (daño moral subjetivo), ₡50,000.00, to be reasonable and proportionate, considering the circumstances of this case. Furthermore, it is quantitatively lower than what has been recognized for similar effects. By way of example, the following precedents can be noted, in which this decision-making body did not consider unreasonable the sums awarded for the delay in the provision of the public health service, nos. 429-F-S1-2024 of 10:41 on May 3 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1229475), in which the adjudicating person awarded ₡500.00,00 and 937-F-S1-2024 of 14:51 on July 10, both from the year 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925), setting the sum of ₡200,000.00 as compensation for non-material damage (daño moral), for the delay in the provision of the service.

**XII. SIXTH.** Furthermore, the appellant alleged that, in the case of the protected party, there was no urgency in performing the surgery. As was set forth in Section I of this ruling, contrary to what was argued, it was the Constitutional Chamber itself, in the enforceable ruling, that determined the urgency with which the petitioner needed to undergo the required surgical procedure, ordering that it must be carried out within a period of three months from the notification of that ruling.

Consequently, within the objective comparison that must prevail in this type of proceeding—enforcement of a constitutional judgment—the issue of urgency is a precluded matter, since, it bears repeating, it was so determined and resolved by the Constitutional Court.

**XIII.** **SEVENTH.** Finally, the appellant argued that the protected party acquiesced to or consented to remaining on the waiting list. Contrary to what was alleged, in this litigation the existence of tacit consent or an act consented to, much less express consent, on the part of Mrs. Carmona Castillo cannot be considered. As the Enforcement Judge correctly indicated, the recurso de amparo was filed on behalf of Mrs. María de los Ángeles in a timely manner. Such is the case that the Constitutional Chamber admitted it for processing and, subsequently, upheld it. This, regardless of the time elapsed between the moment the CCSS placed her on the waiting list and the filing of the amparo. Therefore, the executing party demonstrated her disagreement with her permanence on the waiting list, and said jurisdictional body agreed with her.

**XIV.** In the **second** objection, page 11 of the appeal, the appellant announced that she was filing it on the cassation ground for breach of substantive norms provided for in subsection c) of canon 138 of the CPCA: “***c)*** ***When a legal norm has been improperly applied or interpreted, or has been left unapplied.***” She invoked as transgressed articles 73.1 of the Civil Procedure Code (CPC) and 85 of the Tax Norms and Procedures Code (Código Tributario). Regarding the issue of the personal costs of the recurso de amparo, she said, the Enforcement Judge pointed out: “[…] *it has been weighed that the constitutional judgment established said right in favor of the executing party and that this right cannot be denied in the enforcement phase* […]”. That, she pointed out, despite the non-existence of the issuance of an electronic invoice by any legal professional for professional services to file a recurso de amparo. Even so, she noted, the amount for that petitionary item was granted, in accordance with Article 73.1 of the CPC. She reproduced, in what was of her interest, what was considered in section V of the challenged judgment, called “*COSTS OF THE AMPARO*”. The judicial authority, she stated, based itself on said precept to grant the amount for costs of the recurso de amparo; despite no evidence having been presented related to a professional service (issuance of an electronic invoice). The challenged judgment, she noted, improperly applied that provision, as it limited itself to evaluating only a part of its content, without thoroughly analyzing its literal text and, even, the teleological element. In this regard, she commented, this is an enforcement proceeding for a constitutional judgment. The condemnation made by the Constitutional Chamber was in the abstract. Therefore, she indicated, the right to receive compensation for costs, damages, and losses must be enforced and demonstrated in this venue. She reproduced said canon 73.1 of the CPC. Its content, she stated, establishes that the following shall be considered costs: attorney's fees, compensation for time invested, and indispensable expenses of the proceeding; however, the executing party did not provide any evidence to demonstrate that there had been an outlay of money for attorney's fees. That is to say, she alleged, due to the lack of evidence regarding this, the Judge was compelled not to grant any amount for costs of the recurso de amparo, under the concept of attorney's fees, since there is no proof that they were paid, as there is no electronic invoice involved. Under the Judge's premise, she indicated, any person, through vicarious action, could file recursos de amparo on the issue of waiting lists and, when enforcing the judgment, would receive the costs of the recurso as compensation, which, in her opinion, would be absurd, since to receive full compensation for an expense, it must be demonstrated. This, she pointed out, cannot be condoned, since no evidence whatsoever of that expense was presented. That is where the error of the judgment is markedly found, as it granted the amount for costs of the recurso de amparo as if they were for attorney's fees. It is important that the reasons why costs are awarded to a prevailing person in a judicial proceeding be clear. Furthermore, she added, Justice of the Constitutional Chamber, Mr. Fernando Castillo Víquez, has on multiple occasions been clear in ordering both the CCSS, when extrajudicial satisfaction of the Constitutional Chamber's condemnations is carried out, and the contentious-administrative jurisdiction, to ensure that the amounts awarded actually reach the hands of the protected parties. She transcribed, in what was of her interest, what was stated in Constitutional Chamber vote no. 2016-012528. The challenged judgment, she concluded, should have rejected that item, since, as no electronic invoice was provided, it was not demonstrated that any legal professional had provided a professional service and charged for it.

**XV.** Regarding what was stated in the previous section, the following must be noted. **FIRST.** As indicated, the appellant announced that she was formulating the objection for breach, among others, of canon 85 of the Código Tributario. However, in the development of the objection she did not cite it. Therefore, she did not explain, with the required clarity and precision, how it was violated by the challenged judgment. Consequently, this Chamber is precluded from conducting any analysis regarding that norm. **SECOND.** The Judge, in section V of the challenged judgment, concerning the costs of the recurso de amparo, considered: “*Regarding the personal costs of the recurso de amparo, it has been weighed that the constitutional judgment established said right in favor of the executing party and that this right cannot be denied in the enforcement phase; in this instance the amount of the costs will be defined, but the* [sic] *bases of the judgment being enforced cannot be varied as the CCSS respondent representation intends. Pursuant to article 193 of the Contentious-Administrative Procedure Code, which, in the same manner as Article 73.1 of the Civil Procedure Code, of its own motion condemns the losing party to costs, what is requested is admissible; however, given that the amparo was filed on May 16, 2023, the provisions of article 46 of Executive Decree 41457-JP, which entered into force on February 1, 2019, are applicable, and which establishes an amount of ONE HUNDRED EIGHTY-ONE THOUSAND FIVE HUNDRED COLONES for said concept, therefore, the personal costs of the recurso de amparo are set up to that liquidated amount, rejecting the exception of lack of right and lack of active standing of the liquidated item.*” **THIRD.** On page 12 of the petition, the appellant stated: “Under the premise of Judge Zeledón Hernández, any person, through the Vicarious Action (Acción Vicaria), could file Amparo Appeals (Recursos de Amparo) regarding waiting list issues, and when executing the judgment, could perfectly receive as compensation both the costs [sic] of the appeal, which, respectfully, would be an absurdity […]”. Contrary to what was indicated, this Chamber, for a long time, has pointed out the difference between personal costs (costas personales) and attorney's fees (honorarios de abogado), concluding that personal costs belong to the party, not the lawyer. In this regard, one may consult, mutatis mutandis, judgments nos. 432-F-S1-2017 of 09 hours 30 minutes on April 20, 2017 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-950854); 515-F-S1-2018 of 11 hours 20 minutes on May 30, 2018 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-892742); 28-F-S1-2024 of 11 hours 05 minutes on January 11 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396) and 297-F-S1-2024 of 17 hours 27 minutes on March 21 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250); both from the year 2024.

**XVI.** **CUARTO.** On pages 11, 12, and 13, the appellant stated: “Regarding the issue of personal costs of the **Amparo Appeal (Recurso de Amparo),** Judge **Pablo Zeledón Hernández points out that** […] **despite not fully having the issuance of an electronic invoice by any legal professional for Professional Services to file an Amparo Appeal (Recurso de Amparo),** and even so, grants the amount for said claim, in accordance with article 73-1 of the Civil Procedure Code (Código Procesal Civil). In this regard, the judgment mentions the following: […] That is to say**, knowing that no evidence related to a professional service was presented (the issuance of an electronic invoice), he grants this.** […] With the foregoing, and given that the plaintiff provides no evidence whatsoever that an outlay of money for attorney's fees occurred, **that is, there being a lack of evidence regarding this, the truth of the matter is that the judge was compelled to grant the amount for costs of the Amparo Appeal (Recurso de Amparo), in the form of fees for which there is no evidence they were paid, as there is no electronic invoice involved.** […] Therefore, the judgment should have rejected this item, **since, having not provided an electronic invoice,** it was not demonstrated that any legal professional had provided a professional service and charged for it.” (The highlighting is from the original). In this regard, it must be pointed out that the CPCA, in article 193, expressly regulates the imposition of costs; as does article 73.1 of the CPC. Consequently, it is the CPCA's rule that applies to this litigation. However, this provision does not stipulate, as the CPC's does, what is considered costs. Ergo, this procedural principle, like those contained in articles 76.1 and 76.4 ibid, by virtue of the remission made by article 220 of the CPCA, is applicable to this litigation. In this sense, article 73.1 of the CPC provides: “[…] *Attorney's fees* (honorarios de abogado) *shall be considered costs*, the compensation for the time invested by the party in attending procedural acts where their presence was necessary, and other essential expenses of the process.” (The underlining is supplied). In this same vein, articles 76.1 and 76.4 ibid state: “***76.1 Right to fees and setting***. *Attorney's fees* (honorarios de abogado) *belong to the lawyer*, with the exceptions established by law. When the party is a lawyer and has acted personally, they shall be entitled to them. Unless otherwise agreed, they shall be set considering the work, the status, and the economic significance of the process, based on the provisions of Law No. 13, Organic Law of the Bar Association (Ley Orgánica del Colegio de Abogados y Abogadas), of October 28, 1941, and the decree on attorney and notary fees.* […] ***76.4 Contractual setting of attorney's fees (honorarios de abogado).*** *Lawyers and their clients may contractually set the amount of fees and their payment modalities, respecting the limits imposed by law and the respective decree. Said stipulation shall not affect the opposing parties in the process, for purposes of setting personal costs* (costas personales).” (Only the underlining is supplied). In light of the provisions in said rules, it is clear that, for purposes of costs, attorney's fees must be calculated based on the legal limits and the rates established in the respective Decree, regardless of any private agreement between the lawyer and their client. This implies that, in the liquidation of costs (liquidación de costas), it is not necessary for the executing party to demonstrate the agreement they have with their lawyer or the payment made to them, as the regulations provide that the calculation of this item must be made according to the applicable tariff (arancel) or decree, in order to ensure an objective criterion in the liquidation of costs (liquidación de costas). Thus, if a party had legal representation during the processing of a case and obtained in their favor the payment of costs, the amount to be recognized as attorney's fees will necessarily be that established in the “Fee Schedule for Professional Legal Services” (“Arancel de Honorarios por Servicios Profesionales de Abogacía”), according to the work performed. Consequently, it is not essential that an invoice or proof of payment in favor of the legal professional be provided for the recognition of that item to proceed. In this litigation, the objector did not prove that Ms. María de los Ángeles lacked legal representation during the processing of the amparo proceeding. On the contrary, it is recorded that her special judicial representative in this execution process was the one who filed the amparo appeal (recurso de amparo) on her behalf before the Constitutional Chamber (Sala Constitucional). This allows one to infer that said professional defended the interests of the amparo recipient in the constitutional venue. Ergo, the failure to present the invoice or proof of payment that the appellant demanded is not sufficient to detract from or dismiss the item of personal costs (costas personales) liquidated by the party and expressly recognized in the enforceable judgment. It is reiterated, because the executing party had legal representation during the processing of the amparo and obtained in their favor the payment of costs. That is, they have the right to have recognized as costs the amount established by the applicable tariff (arancel) for attorney's fees.

Corollary, this Chamber does not observe the alleged legal violation and, consequently, the rejection of the challenge will be imposed.

**XVII.** In the **third** ground of disagreement, page 13 of the petition, the appellant announced she was filing it on the cassation ground for breach of substantive norms provided for in subsection d) of numeral 138 of the CPCA: “***d)** When the judgment violates the norms or principles of constitutional law, among others, reasonableness (razonabilidad), proportionality, legal certainty, and equality.*” Specifically, she invoked the principle of reasonableness as infringed. In the judgment under question, she stated, the Enforcement Judge determined the reasonableness of the compensation. She argued that the executing party (besides not consenting to being on a waiting list by having recourse to the Constitutional Chamber, and without restorative justice having taken place) sought compensation, not having an unhealthy desire. She transcribed, as relevant, the recital in section IV of the questioned judgment, concerning subjective moral damages (daño moral subjetivo). The Judge spoke of reparation for “*the injury suffered (la lesión sufrida)*”, she pointed out, which forced the executing party to resort to the filing of an amparo action, but he did not specify what the injury suffered is, whether physical or psychological. Furthermore, she argued, from the enforcement judgment (2024000956) it is not clear what the “alleged injury suffered” is. Nor does the case file contain proof demonstrating that it occurred. Regarding the concept of injury, she reproduced, as relevant, what was indicated by the author Goldstein, Mabel, but did not cite any work. The contested judgment, she indicated, left open the possibility to seek, without restriction, double compensation: that of a material type, by receiving medical attention; and the pecuniary one, without any proof thereof whatsoever. The Judge was clear, she noted, that the executing party sought, for subjective moral damages, an amount of ₡300,000.00, plus the compensation for legal costs. In total, the executing party petitioned for at least ₡481,500.00. The Adjudicator, with his analysis, violated the principle of reasonableness. The spirit of the CCSS, in accordance with Article 73 of the Political Constitution, she related, is to guarantee the fundamental rights to life and health; without which, the other guarantees enshrined in the Magna Carta cannot be fully exercised. Although, she pointed out, waiting lists exist, granting pecuniary compensation for placing a person on one of them, without there being a medical criterion of urgency, implies that the amounts intended to guarantee the two main fundamental rights are diminished, which, she stated, is clearly irrational, because the people contributing to the Health and Maternity Insurance do so with the objective that a health service is provided and that resources exist to guarantee it. Not, she reiterated, so that compensation is awarded for placing a person on a waiting list. The judge, she noted, departing from the principle of reasonableness, determined that the fact that the medical procedure had been performed is insufficient to determine the existence of full restorative justice. Therefore, she argued, there must also be economic reparation. That is, she stated, it follows from the above that the Adjudicator determined that a double compensation must always intervene when a person is placed on a waiting list. However, she affirmed, the truth is that this generates a privilege and unjust enrichment without any cause. The objective of the person who had recourse to the Constitutional Chamber, she stated, was to have a surgical procedure performed, or to receive medical attention. Clearly, she added, she sought a restoration of her health, not to obtain compensation. This, she argued, can lead to a depletion of the health service's resources, necessary for equipment improvements, payment for medications, and instruments to adequately provide the health service, through professionals prepared for it. The Judge, she insisted, directly violated the principle of reasonableness by granting a compensatory item, arguing that the executing party should receive monetary compensation, in addition to the one already substantively received: the performance of the required medical procedure. Regarding this, she reiterated, he transgressed the principle of reasonableness by not determining that the compensation includes restoration. Which, she asserted, was brought about by the judicial resolution, since the health service user received the required medical attention, so it becomes contrary to law, especially to said principle, that in addition to the restoration received, an extra amount be awarded to her, as the situation of being on a waiting list was singularly derogated. That is, awarding her an amount as compensation, in addition to having performed the required medical procedure, grants her a privilege over the other insured persons who were bypassed by the protected person. This was previously analyzed, she noted, by this Chamber in judgment no. 1502-S1-2022, which she reproduced as relevant. Also, in no. 297-F-S1-2024 of 17 hours 27 minutes on March 21, 2024, which she also copied as relevant. This situation, she indicated, as inferred, was presented to the Adjudicator, was directly disregarded and, even, she asserted, there is evidence of a possible existence of some “*animus*” to convict under any scenario. This, she reiterated, is contrary to the principle of reasonableness; because, in addition to depleting the resources the institution has to provide health services, it grants a position of privilege to the person who received the required attention, at the expense of those who collaborate so that an adequate health service is provided. Due to the foregoing, she concluded, awarding compensation for moral damages becomes a violation of the principle of reasonableness.

**XVIII.** Regarding what was indicated in the preceding Considerando (Recital), the following must be stated precisely.

<span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; vertical-align:sub">FIRST.</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> On page 14 of the petition, the appellant stated: </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">[</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">…</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">] </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">in addition to the final judgment</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub"> (2024000956)</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">it is not clear what</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">[sic]</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">the </span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">alleged injury suffered</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> is, and neither does the case file contain evidence proving that it occurred</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">.</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> (The bold and underline are from the original). The appellant's assertion is a source of confusion. As noted in section I of this judgment, the final judgment is no. 2023013051 of 09:45 on June 2, 2023, not no. 2024000956, as erroneously indicated by the appellant.</span></p><p style="margin-top:0pt; margin-bottom:0pt; text-indent:42.55pt; text-align:justify; line-height:200%; font-size:12pt; background-color:#ffffff"><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; vertical-align:sub">XIX. SECOND.</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> The appellant forgot that this procedural stage does not correspond to an ordinary appeal (such as an appeal for reversal). Nor is it sufficient to express a series of general and merely argumentative disagreements. It is necessary to contrast what was decided with the infringement that, in her opinion, took place. In this regard, Article 139, subsection 3 of the CPCA provides for a necessary material requirement, both for the admissibility of the appeal and for its subsequent evaluation on the merits. This is the statement of grounds for the appeal, which, due to the characteristics of cassation, must be clear and precise. In this sense, it must contain, as the aforementioned precept stipulates, the factual and legal grounds of the case. Factual, insofar as it shows disagreement with the facts that have been held as proven or unproven (which leads to the weighing of the evidence), or with the circumstances that occurred in the violation of procedural rules. Legal, when it concerns a problem raised regarding the application, omission, or incorrect interpretation of any norm that makes up the legal order, including, of course, constitutional principles, or that which also operates by reflex or indirect effect, after the facts of the challenged judgment are modified. Both in procedural infringement and in evidentiary infringement, factual reasons may concur, along with the legal reasons (always necessary), and in that sense, the referenced grounds must be directed at both aspects, under penalty of inadmissibility. For its part, it is necessary to clarify that, by express legal mandate, the legal grounds are exempted from indicating those canons relating to the value of the evidentiary element or elements poorly assessed. Likewise, it is unnecessary to cite the rules that the lower court erroneously used and mentioned to issue and reason its decision, because they appear in the appealed ruling itself. And of course, it is not at all indispensable to cite the precepts that establish the basic requirements, deadlines, and rules for the admission of the appeal. Rather than the citation of these latter rules, what is essential is that they be complied with, that they be put into practice at the time of drafting and filing the cassation. Thus, the grounds established by law can be understood, broadly speaking, as that technical-legal argumentation in which a series of articles or legal rules are mentioned, intertwined or concatenated with each other and reasonably linked in a double perspective: with the arguments of the appeal and with the judgment under attack. To the extent that a set of legal rules (or, if applicable, a single one) is cited, pertinent and clearly linked to the contested judgment (whether in its factual or legal basis) and the arguments of the appeal, there is legal grounds. Jurisprudential additions or eventual doctrinal citations will occasionally reinforce the allegations made, but, generally, they do not constitute their essence. As this Chamber has already indicated when interpreting the referenced Article 139, </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">the appeal must have minimal legal grounds ... the reasons on which it bases its action must be explained, combating the legal arguments of the appealed judgment and setting forth, at least, some normative reference to support it</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> (Resolution no. 318-A-2008, of 14:25 on May 8, 2008). The grounds are, therefore, alien to the confused deployment of rules and allegations; to the mixture of unintelligible arguments or the simple exposition of opinions on the appropriateness or justice of the case, or to the recounting of the errors considered to have been committed in the appealed judgment, without support in rules or legal criteria. Hence, if the appeal completely omits that technical-normative connection to which reference has been made, or if the connection it makes is manifestly and evidently impertinent or unrelated to the case, it must be understood that it lacks </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">full legal grounds</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">, and therefore, fails to comply with the necessary requirement established in Article 139.3, which is sanctioned with summary dismissal, in accordance with the provisions of Article 140, subsection c) of the same procedural Code. Likewise, this Chamber has repeatedly stated that, for an appeal to pass the admissibility review, in addition to a sufficient exposition of grounds, the corresponding mention and linkage to the appealed judgment of the applicable rules considered infringed is required. In this sense, see, among other resolutions, nos. 677-A-S1-2021 of 09:40 on March 25, 2021 (</span><a href="https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1029345" style="text-decoration:none"><span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1029345</span></a><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">); 755-A-S1-2022 of 10:55 on March 29 (</span><a href="https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1082042" style="text-decoration:none"><span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1082042</span></a><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">); and 1663-A-S1-2022 of 10:05 on July 21 (</span><a href="https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112340" style="text-decoration:none"><span style="font-family:TAHOMA; font-size:8pt; text-decoration:underline; vertical-align:sub; color:#0563c1">https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112340</span></a><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">) , both from the year 2022.</span></p><p style="margin-top:0pt; margin-bottom:0pt; text-indent:42.55pt; text-align:justify; line-height:200%; font-size:12pt; background-color:#ffffff"><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; vertical-align:sub">XX.</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> Following this line of reasoning, after a thorough study of the appeal under review, this Chamber determines that the appellant alleged two dissimilar hypotheses, but, due to the manner in which it was structured, they are inseparable from each other. In this sense, on page 14 of the petition she stated: </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">It is observed in the paragraph transcribed above that the Judge speaks of compensation for </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">the injury suffered</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> that obliged the plaintiff to resort to the filing of the amparo appeal, </span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">but he does not specify what</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> [sic]</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub"> the injury suffered is, whether it is physical or psychological </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">[</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">…</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">]</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">. (The bold is from the original). If what is indicated were to occur, it would constitute the cassation ground for violation of procedural rules provided for in subsection 1), point d), of canon 137 of the CPCA: lack of reasoning.</span></p> Then, on pages 15 and 16 it stated: “In addition to the foregoing, the first-instance judge, departing from the principle of reasonableness, determines that the fact that the medical procedure was performed is insufficient to speak of restorative justice in its entirety, and that therefore there must also be economic compensation […] In that sense, the first-instance judge directly violates the principle of reasonableness, by granting a compensatory award arguing that the plaintiff also had to receive monetary compensation, in addition to what had already been received substantively: the performance of the required medical procedure. / On this, Judge Zeledón Hernández violates the principle of reasonableness, by failing to determine that compensation includes restoration, and this occurred by judicial resolution, since the health service user received the required medical care, which is contrary to law, especially to said principle, that in addition to the restoration received, an additional amount be granted […] in some way, a possible existence is evidenced, it is reiterated, of an animus to condemn under any scenario, which it is reiterated, is contrary to the principle of reasonableness, since this, besides diminishing the resources available to the Institution to provide the health service, grants a privileged position to the person who received the required care, at the expense of those who collaborate to provide adequate health service. / For the foregoing, granting compensation for non-pecuniary damage (daño moral) becomes a violation of the principle of reasonableness.” (Highlighting is from the original). What has just been set forth would give rise to the cassation ground for breach of substantive norms announced, due to the alleged breach of the constitutional principle of reasonableness. The ambiguity described conflicts with the technique of cassation (casación), which dictates that the grounds for the appeal must be indicated clearly and precisely, with the factual and legal basis of the case (precept 139 subsection 3) of the CPCA). Ergo, the rejection of the objection under study is imperative.

XXI.THIRD. What was argued by the appellant, regarding the existence of restorative justice; as well as the non-existence of urgency in the protected party’s appointment and the inadmissibility of granting compensation for subjective non-pecuniary damage (daño moral subjetivo), was already the subject of analysis in sections VIII through XIII of this judgment, therefore, in order to avoid unnecessary reiterations, reference is made to what was expressed therein.

XXII.In the fourth and last reproach, page 16, the appellant announced that she was formulating it under the cassation ground for breach of substantive norms provided for in subsection c) of article 138 of the CPCA. She alleged improper application of canon 193 ibid. In the contested judgment, she said, the Enforcement Judge (Juez de Ejecución) granted costs of the Enforcement of Judgment (Ejecución de Sentencia). She considered that the enforcing party had sufficient reasons to litigate, having an abstractly granted right. However, she noted, the indicated precept -193 ibidem- establishes that the losing party shall be exonerated from the payment of costs when, due to the nature of the matters debated, there was sufficient reason to litigate. She transcribed, in what was of interest to her, what was considered in section VI of the challenged judgment, called “COSTS OF THE ENFORCEMENT AND INTERESTS”. The contested judgment, she pointed out, was clear that the enforcing party requested, for subjective non-pecuniary damage, an amount of ₡300,000.00, plus compensation for costs. She copied, where relevant, what was stated in section I of the appealed ruling. In total, she stated, the enforcing party petitioned for at least ₡481,500.00. The Judge, she commented, improperly applied article 193 subsection 2) of the CPCA, since said norm establishes that the losing party may be exonerated from the payment of costs when, due to the nature of the issues debated, there was sufficient reason to litigate. Taking into consideration merely arithmetic extremes, and only the amounts granted, they represent a total of ₡231,500.00. This implies, she argued, that from the total sought, the enforcing party obtained 48.07%, which entails, senso contrario, that it did not obtain 51.93% of what it sought to obtain. Consequently, she alleged, it is denoted that her represented party had to litigate. She achieved, she added, that the enforcing party did not obtain the entirety of its claims. Therefore, she questioned, she does not understand how it was not even minimally visualized by the Judge, who deemed that the winning party had sufficient reasons to litigate, when he should have assessed that it was her represented party who had sufficient reason to litigate. Especially being faced with an enforcement of a judgment of an abstractly granted right, where there was a scenario of extreme petitions, which implied that this representation had to exercise the defense of institutional interests. If the Judge had assessed the above, she stated, he would have determined that her represented party had reasons to litigate.

Among different elements, she pointed out the following: 1) the total amount sought by the executing party corresponded to the sum of ₡481,500.00; ₡300,000.00 for moral damages (daño moral) and ₡181,500.00 for costs, for the elapsed period of six months and fifteen days, wherein, indeed, it was never medically classified as an emergency; 2) of the total amount sought, 48.07% was granted (₡50,000.00 for moral damages (daño moral) and ₡181,500.00 for costs), resulting in 51.93% of the total sought being rejected; 3) of the amount for subjective moral damages (daño moral subjetivo) requested, the sum of ₡50,000.00 was granted, representing 16.6% of what was initially required; 4) this is a claim with an evident intent to obtain extremes beyond what can be considered, parallel to reasonableness; 5) this Chamber, in judgment no. 1502-S1-2022, indicated that it is irrational to impose upon the tripartite social security contribution fund and, upon the other insured parties benefited by said funds, an additional compensation to one who has consented to the wait and received, through judicial protection, the required medical care. Added to this, it provided guidelines to determine whether compensation should or should not be involved, such as, whether the type of pathology of the patient refers or not to an emergency, or else, conformity with inclusion on a waiting list and, even, compensation “in natura”. That is to say, her represented party proceeded from positions developed by this Chamber to litigate in the process, which was pointed out to the Judge, without him taking it into consideration. For the foregoing, she argued, it is evident that this representation had to litigate in the process. Not satisfied with that, the Judge decided to condemn her client in costs, thereby leaving her in a clear position of vulnerability and disadvantage, since, defending, indeed, the financial sustainability of the Institution, is clearly a sufficient motive to litigate. Not satisfied with that, she insisted, the Adjudicator condemned her represented party to the payment of costs of the execution process. Therefore, she pointed out, it can be deduced, in a direct, clear, and simple manner, that her represented party had sufficient motives to litigate, in view of the fact that the principles of legality, good faith, loyalty between parties, and preclusion were being effectively protected. If article 193 subsection b) of the CPCA had been adequately applied, she said, the Judge would have exempted her client from the payment of costs, given that it is evident and manifest, she concluded, in addition to being of simple verification, the fact that there was sufficient motive to litigate.

XXIII.Regarding what was set forth in the preceding Considerando, it is necessary to indicate FIRST, the Execution Judge, in section VI of the questioned judgment, pointed out: “Pursuant to articles 119.2, 193 of the Código Procesal Contencioso Administrativo, there existing in this Adjudicator’s opinion sufficient reasons for the plaintiff to litigate in this process, since it had a right granted in the abstract by the Constitutional Chamber that it could come to execute in this venue, the defendant CCSS [sic] is condemned in costs, rejecting the defense of lack of right of the liquidated item. […]” SECOND, after a detailed study of the grievance, it is determined that its core consists of the alleged violation, by erroneous application, of ordinal 193 subsection b) of the CPCA, since, in its judgment, due to the nature of the issues debated, sufficient motive to litigate assisted its client. This is because, she pointed out, the executing party sought payment of, at least, ₡481,500.00, distributed in the following manner: ₡181,500.00 for personal costs of the recurso de amparo and ₡300,000.00 for subjective moral damages (daño moral subjetivo). However, the Execution Judge, she said, only granted a total of ₡231,500.00 (₡181,500.00 for the personal costs of the recurso de amparo and ₡50,000.00 for subjective moral damages (daño moral subjetivo)). That is to say, 48.07% of what was sought. In this regard, the aforementioned would give rise to the announced cassation motive, provided for in subsection c) of precept 138 of the CPCA. However, she then alluded to two more dissimilar hypotheses, the three resulting indivisible, by the way the objection was formulated. In this sense, on pages 17 and 18 she indicated: “On this matter, and taking into consideration purely arithmetic extremes [sic], and only taking into consideration the amounts granted, these represent a total of ¢231,500.00 (two hundred thirty-one thousand five hundred colones), which implies that of the total sought, the plaintiff obtained 48.07%, which entails, contrario sensu, that it did not obtain 51.93% of what it sought to obtain, by which it is denoted that, in the first instance, my represented party did have to litigate the present process [sic] and indeed, managed to ensure that the plaintiff did not obtain the totality of its claims, which, it is not understood how, was not even minimally visualized by the first instance judge, who, estimates that the winning party had sufficient motives to litigate, when he should have assessed that it was my represented party who had sufficient motive to litigate the [sic] judgment execution process, especially being faced with a judgment execution of a right granted in the abstract, where there was practically a scenario of extreme petitions, which imply that this representation had to exercise, without any discussion, the defense of institutional interests.

/ If Judge Zeledón Hernández had assessed the foregoing, he would have determined that my client had ample grounds to litigate the judicial process, given that, among various elements, the following exist: […] The First Chamber of the Supreme Court of Justice, in judgment No. 1502-S1-2022, indicates that it is irrational to impose upon the tripartite social security contribution fund and, upon the other insured beneficiaries of said funds, an additional indemnification on someone who has consented to the wait and received, through judicial protection, the required medical attention, and in addition to that, it provided guidelines for determining whether or not indemnification should be mediated, such as whether the patient's type of pathology refers to an emergency or not, or, the conformity with inclusion on a waiting list, and even, indemnification in kind, that is, my client relied on positions developed by the First Chamber itself, in order to litigate the process, which was pointed out to the trial court judge, without the same even being taken into consideration.” (The highlighting is from the original). In what has now been set forth, the appellant alluded to the cassation ground for breach of procedural rules, provided for in article 137, subsection 1), point d) of the CPCA: lack of reasoning (falta de motivación). However, what is argued is informal. The objector omitted to point out the procedural rule violated, with a clear and precise explanation, as the technique of cassation (técnica de la casación) requires, as was indicated in section XIX of this judgment, in accordance with the provisions of ordinal 139, subsection 3) ibid. On the other hand, on page 18 she added: “Hence, it is evident that this representation had to litigate the process, and not satisfied with that, the trial court judge decides to order my client to pay legal costs (costas), thereby leaving her in a clear position of vulnerability and disadvantage, given that defending even the financial sustainability of the Institution is clearly a sufficient motive to litigate, not satisfied with that, Judge Zeledón Hernández orders my client to pay the legal costs of the enforcement process (proceso de ejecución).” (The highlighting is from the original). In what has now been set forth, she refers to the cassation ground for violation of substantive rules provided for in subsection d) of ordinal 138 of the CPCA. The confusion brought to light, as was indicated, clashes with the technique of cassation, which, as has already been indicated, requires that the objections of the cassation appeal (recurso de casación) must be formulated in a clear and precise manner (article 139, subsection 3) of the CPCA); which implies the rejection of the grievance under study.

**XXIV. THIRD.** In accordance with what was set forth in the statement of defense (contestación de la demanda), images 29 to 38 of the electronic judicial file, the general judicial attorney-in-fact (apoderada general judicial) of the CCSS argued and requested that her principal should not be ordered to pay subjective moral damages (daño moral subjetivo). This, despite what was decided by the Constitutional Chamber, because, in her opinion, the person granted protection (amparada) was not denied access to health services, much less medical attention. Furthermore, as she pointed out, the diagnosis of the person granted protection was not urgent. The person granted protection, she stated, did not explain what the moral damage consisted of. That is, the enforcing party (ejecutante) did not comply with what is provided for in ordinals 163 and 180 of the CPCA. Likewise, she did not prove the causal link between what is in the file and the factual situation on which she intends to base said damage. That is, she did not prove it. Nor are there technical criteria that demonstrate its existence. Ergo, said item should be rejected. For his part, the Enforcement Judge (Juez de Ejecución), in the questioned judgment, according to the transcription carried out in section V of this judgment, considered the appropriateness of the subjective moral damages, by virtue of its demonstration "in re ipsa" based on the facts that served as the basis for the granting of the amparo appeal (recurso de amparo). In accordance with his prudent discretion, and the principles of reasonableness and proportionality, he set the amount at ₡50,000.00. The foregoing means, contrary to what was argued by the appellant (casacionista), that the opposition raised by the general attorney-in-fact of the CCSS was unsuccessful. The Judging Officer, it is reiterated, determined the existence of subjective moral damages by virtue of the facts that served as the basis for the granting of the amparo appeal, which was endorsed by this Chamber, as was stated. Furthermore, he set its amount, as was indicated, according to his prudent discretion and under the protection of the indicated principles of reasonableness and proportionality, which was also shared by this Chamber. Likewise, the amount requested for personal legal costs (costas personales) of the amparo appeal was granted. Similarly, legal interest (réditos legales) was granted on the amounts awarded and the costs of the enforcement process, just as was requested. Corollary, contrary to what was set forth by the appellant, and as was correctly decided, it was necessary to order the payment of the costs of the enforcement process, as provided by canon 193 of the CPCA, since none of the grounds for exoneration provided for in that rule were present. **FOURTH.** Just as was noted in section XXI of this judgment, what was indicated by the challenger, concerning the existence of restorative justice and the non-existence of urgency in the appointment of the person granted protection, having consented to the wait, and the inappropriateness of granting an indemnification for subjective moral damages, was already the subject of analysis in sections VIII through XIII of this judgment, therefore, in order to avoid unnecessary reiterations, reference is made to what was expressed therein.

**XXV.** By virtue of the reasons set forth, the rejection of the appeal filed is required.

In accordance with the provisions of article 150 subsection 3) of the CPCA, as this Chamber does not consider that the cassation appellant has sufficient grounds to appeal, for the reasons set forth in the analysis of each grievance, the appellant shall be ordered to pay the costs of the cassation appeal (recurso de casación), which must be liquidated in the judgment enforcement phase, in order to guarantee the right of defense of the enforced party, by granting it the respective hearing regarding the liquidation submitted (articles 41 and 153 of the Political Constitution).

**XXVI. DISSENTING VOTE OF MAGISTRATE ROJAS MORALES.** I depart from the majority opinion, insofar as it deems it appropriate to order the defendant to pay subjective moral damages (daño moral subjetivo) in the sum of ¢50,000.00. Regarding the damages (daños y perjuicios) arising from a ruling of the Constitutional Chamber (Sala Constitucional) when granting a writ of amparo (recurso de amparo), it is worth bearing in mind that, given their nature, this type of judgments contains an abstract condemnation, without any factual consideration, and does not prejudge—since it was not the subject of analysis—their existence, their causal link or their quantification. Said Court merely determines the constitutional violation. When enforcing those aspects, the causal relationship between what was declared in the abstract and the specific matter must be established. Thus, the fact that the Constitutional Chamber orders in the abstract the payment of damages does not entail an automatic condemnation to be enforced, as the Enforcement Judge seems to wrongly understand. It is for the judges responsible for resolving the liquidation to assess, in each specific case, the existence of sufficient grounds to grant the requested compensation (indemnización). In that regard, the following must be analyzed: the particular circumstances of the case, the position of the parties, the nature, object, and purpose of the remedy, as well as the constitutional principles of reasonableness and proportionality. Furthermore, when the matter concerns an alleged subjective moral suffering endured by a person facing a lack of medical care, as occurs in this case, the examination of additional aspects becomes essential. In the first place, the factor of **urgency** must be assessed, since it is evident that a person requiring urgent care from the CCSS is not in the same situation—for example: an individual suffering from a cancer that advances irremediably, compared to someone who has an ailment for which a surgical intervention or a medical appointment has been prescribed without compelling character; in both cases, the waiting time to receive the medical service does not have the same result. Likewise, the moral impact will not be of equal intensity. On the other hand, the **inactivity of the patient** due to the passage of time on the waiting list must be analyzed (canon 30 subsection ch) of the Law of Constitutional Jurisdiction -LJC- and 38 of the Administrative Contentious Procedure Code), which ceases when they file a writ of amparo before the Constitutional Chamber or before the courts of justice, to claim the medical care or treatment they need (administrative activity). It must be taken into account that the passage of time without taking action has clear consequences in the Costa Rican legal system regarding the expiration (caducidad) of the action, an aspect subject to review ex officio. A pecuniary advantage cannot be derived from inactivity, as this contradicts the principle of proportionality in its strict sense. In the third place, the **satisfaction derived from the order of a court of justice**, by means of which the performance of a medical act or the delivery of medication is ordered (even if it arises from a precautionary measure), must be weighed. Even the most recent jurisprudence of the Constitutional Chamber has assessed **the satisfaction generated from the notification of the amparo proceedings**. These are cases in which, on the occasion of the amparo and regardless of the time elapsed between the filing of the appeal and the administrative response received, the respondent authority grants the individual the required medical care (providing a certain date for a surgery or medical consultation, providing the needed medication, rescheduling an appointment, etc.). Cases from the latest erga omnes binding resolution (according to article 13 of the LJC), in which the Constitutional Judges have considered it inappropriate to order costs and damages, resolving even without a condemnation in those aspects; these cases must be assessed by this Chamber when ruling on ongoing proceedings. In this regard, one may consult, among others, judgments number: 2024-000017 of 9:15 a.m. on January 9, 2024, 2024-000026 of 9:15 a.m. on January 9, 2024, and 2024-006673 of 9:15 a.m. on March 8, 2024. It is worth highlighting that granting the required medical service constitutes a manifestation of restorative justice, which this Deciding Body must assess. The compensation (indemnización) granted in violation of the stated reasoning becomes unreasonable and disproportionate, especially when in a universal social security system, such as the Costa Rican one, such compensations are paid by all insured persons, including those displaced by the petitioner. Upon examining the aspects described and the particular case of Mrs. María de los Ángeles Carmona Castillo, it becomes inappropriate to compensate the emotional distress granted in the judgment. It is recorded in the case file that, on November 15, 2022, the Gynecology Service of the Maximiliano Peralta Jiménez Hospital in Cartago issued to Mrs. María de los Ángeles a hospitalization request for surgery, a date from which she entered the waiting list. On May 16, 2023, she filed a writ of amparo before the Constitutional Chamber, meaning that for approximately six months she remained waiting for the intervention to be scheduled. One must take into account the possibilities of social security in an area such as General Surgery, where there are not enough specialists to serve the population, especially given that the number of people requiring intervention in that area is increasing. On the other hand, it is pertinent to note that, even though the Maximiliano Peralta Jiménez Hospital in Cartago issued her a hospitalization order for surgery, it did not do so with an urgent character (as indicated in technical report no. HMP-DG-1915-2023). In addition to the foregoing, it is recorded in the Expediente Digital Único en Salud that the petitioner's request for medical care was satisfied, since the surgery took place on September 13, 2023, which implies care within a reasonable time, given the noted conditions. *See*, the waiting time endured by Mrs. María de los Ángeles to receive the needed care was approximately four months, counted from when she filed the writ of amparo on May 16, 2023, until she underwent surgery on the following September 13. The period is even shorter if one considers that the enforceable judgment was notified on June 5, 2023. These periods are in themselves reasonable from the point of view of providing a non-urgent service and given the need to fulfill the preoperative requirements inherent to any surgical intervention. Bear in mind that, from the filing of the amparo, the petitioner was never subjected to a prolonged or indefinite wait.

She received medical attention within a more than reasonable period (even shorter than the waiting times for care in private medicine). Without overlooking that the surgery was scheduled for her on a non-emergency basis. The foregoing speaks to the nonexistence of the liquidated damage. It is worth noting, in cases such as the one under study, there is no doubt that the user's satisfaction was already generated; therefore, granting additional compensation beyond what was received (medical assessment in singular derogation of the waiting list) becomes contrary to law. The foregoing, far from causing the petitioner non-material harm (daño moral), granted her a privilege over the other insured persons, which diminishes the claim for non-material harm (daño moral) filed. It is irrational to impose on the tripartite social security contribution fund and on the other insured persons who benefit from those funds an additional compensation for someone who has received the required medical attention through judicial protection. For the reasons indicated, the compensation granted does not conform to criteria of reasonableness and proportionality (established by the Constitutional Chamber itself). On the merits of the foregoing, the undersigned considers that the proper course was to uphold the first and second grievances of the filed appeal and, consequently, to annul the contested judgment -only- insofar as it recognized the amount of ¢50,000.00 for subjective non-material harm (daño moral subjetivo), and instead, ruling on the merits, to reject that claim.

POR TANTO

By majority, the appeal is dismissed, with costs to be borne by the cassation appellant, Caja Costarricense de Seguro Social, which shall be calculated in the judgment execution stage.

Magistrate Rojas Morales saves her vote to grant the appeal by virtue of restorative justice (justicia restaurativa) having been configured.

<p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10.5pt; background-color:#ffffff"><span style="font-family:'Times New Roman'; font-size:7pt; vertical-align:sub">Jorge Leiva Poveda</span></p></td><td style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10.5pt; background-color:#ffffff"><span style="font-family:'Times New Roman'; font-size:7pt; vertical-align:sub; -aw-import:ignore">&#xa0;</span></p></td><td style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10.5pt; background-color:#ffffff"><img 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width="162" height="74" alt="" style="-aw-left-pos:0pt; -aw-rel-hpos:column; -aw-rel-vpos:paragraph; -aw-top-pos:0pt; -aw-wrap-type:inline" /></p><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10.5pt; background-color:#ffffff"><span style="font-family:'Times New Roman'; font-size:7pt; vertical-align:sub">Carlos Guillermo Zamora Campos</span></p></td></tr></table><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:12pt; background-color:#ffffff"><span style="font-size:8pt; vertical-align:sub; -aw-import:ignore">&#xa0;</span></p><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:12pt; background-color:#ffffff"><span style="font-size:8pt; vertical-align:sub; -aw-import:ignore">&#xa0;</span></p><p style="margin-top:0pt; margin-bottom:0pt; background-color:#ffffff"><span style="font-family:'Times New Roman'; font-size:5.33pt; vertical-align:sub">Digitally Signed Document</span></p><p style="margin-top:0pt; margin-bottom:0pt; background-color:#ffffff"><span style="font-family:'Times New Roman'; font-size:5.33pt; vertical-align:sub">-- Verification Code --</span></p><p style="margin-top:0pt; margin-bottom:0pt; font-size:14pt; background-color:#ffffff"><span style="font-family:'WASP 39 L'; font-size:9.33pt; vertical-align:sub"></span></p><p style="margin-top:0pt; margin-bottom:0pt; font-size:14pt; background-color:#ffffff"><span style="font-family:TAHOMA; font-size:9.33pt; vertical-align:sub; -aw-import:spaces">&#xa0;</span><span style="font-family:TAHOMA; font-size:9.33pt; vertical-align:sub">DN9X62L7LZW61 </span></p><div style="-aw-headerfooter-type:footer-primary; clear:both"><p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10pt; background-color:#ffffff"><span style="font-family:TAHOMA; font-size:6.67pt; vertical-align:sub">Phones: (506) 2295-3658 or 2295-3659, email [email protected]</span></p></div></div></body></html> See resolutions 112-1996, 41-1997, 468-2019, and 1098-2023 of the First Chamber. The Constitutional Chamber granted an amparo action against the Caja Costarricense de Seguro Social, for placing the amparo petitioner on an indefinite waiting list for the total abdominal hysterectomy she required, such that the time elapsed up to that point (6 months, 15 days) was disproportionate and violated her right to health. It ordered the entity to perform the operation within a maximum period of three months from notification of the judgment; which subsequently occurred. In the constitutional judgment enforcement proceeding, the Court ordered the judgment debtor to pay a sum for subjective non-pecuniary damage (daño moral subjetivo). The appellant alleges that restorative justice applied. This Chamber considers that the service-related rectification does not exclude that the injured person suffered harm in her moral and pecuniary spheres while the abnormal conduct persisted. If that occurred and was so proven, it is obligatory to impose the corresponding compensatory consequence, if requested by the person whose legal sphere was harmed. This is in accordance with the principle of integral reparation of damage (canons 9, 41, 49 of the Constitution, 190, 196, and 197 of the General Law of Public Administration). Moreover, when the surgical intervention was performed, the wait was 10 months. Such a situation—an unlawful act (hecho antijurídico)—declared in the constitutional venue, according to the maxims of logic, experience, and correct human understanding, as was resolved, is an adequate cause of moral affliction associated with anxiety, discomfort, frustration, and worry about a health situation that "per se" is a cause of concern for the person suffering from it. Therefore, the existence of those feelings can be inferred "in re ipsa," without her having a legal duty to bear them, as they derive from an abnormal functioning of the Administration. Ergo, their existence is determined and, therefore, the appropriateness of their compensation. Regarding legal reasonableness (see resolutions 5236-1999 and 1354-2011 of the Constitutional Chamber, 760-2023, 1934-2022, and 1087-2023 of the First Chamber), the sum granted is reasonable and proportionate, considering the circumstances of this case. Furthermore, it is quantitatively lower than what has been recognized for similar harms (see resolutions 429-2024 and 937-2024). It is also alleged that there was no urgency in performing the operation. However, this is a precluded aspect, as it was the Constitutional Chamber itself—in the enforceable judgment (resolución ejecutoria)—that determined it, establishing the timeframe for performing it. It was argued that the amparo petitioner acquiesced to remaining on a waiting list; but the existence of an express or tacit consented act cannot be considered, since she showed her disagreement by filing the amparo action; regardless of the time elapsed between the moment she entered said list and the filing of the amparo action (voto 571-F-2025).

Therefore, it was necessary to impose the payment of the costs of the execution proceeding (section 193 of the Contentious-Administrative Procedure Code (Código Procesal Contencioso Administrativo)) (vote 571-F-2025).

The appeal filed is rejected. As this Chamber does not consider that the cassation appellant has sufficient grounds to appeal, for the reasons stated when analyzing each grievance, the appellant is ordered to pay the costs of the cassation appeal (article 150.3 of the Contentious-Administrative Procedure Code (Código Procesal Contencioso Administrativo)), which must be liquidated in the execution phase of the judgment, in order to guarantee the right of defense of the party against whom execution is sought, by granting them the respective hearing on the liquidation that is submitted (articles 41 and 153 of the Political Constitution (Constitución Política)) (vote 571-F-2025).

**FIRST CHAMBER OF THE SUPREME COURT OF JUSTICE.** San José, at eleven hours forty-four minutes on the twenty-seventh of March of two thousand twenty-five.

Execution proceeding of the judgment issued by the Constitutional Chamber of the Supreme Court of Justice in an amparo action filed by **LEONARDO GÓMEZ SALAZAR**, attorney, holder of identity card number 108760664 and bar association number 17,049, in his capacity as special judicial representative of **MARÍA DE LOS ÁNGELES CARMONA CASTILLO**, homemaker, holder of identity card number 108300488 **against** the **COSTA RICAN SOCIAL SECURITY FUND (CAJA COSTARRICENSE DE SEGURO SOCIAL)**, with legal entity identification number 4-000-042147, represented by its general judicial representative without sum limit, Xinia Enid Calderón Umaña, attorney, holder of identity card number 111430399 and bar association number 27,700. The general judicial representative of the entity against which execution is sought filed a cassation appeal challenging judgment number 2024000956 of 14 hours 50 minutes on May 6, 2024, issued by the Contentious-Administrative and Civil Treasury Court of the Second Judicial Circuit of San José, composed of Judge Pablo Zeledón Hernández.

**Reporting Magistrate Jorge Leiva Poveda** **WHEREAS** **I.** The Constitutional Chamber of the Supreme Court of Justice, through judgment number 2023013051 of 09 hours 45 minutes on June 2, 2023, granted the amparo action filed by Leonardo Gómez Salazar on behalf of María de los Ángeles Carmona Castillo against the Costa Rican Social Security Fund (CCSS). Said action, filed before that Chamber on May 16, 2023, originated from the violation of the fundamental right to health.

This, by virtue of the fact that the amparo petitioner is a patient of the Gynecology Service of the Hospital Maximiliano Peralta Jiménez in Cartago. She was diagnosed with "uterine leiomyoma." On November 15, 2022, she entered the waiting list of that hospital for a "total abdominal hysterectomy" surgery. However, as of the date the amparo was filed, she had not received the required medical attention. Nor did she have a firm date for the surgery. In this regard, the Chamber stated: "IV.- [...] Thus, this Chamber considers that the appeal must be granted, since approximately 6 months and 15 days have passed since the petitioner was placed on the waiting list for the surgery required as treatment for her pathology, a period that is disproportionate and violates the fundamental rights of the protected person. In addition to the above, according to the report rendered by the respondent authority, there is no firm date for the surgical intervention, maintaining uncertainty regarding the timeline for its performance. Precisely, it is the duty of the Caja Costarricense de Seguro Social to effectively safeguard the right to health of all its users, which includes—evidently—the obligation to provide timely and diligent medical care and treatment that its patients need. Given the foregoing, the appropriate course is to declare the appeal granted, due to violation of the right to health." (The underlining is supplied). It ordered the General Director and the Head of the Gynecology Service, both of said Hospital, to promptly and timely arrange the necessary actions and coordination so that, within a maximum period of three months, counted from the notification of that judgment, the petitioner would undergo the appropriate surgical procedure she needs. All under the strict supervision and responsibility of her treating physician, provided there is no cause preventing it and all preoperative and institutional requirements have been met. They were warned that, in accordance with the provisions of Article 71 of the Ley de la Jurisdicción Constitucional, imprisonment of three months to two years or a fine of twenty to sixty days shall be imposed on anyone who receives an order that must be complied with or enforced, issued within an amparo appeal, and does not comply with it or does not enforce it, provided the crime is not more severely punished. Likewise, it condemned the CCSS to pay the costs, damages, and losses caused by the facts that served as the basis for that declaration, which, it ordered, shall be liquidated in the enforcement of judgment phase of the administrative contentious proceeding.

II.By brief filed with the Court on November 08, 2023, uploaded to the electronic judicial file that day at 13:01:02, images 01 through 25, Attorney Leonardo Gómez Salazar, in his capacity as special judicial representative of María de los Ángeles Carmona Castillo, submitted the corresponding liquidation to the court. He requested the following items be granted: 1) that the executed entity be ordered to pay the costs of the judgment enforcement proceeding; 2) ₡181,500.00 for the personal costs of the amparo appeal; 3) ₡300,000.00 for subjective moral damage (daño moral subjetivo); and 4) the payment of legal interest, from the moment the judgment became final until its effective payment. By resolution at 15:48 on the 17th of that month and year (images 26 and 27), the processing judge, Giovanni Marchena Jara, admitted the claim. In a brief uploaded to the file on January 18, 2024, at 10:36:52, images 29 through 79, the general judicial representative without sum limit of the CCSS opposed the enforcement. She raised the defenses of lack of: right, active standing, and passive standing. In the now-challenged judgment, the Enforcement Judge, Pablo Zeledón Hernández, rejected said exceptions. Consequently, he granted the liquidation in the following terms. He ordered the CCSS to pay: 1) ₡50,000.00 for subjective moral damage (daño moral subjetivo); 2) ₡181,500.00 for the costs of the amparo appeal; 3) he also imposed on the executed institution the recognition of legal interest on the sums granted from the finality of that resolution until their effective payment; and 4) finally, he ordered the CCSS to pay the costs of the judgment enforcement proceeding. Dissatisfied, the general judicial representative of the CCSS filed a cassation appeal. For its resolution, the brief uploaded to this Chamber's virtual desktop on February 12, 2025, at 13:25:51, signed by Attorney Gómez Salazar, was considered.

III.In the first censure, page three of the brief, the appellant announced she was filing it based on the cassation ground of violation of substantive norms provided for in Article 138, subsection a) of the Código Procesal Contencioso Administrativo (CPCA): "The cassation appeal shall also proceed for violation of substantive norms of the legal system, in the following cases: / a) When an improper assessment is attributed to the evidence or it has been pretermitted." She said this was due to the improper assessment of the means of conviction contained in the record, specifically, the enforcement order of the constitutional judgment on the amparo appeal. She alleged the violation of Article 196 of the Ley General de la Administración Pública (LGAP).

The challenged judgment, it noted, based its argument for granting the item of subjective moral damages on a factual element, but without analyzing the facets contained in the line of this Chamber (it alluded to ruling no. 297-F-S1-2024 of 17:27 on March 21, 2024), such as the determination of extreme medical necessity from the patient’s perspective —urgency—, their consent to be on a waiting list, or, alternatively, the existence of physical injury. The resolution, it stated, mentioned conditions of the enforcing party; however, it did not determine whether or not it is related to a medical emergency. The Judge indicated that a simple final judgment of a constitutional ruling is sufficient to demonstrate a factual situation. It reproduced, insofar as relevant, what was considered in Section IV of the challenged judgment, regarding subjective moral damages. With a simple final judgment of a ruling, it alleged, the judicial authority was able to determine that the Administration caused the enforcing party “an emotional impairment (un menoscabo emocional)”, without taking into account the factors of restorative justice, urgency, and the patient’s condition. It copied the proven facts from the final judgment. With them, it indicated, no moral damage whatsoever suffered by the patient is proven. They make no reference to the aggravation of her condition or that she suffered “an emotional impairment (un menoscabo emocional)”. The Judge, with the simple final judgment of the ruling, according to his words, it insisted, determined the existence of an injury (lesión) in the patient, without specifying what type. It transcribed another fragment of what was considered in Section IV of the questioned ruling regarding subjective moral damages. In the substantive analysis of the Constitutional Chamber’s judgment, it alleged, it was deemed that the amparo was granted because the enforcing party was subjected to a waiting list for a period of 06 months and 15 days, without mentioning whether or not there was a need for immediate follow-up. It reproduced what was stated in that Chamber’s ruling in Section IV. The Constitutional Court determined that said waiting period —06 months and 15 days— was disproportionate and violated the fundamental rights of the protected party. However, it added, the Chamber has also mentioned, on other occasions, that it exceeds the scope of its powers to determine how much time is fair and necessary, from a medical standpoint, to generally treat the sick persons who attend CCSS services and that, for this, it depends on a precise technical-scientific assessment or criterion regarding the urgency or not of the treatment that each one requires. Assessment or criterion that, in this case, does not appear in the amparo file to determine that a period of 06 months and 15 days is disproportionate and violatory. To Mrs. Carmona Castillo, it noted, its represented party did not deny access to health services, to medical attention. Contrary to that, it stated, at the time of filing the amparo appeal, it was clear that what the amparo petitioner sought was a hysterectomy procedure that, under no circumstances, was considered an emergency or pathology of an urgent or oncological nature, as was indicated in due course. The Execution Judge, it stated, took as a basis for granting the execution of judgment an element that was not mentioned by the Constitutional Chamber to grant the amparo appeal and that, therefore, could not serve as a basis for granting claims. It transcribed another part of what was stated in the indicated Considering IV of the challenged judgment. It issued the ruling considering the elapsed waiting time to be excessive. However, it said, nowhere in what was indicated in resolution no. 20233013051 of the Constitutional Chamber did it focus on an indication of excessive waiting time and urgency. Contrary to that, from the point of view of the treating physician, technical report no. HMP–DG-1915-2023, which is in the amparo appeal file, refers to Mrs. Carmona’s pathology as non-priority or urgent. The challenged judgment, directly, it asserted, violated numeral 196 of the LGAP, by having determined the existence of an injury (lesión) and damage (daño), with a final judgment of a ruling. It required for this, it stated, technical proof that would accredit it, which is aggravated by the fact that the Judge indicated that an “emotional impairment (un menoscabo emocional)” occurred (page five of the ruling) and its prolongation, with the simple fact of having analyzed the final judgment of the ruling. The questioned resolution, it insisted, violated said rule, which provides that the damage must be effective, assessable, and individualizable, in relation to a person or group. The truth, it pointed out, is that, starting from a ruling on an amparo appeal, for placement on a waiting list, there is no proof whatsoever of any impact on the inner self of the enforcing party. There is no proof whatsoever of an injury (lesión) suffered. Nor what type of injury (lesión), given that said legal concept arises from damage resulting from a lack of equivalence between what is given and what is received. In an onerous title. Damage resulting from a crime where the body of a person is diminished or transgressed. Or, an organic or functional disturbance of an individual. That is, the Judge, from a simple final judgment of a ruling, validated and determined the existence of an injury (lesión) in the patient; without specifying which type of injury (lesión), without having technical proof that would accredit it. This, it argued, entails that the damage is not real nor effective, infringing said precept. It insisted, the Judge did not take into account the factors of restorative justice, urgency, the patient’s condition, reiterated in the jurisprudence of this Chamber. It mentioned the rulings (in citation order) nos. 28-F-S1-2024 of 11:05 on January 11; 297-F-S1-2024 of 17:27 on March 21, both of the year 2024; 1502-F-S1-2022 of 11:24 on September 1; 1823-F-S1-2022 of 14:26 on August 4 of two thousand twenty-two; and 2429-F-S1-2022, the three from the year 2022. It included a table in which it set forth, in its opinion, what was pointed out in each of those rulings.

If the Judge, it noted, had properly analyzed the evidence, he would determine that a final judgment is insufficient to establish the appropriateness of subjective moral damages. Especially, and taking into consideration that the placement of a person on a waiting list is not “per se”, sufficient grounds to grant compensation. On this, it indicated, this Chamber established, in resolution no.

1502-S1-2022 of 11 hours 24 minutes on September 1, 2022, which, regarding compensation for amparo appeals due to placement on waiting lists, finds it irrational to impose on the tripartite social security contribution fund a compensation payment to someone who has consented to a wait and received the required medical attention. He reiterated once again that this was pointed out to the jurisdictional authority. However, in his view, he denoted that there exists an "animus" to condemn the CCSS at all costs (and, of course, the contributors), without any support whatsoever from an evidentiary standpoint. If the Judge had properly assessed the evidence, he asserted, the reasoning of the ruling would be different. He would have determined that the evidence was insufficient to establish the existence of any type of damage. From the proven facts of the amparo appeal judgment, he stated, it is not denoted that it refers to an issue of injury to the executing party. That is, if the amparo appeal judgment did not mention any aspect related to an injury caused by placement on a waiting list, the judicial authority was barred from considering it and, above all, from taking it as a starting point to determine compensation. Without technical evidence, and without the amparo appeal judgment mentioning any aspect from a medical standpoint, he pointed out, it determined complex technical-medical elements to conclude the existence of effective and individualized damage with respect to the executing party. He affirmed that one cannot condone this view of the Judge, since from the series of elements that were taken into consideration, it is not inferred from what was analyzed by the Constitutional Chamber (Sala Constitucional) to grant the amparo appeal. Especially, taking into account that it referred to extremely technical aspects from a medical standpoint (with specialties such as gynecology, for example), which can only be verified with that type of (technical) evidence. The judgment of a constitutional sentence, he indicated, in and of itself, does not have a nuance of such magnitude as to conclude the existence of an injury, taking into consideration, he insisted, that there was no technical evidence on this matter. If the Judge had duly analyzed the evidence, he concluded, he would determine that a judgment is insufficient for the applicability of subjective moral damage (daño moral subjetivo).

**IV.** This Chamber (Cámara) will approach the analysis of the extensive censure in the following manner. **FIRST.** After its detailed analysis, it is determined that it suffers from a contradiction that causes perplexity. On page five of the writ, he affirmed: "*Let it be noted by the honorable First Chamber (Sala Primera), that the High Constitutional Court determined that the waiting period of 6 months and 15 days was disproportionate and violative of the fundamental rights of the protected party* [...]". However, on the following page -six- he stated: "*As can be seen by the honorable First Chamber (Sala Primera), Judge Zeledón Hernández issues a ruling considering the elapsed waiting time excessive, however, in no part of what is indicated in resolution No. 20233013051 of the Constitutional Chamber (Sala Constitucional), does it focus on pointing out an excessive and urgent waiting time, contrary to that, from the point of view of the treating physician, technical report No. HMP–DG- 1915-2023 which is in the amparo, refers to Mrs. Carmona's pathology as non-priority or urgent.*" (The emphasis is from the original). That is, at first, he affirmed that the Constitutional Chamber (Sala Constitucional) determined that the waiting period for the required surgery, which at the time of the issuance of the amparo judgment was six months and fifteen days, was disproportionate and violative of the fundamental rights of the protected party, which is why the amparo appeal was granted. However, he later indicated that the Enforcement Judge (Juez de Ejecución), by considering the waiting period suffered by the executing party excessive in order to determine the applicability of subjective moral damage (daño moral subjetivo), transgressed the amparo judgment, since the Constitutional Chamber (Sala Constitucional) did not indicate that the waiting time was excessive. The contradiction is evident. In this sense, as noted in Considerando I of this judgment, it is insisted, the Constitutional Chamber (Sala Constitucional) granted the amparo appeal filed on behalf of Mrs. María de los Ángeles Carmona Castilla, as determined from what was considered in section IV of the amparo judgment, by estimating that the waiting period up to that point for the required surgery, of six months and fifteen days, was indeed disproportionate and violative of her fundamental right to health. That is, the Enforcement Judge (Juez de Ejecución), adhering to what was resolved in the constitutional court, as will be developed further on, determined that the waiting period suffered by the protected party was excessive. Furthermore, according to the response to the lawsuit -image 30- and the evidence provided by the CCSS itself, visible in images 40 through 79, it is determined that, in compliance with what was ordered by the Constitutional Chamber (Sala Constitucional), Mrs. María de los Ángeles underwent surgery at the Hospital Dr. Maximiliano Peralta Jiménez in Cartago, on September 13, 2023. That is, ultimately, she had to wait approximately 10 months for the surgery she required. Which, in accordance with what was resolved by the Constitutional Chamber (Sala Constitucional), is harmful to her fundamental right to health.

**V.** **SECOND.** In order to have a thorough understanding of what will be said, it is opportune to reproduce what was resolved by the Enforcement Judge (Juzgador de Ejecución) in section IV of the contested judgment regarding subjective moral damage (daño moral subjetivo): "**IV.-** [...] *This Judge estimates that in the specific case under analysis, regarding* ***subjective moral damage,*** *it is not difficult to determine without further evidence than the judgment provided, it has been weighed that the claimant* [sic] *went to the medical center, and entered the waiting list on November 15, 2022, however, by the date of filing the amparo appeal, the claimant party* [sic] *had not been operated on. The elapsed waiting period was weighed by the Constitutional Chamber (Sala Constitucional), and it was considered excessive and injurious to the right to health.*" Regarding the arguments of the CCSS to reject the liquidated non-economic damages (daño moral), they must be rejected, as it seeks to change the bases established in the constitutional judgment being enforced, it seeks to re-litigate the matter that was analyzed by the Constitutional Chamber, indeed the Constitutional Court found an abnormal functioning, where the plaintiff's health was neglected, it declared that there was a violation of the right to health, therefore, it is not admissible to re-litigate the same facts for which the CCSS was condemned, since they were taken as true in the judgment being enforced. It has been weighed that there is emotional detriment, in the fact that occurred, when the plaintiff [sic] found herself with the panorama of a prolonged wait for her medical care, and therefore, had to resort to the Constitutional Chamber to repair the grievance of an excessive delay in the provision of medical services; the fact that by order of the Constitutional Court, the medical care was more immediate, does not erase the emotional detriment suffered by the plaintiff, in the face of a true dysfunction in the provision of health services, the CCSS's thesis is not admissible, understanding that we are before a judgment enforcement process, where the aim is to establish the amounts of the bases set by the Constitutional Chamber, it is not appropriate to enter into evaluations of the merits of the constitutional proceeding, the enforced judgment considered excessive the waiting time set for the medical care of the enforcing party, it was determined in the constitutional process that there was urgency, so much so that medical care was ordered within a period of no more than three months, therefore the argument of the CCSS, which seeks to vary the bases established in the enforced judgment, must be rejected. The elapsed waiting time for medical care is considered disproportionate, violating her Right to Health, so the Constitutional Chamber had to order her care, in accordance with the principles of good public service and respect for the right to health, it is logical to deduce in re ipsa that it had to cause an emotional impact on the inner self of the enforcing party, and suffering resulting from the impotence in the face of the excessive and unjustified delay by the administrative authorities which prolonged her care, clearly adds compensable worry, sadness, and anger, due to the inoperability of the service that is charged in advance and mandatorily (causal link). It is clear that there is no consent to the delay in her medical care since she resorted to the Constitutional Chamber to obtain the health service within a reasonable time, and to this enforcement court, to find compensation for the injury suffered, which forced her to activate the judicial system to receive a service that functions abnormally. In addition to the foregoing, it is considered that restorative justice operated regarding the condemnation to provide the health service, but not regarding the other distinct condemnation in costs, damages, and losses (costas, daños y perjuicios), so the right subsists regarding these unpaid aspects. Therefore, and based on the principles of proportionality and reasonableness, the subjective non-economic damages (daño moral subjetivo) are appropriate, in the sum of FIFTY THOUSAND COLONES, the indicated amount is considered adjusted to the results of the process, it is supported by the principles of sound rational criticism. The amount proposed by the enforcing party is rejected, as it is considered excessive, according to the results of the process. The defenses of lack of right and lack of passive standing (falta de derecho y falta de legitimación pasiva) are rejected.” (The highlighting and underlining are from the original).

VI.THIRD. Regarding what was argued by the appellant, it must be remembered that, in judgment enforcement processes in general and, mainly, those issued by the Constitutional Chamber, what is enforced must necessarily be constrained to what was resolved in the amparo judgment subject to enforcement. This Chamber has indicated, the judgment enforcement process seeks to materialize the -abstract- condemnation imposed on the losing party. If different aspects are granted -or contrary- to the pronouncement that gives rise to the enforcement or against persons who were not condemned, res judicata is violated. See, among other rulings of this decision-making body nos. 383-2019 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-925036) and 309-2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1024927). Consequently, the oversight function of this Chamber is constrained to an objective comparison between the enforceable judgment and the appealed resolution. In this sense, resolutions nos. 82-A-S1-22 from 10:06 a.m. on January 26 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1072742) and 1984-F-S1-2022 from 11:18 a.m. on September 8, both of the year 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112319), can be consulted, among many others.

VII.FOURTH. As noted in Considerandos I and IV of this judgment, the Constitutional Chamber, in the judgment being enforced, granted the amparo appeal filed on behalf of the protected party, it having been proven that on November 15, 2022, she was placed on the waiting list for total abdominal hysterectomy surgery and that, at the time of the issuance of the constitutional judgment, she did not have a certain date for the performance of said surgical procedure. Therefore, said Chamber deemed the elapsed time up to that moment, of six months and fifteen days, was disproportionate and violative of her fundamental rights. Therefore, it granted the amparo appeal and ordered both the General Director of the Hospital and the Head of Gynecology to arrange, promptly and in a timely manner, the actions and coordination necessary so that, within a maximum period of three months, counted from the notification of the constitutional judgment, the surgery be performed on the protected party. Which did occur, as she was operated on on September 13, 2023. As is clearly inferred, the Constitutional Chamber granted the appeal because it deemed the time the protected party had been on the waiting list was disproportionate and violative of her fundamental right to health, considering her pathology. Precisely, the Enforcement Judge, it is insisted, adhering to what was resolved in the constitutional court, considered: “[…] the fact that by order of the Constitutional Court, the medical care was more immediate, does not erase the emotional detriment suffered by the plaintiff [sic], in the face of a true dysfunction in the provision of health services, the CCSS's thesis is not admissible, understanding that we are before a judgment enforcement process, where the aim is to establish the amounts of the bases set by the Constitutional Chamber, it is not appropriate to enter into evaluations of the merits of the constitutional proceeding, the enforced judgment considered excessive the waiting time set for the medical care of the enforcing party, it was determined in the constitutional process that there was urgency, so much so that medical care was ordered within a period of no more than three months, therefore the argument of the CCSS, which seeks to vary the bases established in the enforced judgment, must be rejected.

The time elapsed waiting for medical care is considered disproportionate, violating his Right to Health, which is why the Constitutional Chamber had to order his care, in accordance with the principles of good public service and respect for the right to health. It is logical to deduce in re ipsa that it must have caused an emotional impact on the inner self of the executing party, and suffering stemming from the impotence in the face of the excessive and unjustified delay by the administrative authorities, which prolonged his care. This clearly adds compensable worry, sadness, and anger, due to the <span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; text-decoration:underline; vertical-align:sub">inoperativeness of the service for which he is charged in advance and on a mandatory basis</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">(causal link). It is clear that there is no consent to the delay in his medical care, since he resorted to the Constitutional Chamber to obtain the health service within a reasonable time, and to this execution venue to seek redress for the injury suffered, which forced him to activate the judicial system to receive a service that </span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; text-decoration:underline; vertical-align:sub">functions abnormally</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">. In addition to the foregoing, it is considered that restorative justice operated with respect to the order to provide the health service, but not with respect to the other distinct order for costs, damages, and losses, so the right regarding these unpaid claims persists.</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> [</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">…</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">]</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub"> (The highlighting and underlining is from the original). However, the appellant did not challenge that basis for determining the existence and quantification of that damage in due form, as the technique of cassation requires, in accordance with the provisions of article 139, subsection 3) of the CPCA. She limited herself to a generic argument, without questioning, in a clear and precise manner, what was ordered by the Execution Judge. On the contrary, she alluded to other topics, not raised by the judicial authority, such as restorative justice, urgency, and consent. As well as that the damage claimed cannot be inferred from the relevant decision; however, it is insisted once again, without questioning what was stated regarding its determination being </span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">in re ipsa</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; vertical-align:sub">. This makes the arguments futile for the purpose of varying what was decided.</span>

VIII.Notwithstanding the foregoing section and for the sake of providing additional reasons, the following must be pointed out. FIFTH. The cassation appellant insistently alluded to the fact that what she called “restorative justice” operated in the sub judice matter. In this regard, it is necessary to point out that this Chamber, in previous cases, recognized its applicability regarding compensation for subjective moral damage (daño moral subjetivo) for the violation of the fundamental right to health (as recognized by the Constitutional Chamber of the Supreme Court of Justice upon granting the respective amparo appeal, due to the delay by the CCSS in providing the medical service required by the administered person), when the CCSS provides the service within the deadline ordered in the constitutional venue. In this regard, see decisions nos. 1502-S1-2022 at 11 hours 24 minutes of September 1st, 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112330), 2429-F-S1-2022 at 14 hours 16 minutes of November 3rd, 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1123608), both from the year 2022; 28-F-S1-2024 at 11 hours 05 minutes of January 11th, 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396), 297-F-S1-2024 at 17 hours 27 minutes of March 21st, 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250), 901-F-S1-2024 at 12 hours 31 minutes of July 4th, 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1240015) and 937 at 14 hours 51 minutes of July 10th, 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925); all from the year 2024. However, the current integration of this Chamber, after a new study, considers it necessary to reconsider that position. Undoubtedly, it is a vindication of the injured legal situation, due to a lack of service, that it be provided. Even more so when it is necessary, as occurs with a pending health service. However, said reparation does not exclude, as the Execution Judge correctly indicated, the fact that the aggrieved person suffered impacts on their moral and patrimonial sphere while the abnormal conduct persisted due to the administrative dysfunction. If effective impairments (precepts 196 and 197 of the LGAP) specific to the concrete case and derived from its particular characteristics are demonstrated, their existence being inferred even through the intellectual process “in re ipsa”, despite the user having been jurisdictionally protected, their reparation is appropriate. That is to say, the service-related rectification does not exclude that the aggrieved person suffered impacts on their moral and patrimonial sphere while the abnormal conduct persisted. If that occurred and was thus proven, it is mandatory to impose the corresponding compensatory consequence, if requested by the person whose legal sphere was damaged. This is so in accordance with the principle of full reparation of damage (reparación integral del daño), which has constitutional and legal roots (constitutional canons 9, 41, 49; 190 and 197 of the LGAP).

IX.Within this line of thought, and regarding the existence and quantification of subjective moral damage (daño moral subjetivo), this Chamber, since long ago, has indicated that: <span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-weight:bold; font-style:italic; vertical-align:sub">IV. </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">[...]</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">it stems from the injury to an extra-patrimonial right. That is, it does not impact the patrimony directly. It implies an unjust disturbance of the person's emotional conditions. It does not require direct proof and is left to the equitable assessment of the Judge. If it concerns subjective moral damage (daño moral subjetivo), the courts are empowered to decree and quantify the award. The legal nature of this type of damage does not obligate the liquidator to determine its existence because it corresponds to its internal sphere. This is not a problem for psychiatrists or doctors. Its existence or not must be understood because it belongs to the conscience. It is deduced through presumptions inferred from indicia, since the unlawful generating act reveals the moral damage (daño moral), because when the psyche, health, physical integrity, honor, intimacy, etc., are damaged, the damage is easy to infer; for this reason it is said that the proof of moral damage exists </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">“</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">in re</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub"> </span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">ipsa</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">”</span><span style="font-family:TAHOMA; font-size:8pt; font-style:italic; vertical-align:sub">. Nor must its value be proved because it has no concrete value. It is assessed prudentially.</span>

It is not, then, a matter of quantifying the suffering, since it is inestimable, but rather of fixing monetary compensation for their injury, the only mechanism to which the law can resort, in order to at least partially repair the offense. For greater detail on this aspect, one may consult, among others, from this collegiate body, rulings no. 112 already cited, no. 17 of 14:30 on February 21, 1996, and no. 41 of 14:40 on May 14, 1997. Its granting is not closely tied to evidentiary factors (except those referring to the causal link), but rather to the prudence and objective discretion of the judge. However, its determination is subject to the principles of reasonableness and proportionality, which must be assessed by the competent authority in each case, so that its quantification is in accordance with the Law and does not lead to excessive compensation that unjustifiably benefits one of the parties. That is, it must maintain a fair balance derived from the specific factual scenario, a matter that must be weighed within the indicated limits.” (Among many others, one may consult the ruling of that Chamber no. 468-F-S1-19 of 9:45 on May 30, 2019). In accordance with the foregoing, once the existence of the non-material damage (daño moral) and its causal link to the cause of action alleged by the plaintiff has been established—which is not contested by the appellant in cassation—the determination of the amount depends on the equitable assessment of the Judge; for which, attention must be paid to the special circumstances of the case, as well as to the constitutional principles of reasonableness and proportionality.” In this regard, one may consult, among many others, ruling no. 1098-F-S1-2023 of 10:09 on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1170686). That is, it is regarding subjective non-material damage (daño moral subjetivo) that its demonstration is “in re ipsa,” provided it is the consequence of an unlawful generating event or cause.

**X.** In this litigation, the Constitutional Chamber (Sala Constitucional), as has already been indicated, determined the unlawful conduct of the CCSS upon verifying the breach of the fundamental right to health of Mrs. María de los Ángeles. The postponement of the required surgery was, at the time the constitutional ruling was issued, six months and fifteen days; when it was performed, on September 13, 2023, the total wait was approximately 10 months, as indicated in Section IV of this ruling. Such a situation—an unlawful act—according to the maxims of logic, experience, and correct human understanding, as was resolved, is the adequate cause of a non-material affliction (aflicción moral), associated with anxiety, discomfort, frustration, and worry, due to the excessive waiting time for care—so declared, it is insisted, in the constitutional venue—for a health situation that, “per se,” is a cause of worry for the person suffering from it. In accordance with correct human understanding and experience, it is insisted, one can infer, “in re ipsa,” as the Enforcement Judge (Juez de Ejecución) did, the existence of feelings such as those described above, without her having the legal duty to bear them, as they derive from an abnormal functioning of the Administration, so decreed, it is repeated once more, by the Constitutional Chamber. Ergo, contrary to what was indicated by the appellant, its existence is determined and, therefore, the appropriateness of its compensation.

**XI.** Likewise, this Chamber has stated: “**VIII.** […] On other occasions, this cassation body has had the opportunity to highlight the necessary “legal reasonableness” (razonabilidad jurídica) that this type of compensation must maintain, for the verification of which the observance of a “reasonableness of equality” (razonabilidad de igualdad) must be verified, which the Constitutional Chamber has defined as “…the type of legal assessment that proceeds from the premise that equal antecedents must have equal consequences, without arbitrary exceptions” (e.g., Votos no. 5236-99 and 1354-2011). That is, to avoid inequitable and illegitimate treatment in the various cases where compensation for non-material damage (daños morales) is discussed, it is necessary to verify that the amounts recognized are not disproportionate, when compared with those that have been established in other similar cases. In that order of ideas, this Chamber considers that the sum granted conforms to the intensity of the damage caused.” Ruling no. 760-F-S1-2023 of 13:24 on May 29, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1157835). In the same vein, one may consult, among others, rulings nos. 1934-F-S1-2022 of 15:00 on August 12; 2654-F-S1-2022 of 10:10 on December 8 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1132117), both from the year 2022, and 1087-F-S1-2023 of 09:36 on July 5, 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1173505). In that order of ideas, this Chamber considers the sum granted for subjective non-material damage (daño moral subjetivo), ₡50,000.00, to be reasonable and proportionate, considering the circumstances of this case. Furthermore, it is quantitatively lower than what has been recognized for similar effects. By way of example, the following precedents can be noted, in which this decision-making body did not consider unreasonable the sums awarded for the delay in the provision of the public health service, nos. 429-F-S1-2024 of 10:41 on May 3 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1229475), in which the adjudicating person awarded ₡500.00,00 and 937-F-S1-2024 of 14:51 on July 10, both from the year 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925), setting the sum of ₡200,000.00 as compensation for non-material damage (daño moral), for the delay in the provision of the service.

**XII. SIXTH.** Furthermore, the appellant alleged that, in the case of the protected party, there was no urgency in performing the surgery. As was set forth in Section I of this ruling, contrary to what was argued, it was the Constitutional Chamber itself, in the enforceable ruling, that determined the urgency with which the petitioner needed to undergo the required surgical procedure, ordering that it must be carried out within a period of three months from the notification of that ruling.

Consequently, within the objective comparison that must prevail in this type of proceeding—enforcement of a constitutional judgment—the issue of urgency is a precluded matter, since, it bears repeating, it was so determined and resolved by the Constitutional Court.

**XIII.** **SEVENTH.** Finally, the appellant argued that the protected party acquiesced to or consented to remaining on the waiting list. Contrary to what was alleged, in this litigation the existence of tacit consent or an act consented to, much less express consent, on the part of Mrs. Carmona Castillo cannot be considered. As the Enforcement Judge correctly indicated, the recurso de amparo was filed on behalf of Mrs. María de los Ángeles in a timely manner. Such is the case that the Constitutional Chamber admitted it for processing and, subsequently, upheld it. This, regardless of the time elapsed between the moment the CCSS placed her on the waiting list and the filing of the amparo. Therefore, the executing party demonstrated her disagreement with her permanence on the waiting list, and said jurisdictional body agreed with her.

**XIV.** In the **second** objection, page 11 of the appeal, the appellant announced that she was filing it on the cassation ground for breach of substantive norms provided for in subsection c) of canon 138 of the CPCA: “***c)*** ***When a legal norm has been improperly applied or interpreted, or has been left unapplied.***” She invoked as transgressed articles 73.1 of the Civil Procedure Code (CPC) and 85 of the Tax Norms and Procedures Code (Código Tributario). Regarding the issue of the personal costs of the recurso de amparo, she said, the Enforcement Judge pointed out: “[…] *it has been weighed that the constitutional judgment established said right in favor of the executing party and that this right cannot be denied in the enforcement phase* […]”. That, she pointed out, despite the non-existence of the issuance of an electronic invoice by any legal professional for professional services to file a recurso de amparo. Even so, she noted, the amount for that petitionary item was granted, in accordance with Article 73.1 of the CPC. She reproduced, in what was of her interest, what was considered in section V of the challenged judgment, called “*COSTS OF THE AMPARO*”. The judicial authority, she stated, based itself on said precept to grant the amount for costs of the recurso de amparo; despite no evidence having been presented related to a professional service (issuance of an electronic invoice). The challenged judgment, she noted, improperly applied that provision, as it limited itself to evaluating only a part of its content, without thoroughly analyzing its literal text and, even, the teleological element. In this regard, she commented, this is an enforcement proceeding for a constitutional judgment. The condemnation made by the Constitutional Chamber was in the abstract. Therefore, she indicated, the right to receive compensation for costs, damages, and losses must be enforced and demonstrated in this venue. She reproduced said canon 73.1 of the CPC. Its content, she stated, establishes that the following shall be considered costs: attorney's fees, compensation for time invested, and indispensable expenses of the proceeding; however, the executing party did not provide any evidence to demonstrate that there had been an outlay of money for attorney's fees. That is to say, she alleged, due to the lack of evidence regarding this, the Judge was compelled not to grant any amount for costs of the recurso de amparo, under the concept of attorney's fees, since there is no proof that they were paid, as there is no electronic invoice involved. Under the Judge's premise, she indicated, any person, through vicarious action, could file recursos de amparo on the issue of waiting lists and, when enforcing the judgment, would receive the costs of the recurso as compensation, which, in her opinion, would be absurd, since to receive full compensation for an expense, it must be demonstrated. This, she pointed out, cannot be condoned, since no evidence whatsoever of that expense was presented. That is where the error of the judgment is markedly found, as it granted the amount for costs of the recurso de amparo as if they were for attorney's fees. It is important that the reasons why costs are awarded to a prevailing person in a judicial proceeding be clear. Furthermore, she added, Justice of the Constitutional Chamber, Mr. Fernando Castillo Víquez, has on multiple occasions been clear in ordering both the CCSS, when extrajudicial satisfaction of the Constitutional Chamber's condemnations is carried out, and the contentious-administrative jurisdiction, to ensure that the amounts awarded actually reach the hands of the protected parties. She transcribed, in what was of her interest, what was stated in Constitutional Chamber vote no. 2016-012528. The challenged judgment, she concluded, should have rejected that item, since, as no electronic invoice was provided, it was not demonstrated that any legal professional had provided a professional service and charged for it.

**XV.** Regarding what was stated in the previous section, the following must be noted. **FIRST.** As indicated, the appellant announced that she was formulating the objection for breach, among others, of canon 85 of the Código Tributario. However, in the development of the objection she did not cite it. Therefore, she did not explain, with the required clarity and precision, how it was violated by the challenged judgment. Consequently, this Chamber is precluded from conducting any analysis regarding that norm. **SECOND.** The Judge, in section V of the challenged judgment, concerning the costs of the recurso de amparo, considered: “*Regarding the personal costs of the recurso de amparo, it has been weighed that the constitutional judgment established said right in favor of the executing party and that this right cannot be denied in the enforcement phase; in this instance the amount of the costs will be defined, but the* [sic] *bases of the judgment being enforced cannot be varied as the CCSS respondent representation intends. Pursuant to article 193 of the Contentious-Administrative Procedure Code, which, in the same manner as Article 73.1 of the Civil Procedure Code, of its own motion condemns the losing party to costs, what is requested is admissible; however, given that the amparo was filed on May 16, 2023, the provisions of article 46 of Executive Decree 41457-JP, which entered into force on February 1, 2019, are applicable, and which establishes an amount of ONE HUNDRED EIGHTY-ONE THOUSAND FIVE HUNDRED COLONES for said concept, therefore, the personal costs of the recurso de amparo are set up to that liquidated amount, rejecting the exception of lack of right and lack of active standing of the liquidated item.*” **THIRD.** On page 12 of the petition, the appellant stated: “Under the premise of Judge Zeledón Hernández, any person, through the Vicarious Action (Acción Vicaria), could file Amparo Appeals (Recursos de Amparo) regarding waiting list issues, and when executing the judgment, could perfectly receive as compensation both the costs [sic] of the appeal, which, respectfully, would be an absurdity […]”. Contrary to what was indicated, this Chamber, for a long time, has pointed out the difference between personal costs (costas personales) and attorney's fees (honorarios de abogado), concluding that personal costs belong to the party, not the lawyer. In this regard, one may consult, mutatis mutandis, judgments nos. 432-F-S1-2017 of 09 hours 30 minutes on April 20, 2017 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-950854); 515-F-S1-2018 of 11 hours 20 minutes on May 30, 2018 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-892742); 28-F-S1-2024 of 11 hours 05 minutes on January 11 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396) and 297-F-S1-2024 of 17 hours 27 minutes on March 21 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250); both from the year 2024.

**XVI.** **CUARTO.** On pages 11, 12, and 13, the appellant stated: “Regarding the issue of personal costs of the **Amparo Appeal (Recurso de Amparo),** Judge **Pablo Zeledón Hernández points out that** […] **despite not fully having the issuance of an electronic invoice by any legal professional for Professional Services to file an Amparo Appeal (Recurso de Amparo),** and even so, grants the amount for said claim, in accordance with article 73-1 of the Civil Procedure Code (Código Procesal Civil). In this regard, the judgment mentions the following: […] That is to say**, knowing that no evidence related to a professional service was presented (the issuance of an electronic invoice), he grants this.** […] With the foregoing, and given that the plaintiff provides no evidence whatsoever that an outlay of money for attorney's fees occurred, **that is, there being a lack of evidence regarding this, the truth of the matter is that the judge was compelled to grant the amount for costs of the Amparo Appeal (Recurso de Amparo), in the form of fees for which there is no evidence they were paid, as there is no electronic invoice involved.** […] Therefore, the judgment should have rejected this item, **since, having not provided an electronic invoice,** it was not demonstrated that any legal professional had provided a professional service and charged for it.” (The highlighting is from the original). In this regard, it must be pointed out that the CPCA, in article 193, expressly regulates the imposition of costs; as does article 73.1 of the CPC. Consequently, it is the CPCA's rule that applies to this litigation. However, this provision does not stipulate, as the CPC's does, what is considered costs. Ergo, this procedural principle, like those contained in articles 76.1 and 76.4 ibid, by virtue of the remission made by article 220 of the CPCA, is applicable to this litigation. In this sense, article 73.1 of the CPC provides: “[…] *Attorney's fees* (honorarios de abogado) *shall be considered costs*, the compensation for the time invested by the party in attending procedural acts where their presence was necessary, and other essential expenses of the process.” (The underlining is supplied). In this same vein, articles 76.1 and 76.4 ibid state: “***76.1 Right to fees and setting***. *Attorney's fees* (honorarios de abogado) *belong to the lawyer*, with the exceptions established by law. When the party is a lawyer and has acted personally, they shall be entitled to them. Unless otherwise agreed, they shall be set considering the work, the status, and the economic significance of the process, based on the provisions of Law No. 13, Organic Law of the Bar Association (Ley Orgánica del Colegio de Abogados y Abogadas), of October 28, 1941, and the decree on attorney and notary fees.* […] ***76.4 Contractual setting of attorney's fees (honorarios de abogado).*** *Lawyers and their clients may contractually set the amount of fees and their payment modalities, respecting the limits imposed by law and the respective decree. Said stipulation shall not affect the opposing parties in the process, for purposes of setting personal costs* (costas personales).” (Only the underlining is supplied). In light of the provisions in said rules, it is clear that, for purposes of costs, attorney's fees must be calculated based on the legal limits and the rates established in the respective Decree, regardless of any private agreement between the lawyer and their client. This implies that, in the liquidation of costs (liquidación de costas), it is not necessary for the executing party to demonstrate the agreement they have with their lawyer or the payment made to them, as the regulations provide that the calculation of this item must be made according to the applicable tariff (arancel) or decree, in order to ensure an objective criterion in the liquidation of costs (liquidación de costas). Thus, if a party had legal representation during the processing of a case and obtained in their favor the payment of costs, the amount to be recognized as attorney's fees will necessarily be that established in the “Fee Schedule for Professional Legal Services” (“Arancel de Honorarios por Servicios Profesionales de Abogacía”), according to the work performed. Consequently, it is not essential that an invoice or proof of payment in favor of the legal professional be provided for the recognition of that item to proceed. In this litigation, the objector did not prove that Ms. María de los Ángeles lacked legal representation during the processing of the amparo proceeding. On the contrary, it is recorded that her special judicial representative in this execution process was the one who filed the amparo appeal (recurso de amparo) on her behalf before the Constitutional Chamber (Sala Constitucional). This allows one to infer that said professional defended the interests of the amparo recipient in the constitutional venue. Ergo, the failure to present the invoice or proof of payment that the appellant demanded is not sufficient to detract from or dismiss the item of personal costs (costas personales) liquidated by the party and expressly recognized in the enforceable judgment. It is reiterated, because the executing party had legal representation during the processing of the amparo and obtained in their favor the payment of costs. That is, they have the right to have recognized as costs the amount established by the applicable tariff (arancel) for attorney's fees.

Corollary, this Chamber does not observe the alleged legal violation and, consequently, the rejection of the challenge will be imposed.

**XVII.** In the **third** ground of disagreement, page 13 of the petition, the appellant announced she was filing it on the cassation ground for breach of substantive norms provided for in subsection d) of numeral 138 of the CPCA: “***d)** When the judgment violates the norms or principles of constitutional law, among others, reasonableness (razonabilidad), proportionality, legal certainty, and equality.*” Specifically, she invoked the principle of reasonableness as infringed. In the judgment under question, she stated, the Enforcement Judge determined the reasonableness of the compensation. She argued that the executing party (besides not consenting to being on a waiting list by having recourse to the Constitutional Chamber, and without restorative justice having taken place) sought compensation, not having an unhealthy desire. She transcribed, as relevant, the recital in section IV of the questioned judgment, concerning subjective moral damages (daño moral subjetivo). The Judge spoke of reparation for “*the injury suffered (la lesión sufrida)*”, she pointed out, which forced the executing party to resort to the filing of an amparo action, but he did not specify what the injury suffered is, whether physical or psychological. Furthermore, she argued, from the enforcement judgment (2024000956) it is not clear what the “alleged injury suffered” is. Nor does the case file contain proof demonstrating that it occurred. Regarding the concept of injury, she reproduced, as relevant, what was indicated by the author Goldstein, Mabel, but did not cite any work. The contested judgment, she indicated, left open the possibility to seek, without restriction, double compensation: that of a material type, by receiving medical attention; and the pecuniary one, without any proof thereof whatsoever. The Judge was clear, she noted, that the executing party sought, for subjective moral damages, an amount of ₡300,000.00, plus the compensation for legal costs. In total, the executing party petitioned for at least ₡481,500.00. The Adjudicator, with his analysis, violated the principle of reasonableness. The spirit of the CCSS, in accordance with Article 73 of the Political Constitution, she related, is to guarantee the fundamental rights to life and health; without which, the other guarantees enshrined in the Magna Carta cannot be fully exercised. Although, she pointed out, waiting lists exist, granting pecuniary compensation for placing a person on one of them, without there being a medical criterion of urgency, implies that the amounts intended to guarantee the two main fundamental rights are diminished, which, she stated, is clearly irrational, because the people contributing to the Health and Maternity Insurance do so with the objective that a health service is provided and that resources exist to guarantee it. Not, she reiterated, so that compensation is awarded for placing a person on a waiting list. The judge, she noted, departing from the principle of reasonableness, determined that the fact that the medical procedure had been performed is insufficient to determine the existence of full restorative justice. Therefore, she argued, there must also be economic reparation. That is, she stated, it follows from the above that the Adjudicator determined that a double compensation must always intervene when a person is placed on a waiting list. However, she affirmed, the truth is that this generates a privilege and unjust enrichment without any cause. The objective of the person who had recourse to the Constitutional Chamber, she stated, was to have a surgical procedure performed, or to receive medical attention. Clearly, she added, she sought a restoration of her health, not to obtain compensation. This, she argued, can lead to a depletion of the health service's resources, necessary for equipment improvements, payment for medications, and instruments to adequately provide the health service, through professionals prepared for it. The Judge, she insisted, directly violated the principle of reasonableness by granting a compensatory item, arguing that the executing party should receive monetary compensation, in addition to the one already substantively received: the performance of the required medical procedure. Regarding this, she reiterated, he transgressed the principle of reasonableness by not determining that the compensation includes restoration. Which, she asserted, was brought about by the judicial resolution, since the health service user received the required medical attention, so it becomes contrary to law, especially to said principle, that in addition to the restoration received, an extra amount be awarded to her, as the situation of being on a waiting list was singularly derogated. That is, awarding her an amount as compensation, in addition to having performed the required medical procedure, grants her a privilege over the other insured persons who were bypassed by the protected person. This was previously analyzed, she noted, by this Chamber in judgment no. 1502-S1-2022, which she reproduced as relevant. Also, in no. 297-F-S1-2024 of 17 hours 27 minutes on March 21, 2024, which she also copied as relevant. This situation, she indicated, as inferred, was presented to the Adjudicator, was directly disregarded and, even, she asserted, there is evidence of a possible existence of some “*animus*” to convict under any scenario. This, she reiterated, is contrary to the principle of reasonableness; because, in addition to depleting the resources the institution has to provide health services, it grants a position of privilege to the person who received the required attention, at the expense of those who collaborate so that an adequate health service is provided. Due to the foregoing, she concluded, awarding compensation for moral damages becomes a violation of the principle of reasonableness.

**XVIII.** Regarding what was indicated in the preceding Considerando (Recital), the following must be stated precisely.

**FIRST.** On page 14 of the brief, the appellant stated: “[…] *in addition, from the final judgment* **(2024000956)** *it is not clear* [sic] *what the “alleged injury suffered” is, and neither does the case file contain evidence demonstrating that it occurred*.” (The bolding and underlining are from the original). The cassation appellant's assertion is a source of confusion. As noted in section I of this judgment, the final judgment is no. 2023013051 of 09:45 hours on June 2, 2023, not no. 2024000956, as the appellant erroneously indicated.

**XIX. SECOND.** The appellant forgot that this procedural stage does not correspond to an ordinary appeal (such as an appeal for reversal). Nor is it sufficient to express a series of general and merely argumentative disagreements. It is necessary to contrast what was decided with the violation that, in her opinion, took place. In this regard, numeral 139, subsection 3 of the CPCA provides a necessary material requirement, both for the admissibility of the appeal and for its subsequent evaluation on the merits. This refers to the grounds of the appeal, which, due to the characteristics of cassation, must be clear and precise. In this sense, it must contain, as the provision under discussion dictates, the factual and legal basis of the case. Factual, insofar as it shows disagreement with the facts that have been deemed proven or unproven (which leads to the weighing of evidence), or with the circumstances occurring in the violation of procedural rules. Legal, when dealing with an issue raised concerning the application, omission, or incorrect interpretation of any norm that forms part of the legality framework, including, of course, constitutional principles, or that one which also operates by reflexive or indirect effect, after the facts of the appealed judgment are modified. In both procedural and evidentiary violations, factual reasons can concur, along with legal reasons (always necessary), and in that sense, the referenced grounds must be directed along both lines, under penalty of inadmissibility. For its part, it is necessary to clarify that the indication of those canons relative to the value of the poorly assessed evidentiary element or elements is exempt from legal grounds by express legal mandate. Likewise, it is unnecessary to cite the rules that the jurisdictional body of the instance erroneously used and mentioned in issuing and reasoning its decision, because they are recorded in the very ruling being appealed. And of course, it is not at all essential to cite the precepts that establish the basic requirements, time limits, and rules for the admissibility of the appeal. Rather than citing the latter, what is essential is that they be fulfilled, that they be put into practice when preparing and filing the cassation appeal. Thus, the grounding provided by law can be understood, broadly speaking, as that technical-legal argumentation in which a series of articles or legal rules are mentioned, interwoven or concatenated with each other and reasonably linked in a dual perspective: with the arguments of the appeal and with the judgment under challenge. To the extent that a set of legal norms (or, if applicable, a single one) is cited, pertinent and clearly linked to the contested judgment (whether in its factual or legal support) and the arguments of the appeal, there is legal grounding. Jurisprudential additions or eventual doctrinal citations will sometimes reinforce the allegations made, but, in general, they do not form their essence. As this Chamber has already indicated when interpreting the referenced Article 139, “*it is required that the appeal have minimal legal grounds ... the reasons on which the action is based must be explained, combating the legal arguments of the appealed judgment and recording, at least, some normative reference that supports it*” (Resolution no. 318-A-2008, of 14:25 hours on May 8, 2008). The grounding is, therefore, alien to the confused display of norms and allegations; to the mixture of unintelligible arguments or the simple exposition of opinions on the appropriateness or justice of the case, or to the recounting of the errors considered committed in the appealed judgment, without support in legal norms or criteria. Hence, if the appeal completely omits this technical-normative relationship to which reference has been made, or the one it makes is manifestly and evidently impertinent or disconnected from the case, it must be understood that it lacks “total legal grounds,” and therefore, fails to meet the necessary requirement established in numeral 139.3, which is sanctioned with outright rejection, pursuant to the provisions of Article 140, subsection c) of the same procedural Code. Similarly, this Chamber has repeatedly indicated that for an appeal to pass the admissibility review, it requires, in addition to a sufficient statement of reasons, the corresponding mention and linkage with the appealed judgment of the applicable norms that are considered violated. In this regard, one may consult, among other resolutions, nos. 677-A-S1-2021 of 09:40 hours on March 25, 2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1029345); 755-A-S1-2022 of 10:55 hours on March 29 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1082042); and 1663-A-S1-2022 of 10:05 hours on July 21 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112340), both from the year 2022.

**XX.** In this line of thought, after a thorough study of the appeal under review, this Chamber determines that the cassation appellant alleged two dissimilar hypotheses, but, due to the way it was structured, they are inseparable from each other. In this sense, on page 14 of the brief, she indicated: “*It is observed in the paragraph transcribed above that the Judge speaks of the compensation for “the injury suffered” that forced the plaintiff to resort to filing the amparo appeal,* **but does not specify what** [sic] **the injury suffered is, whether physical or psychological** […].” (The bolding is from the original). If what was indicated were to occur, it would constitute the cassation ground for violation of procedural rules provided for in subsection 1), point d), of canon 137 of the CPCA: failure to state reasons.

Then, on pages 15 and 16 it stated: “In addition to the foregoing, the first-instance judge, departing from the principle of reasonableness, determines that the fact that the medical procedure was performed is insufficient to speak of restorative justice in its entirety, and that therefore there must also be economic compensation […] In that sense, the first-instance judge directly violates the principle of reasonableness, by granting a compensatory award arguing that the plaintiff also had to receive monetary compensation, in addition to what had already been received substantively: the performance of the required medical procedure. / On this, Judge Zeledón Hernández violates the principle of reasonableness, by failing to determine that compensation includes restoration, and this occurred by judicial resolution, since the health service user received the required medical care, which is contrary to law, especially to said principle, that in addition to the restoration received, an additional amount be granted […] in some way, a possible existence is evidenced, it is reiterated, of an animus to condemn under any scenario, which it is reiterated, is contrary to the principle of reasonableness, since this, besides diminishing the resources available to the Institution to provide the health service, grants a privileged position to the person who received the required care, at the expense of those who collaborate to provide adequate health service. / For the foregoing, granting compensation for non-pecuniary damage (daño moral) becomes a violation of the principle of reasonableness.” (Highlighting is from the original). What has just been set forth would give rise to the cassation ground for breach of substantive norms announced, due to the alleged breach of the constitutional principle of reasonableness. The ambiguity described conflicts with the technique of cassation (casación), which dictates that the grounds for the appeal must be indicated clearly and precisely, with the factual and legal basis of the case (precept 139 subsection 3) of the CPCA). Ergo, the rejection of the objection under study is imperative.

XXI.THIRD. What was argued by the appellant, regarding the existence of restorative justice; as well as the non-existence of urgency in the protected party’s appointment and the inadmissibility of granting compensation for subjective non-pecuniary damage (daño moral subjetivo), was already the subject of analysis in sections VIII through XIII of this judgment, therefore, in order to avoid unnecessary reiterations, reference is made to what was expressed therein.

XXII.In the fourth and last reproach, page 16, the appellant announced that she was formulating it under the cassation ground for breach of substantive norms provided for in subsection c) of article 138 of the CPCA. She alleged improper application of canon 193 ibid. In the contested judgment, she said, the Enforcement Judge (Juez de Ejecución) granted costs of the Enforcement of Judgment (Ejecución de Sentencia). She considered that the enforcing party had sufficient reasons to litigate, having an abstractly granted right. However, she noted, the indicated precept -193 ibidem- establishes that the losing party shall be exonerated from the payment of costs when, due to the nature of the matters debated, there was sufficient reason to litigate. She transcribed, in what was of interest to her, what was considered in section VI of the challenged judgment, called “COSTS OF THE ENFORCEMENT AND INTERESTS”. The contested judgment, she pointed out, was clear that the enforcing party requested, for subjective non-pecuniary damage, an amount of ₡300,000.00, plus compensation for costs. She copied, where relevant, what was stated in section I of the appealed ruling. In total, she stated, the enforcing party petitioned for at least ₡481,500.00. The Judge, she commented, improperly applied article 193 subsection 2) of the CPCA, since said norm establishes that the losing party may be exonerated from the payment of costs when, due to the nature of the issues debated, there was sufficient reason to litigate. Taking into consideration merely arithmetic extremes, and only the amounts granted, they represent a total of ₡231,500.00. This implies, she argued, that from the total sought, the enforcing party obtained 48.07%, which entails, senso contrario, that it did not obtain 51.93% of what it sought to obtain. Consequently, she alleged, it is denoted that her represented party had to litigate. She achieved, she added, that the enforcing party did not obtain the entirety of its claims. Therefore, she questioned, she does not understand how it was not even minimally visualized by the Judge, who deemed that the winning party had sufficient reasons to litigate, when he should have assessed that it was her represented party who had sufficient reason to litigate. Especially being faced with an enforcement of a judgment of an abstractly granted right, where there was a scenario of extreme petitions, which implied that this representation had to exercise the defense of institutional interests. If the Judge had assessed the above, she stated, he would have determined that her represented party had reasons to litigate.

Among different elements, she pointed out the following: 1) the total amount sought by the executing party corresponded to the sum of ₡481,500.00; ₡300,000.00 for moral damages (daño moral) and ₡181,500.00 for costs, for the elapsed period of six months and fifteen days, wherein, indeed, it was never medically classified as an emergency; 2) of the total amount sought, 48.07% was granted (₡50,000.00 for moral damages (daño moral) and ₡181,500.00 for costs), resulting in 51.93% of the total sought being rejected; 3) of the amount for subjective moral damages (daño moral subjetivo) requested, the sum of ₡50,000.00 was granted, representing 16.6% of what was initially required; 4) this is a claim with an evident intent to obtain extremes beyond what can be considered, parallel to reasonableness; 5) this Chamber, in judgment no. 1502-S1-2022, indicated that it is irrational to impose upon the tripartite social security contribution fund and, upon the other insured parties benefited by said funds, an additional compensation to one who has consented to the wait and received, through judicial protection, the required medical care. Added to this, it provided guidelines to determine whether compensation should or should not be involved, such as, whether the type of pathology of the patient refers or not to an emergency, or else, conformity with inclusion on a waiting list and, even, compensation “in natura”. That is to say, her represented party proceeded from positions developed by this Chamber to litigate in the process, which was pointed out to the Judge, without him taking it into consideration. For the foregoing, she argued, it is evident that this representation had to litigate in the process. Not satisfied with that, the Judge decided to condemn her client in costs, thereby leaving her in a clear position of vulnerability and disadvantage, since, defending, indeed, the financial sustainability of the Institution, is clearly a sufficient motive to litigate. Not satisfied with that, she insisted, the Adjudicator condemned her represented party to the payment of costs of the execution process. Therefore, she pointed out, it can be deduced, in a direct, clear, and simple manner, that her represented party had sufficient motives to litigate, in view of the fact that the principles of legality, good faith, loyalty between parties, and preclusion were being effectively protected. If article 193 subsection b) of the CPCA had been adequately applied, she said, the Judge would have exempted her client from the payment of costs, given that it is evident and manifest, she concluded, in addition to being of simple verification, the fact that there was sufficient motive to litigate.

XXIII.Regarding what was set forth in the preceding Considerando, it is necessary to indicate FIRST, the Execution Judge, in section VI of the questioned judgment, pointed out: “Pursuant to articles 119.2, 193 of the Código Procesal Contencioso Administrativo, there existing in this Adjudicator’s opinion sufficient reasons for the plaintiff to litigate in this process, since it had a right granted in the abstract by the Constitutional Chamber that it could come to execute in this venue, the defendant CCSS [sic] is condemned in costs, rejecting the defense of lack of right of the liquidated item. […]” SECOND, after a detailed study of the grievance, it is determined that its core consists of the alleged violation, by erroneous application, of ordinal 193 subsection b) of the CPCA, since, in its judgment, due to the nature of the issues debated, sufficient motive to litigate assisted its client. This is because, she pointed out, the executing party sought payment of, at least, ₡481,500.00, distributed in the following manner: ₡181,500.00 for personal costs of the recurso de amparo and ₡300,000.00 for subjective moral damages (daño moral subjetivo). However, the Execution Judge, she said, only granted a total of ₡231,500.00 (₡181,500.00 for the personal costs of the recurso de amparo and ₡50,000.00 for subjective moral damages (daño moral subjetivo)). That is to say, 48.07% of what was sought. In this regard, the aforementioned would give rise to the announced cassation motive, provided for in subsection c) of precept 138 of the CPCA. However, she then alluded to two more dissimilar hypotheses, the three resulting indivisible, by the way the objection was formulated. In this sense, on pages 17 and 18 she indicated: “On this matter, and taking into consideration purely arithmetic extremes [sic], and only taking into consideration the amounts granted, these represent a total of ¢231,500.00 (two hundred thirty-one thousand five hundred colones), which implies that of the total sought, the plaintiff obtained 48.07%, which entails, contrario sensu, that it did not obtain 51.93% of what it sought to obtain, by which it is denoted that, in the first instance, my represented party did have to litigate the present process [sic] and indeed, managed to ensure that the plaintiff did not obtain the totality of its claims, which, it is not understood how, was not even minimally visualized by the first instance judge, who, estimates that the winning party had sufficient motives to litigate, when he should have assessed that it was my represented party who had sufficient motive to litigate the [sic] judgment execution process, especially being faced with a judgment execution of a right granted in the abstract, where there was practically a scenario of extreme petitions, which imply that this representation had to exercise, without any discussion, the defense of institutional interests.

/ If Judge Zeledón Hernández had assessed the foregoing, he would have determined that my client had ample grounds to litigate the judicial process, given that, among various elements, the following exist: […] The First Chamber of the Supreme Court of Justice, in judgment No. 1502-S1-2022, indicates that it is irrational to impose upon the tripartite social security contribution fund and, upon the other insured beneficiaries of said funds, an additional indemnification on someone who has consented to the wait and received, through judicial protection, the required medical attention, and in addition to that, it provided guidelines for determining whether or not indemnification should be mediated, such as whether the patient's type of pathology refers to an emergency or not, or, the conformity with inclusion on a waiting list, and even, indemnification in kind, that is, my client relied on positions developed by the First Chamber itself, in order to litigate the process, which was pointed out to the trial court judge, without the same even being taken into consideration.” (The highlighting is from the original). In what has now been set forth, the appellant alluded to the cassation ground for breach of procedural rules, provided for in article 137, subsection 1), point d) of the CPCA: lack of reasoning (falta de motivación). However, what is argued is informal. The objector omitted to point out the procedural rule violated, with a clear and precise explanation, as the technique of cassation (técnica de la casación) requires, as was indicated in section XIX of this judgment, in accordance with the provisions of ordinal 139, subsection 3) ibid. On the other hand, on page 18 she added: “Hence, it is evident that this representation had to litigate the process, and not satisfied with that, the trial court judge decides to order my client to pay legal costs (costas), thereby leaving her in a clear position of vulnerability and disadvantage, given that defending even the financial sustainability of the Institution is clearly a sufficient motive to litigate, not satisfied with that, Judge Zeledón Hernández orders my client to pay the legal costs of the enforcement process (proceso de ejecución).” (The highlighting is from the original). In what has now been set forth, she refers to the cassation ground for violation of substantive rules provided for in subsection d) of ordinal 138 of the CPCA. The confusion brought to light, as was indicated, clashes with the technique of cassation, which, as has already been indicated, requires that the objections of the cassation appeal (recurso de casación) must be formulated in a clear and precise manner (article 139, subsection 3) of the CPCA); which implies the rejection of the grievance under study.

**XXIV. THIRD.** In accordance with what was set forth in the statement of defense (contestación de la demanda), images 29 to 38 of the electronic judicial file, the general judicial attorney-in-fact (apoderada general judicial) of the CCSS argued and requested that her principal should not be ordered to pay subjective moral damages (daño moral subjetivo). This, despite what was decided by the Constitutional Chamber, because, in her opinion, the person granted protection (amparada) was not denied access to health services, much less medical attention. Furthermore, as she pointed out, the diagnosis of the person granted protection was not urgent. The person granted protection, she stated, did not explain what the moral damage consisted of. That is, the enforcing party (ejecutante) did not comply with what is provided for in ordinals 163 and 180 of the CPCA. Likewise, she did not prove the causal link between what is in the file and the factual situation on which she intends to base said damage. That is, she did not prove it. Nor are there technical criteria that demonstrate its existence. Ergo, said item should be rejected. For his part, the Enforcement Judge (Juez de Ejecución), in the questioned judgment, according to the transcription carried out in section V of this judgment, considered the appropriateness of the subjective moral damages, by virtue of its demonstration "in re ipsa" based on the facts that served as the basis for the granting of the amparo appeal (recurso de amparo). In accordance with his prudent discretion, and the principles of reasonableness and proportionality, he set the amount at ₡50,000.00. The foregoing means, contrary to what was argued by the appellant (casacionista), that the opposition raised by the general attorney-in-fact of the CCSS was unsuccessful. The Judging Officer, it is reiterated, determined the existence of subjective moral damages by virtue of the facts that served as the basis for the granting of the amparo appeal, which was endorsed by this Chamber, as was stated. Furthermore, he set its amount, as was indicated, according to his prudent discretion and under the protection of the indicated principles of reasonableness and proportionality, which was also shared by this Chamber. Likewise, the amount requested for personal legal costs (costas personales) of the amparo appeal was granted. Similarly, legal interest (réditos legales) was granted on the amounts awarded and the costs of the enforcement process, just as was requested. Corollary, contrary to what was set forth by the appellant, and as was correctly decided, it was necessary to order the payment of the costs of the enforcement process, as provided by canon 193 of the CPCA, since none of the grounds for exoneration provided for in that rule were present. **FOURTH.** Just as was noted in section XXI of this judgment, what was indicated by the challenger, concerning the existence of restorative justice and the non-existence of urgency in the appointment of the person granted protection, having consented to the wait, and the inappropriateness of granting an indemnification for subjective moral damages, was already the subject of analysis in sections VIII through XIII of this judgment, therefore, in order to avoid unnecessary reiterations, reference is made to what was expressed therein.

**XXV.** By virtue of the reasons set forth, the rejection of the appeal filed is required.

In accordance with the provisions of Article 150, subsection 3) of the CPCA, as this Chamber finds that the cassation appellant lacks sufficient grounds to appeal, for the reasons set forth in the analysis of each grievance, it shall be ordered to bear the costs of the cassation appeal, which must be liquidated in the sentence execution phase, in order to guarantee the right of defense of the executed party, who shall be granted the respective hearing on the liquidation presented (Articles 41 and 153 of the Political Constitution).

XXVI.DISSENTING VOTE OF JUDGE ROJAS MORALES. I depart from the majority opinion, insofar as it deems it appropriate to order the defendant to pay subjective moral damages (daño moral subjetivo) in the sum of ¢50,000.00. Regarding the damages (daños y perjuicios) arising from a ruling of the Constitutional Chamber (Sala Constitucional) granting an amparo appeal, it should be borne in mind that, given their nature, such judgments contain an abstract condemnation, without any factual consideration, and do not prejudge, as they were not the object of analysis, their existence, their causal link, or their quantification. Said Court merely determines the constitutional violation. When executing those aspects, the causal link between what was declared in the abstract and the specific matter must be established. Thus, the fact that the Constitutional Chamber issues an abstract condemnation for the payment of damages does not entail an automatic enforceable condemnation, as the Executing Judge seems to erroneously understand. It falls to the judges responsible for deciding on the liquidation to assess, in each specific case, whether there is sufficient merit to grant the requested compensation. In this regard, the following must be analyzed: the particular circumstances of the case, the position of the parties, the nature, object, and purpose of the redress, as well as the constitutional principles of reasonableness and proportionality. Furthermore, when the matter concerns an alleged subjective moral damage suffered by a person facing a lack of medical care, as is the case here, the examination of additional facets becomes indispensable. In the first place, the factor of urgency must be assessed, since it is evident that a person requiring urgent care from the CCSS is not in the same situation—for example: an administered person suffering from cancer that advances irremediably, versus someone presenting an ailment for whom a surgical intervention or a non-urgent medical appointment has been prescribed; in both cases, the waiting time to receive the medical service does not have the same outcome. Likewise, the moral impact will not be of the same intensity. On the other hand, the inactivity of the patient during the time spent on the waiting list must be analyzed (canon 30 subsection ch) of the Constitutional Jurisdiction Law -LJC- and 38 of the Contentious Administrative Procedure Code), which ceases when they resort to amparo before the Constitutional Chamber or to the courts of justice, to claim the medical care or treatment they need (administrative activity). It should be noted that the passage of time without taking action has clear consequences in the Costa Rican legal system regarding the expiration (caducidad) of the action, an aspect that can be assessed ex officio. A pecuniary advantage cannot be derived from inactivity, as this conflicts with the principle of proportionality in a strict sense. Thirdly, the satisfaction afforded by the order of a court of justice must be weighed, through which the performance of a medical act or the delivery of medications is ordered (even if it arises from a precautionary measure). Even the most recent jurisprudence of the Constitutional Chamber has assessed the satisfaction generated from the notification of the amparo proceeding. These are cases in which, on the occasion of the amparo and irrespective of the time elapsed between the filing of the appeal and the administrative response received, the respondent authority grants the administered person the required medical care (providing a firm date for a surgery or medical consultation, supplying the needed medication, rescheduling an appointment, etc.). Cases of the latest erga omnes binding resolution (according to Article 13 of the LJC), in which the Constitutional Judges have deemed it inappropriate to order costs, damages, and losses, even resolving without condemnation in those aspects; these cases must be assessed by this Chamber when ruling on ongoing proceedings. In this sense, the following judgments, among others, may be consulted: numbers 2024-000017 of 9:15 a.m. on January 9, 2024, 2024-000026 of 9:15 a.m. on January 9, 2024, and 2024-006673 of 9:15 a.m. on March 8, 2024. It should be highlighted that granting the required medical service constitutes a manifestation of restorative justice, which this Decision-Making Body must assess. The compensation granted in violation of the stated reasoning becomes unreasonable and disproportionate, especially when, in a universal social security system like Costa Rica's, such compensations are paid by all insured persons, including those displaced by the executing party. Upon examining the described aspects and the particular case of Mrs. María de los Ángeles Carmona Castillo, it becomes improper to compensate the emotional impact awarded in the judgment. It is recorded in the case file that on November 15, 2022, the Gynecology Service of the Maximiliano Peralta Jiménez Hospital in Cartago issued a hospitalization request for surgery to Mrs. María de los Ángeles, the date from which she entered the waiting list. On May 16, 2023, she resorted to amparo before the Constitutional Chamber; that is, for approximately six months she waited for the intervention to be scheduled. The possibilities of social security in an area such as General Surgery must be taken into account, where there are not enough specialists to serve the population, especially as the number of people requiring intervention in that area is increasing. Furthermore, it is important to note that even though the Maximiliano Peralta Jiménez Hospital in Cartago issued a hospitalization order for surgery, it did not do so with an urgent character (as indicated in technical report no. HMP-DG-1915-2023). Added to the above, it is recorded in the Expediente Digital Único en Salud that the executing party's request for medical care was satisfied, as the surgery was performed on September 13, 2023, which implies care within a reasonable timeframe, given the noted conditions. Consider that the waiting time Mrs. María de los Ángeles endured to receive the needed care was approximately four months, counted from when she filed the amparo appeal on May 16, 2023, until she underwent surgery on the following September 13th. Indeed, the period is even shorter if one considers that the enforceable judgment was notified on June 5, 2023. These are reasonable timeframes from the standpoint of providing a non-urgent service and given the need to fulfill the preoperative requirements involved in any surgical intervention. It should be kept in mind that, from the filing of the amparo, the executing party was never subjected to a prolonged or indefinite wait.

She received medical attention within a more than reasonable period (even shorter than the waiting times for care in private medicine). Without overlooking that the surgery was scheduled for her on a non-emergency basis. The foregoing speaks to the nonexistence of the liquidated damage. It is worth noting, in cases such as the one under study, there is no doubt that the user's satisfaction was already generated; therefore, granting additional compensation beyond what was received (medical assessment in singular derogation of the waiting list) becomes contrary to law. The foregoing, far from causing the petitioner non-material harm (daño moral), granted her a privilege over the other insured persons, which diminishes the claim for non-material harm (daño moral) filed. It is irrational to impose on the tripartite social security contribution fund and on the other insured persons who benefit from those funds an additional compensation for someone who has received the required medical attention through judicial protection. For the reasons indicated, the compensation granted does not conform to criteria of reasonableness and proportionality (established by the Constitutional Chamber itself). On the merits of the foregoing, the undersigned considers that the proper course was to uphold the first and second grievances of the filed appeal and, consequently, to annul the contested judgment -only- insofar as it recognized the amount of ¢50,000.00 for subjective non-material harm (daño moral subjetivo), and instead, ruling on the merits, to reject that claim.

POR TANTO

By majority, the appeal is dismissed, with costs to be borne by the cassation appellant, Caja Costarricense de Seguro Social, which shall be calculated in the judgment execution stage.

Magistrate Rojas Morales saves her vote to grant the appeal by virtue of restorative justice (justicia restaurativa) having been configured.

Here is the translation of the provided content, following all instructions.

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Revisión del Documento  Res. 000571-F-S1-2025 SALA PRIMERA DE LA CORTE SUPREMA DE JUSTICIA. San José, a las once horas cuarenta y cuatro minutos del veintisiete de marzo de dos mil veinticinco .

Proceso de ejecución de la sentencia emitida por la Sala Constitucional de la Corte Suprema de Justicia en recurso de amparo establecido por LEONARDO GÓMEZ SALAZAR, abogado, portador de la cédula de identidad número 108760664 y del carné de colegiado número 17.049, en su condición de apoderado especial judicial de MARÍA DE LOS ÁNGELES CARMONA CASTILLO, ama de casa, portadora de la cédula de identidad número 108300488 contra la CAJA COSTARRICENSE DE SEGURO SOCIAL, con cédula de persona jurídica número 4-000-042147, representada por su apoderada general judicial sin límite de suma, Xinia Enid Calderón Umaña, abogada, portadora de la cédula de identidad número 111430399 y del carné de colegiada número 27.700. La apoderada general judicial del ente ejecutado formuló recurso de casación impugnando la sentencia número 2024000956 de las 14 horas 50 minutos del 06 de mayo de 2024, emitida por el Juzgado Contencioso Administrativo y Civil de Hacienda del Segundo Circuito Judicial de San José, integrado por el juzgador Pablo Zeledón Hernández.

Magistrado ponente Jorge Leiva Poveda

CONSIDERANDO

I.La Sala Constitucional de la Corte Suprema de Justicia, mediante sentencia número 2023013051 de las 09 horas 45 minutos del 02 de junio de 2023, acogió el recurso de amparo interpuesto por Leonardo Gómez Salazar a favor de María de los Ángeles Carmona Castillo en contra de la Caja Costarricense de Seguro Social (CCSS). Dicho recurso, presentado ante esa Cámara el 16 de mayo de 2023, se originó por la transgresión al derecho fundamental a la salud. Ello, en virtud de que, la amparada es paciente del servicio de Ginecología del Hospital Maximiliano Peralta Jiménez de Cartago. Se le diagnosticó “leiomioma del útero”. El 15 de noviembre de 2022 ingresó a lista de espera de ese nosocomio, con el fin de que se le practicara una “cirugía de histerectomía total abdominal”. Empero, a la fecha de formulación del amparo no había recibido la atención médica requerida. Tampoco contaba con fecha cierta para la realización de la cirugía. Al respecto, indicó dicha Cámara: “IV.- […] Así las cosas, considera esta Sala que el recurso debe estimarse, pues ha transcurrido aproximadamente 6 meses y 15 días desde que la amparada fue ingresada a lista de espera, para la realización de la cirugía que requiere como tratamiento a su patología, plazo que resulta desproporcionado y violatorio de los derechos fundamentales de la tutelada. Aunado a lo anterior, según se desprende del informe rendido por la autoridad recurrida no existe fecha cierta para la realización de la intervención quirúrgica, manteniéndose la incerteza en cuanto al plazo de realización de la misma. Precisamente, es deber de la Caja Costarricense de Seguro Social resguardar de forma efectiva el derecho a la salud de todos sus usuarios, lo que incluye -evidentemente- la obligación de prestar de manera oportuna y diligente la atención y el tratamiento médico que necesitan sus pacientes. Dado lo expuesto, lo procedente es declarar con lugar el recurso, por violación al derecho a la salud.” (Lo subrayado es suplido). Le ordenó a la Directora General y al Jefe del Servicio de Ginecología, ambos de dicho Hospital, disponer de manera pronta y oportuna, las acciones y coordinaciones necesarias para que, en el plazo máximo de tres meses, contado a partir de la notificación de esa sentencia, se le realizara a la amparada el procedimiento quirúrgico idóneo que necesita. Todo, bajo estricta supervisión y responsabilidad de su médico tratante, siempre y cuando no exista alguna causa que lo impida y se hayan cumplido todos los requerimientos preoperatorios e institucionales. Se les advirtió que, de conformidad con lo establecido por el artículo 71 de la Ley de la Jurisdicción Constitucional, se impondrá prisión de tres meses a dos años o de veinte a sesenta días multa, a quien recibiere una orden que deba cumplir o hacer cumplir, dictada dentro de un recurso de amparo y no la cumpliere o no la hiciere cumplir, siempre que el delito no esté más gravemente penado. De igual manera, condenó a la CCSS al pago de las costas, daños y perjuicios causados con los hechos que sirvieron de base a esa declaratoria, los cuales, dispuso, se liquidarán en ejecución de sentencia de lo contencioso administrativo.

II.Mediante escrito presentado al Despacho el 08 de noviembre de 2023, subido al expediente judicial electrónico ese día a las 13:01:02, imágenes de la 01 a la 25, el licenciado Leonardo Gómez Salazar, en su condición de apoderado especial judicial de María de los Ángeles Carmona Castillo, presentó a estrados la liquidación correspondiente. Solicitó se acogieran las siguientes partidas: 1) se condene al ente ejecutado al pago de las costas del proceso de ejecución de sentencia; 2) ₡181.500,00 por las costas personales del recurso de amparo; 3) ₡300.000,00 por el daño moral subjetivo; y 4) el pago de los intereses de ley, desde el momento de la firmeza de la sentencia y hasta su efectivo pago. Mediante resolución de las 15 horas 48 minutos del día 17 de ese mes y año (imágenes 26 y 27), el juzgador de trámite, Giovanni Marchena Jara, dio curso a la demanda. En escrito subido al expediente el día 18 de enero de 2024 a las 10:36:52, imágenes de la 29 a la 79, la apoderada general judicial sin límite de suma de la CCSS se opuso a la ejecución. Formuló las defensas de falta de: derecho, legitimación activa y pasiva. En la sentencia ahora cuestionada el Juez de Ejecución, Pablo Zeledón Hernández, rechazó dichas excepciones. En consecuencia, acogió la liquidación en los siguientes términos. Condenó a la CCSS al pago de: 1) ₡50.000,00 por el daño moral subjetivo; 2) ₡181.500,00 por las costas del recurso de amparo; 3) también le impuso a la institución ejecutada el reconocimiento de los réditos legales sobre las sumas concedidas a partir de la firmeza de esa resolución y hasta su efectivo pago; y 4) por último, condenó a la CCSS al pago de las costas del proceso de ejecución de sentencia. Disconforme, la apoderada general judicial de la CCSS formuló recurso de casación. Para su resolución, se consideró el escrito subido al escritorio virtual de esta Sala el 12 de febrero de 2025 a las 13:25:51, suscrito por el licenciado Gómez Salazar.

III.En la primera censura, página tres del libelo, anunció la recurrente interponerla por el motivo casacional de quebranto de normas sustantivas previsto en el artículo 138 inciso a) del Código Procesal Contencioso Administrativo (CPCA): “También procederá el recurso de casación por violación de normas sustantivas del ordenamiento jurídico, en los siguientes casos: / a) Cuando se atribuya a la prueba una indebida valoración o se haya preterido.” Ello, dijo, por la indebida valoración de los medios de convicción que constan en autos, específicamente, la ejecutoria de la sentencia constitucional del recurso de amparo. Alegó conculcado el ordinal 196 de la Ley General de la Administración Pública (LGAP). La sentencia impugnada, anotó, basó su argumento, para otorgar el rubro de daño moral subjetivo, en un extremo fáctico, pero sin analizar las aristas contenidas en la línea de esta Sala (aludió al fallo no. 297-F-S1-2024 de las 17 horas 27 minutos del 21 de marzo de 2024), tales como la determinación de necesidad extrema del caso de la persona paciente desde el punto de vista médico -urgencia-, su consentimiento en estar en una lista de espera o, bien, la existencia de un daño físico. La resolución, expuso, mencionó condiciones de la ejecutante; sin embargo, no determinó si se relaciona o no con una emergencia desde el punto de vista médico. El Juzgador señaló que solo se necesita una ejecutoria de sentencia constitucional para demostrar una situación fáctica. Reprodujo, en lo de su interés, lo considerado en el apartado IV de la sentencia objetada, respecto al daño moral subjetivo. Con una simple ejecutoria de una sentencia, alegó, la autoridad judicial pudo determinar que la Administración le provocó al ejecutante “un menoscabo emocional”, sin tomar en cuenta los factores de justicia restaurativa, urgencia, y conformación del paciente. Copió los hechos probados de la sentencia ejecutoria. Con ellos, señaló, no se comprueba daño moral alguno sufrido por la paciente. No hacen referencia alguna al agravamiento de su condición ni que sufriera “un menoscabo emocional”. El Juez, con la simple ejecutoria de la sentencia, según sus palabras, insistió, determinó la existencia de una lesión en la paciente, sin especificar de qué tipo. Transcribió otro fragmento de lo considerado en el apartado IV del fallo cuestionado tocante al daño moral subjetivo. En el análisis de fondo de la sentencia de la Sala Constitucional, alegó, se estimó que se declaraba con lugar el amparo porque se sometió a la ejecutante a una lista de espera por espacio de 06 meses y 15 días, sin que se mencione o no la necesidad de dar seguimiento de manera inmediata. Reprodujo lo expuesto en el fallo de dicha Sala en el apartado IV. El Tribunal Constitucional determinó que dicho plazo de espera -06 meses y 15 días- era desproporcionado y violatorio de los derechos fundamentales de la tutelada. No obstante, agregó, la Sala también ha mencionado, en otras oportunidades, que excede el marco de sus competencias determinar cuánto tiempo es justo y necesario, desde el punto de vista médico, para atender, en general, a las personas enfermas que acuden a los servicios de la CCSS y que, para ello, depende de una evaluación o criterio técnico-científico preciso sobre la premura o no del tratamiento que amerita cada una. Evaluación o criterio que, en este caso, no consta en el expediente de la ampara para determinar que un plazo de 06 meses y 15 días es desproporcionado y violatorio. A la señora Carmona Castillo, anotó, su representada no le negó el acceso a los servicios de salud, a la atención médica. Contrario a ello, expuso, al momento de la interposición del recurso de amparo, quedó claro que lo pretendido por la amparada era un procedimiento de histerectomía que, en ninguna circunstancia, se consideró como una emergencia o patología de carácter urgente u oncológica, tal y como se indicó en su oportunidad. El Juez de Ejecución, manifestó, tomó como base para acoger la ejecución de sentencia un elemento que no fue mencionado por la Sala Constitucional para declarar con lugar el recurso de amparo y que, por lo tanto, no podía servir de base para otorgar pretensiones. Transcribió otra parte de lo expuesto en el indicado Considerando IV de la sentencia objetada. Dictó el fallo considerando excesivo el plazo trascurrido de espera. Sin embargo, dijo, en ninguna parte de lo señalado en la resolución no. 20233013051 de la Sala Constitucional, enfocó señalamiento de un tiempo de espera excesivo y de urgencia. Contrario a ello, desde el punto de vista del médico tratante, informe técnico no. HMP–DG-1915-2023, que se encuentra en el expediente del recurso de amparo, refiere la patología de la señora Carmona como no prioritaria o urgente. La sentencia objetada, de forma directa, aseveró, violentó el numeral 196 de la LGAP, al haber determinado la existencia de una lesión y de un daño, con una ejecutoria de sentencia. Se requería para ello, expuso, prueba técnica que así lo acreditara, lo cual se agrava con el hecho que el Juzgador indicó que se dio “un menoscabo emocional” (página cinco del fallo) y su prolongación, con el simple hecho de haber analizado la ejecutoria de la sentencia. La resolución cuestionada, insistió, violó dicha norma, la cual dispone que el daño debe ser efectivo, evaluable e individualizable, en relación con una persona o grupo. Lo cierto, apuntó, es que, partiendo de una de una sentencia de un recurso de amparo, por colocación en lista de espera, no se tiene prueba alguna de una afectación al fuero interno de la parte ejecutante. No existe prueba alguna de una lesión sufrida. Tampoco qué tipo de lesión, toda vez que dicho concepto jurídico obedece a un daño producto de falta de equivalencia entre lo que se da y lo que se recibe. En un título oneroso. Un daño producto de un delito donde se merma o transgrede el cuerpo de una persona. O bien, una perturbación orgánica o funcional de un individuo. Es decir, el Juez, de una simple ejecutoria de sentencia, validó y determinó la existencia de una lesión en la paciente; sin puntualizar cuál tipo de lesión, sin tener prueba técnica que así lo acreditara. Esto, arguyó, acarrea que el daño no sea real ni efectivo, conculcándose dicho precepto. Insistió, el Juzgador no tomó en cuenta los factores de la justicia restaurativa, urgencia, conformación del paciente, reiterados en la jurisprudencia de esta Sala. Mencionó las sentencias (según el orden de cita) nos. 28-F-S1-2024 de las 11 horas 05 minutos del 11 de enero; 297-F-S1-2024 de las 17 horas 27 minutos del 21 de marzo, ambas del año 2024; 1502-F-S1-2022 de las 11 horas 24 minutos del 01 de setiembre; 1823-F-S1-2022 de las 14 horas 26 minutos del 04 de agosto de dos mil veintidós; y 2429-F-S1-2022, las tres del año 2022. Incluyó una tabla en donde expuso, en su criterio, lo puntualizado en cada uno de esos fallos. Si el Juez, acotó, hubiera analizado debidamente la prueba, determinaría que una ejecutoria es insuficiente para establecer la procedencia de un daño moral subjetivo. Máxime, y tomando en consideración que la colocación de una persona en una lista de espera no es “per se”, motivo suficiente para otorgar una indemnización. Sobre esto, indicó, esta Cámara estableció, en la resolución no. 1502-S1-2022 de las 11 horas 24 minutos del 01 de setiembre de 2022 que, en cuanto a indemnizaciones por recursos de amparo por colocación en listas de espera, resulta irracional imponerle al fondo de contribución tripartito de la seguridad social, una indemnización a quien ha consentido una espera y recibido la atención médica requerida. Reiteró una vez más, ello le fue señalado a la autoridad jurisdiccional. Sin embargo, en su criterio, denotó que existe un “animus” de condenar a la CCSS a toda costa (y, claro está, a los cotizantes), sin que medie sustento alguno desde el punto de vista probatorio. Si el Juez hubiera valorado adecuadamente la prueba, aseveró, la argumentación del fallo sería diferente. Habría determinado que la prueba resultaba insuficiente para establecer la existencia de un daño de cualquier tipo. De los hechos probados de la sentencia del recurso de amparo, expuso, no se denota que se refiera a un tema de lesión de la parte ejecutante. Es decir, si la sentencia del recurso de amparo no mencionó aspecto alguno relacionado con una lesión por la colocación en una lista de espera, le estaba vedado a la autoridad judicial de conocerlo y, sobre todo, tomarlo como punto de partida para determinar una indemnización. Sin prueba técnica, y sin que la ejecutoria del recurso de amparo mencionare aspecto alguno, desde el punto de vista médico, apuntó, determinó elementos técnico-médicos complejos, para concluir la existencia de un daño, efectivo e individualizado, con respecto a la ejecutante. No puede cohonestar dicho parecer del Juzgador, afirmó, pues, de la serie de elementos que fueron tomados en consideración, no se desprende de lo analizado por la Sala Constitucional para declarar con lugar el recurso de amparo. Máxime, tomando en cuenta que se remitió a aspectos sumamente técnicos, desde el punto de vista médico (con especialidades como la ginecología, por ejemplo), lo cual solo puede constatarse con dicho tipo de prueba (técnica). La ejecutoria de una sentencia constitucional, indicó, por sí sola, no tiene un matiz de tal magnitud como para concluir la existencia de una lesión, tomando en consideración, insistió, que no existía prueba técnica sobre ello. Si el Juez hubiera analizado debidamente la prueba, concluyó, determinaría que una ejecutoria es insuficiente para la procedencia de un daño moral subjetivo.

IV.Esta Cámara se avocará al análisis de la extensa censura de la siguiente manea. PRIMERO. Luego de su análisis pormenorizado, se determina que padece de una contradicción que causa perplejidad. En la página cinco del libelo afirmó: “Nótese por parte de la honorable Sala Primera, que el Alto Tribunal Constitucional determinó que el plazo de espera de 6 meses y 15 días era desproporcionado y violatorio de los derechos fundamentales de la tutelada […]”. Sin embargo, en la página siguiente -seis- manifestó: “Como puede verse por parte de la honorable Sala Primera, el juez Zeledón Hernández dicta sentencia considerando excesivo el plazo trascurrido de espera, sin embargo, en ninguna parte de lo señalado en la resolución N° 20233013051 de la Sala Constitucional, enfoca señalamiento de un tiempo de espera excesivo y de urgencia, contrario a ello, desde el punto de vista del médico tratante, informe técnico N° HMP–DG- 1915-2023 que se encuentra en el amparo, refiere la patología de la señora Carmona como no prioritaria o urgente.” (Lo resaltado es del original). Es decir, en un primer momento afirmó que la Sala Constitucional determinó que el plazo de espera para la práctica de la cirugía requerida, que al momento del dictado de la sentencia ejecutoria era de seis meses y quince días, resultaba desproporcionado y violatorio de los derechos fundamentales de la amparada, motivo por el cual fue acogido el recurso de amparo. No obstante, luego indicó que el Juez de Ejecución, al considerar excesivo el plazo de espera padecido por la ejecutante, a fin de determinar la procedencia del daño moral subjetivo, transgredió el fallo ejecutorio, pues, la Sala Constitucional no indicó que el tiempo de espera fuera excesivo. La contradicción resulta evidente. En este sentido, tal y como se anotó en el Considerando I de esta sentencia, se insiste, la Sala Constitucional acogió el recurso de amparo formulado a favor de la señora María de los Ángeles Carmona Castilla, según se determina de lo considerado en el apartado IV del fallo ejecutorio, al estimar que el plazo que llevaba en espera hasta ese momento para que se le practicara la cirugía requerida, de seis meses y quince días, en efecto, resultaba desproporcionado y violatorio de su derecho fundamental a la salud. Es decir, el Juez de Ejecución, ciñéndose a lo resuelto en sede constitucional, tal y como será desarrollado más adelante, dispuso que el plazo de espera padecido por la amparada resultaba excesivo. Además, conforme a la contestación de la demanda -imagen 30- y la prueba aportada por la propia CCSS, visible a imágenes de la 40 a la 79, se determina que, en cumplimiento de lo ordenado por la Sala Constitucional, doña María de los Ángeles fue intervenida quirúrgicamente en el Hospital Dr. Maximiliano Peralta Jiménez de Cartago, el día 13 de setiembre de 2023. Es decir, en definitiva, tuvo que esperar para que se le practicara la cirugía que requería, aproximadamente, 10 meses. Lo cual, acorde a lo resuelto por la Sala Constitucional, resulta lesivo a su derecho fundamental a la salud.

V.SEGUNDO. A efecto de tener una comprensión cabal de lo que se dirá, es oportuno reproducir lo resuelto por el Juzgador de Ejecución en el apartado IV de la sentencia objetada tocante al daño moral subjetivo: “IV.- […] Estima este Juzgador que en el caso concreto en análisis, respecto del daño moral subjetivo, no es difícil determinar sin más prueba que la ejecutoria aportada, se ha ponderado que el accionante [sic] acudió al centro médico, e ingresó en la lista de espera el 15 de noviembre del 2022, no obstante a la fecha de interposición del recurso de amparo no había sido operada la parte accionante [sic]. El plazo transcurrido de espera fue ponderado por la Sala Constitucional, y se consideró excesivo y lesiona el derecho a la salud. Con respecto de las argumentaciones de la CCSS, para rechazar el daño moral liquidado, se deben ser [sic] rechazadas, por cuanto pretende cambiar las bases establecidas en el fallo constitucional que se ejecuta, pretende volver a discutir el tema que fue analizado por Sala Constitucional, efectivamente el Tribunal Constitucional encontró un funcionamiento anormal, donde se descuidó la salud de la accionante, declaró que existió violación al derecho a la salud, por lo tanto, no es admisible volver a discutir los mismos hechos por los que la CCSS fue condenada, ya que se tuvieron por ciertos en la sentencia que se ejecuta. Se ha ponderado que existe un menoscabo emocional, en el hecho que ocurrió, cuando el accionante [sic] se encontró con el panorama de una prolongada espera para su atención médica, y por lo tanto, tuvo que acudir a la Sala Constitucional para reparar el agravio de una dilación excesiva en la prestación de los servicios médicos; el hecho que por orden del Tribunal Constitucional, la atención médica fuera más inmediata, no borra el menoscabo emocional sufrido por el accionante, ante una verdadera disfunción en la prestación de los servicios de salud, no es admisible la tesis de la CCSS, entendiendo que estamos ante un proceso de ejecución de sentencia, donde se pretende establecer los montos de las bases fijadas por Sala Constitucional, no es procedente entrar a realizar valoraciones del fondo de la gestión constitucional, la sentencia ejecutada, consideró excesivo el tiempo de espera fijado para la atención médica del ejecutante, se determinó en el proceso constitucional que existía urgencia, tanto así que se ordenó la atención médica en un plazo no mayor de tres meses, por lo tanto el argumento de la CCSS, que pretende variar las bases fijadas en la sentencia ejecutada debe ser rechazado. El tiempo transcurrido de espera en la atención médica, se considera desproporcionado, violentándose su Derecho a la Salud, por lo que tuvo la Sala Constitucional que ordenar su atención, acorde con los principios del buen servicio público y el respeto al derecho a la salud, es lógico deducir in re ipsa que tuvo que provocar una afectación emocional en el fuero interno del ejecutante, y un sufrimiento producto de la impotencia ante la dilación excesiva e injustificada de las autoridades administrativas la que le prolongaba su atención, claramente añade preocupación, tristeza y enojo resarcible, por la inoperancia del servicio que se le cobra de antemano y de manera obligatoria (nexo de causalidad). Es claro que no hay un consentimiento en el atraso de su atención médica por cuanto acudió a la Sala Constitucional para obtener el servicio de salud en un plazo razonable, y a esta sede de ejecución, para encontrar resarcimiento por la lesión sufrida, que lo obligó a activar el sistema judicial para recibir un servicio que funciona anormalmente. Adicional a lo anterior, se considera que operó justicia restaurativa en cuanto a la condena de brindar el servicio de salud, pero no respecto de la otra condena diferente en costas, daños y perjuicios, por lo que subsiste el derecho respecto a estos extremos impagos. Por lo anterior, y con base en los principios de proporcionalidad y razonabilidad, el daño moral subjetivo es procedente, en la suma de CINCUENTA MIL COLONES, el monto indicado se considera ajustado a las resultas del proceso, es respaldado por los principios de sana critica racional. Se rechaza el monto propuesto por la parte ejecutante, ya que se considera excesivo, según las resultas del proceso. Se rechaza la excepción de falta de derecho y falta de legitimación pasiva.” (Lo resaltado y subrayado es del original).

VI.TERCERO. En torno a lo argumentado por la casacionista, debe recordarse que, en procesos de ejecución de sentencia en general y, principalmente, los emitidos por la Sala Constitucional, lo ejecutado debe necesariamente constreñirse a lo resuelto en la sentencia de amparo objeto de la ejecutoria. Esta Sala ha indicado, el proceso de ejecución de sentencia procura materializar la condena -abstracta- impuesta al perdidoso. De otorgarse aspectos diferentes -o contrarios- al pronunciamiento que da lugar a la ejecución o contra personas que no resultaron condenadas, se vulnera la cosa juzgada. Ver, entre otros fallos de este órgano decisor nos. 383-2019 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-925036) y 309-2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1024927). En consecuencia, la labor fiscalizadora de esta Cámara se constriñe a un cotejo objetivo entre la sentencia ejecutoria y la resolución recurrida. En este sentido, pueden consultarse, entre muchas otras las resoluciones nos. 82-A-S1-22 de las 10 horas 06 minutos del 26 de enero (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1072742) y 1984-F-S1-2022 de las 11 horas 18 minutos del 08 de setiembre, ambas del año 2022 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112319).

VII.CUARTO. Como se apuntó en los Considerandos I y IV de esta sentencia, la Sala Constitucional, en la sentencia que se ejecuta, acogió el recurso de amparo interpuesto a favor de la amparada, al tenerse por comprobado que el 15 de noviembre de 2022 fue ingresada en lista de espera para cirugía de histerectomía total abdominal y que, al momento del dictado de la sentencia constitucional, no contaba como fecha cierta para la realización de dicho procedimiento quirúrgico. Por lo tanto, estimó dicha Cámara, el plazo transcurrido hasta ese momento, de seis meses y quince días, resultaba desproporcionado y violatorio de sus derechos fundamentales. Por lo tanto, acogió el recurso de amparo y le ordenó tanto a la Directora General del Nosocomio como al Jefe de Ginecología, disponer, de manera pronta y oportuna, las acciones y coordinaciones necesarias para que, en el plazo máximo de tres meses, contado a partir de la notificación de la sentencia constitucional, se le practicara la cirugía a la amparada. Lo cual así sucedió, pues, el 13 de setiembre de 2023 fue operada. Como se colige con nitidez, la Sala Constitucional acogió el recurso porque estimó que el plazo que llevaba en lista de espera la amparada era desproporcionado y violatorio de su derecho fundamental a la salud, considerando su patología. Precisamente, el Juez de Ejecución, se insiste, ciñéndose a lo resuelto en sede constitucional, consideró: “[…] el hecho que por orden del Tribunal Constitucional, la atención médica fuera más inmediata, no borra el menoscabo emocional sufrido por el accionante [sic], ante una verdadera disfunción en la prestación de los servicios de salud, no es admisible la tesis de la CCSS, entendiendo que estamos ante un proceso de ejecución de sentencia, donde se pretende establecer los montos de las bases fijadas por Sala Constitucional, no es procedente entrar a realizar valoraciones del fondo de la gestión constitucional, la sentencia ejecutada, consideró excesivo el tiempo de espera fijado para la atención médica del ejecutante, se determinó en el proceso constitucional que existía urgencia, tanto así que se ordenó la atención médica en un plazo no mayor de tres meses, por lo tanto el argumento de la CCSS, que pretende variar las bases fijadas en la sentencia ejecutada debe ser rechazado. El tiempo transcurrido de espera en la atención médica, se considera desproporcionado, violentándose su Derecho a la Salud, por lo que tuvo la Sala Constitucional que ordenar su atención, acorde con los principios del buen servicio público y el respeto al derecho a la salud, es lógico deducir in re ipsa que tuvo que provocar una afectación emocional en el fuero interno del ejecutante, y un sufrimiento producto de la impotencia ante la dilación excesiva e injustificada de las autoridades administrativas la que le prolongaba su atención, claramente añade preocupación, tristeza y enojo resarcible, por la inoperancia del servicio que se le cobra de antemano y de manera obligatoria (nexo de causalidad). Es claro que no hay un consentimiento en el atraso de su atención médica por cuanto acudió a la Sala Constitucional para obtener el servicio de salud en un plazo razonable, y a esta sede de ejecución, para encontrar resarcimiento por la lesión sufrida, que lo obligó a activar el sistema judicial para recibir un servicio que funciona anormalmente. Adicional a lo anterior, se considera que operó justicia restaurativa en cuanto a la condena de brindar el servicio de salud, pero no respecto de la otra condena diferente en costas, daños y perjuicios, por lo que subsiste el derecho respecto a estos extremos impagos. […]” (Lo resaltado y subrayado es del original). Sin embargo, la recurrente no objetó dicho fundamento para la determinación de la existencia y cuantificación de ese daño en debida forma, tal y como la técnica de la casación se lo impone, acorde a lo previsto en el artículo 139 inciso 3) del CPCA. Se limitó a efectuar una argumentación genérica, sin cuestionar, de manera clara y precisa, lo dispuesto por el Juzgador de Ejecución. Por el contrario, aludió a otros temas, no expuestos por la autoridad judicial, como justicia restaurativa, urgencia y consentimiento. Así como que de la ejecutoria no se colige el daño reclamado; sin embargo, se insiste una vez más, sin cuestionar lo expuesto en cuanto a que su determinación es “in re ipsa”. Esto hace que lo argüido resulte fútil a efecto de variar lo resuelto.

VIII.Sin perjuicio de lo indicado en el apartado anterior y, a mayor abundamiento de razones, se impone señalar lo siguiente. QUINTO. La casacionista, de manera insistente, aludió a que en el sub júdice operó lo que denominó “justicia restaurativa”. Al respecto, precisa señalar, esta Sala, en anteriores asuntos, reconoció su procedencia en materia de indemnización del daño moral subjetivo por la infracción al derecho fundamental a la salud (así reconocido por la Sala Constitucional de la Corte Suprema de Justicia al acoger el respectivo recurso de amparo, debido al retardo, por parte de la CCSS, en la prestación del servicio médico requerido por la persona administrada), cuando la CCSS presta el servicio dentro del plazo ordenado en sede constitucional. Al respecto, pueden consultarse las sentencias nos. 1502-S1-2022 de las 11 horas 24 minutos del 01 de setiembre (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112330), 2429-F-S1-2022 de las 14 horas 16 minutos del 03 de noviembre (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1123608), ambas del año 2022; 28-F-S1-2024 de las 11 horas 05 minutos del 11 de enero (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396), 297-F-S1-2024 de las 17 horas 27 minutos del 21 de marzo (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250), 901-F-S1-2024 de las 12 horas 31 minutos del 04 de julio (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1240015) y 937 de las 14 horas 51 minutos del 10 de julio (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925); todas del año 2024. Empero, la actual integración de esta Cámara, luego de nuevo estudio, considera necesario reconsiderar esa posición. Sin duda, se trata de una reivindicación de la situación jurídica lesionada, por una falta de servicio, el que se suministre. Más aún, cuando resulte necesario, como ocurre con un servicio de salud pendiente. Sin embargo, dicha reparación no excluye, como bien lo indicó el Juzgador de Ejecución, que la persona perjudicada haya sufrido afectaciones en su esfera moral y patrimonial mientras la conducta anormal persistió por la disfunción administrativa. Si se demuestran menoscabos efectivos (preceptos 196 y 197 de la LGAP) propios del caso concreto y derivados de sus particulares características, coligiéndose su existencia, incluso, por medio del proceso intelectivo “in re ipsa”, pese haberse tutelado jurisdiccionalmente a la persona usuaria, procede su reparación. Es decir, la rectificación servicial no excluye que la persona perjudicada sufriera afectaciones en su esfera moral y patrimonial mientras la conducta anormal persistió. Si eso ocurrió y así se acreditó, resulta obligado imponer la consecuencia resarcitoria correspondiente, si fue solicitado por quien vio su esfera jurídica damnificada. Esto es así conforme al principio de reparación integral del daño, el cual tiene raigambre constitucional y legal (cánones 9, 41, 49 constitucionales; 190 y 197 de la LGAP).

IX.Dentro de esta línea de pensamiento, y respecto a la existencia y cuantificación del daño moral subjetivo, esta Sala, desde vieja data, ha indicado que: “IV. [...] proviene de la lesión a un derecho extrapatrimonial. Sea, no repercute en el patrimonio de manera directa. Supone una perturbación injusta de las condiciones anímicas. No requiere de una prueba directa y queda a la equitativa valoración del Juez. Si se trata de daño moral subjetivo los tribunales están facultados para decretar y cuantificar la condena. La naturaleza jurídica de este tipo de daño no obliga al liquidador a determinar su existencia porque corresponde a su ámbito interno. Ello no es problema de psiquiatras o médicos. Se debe comprender su existencia o no porque pertenece a la conciencia. Se deduce a través de las presunciones inferidas de indicios, ya que, el hecho generador antijurídico pone de manifiesto el daño moral, pues cuando se daña la psiquis, la salud, la integridad física, el honor, la intimidad, etc., es fácil inferir el daño, por ello se dice que la prueba del daño moral existe “in re ipsa”. Tampoco se debe probar su valor porque no tiene un valor concreto. Se valora prudencialmente. No se trata, entonces, de cuantificar el sufrimiento, pues es inapreciable, sino de fijar una compensación monetaria a su lesión, único mecanismo al cual puede acudir el derecho, para así reparar, al menos en parte, su ofensa. Para mayor detalle sobre este aspecto, se pueden consultar, entre otros, de este órgano colegiado, los fallos no. 112 ya citado, no. 17 de las 14 horas 30 minutos del 21 de febrero de 1996 y no. 41 de las 14 horas 40 minutos del 14 de mayo de 1997. Su otorgamiento no guarda una estrecha sujeción a factores probatorios (salvo que se refieran a la relación de causalidad), sino a la prudencia y objetivo arbitrio del juzgador. Sin embargo, su fijación está sujeta a los principios de razonabilidad y de proporcionalidad, los que deben ser valorados por la autoridad competente en cada caso, para que su cuantificación sea acorde a Derecho y no lleve a indemnizaciones excesivas que beneficien injustificadamente a una de las partes. Es decir, debe guardar un justo equilibrio derivado del cuadro fáctico específico, cuestión que ha de ponderarse dentro de los límites señalados.” (Entre muchas otras, puede consultarse la sentencia de esa Cámara no. 468-F-S1-19 de las 9 horas 45 minutos del 30 de mayo de 2019). Acorde a lo expuesto, una vez establecida la existencia del daño moral y su nexo de causalidad con la causa de pedir alegada por la parte actora -lo cual, no es objetado por el casacionista-, la determinación del cuántum depende de la equitativa valoración del Juez; para lo cual, se deberá atender a las circunstancias especiales del caso, así como a los principios constitucionales de razonabilidad y proporcionalidad.” Al respecto, puede consultarse, entre muchas otras, la sentencia no. 1098-F-S1-2023 de las 10 horas 09 minutos del 05 de julio de 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1170686). Es decir, es respecto al daño moral subjetivo que su demostración es “in re ipsa”, siempre y cuando sea como consecuencia de un hecho generador o motivo antijurídico.

X.En esta lite, la Sala Constitucional, según ya se ha indicado, determinó la conducta antijurídica de la CCSS al verificar el quebranto al derecho fundamental a la salud de doña María de los Ángeles. La postergación de la cirugía requerida era, al momento del dictado de la sentencia constitucional, de seis meses y quince días; cuando se le practicó, el 13 de setiembre de 2023, la espera total fue de, aproximadamente, 10 meses, según se indicó en el apartado IV de esta sentencia. Tal situación -hecho antijurídico-, conforme a las máximas de la lógica, experiencia y correcto entendimiento humano, tal y como fue resuelto, es causa adecuada de una aflicción moral, asociada a ansiedad, molestia, frustración y preocupación, por el tiempo excesivo de atención -así declarado, se insiste, en sede constitucional- de una situación de salud que, “per se”, es causa de preocupación para quien lo padece. Acorde con el correcto entendimiento humano y la experiencia, se insiste, se puede colegir, “in re ipsa”, tal y como lo hizo del Juez de Ejecución, la existencia de sentimientos como los antes descritos, sin que tuviera el deber jurídico de soportarlos, al derivar de un funcionamiento anormal de la Administración, así decretado, se repite una vez más, por la Sala Constitucional. Ergo, distinto a lo indicado por la recurrente, se determina su existencia y, por ende, la procedencia de su resarcimiento.

XI.De igual manera, ha expuesto esta Cámara: “VIII. […] En otras oportunidades, este órgano de casación ha tenido oportunidad de resaltar la necesaria “razonabilidad jurídica” que deben guardar este tipo de indemnizaciones, para cuya verificación se debe constatar la observancia de una “razonabilidad de igualdad”, la que la Sala Constitucional ha definido como “…el tipo de valoración jurídica que parte de que ante iguales antecedentes deben haber iguales consecuencias, sin excepciones arbitrarias” (v.g., votos no. 5236-99 y 1354-2011). Es decir, para evitar tratamientos inequitativos e ilegítimos en los diversos asuntos en los que se discuta la indemnización de daños morales, resulta menester verificar que los montos reconocidos no resulten desproporcionados, al compararlos con los que fueron establecidos en otros asuntos similares. En ese orden de ideas, estima la Sala que la suma concedida se ajusta a la intensidad del daño causado.” Sentencia no. 760-F-S1-2023 de las 13 horas 24 minutos del 29 de mayo de 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1157835). En igual sentido, pueden consultarse, entre otros, los fallos nos. 1934-F-S1-2022 de las 15 horas del 12 de agosto; 2654-F-S1-2022 de las 10 horas 10 minutos del 08 de diciembre https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1132117), ambas del año 2022 y 1087-F-S1-2023 de las 09 horas 36 minutos del 05 de julio de 2023 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1173505). En ese orden de ideas, estima esta Sala, la suma concedida por concepto de daño moral subjetivo, ₡50.000,00, resulta razonable y proporcionada, considerando las circunstancias de este caso. Además, es inferior, cuantitativamente, a la que ha sido reconocida para afectaciones similares. A modo de ejemplo, se pueden señalar los siguientes precedentes, en donde, este órgano decisor no consideró irrazonables las sumas otorgadas por el atraso en la prestación del servicio público de salud, nos. 429-F-S1-2024 de las 10 horas 41 minutos del 03 de mayo (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1229475), en donde la persona Juzgadora otorgó ₡500.00,00 y 937-F-S1-2024 de las 14 horas 51 minutos del 10 de julio, ambas del año 2024 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1239925), fijándose como indemnización del daño moral, por el atraso en la prestación del servicio, la suma de ₡200.000,00.

XII.SEXTO. Asimismo, la recurrente alegó que, en el caso de la amparada, no existía urgencia en la práctica de la cirugía. Como se expuso en el apartado I de esta sentencia, distinto a lo argüido, fue la propia Sala Constitucional, en la sentencia ejecutoria, quien determinó la urgencia en que a la ejecutante se le practicara el procedimiento quirúrgico requerido, disponiendo que debía efectuarse dentro del plazo de tres meses a partir de la notificación de ese fallo. Por consiguiente, dentro del cotejo objetivo que debe prevalecer en este tipo de procesos -ejecución de sentencia constitucional- el tema de la urgencia es un aspecto precluido, pues, se repite, así fue determinado y resuelto por el Tribunal Constitucional.

XIII.SÉTIMO. Por último, la impugnante adujo que la amparada se conformó o consintió en permanecer en la lista de espera. Diferente a lo alegado, en esta lite no puede considerarse la existencia de consentimiento o acto consentido tácito y, mucho menos, expreso por parte de la señora Carmona Castillo. Como bien lo indicó el Juez de Ejecución, el recurso de amparo fue presentado a favor de doña María de los Ángeles en tiempo. Tanto es así que la Sala Constitucional lo admitió para su trámite y, posteriormente, lo acogió. Esto, con independencia del plazo transcurrido entre el momento cuando la CCSS la ingresó en lista de espera y la presentación del amparo. Por lo tanto, la ejecutante mostró su disconformidad con su permanencia en la lista de espera, dándole la razón dicho órgano jurisdiccional.

XIV.En la segunda objeción, página 11 del recurso, anunció la recurrente interponerlo por el motivo casacional por quebranto de normas sustantivas previsto en el inciso c) del canon 138 del CPCA: “c) Cuando se haya aplicado o interpretado indebidamente una norma jurídica o se haya dejado de aplicar.” Invocó transgredidos los ordinales 73.1 del Código Procesal Civil (CPC) y 85 del Código de Normas y Procedimientos Tributarios (Código Tributario). En torno al tema de las costas personales del recurso de amparo, dijo, el Juez de Ejecución señaló: “[…] se ha ponderado que la sentencia constitucional estableció dicho derecho a favor de la parte ejecutante y que no puede denegarse ese derecho en fase de ejecución […]”. Ello, señaló, pese a la inexistencia de emisión de una factura electrónica por parte de ningún profesional en Derecho por servicios profesionales para presentar un recurso de amparo. Aun así, anotó, se otorgó el monto por dicho extremo petitorio, de conformidad con el artículo 73.1 del CPC. Reprodujo, en lo de su interés, lo considerando en el apartado V de la sentencia cuestionada, denominado “COSTAS DEL AMPARO”. La autoridad judicial, expuso, para otorgar el monto por concepto de costas del recurso de amparo, se basó en dicho precepto; a pesar de no haberse presentado prueba alguna relacionada con un servicio profesional (emisión de factura electrónica). La sentencia objetada, anotó, aplicó indebidamente esa disposición, pues, remitió a valorar solo una parte de su contenido, sin analizar, a cabalidad su literalidad e, incluso, el elemento teleológico. Al respecto, comentó, se está ante un proceso de ejecución de sentencia constitucional. La condenatoria que realizó la Sala Constitucional fue en abstracto. Por ello, indicó, debe ejecutarse y demostrarse en esta sede el derecho a recibir una indemnización por costas, daños y perjuicios. Reprodujo dicho canon 73.1 del CPC. Su contenido, expuso, establece que se considerarán como costas: los honorarios de abogado, la indemnización de tiempo invertido y gastos indispensables del proceso; pero, la parte ejecutante no aportó prueba alguna para demostrar que hubiese mediado inversión de dinero por concepto de honorarios de abogado. Es decir, alegó, por existir carencia de prueba en torno a ello, el Juzgador tenía compelido otorgar monto alguno por concepto de costas del recurso de amparo, en la figura de honorarios, pues, no se tiene prueba de que hayan sido cancelados, al no haber de por medio una factura electrónica. Bajo la premisa del Juez, indicó, cualquier persona, a través de la acción vicaria, podría interponer recursos de amparo por tema de listas de espera y, a la hora de ejecutar la sentencia, recibiría, como indemnización, las costas del recurso, lo cual, en su criterio, sería un absurdo, pues, para recibir la indemnización plena de un gasto, debe demostrarse. Esto, señaló, no puede cohonestarse, ya que no se presentó prueba alguna de ese gasto. Es ahí donde se encuentra marcado el yerro de la sentencia, toda vez que otorgó el monto por concepto de costas del recurso de amparo como si fueran por honorarios. Es importante que queden claras las razones por las cuales se otorgan las costas a una persona vencedora en un proceso judicial. Además, agregó, el magistrado de la Sala Constitucional, don Fernando Castillo Víquez, en múltiples ocasiones ha sido claro en ordenar, tanto a la CCSS, cuando se realiza la satisfacción extraprocesal de las condenas de la Sala Constitucional, como a la jurisdicción contencioso-administrativa, de asegurarse de que los importes otorgados efectivamente lleguen a manos de los amparados. Transcribió, en lo de su interés, lo expuesto en el voto de la Sala Constitucional no. 2016-012528. La sentencia cuestionada, concluyó, debió rechazar dicho extremo, pues, al no haberse aportado una factura electrónica, no se demostró que ningún profesional en Derecho hubiese brindado un servicio profesional y cobrado por el mismo.

XV.En torno a lo expuesto en el apartado anterior, precisa apuntar lo siguiente. PRIMERO. Como se indicó, la recurrente anunció formular el reparo por quebranto, entre otro, del canon 85 del Código Tributario. Sin embargo, en el desarrollo de la objeción no lo citó. Por ende, no explicó, con la claridad y precisión requeridas, cómo fue vulnerado por la sentencia objetada. En consecuencia, esta Sala tiene vedado efectuar análisis alguno respecto a dicha norma. SEGUNDO. El Juzgador, en el apartado V de la sentencia cuestionada, tocante a las costas del recurso de amparo, consideró; “En cuanto a las costas personales del recurso de amparo, se ha ponderado que la sentencia constitucional estableció dicho derecho a favor de la parte ejecutante y que no puede denegarse ese derecho en fase de ejecución, en esta instancia se definirá el monto de las costas, pero no pueden ser variadas la [sic] bases de la sentencia que se ejecuta como lo pretende la representación demandada CCSS. De conformidad con el numeral 193 del Código Procesal Contencioso Administrativo, que al igual que lo hace el artículo 73.1 del Código Procesal Civil, de oficio condena al vencido en costas, lo pedido resulta procedente, ahora bien, siendo que el amparo fue presentado el 16 de mayo del 2023, le resulta aplicable lo dispuesto por el numeral 46 del Decreto Ejecutivo 41457-JP que entró en vigencia el 01 de febrero del 2019, y que establece un monto de CIENTO OCHENTA Y UN MIL QUINIENTOS COLONES por dicho concepto, por lo que hasta por dicho monto liquidado se fijan las costas personales del recurso de amparo, rechazándose la excepción de falta de derecho y falta de legitimación activa de la partida liquidada.” TERCERO. En la página 12 del libelo, manifestó la impugnante: “Bajo la premisa del juez Zeledón Hernández, cualquier persona, a través de la Acción Vicaria, podría interponer Recursos de Amparo por tema de listas de espera, y a la hora de ejecutar la sentencia, perfectamente recibiría como indemnización tanto costas [sic] del recurso, lo cual, respetuosamente, sería un absurdo […]”. Distinto a lo indicado, esta Sala, desde vieja data, ha señalado la diferencia entre costas personales y honorarios de abogado, concluyendo que las costas personales le pertenecen a la parte, no al letrado. Al respecto, pueden consultare, mutatis mutandis, los fallos nos. 432-F-S1-2017 de las 09 horas 30 minutos del 20 de abril de 2017 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-950854); 515-F-S1-2018 de las 11 horas 20 minutos del 30 de mayo de 2018 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-892742); 28-F-S1-2024 de las 11 horas 05 minutos del 11 de enero (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1208396) y 297-F-S1-2024 de las 17 horas 27 minutos del 21 de marzo (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1221250); ambas del año 2024.

XVI.CUARTO. En las páginas 11, 12 y 13, indicó la recurrente: “En torno al tema de las costas personales del Recurso de Amparo, el juez Pablo Zeledón Hernández señala que […] pese a no tener plenamente la emisión de una factura electrónica por parte de ningún profesional en Derecho por Servicios Profesionales para presentar un Recurso de Amparo, y aún así, otorga el monto por dicho extremo petitorio, de conformidad con el artículo 73-1 del Código Procesal Civil. Al respecto, menciona la sentencia lo siguiente: […] Es decir, a sabiendas de que no se presentó prueba alguna relacionada con un servicio profesional (la emisión de factura electrónica), otorga este. […] Con lo anterior, y siendo que la parte actora no aporta prueba alguna de que haya mediado inversión de dinero por concepto de honorarios de abogado, es decir, al haber carencia de prueba en torno a ello, lo cierto del caso es que el juez tenía compelido el otorgar el monto por concepto de costas del Recurso de Amparo, en la figura de honorarios que no se tiene prueba, hayan sido cancelados, al no haber de por medio, una factura electrónica de por medio. […] Por lo anterior, se tiene que la sentencia debió haber rechazado dicho extremo, toda vez que al no haberse aportado factura electrónica, no se demostró que ningún profesional en Derecho, hubiera brindado un servicio profesional y cobrado por el mismo.” (Lo resaltado es del original). Al respecto, se impone indicar, el CPCA, en el ordinal 193 regula, de manera expresa, la imposición de las costas; al igual que lo hace el canon 73.1 del CPC. Por consiguiente, es la norma del CPCA la aplicable a esta lite. No obstante, esta disposición no preceptúa, como sí lo hace la del CPC, qué se consideran costas. Ergo, este principio procesal, al igual que los contenidos en los ordinales 76.1 y 76.4 íbid, en virtud de la remisión efectuada por el artículo 220 del CPCA, es de aplicación a esta lite. En este sentido, dispone el precepto 73.1 del CPC: “[…] Se considerarán costas los honorarios de abogado, la indemnización del tiempo invertido por la parte en asistir a los actos del procedimiento en que fuera necesaria su presencia y los demás gastos indispensables del proceso.” (Lo subrayado es suplido). En este mismo orden de ideas, los preceptos 76.1 y 76.4 íbid indican: “76.1 Derecho a honorarios y fijación. Los honorarios de abogado pertenecen a este, con las excepciones establecidas por ley. Cuando la parte fuera abogada y haya actuado personalmente tendrá derecho a ellos. Salvo pacto en contrario, se fijarán en atención al trabajo, al estado y la trascendencia económica del proceso, con base en lo dispuesto en la Ley N.° 13, Ley Orgánica del Colegio de Abogados y Abogadas, de 28 de octubre de 1941, y el decreto de honorarios de abogados y notarios. […] 76.4 Fijación contractual de honorarios de abogado. Los abogados y sus clientes podrán fijar contractualmente el monto de los honorarios y sus modalidades de pago respetando los límites impuestos por la ley y el decreto respectivo. Dicha estipulación no afectará a las partes contrarias del proceso, para efectos de fijación de costas personales.” (Solo lo subrayado es suplido). A la luz de lo dispuesto en dichas normas, es claro que, para efectos de las costas, los honorarios de abogado deben calcularse con base en los límites legales y las tarifas establecidas en el Decreto respectivo, independientemente de cualquier acuerdo privado entre el abogado y su cliente. Esto implica que, en la liquidación de costas, no es necesario que la persona ejecutante demuestre el convenio que tiene con su abogado o el pago que le haya realizado, ya que la normativa prevé que el cálculo de ese extremo debe realizarse de acuerdo con el arancel o decreto respectivo, a fin de asegurar un criterio objetivo en la liquidación de costas. Así, si una parte contó con patrocinio letrado en la tramitación de una causa y obtuvo a su favor el pago de las costas, el importe que se reconocerá como honorarios de abogado será, necesariamente, el que se establezca en el “Arancel de Honorarios por Servicios Profesionales de Abogacía”, según las labores efectuadas. Consecuentemente, no resulta indispensable que se aporte una factura o comprobante de pago a favor del profesional en derecho para que proceda el reconocimiento de ese extremo. En esta lite, la objetante no acreditó que doña María de los Ángeles hubiese carecido de patrocinio letrado durante la tramitación del proceso de amparo. Por el contrario, consta que su apoderado especial judicial en este proceso de ejecución fue quien presentó el recurso de amparo a su favor ante la Sala Constitucional. Esto permite colegir que dicho profesional defendió los intereses del amparado en sede constitucional. Ergo, la falta de presentación de la factura o comprobante de pago que reclamó la recurrente no es suficiente para demeritar o desestimar el rubro de costas personales liquidado por la parte y reconocido expresamente en el fallo ejecutorio. Se reitera, porque el ejecutante contó con patrocinio letrado durante la tramitación del amparo y obtuvo a su favor el pago de las costas. Es decir, tiene derecho a que se le reconozca como costas el monto que, por concepto de honorarios de abogado, establece el arancel aplicable. Corolario, esta Sala no observa la infracción legal aducida y, por consiguiente, se impondrá el rechazo del embate.

XVII.En el tercer motivo de disconformidad, página 13 del libelo, anunció la recurrente interponerlo por el motivo casacional por quebranto de normas sustantivas previsto en el inciso d) del numeral 138 del CPCA: “d) Cuando la sentencia viole las normas o los principios del Derecho constitucional, entre otros, la razonabilidad, proporcionalidad, seguridad jurídica e igualdad.” En concreto, invocó infringido el postulado de razonabilidad. En la sentencia cuestionada, manifestó, el Juez de Ejecución determinó la razonabilidad de la indemnización. Adujo que la ejecutante (además de no consentir estar en una lista de espera al haber recurrido a la Sala Constitucional, y que no medió justicia restaurativa), buscó una indemnización, no teniendo un afán malsano. Transcribió, en lo conducente, lo considerando en el apartado IV de la sentencia cuestionada, tocante al daño moral subjetivo. El Juez habló del resarcimiento de “la lesión sufrida”, apuntó, que obligó a la ejecutante a recurrir a la interposición del recurso de amparo, pero no puntualizó cuál es la lesión sufrida, si es física o psicológica. Además, de la ejecutoria (2024000956) no se desprende cuál es la “supuesta lesión sufrida”. Tampoco consta en el expediente prueba que demuestre que se haya producido. En torno al concepto de lesión, reprodujo, en lo conducente, lo señalado por el autor Goldstein, Mabel, mas no indicó obra alguna. La sentencia impugnada, señaló, dejó abierta la posibilidad para buscar, de manera irrestricta, obtener dobles indemnizaciones: la de tipo material, al recibir la atención médica; y la pecuniaria, sin que medie prueba alguna sobre ello. El Juez tenía claro que la ejecutante pretendió por el daño moral subjetivo un monto de ₡300.000,00, más la indemnización por materia de costas. En total, la ejecutante peticionó, al menos, ₡481.500,00. El Juzgador, con su análisis, violó el principio de razonabilidad. El espíritu de la CCSS, de conformidad con el artículo 73 de la Constitución Política, relató, es garantizar los derechos fundamentales a la vida y la salud; sin los cuales, las demás garantías que consagra la Carta Magna no pueden ejercerse a cabalidad. Si bien, apuntó, existen listas de espera, el otorgar una indemnización pecuniaria por colocar a una persona en una de ellas, sin que exista criterio médico de urgencia, implica que los montos destinados a garantizar los dos principales derechos fundamentales, se vean mermados, lo cual, a todas luces, dijo, es irracional, pues, las personas cotizantes para el Seguro de Enfermedad y Maternidad lo hacen con el objetivo de que se brinde un servicio de salud y que se tengan recursos para garantizarlo. No así, reiteró, para que se otorguen indemnizaciones por colocar a una persona en una lista de espera. El juez, acotó, alejándose del principio de razonabilidad, determinó que el hecho que se hubiese realizado el procedimiento médico, resulta insuficiente para determinar la existencia de una justicia restaurativa en su totalidad. Por ello, debe haber también un resarcimiento económico. Es decir, se desprende con lo anterior que el Juzgador determinó que debe mediar, en todo momento, una doble indemnización, cuando se coloca a una persona en una lista de espera. Empero, afirmó, lo cierto es que ello genera un privilegio y un enriquecimiento sin causa alguna. El objetivo de quien recurrió a la Sala Constitucional fue que se le realizara un procedimiento quirúrgico, o se le brindara atención médica. A todas luces, añadió, buscó un restablecimiento de su salud, no obtener una indemnización. Ello, argumentó, puede acarrear una merma en los recursos del servicio de salud, necesarios para mejoras de equipo, pago de medicamentos, y de instrumentos para brindar, adecuadamente, el servicio de salud, a través de profesionales preparados para ello. El Juez, insistió, violó de forma directa el principio de razonabilidad, al otorgar un extremo indemnizatorio aduciendo que la parte ejecutante debía recibir una compensación monetaria, además de la ya recibida sustantivamente: la realización del procedimiento médico requerido. Sobre ello, reiteró, transgredió el principio de razonabilidad, al no determinar que la indemnización incluye la restauración. La cual, aseveró, se produjo por la resolución judicial, pues, la usuaria del servicio de salud recibió la atención médica requerida, por lo que deviene contrario a derecho, especialmente a dicho principio que, adicional a la restauración recibida, se le otorgue un monto extra, al haberse derogado, singularmente, la situación de estar en una lista de espera. Es decir, el otorgarle un monto por concepto de indemnización, adicional a haberle realizado el procedimiento médico requerido, le otorga un privilegio sobre los demás asegurados, que se vieron superados por la persona amparada. Así fue previamente analizado, anotó, por esta Sala en la sentencia no. 1502-S1-2022, la cual reprodujo en lo de su interés. También, en la no. 297-F-S1-2024 de las 17 horas 27 minutos del 21 de marzo de 2024 que, también copió en lo conducente. Esa situación, señaló, que como se infiere, le fue presentada al Juzgador, fue inobservada de forma directa e, incluso, se evidencia, de alguna forma, una posible existencia de un “animus” de condenar bajo cualquier escenario. Esto reiteró, es contrario al principio de razonabilidad; pues, además de mermar los recursos con los que cuenta la institución para brindar el servicio de salud, otorga una posición de privilegio a la persona que recibió la atención requerida, a cargo de quienes colaboran para que se brinde un adecuado servicio de salud. Por lo anterior, concluyó, otorgar una indemnización por concepto de daño moral, deviene en violatorio del principio de razonabilidad.

XVIII.En torno a lo señalado en el Considerando anterior, precisa indicar lo siguiente. PRIMERO. En la página 14 de libelo, manifestó la impugnante: “[…] además de la ejecutoria (2024000956) no se desprende cual [sic] es la “supuesta lesión sufrida”, y tampoco consta en el expediente prueba que demuestra que se haya producido.” (Lo resaltado y subrayado es del original). Lo afirmado por la casacionista es motivo de confusión. Como se apuntó en el apartado I de esta sentencia, la sentencia ejecutoria es la no. 2023013051 de las 09 horas 45 minutos del 02 de junio de 2023, no la no. 2024000956, como erróneamente se indicó la impugnante.

XIX.SEGUNDO. La recurrente olvidó que esta instancia procesal no corresponde a un recurso ordinario (como es el de apelación). Tampoco resulta suficiente manifestar una serie de disconformidades generales y meramente argumentativas. Es menester el contraste de lo decidido con la infracción que, en su criterio, tuvo lugar. Al respecto, el numeral 139 inciso 3 del CPCA prevé un requerimiento de orden material necesario, tanto para la admisibilidad del recurso cuanto para su posterior valoración por el fondo. Se trata de la motivación del recurso que, por las características de la casación, ha de ser clara y precisa. En este sentido, debe contener, tal como lo dispone el precepto de comentario, la fundamentación fáctica y jurídica del caso. Fáctica, en la medida en que se muestre inconforme con los hechos que se han tenido por demostrados o por indemostrados (lo cual lleva a la ponderación de las probanzas), o con las circunstancias acaecidas en la violación de normas procesales. Jurídica, cuando se trata de un problema que se expone acerca de la aplicación, omisión o indebida interpretación de cualquier norma que integre el bloque de juricidad, incluidos, por supuesto, los principios de rango constitucional, o aquella que también opera por efecto reflejo o indirecto, después de que se modifican los hechos de la sentencia impugnada. Tanto en la infracción procesal, como en la probatoria, puede concurrir, junto con las razones jurídicas (siempre necesarias), las de carácter fáctico y, en ese sentido, los fundamentos de referencia deberán ser dirigidos en ambas vertientes, so pena de inadmisibilidad. Por su parte, es necesario aclarar que de la fundamentación jurídica se exonera, por expreso mandato legal, la indicación de aquellos cánones relativos al valor del elemento o elementos probatorios mal apreciados. De igual forma, resulta innecesario citar las normas que equivocadamente utilizó y mencionó el órgano jurisdiccional de instancia para emitir y razonar su decisión, porque constan en el mismo pronunciamiento recurrido. Y desde luego, no es para nada indispensable citar los preceptos que establecen los requisitos, plazos y reglas básicas para la admisión del recurso. Antes que la cita de estas últimas, lo imprescindible es que se cumplan, que se pongan en práctica al momento de elaborar e interponer la casación. Así las cosas, la fundamentación dispuesta por ley, puede entenderse, grosso modo, como aquella argumentación técnico-jurídica en la que se mencionan una serie de artículos, o reglas jurídicas entrelazadas o concatenadas entre sí y vinculadas razonablemente en una doble perspectiva: con los argumentos del recurso y con la sentencia que se ataca. En la medida en que se cite un conjunto de normas jurídicas (o si es del caso, una sola de ellas), atinente y vinculada de manera clara con la sentencia combatida (ya sea en el sustento de hecho o derecho) y los argumentos del recurso, hay fundamentación jurídica. Los agregados jurisprudenciales o las eventuales citas doctrinales, reforzarán en ocasiones las alegaciones efectuadas, pero, por lo general, no hacen a su esencia. Como ya lo ha indicado esta Sala interpretando el artículo 139 de referencia, “se requiere que el recurso cuente con una fundamentación jurídica mínima ... deben explicarse las razones en las cuales sustenta su gestión, combatiendo los argumentos de derecho de la sentencia recurrida y consignando, al menos, alguna referencia normativa que le dé sustento” (Resolución no. 318-A-2008, de las 14 horas 25 minutos del 8 de mayo del 2008). La fundamentación es, por tanto, ajena al despliegue confuso de normas y alegatos; a la mezcla de argumentos ininteligibles o a la simple exposición de opiniones sobre la procedencia o justicia del caso, o bien, al recuento de los desaciertos que se consideran cometidos en la sentencia recurrida, sin respaldo en normas o criterios jurídicos. De allí que, si el recurso omite por completo esa relación técnico-normativa a la que se ha hecho referencia, o la que realiza, resulta impertinente o desvinculada al caso de manera manifiesta y evidente, habrá que entender que carece de “total fundamentación jurídica”, y por tanto, incumple el necesario requisito establecido en el numeral 139.3, que se sanciona con el rechazo de plano, a tenor de lo dispuesto en el artículo 140 inciso c) del mismo Código de rito. del mismo Código de referencia. De igual manera, esta Sala, en forma reiterada, ha señalado, para que un recurso pase el control de admisión, se precisa, además de la suficiente exposición de motivos, la correspondiente mención y vinculación con la sentencia cuestionada de las normas aplicables que se estimen infringidas. En este sentido pueden consultarse, entre otras resoluciones, las nos. 677-A-S1-2021 de las 09 horas 40 minutos del 25 de marzo de 2021 (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1029345); 755-A-S1-2022 de las 10 horas 55 minutos del 29 de marzo (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1082042); y 1663-A-S1-2022 de las 10 horas 05 minutos del 21 de julio (https://nexuspj.poder-judicial.go.cr/document/sen-1-0004-1112340) , ambas del año 2022.

XX.En esta línea de pensamiento, luego de un estudio concienzudo de la censura en estudio, esta Sala determina que la casacionista alegó dos hipótesis disímiles, pero, por la manera como se estructuró, resultan inseparables entre sí. En este sentido, en la página 14 del libelo indicó: “Se observa en el párrafo antes transcrito que, el Juez habla del resarcimiento de “la lesión sufrida” que obligó a la actora a recurrir a la interposición del recurso de amparo, pero no puntualiza cual [sic] es la lesión sufrida si es física o psicológica […]”. (Lo resaltado es del original). De darse lo señalado configuraría el motivo casacional por quebranto de normas procesales previsto en el inciso 1), punto d), del canon 137 del CPCA: falta de motivación. Luego, en las páginas 15 y 16 señaló: “Aunado a lo anterior, el juez de primera instancia, alejándose del principio de razonabilidad, determina que el hecho que se haya realizado el procedimiento médico, es insuficiente para hablar de justicia restaurativa en su totalidad, y que por ello debe haber también un resarcimiento económico […] En ese sentido, el juez de primera instancia viola de forma directa el principio de razonabilidad, al otorgar un extremo indemnizatorio aduciendo que la parte actora, también debía recibir una compensación monetaria, además de la ya recibida sustantivamente: la realización del procedimiento médico requerido. / Sobre ello, el juez Zeledón Hernández, viola el principio de razonabilidad, al no determinar que la indemnización incluye la restauración, y esta se produjo por la resolución judicial, ya que la usuaria del servicio de salud, recibió la atención médica requerida, por lo que deviene contrario a derecho, especialmente a dicho principio, que adicional a la restauración recibida, se le otorgue un monto adicional […] se evidencia de alguna forma, una posible existencia, se reitera, de un animus de condenar bajo cualquier escenario, lo cual se reitera, es contrario al principio de razonabilidad, toda vez que ello además de mermar los recursos con los que cuenta la Institución para brindar el servicio de salud, otorga una posición de privilegio a la persona que recibió la atención requerida, a cargo de quienes colaboren para que se brinde un adecuado servicio de salud. / Por lo anterior, otorgar una indemnización por concepto de daño moral, deviene en violatorio del principio de razonabilidad.” (Lo resaltado es del original). Lo ahora expuesto daría lugar al motivo de casación por quebranto de normas sustantivas anunciado, por el supuesto quebranto del principio constitucional de razonabilidad. La ambigüedad reseñada, riñe con la técnica de la casación, la cual impone que los motivos del recurso deben indicarse de manera clara y precisa, con la fundamentación fáctica y jurídica del caso (precepto 139 inciso 3) del CPCA). Ergo, se impone el rechazo de la objeción en estudio.

XXI.TERCERO. Lo argüido por la impugnante, tocante a la existencia de justicia restaurativa; así como la inexistencia de urgencia en la cita de la amparada y la improcedencia del otorgamiento de una indemnización por concepto de daño moral subjetivo, ya fue objeto de análisis en los apartados del VIII al XIII de esta sentencia, por lo que, a fin de evitar reiteraciones innecesarias, se remite a lo ahí expresado.

XXII.En el cuarto y último reproche, página 16, anunció la impugnante formularlo por el motivo casacional por quebranto de normas sustantivas previsto en el inciso c) del artículo 138 del CPCA. Alegó indebida aplicación del canon 193 íbid. En la sentencia impugnada, dijo, el Juez de Ejecución otorgó costas de la Ejecución de Sentencia. Estimó que la parte ejecutante tenía razones suficientes para litigar, al tener un derecho concedido en abstracto. No obstante, anotó, el indicado precepto -193 ibídem- establece que la parte vencida será exonerada del pago de las costas cuando, por la naturaleza de las cosas debatidas, haya existido motivo bastante para litigar. Transcribió, en lo de su interés, lo considerado en el apartado VI de la sentencia objetada, denominado “COSTAS DE LA EJECUCIÓN E INTERESES”. La sentencia impugnada, apuntó, tuvo claro que la ejecutante pidió, por daño moral subjetivo, un monto de ₡300.000,00, más la indemnización por materia de costas. Copió, en lo conducente, lo expuesto en el apartado I del fallo recurrido. En total, manifestó, la parte ejecutante peticionó, al menos, ₡481.500,00. El Juez, comentó, aplicó indebidamente el artículo 193 inciso 2) del CPCA, pues, dicha norma establece que la parte vencida podrá ser exonerada del pago de las costas cuando, por la naturaleza de las cuestiones debatidas, haya existido motivo suficiente para litigar. Tomando en consideración extremos meramente aritméticos, y solo los montos otorgados, representan un total de ₡231.500,00. Esto implica que, arguyó, del total pretendido, la parte ejecutante obtuvo un 48,07%, lo que acarrea, contrario sensu, que no obtuviera un 51,93% de lo que buscaba obtener. En consecuencia, alegó, se denota que su representada debía litigar. Logró, añadió, que la parte ejecutante no obtuviere el total de sus pretensiones. Por ello, se cuestionó, no entiende cómo no fue siquiera ínfimamente visualizado por el Juzgador, quien estimó que la parte vencedora tenía motivos suficientes para litigar, cuando debió haber valorado que era su representada quien tenía motivo suficiente para litigar. Máxime estando frente a una ejecución de sentencia de un derecho concedido en abstracto, donde se estaba ante un escenario de petitorias extremas, que implicaban que esa representación debía ejercer la defensa de los intereses institucionales. Si el Juez hubiera valorado lo anterior, expuso, habría determinado que su representada tenía motivos para litigar. Entre distintos elementos, señaló, se tienen los siguientes: 1) el monto total pretendido por la parte ejecutante correspondía a la suma de ₡481.500,00; ₡300.000,00 por el daño moral y ₡181.500,00 por las costas, por el plazo trascurrido de seis meses y quince días, en donde, incluso, médicamente nunca se catalogó como urgencia; 2) del monto total pretendido, se otorgó un 48.07% (₡50.000,00 por el daño moral y ₡181.500,00 por las costas), resultando que un 51.93% del total pretendido fue rechazado; 3) del monto por el daño moral subjetivo solicitado se otorgó la suma de ₡50,000,00, representando el 16,6% de lo inicialmente requerido; 4) se está ante una pretensión con evidente búsqueda de obtener extremos por encima de lo que se puede considerar, paralelo a la razonabilidad; 5) esta Sala, en la sentencia no. 1502-S1-2022, indicó que resulta irracional imponerle al fondo de contribución tripartito de la seguridad social y, a los demás asegurados beneficiados con dichos fondos, una indemnización adicional a quien ha consentido la espera y recibido, por tutela judicial, la atención médica requerida. Aunado a ello, brindó pautas para determinar si debe mediar o no indemnización, como lo es, si el tipo de patología de la paciente remite o no a una emergencia, o bien, la conformación con la inclusión en una lista de espera e, incluso, la indemnización “in natura”. Es decir, su representada partió de posiciones desarrolladas por esta Sala para litigar en el proceso, lo cual le fue señalado al Juez, sin que lo tomare en consideración. Por lo anterior, argumentó, es evidente que esa representación debía litigar en el proceso. No conforme con ello, el Juez decidió condenar en costas a su mandante, dejándola con ello en una clara posición de vulnerabilidad y desventaja, pues, el defender, incluso, la sostenibilidad financiera de la Institución, es claramente un motivo suficiente para litigar. No conforme con ello, insistió, el Juzgador condenó a su representada al pago de costas del proceso de ejecución. Por ello, señaló, se puede deducir, de forma directa, clara y sencilla, que su representada tenía motivos suficientes para litigar, en vista de que se estaba protegiendo, de forma efectiva, los principios de: legalidad, buena fe, lealtad entre partes y preclusión. Si se hubiera aplicado adecuadamente el artículo 193 inciso b) del CPCA, dijo, el Juez hubiera eximido a su mandante del pago de costas, dado que es evidente y manifiesto, concluyó, además de simple constatación, el hecho de que se tenía motivo suficiente para litigar.

XXIII.En torno a lo expuesto en el Considerando anterior, es menester indicar PRIMERO, el Juez de Ejecución, en el apartado VI de la sentencia cuestionada, señaló: “Conforme los artículos 119.2, 193 del Código Procesal Contencioso Administrativo, existiendo a criterio de este Juzgador razones suficientes para que la parte actora litigara en este proceso, ya que tenía un derecho concedido en abstracto por parte de la Sala Constitucional que podía venir a ejecutar a esta sede, se condena en costas a la demandada [sic] CCSS, rechazándose la excepción de falta de derecho de la partida liquidada. […]”. SEGUNDO, luego de un estudio pormenorizado del agravio, se determina que su meollo consiste en la alegada infracción, por errónea aplicación, del ordinal 193 inciso b) del CPCA, pues, a su juicio, por la naturaleza de las cuestiones debatidas, a su mandante le asistía suficiente motivo para litigar. Ello por cuanto, señaló, la ejecutante pretendió el pago de, al menos, ₡481.500,00, distribuidos de la siguiente manera: ₡181.500,00 por costas personales del recurso de amparo y ₡300.000,00 por el daño moral subjetivo. No obstante, el Juez de Ejecución, dijo, solo otorgó un total de ₡231.500,00 (₡181.500,00 por las costas personales del recurso de amparo y ₡50.000,00 por el daño moral subjetivo). Es decir, un 48.07% de lo pretendido. Al respecto, lo indicado daría lugar al motivo casacional anunciado, previsto en el inciso c) del precepto 138 del CPCA. No obstante, luego aludió a dos hipótesis disímiles más, resultando las tres indivisibles, por la manera cómo se formuló la objeción. En este sentido, en las páginas 17 y 18 indicó: “Sobre ello, y tomando en consideración extremos meramente ariméticos [sic], y solo tomando en consideración los montos otorgados, estos representan un total de ¢231.500,00 (doscientos treinta y mil quinientos colones), lo que implica que de lo total pretendido, la parte actora obtuvo un 48.07%, lo que acarrea, contrario sensu, que no obtuviera un 51.93% de lo que buscaba obtener, por lo que se denota que, en primera instancia, mi representada sí debía litigar el presente proceso [sic] e incluso, logró que la parte actora no obtuviere el total de sus pretensiones, lo cual, no se entiende cómo, no fue ni siquiera ínfimamente visualizado por el juez de primera instancia, quien, estima que la parte vencedora tenía motivos suficientes para litigar, cuando debió haber valorado que era mi representada quien tenía motivo suficiente para litigar el [sic] proceso de ejecución de sentencia, máxime estando frente a una ejecución de sentencia de un derecho concedido en abstracto, donde prácticamente se estaba ante un escenario de petitorias extremas, que implican que esta representación debiera ejercer sin discusión alguna, la defensa de los intereses institucionales. / Si el juez Zeledón Hernández hubiera valorado lo anterior, habría determinado que mi representada tenía motivos de sobra para litigar el proceso judicial, toda vez que, entre distintos elementos, se tienen los siguientes: […] La Sala Primera de la Corte Suprema de Justicia, en la sentencia N° 1502-S1-2022, indica que resulta irracional imponerle al fondo de contribución tripartito de la seguridad social y, a los demás asegurados beneficiados con dichos fondos, una indemnización adicional a quien ha consentido la espera y recibido por tutela judicial la atención médica requerida, y aunado a ello, otorgó pautas para determinar si debe mediar o no indemnización, como lo es si el tipo de patología de la paciente remite o no a una emergencia, o bien, la conformación con la inclusión en una lista de espera, e incluso, la indemnización in natura, es decir, mi representada partió de posiciones desarrolladas por la misma Sala Primera, para litigar el proceso, lo cual le fue señalado al juez de primera instancia, sin que la misma ni siquiera, lo tomare en consideración.” (Lo resaltado es del original). En lo ahora expuesto, la recurrente aludió al motivo casacional por quebranto de normas procesales, previsto en el artículo 137 inciso 1) punto d) del CPCA: falta de motivación. Empero, lo argüido es informal. La objetante omitió señalar la norma procesal conculcada, con la explicación clara y precisa, tal y como la técnica de la casación lo impone, según se indicó en el apartado XIX de esta sentencia, acorde a lo dispuesto en el ordinal 139 inciso 3) íbid. Por otro lado, en la página 18 agregó: “Por lo anterior, es evidente que esta representación debía litigar el proceso, y no conforme con ello, el juez de primera instancia decide condenar en costas a mi representada, dejándola con ello en una clara posición de vulnerabilidad y desventaja, toda vez que el defender incluso la sostenibilidad financiera de la Institución, es claramente un motivo suficiente para litigar, no conforme con ello, el Juez Zeledón Hernández, condena a mi representada al pago de costas del proceso de ejecución.” (Lo resaltado es del original). En lo ahora expuesto, se refiere al motivo de casación por violación de normas sustantivas previsto en el inciso d) del ordinal 138 del CPCA. La confusión puesta en evidencia, como se indicó, riñe con la técnica de la casación, la cual, según ya se ha indicado, impone que los reparos del recurso de casación se deben formular de manera clara y precisa (artículo 139 inciso 3) del CPCA); lo cual implica el rechazo del agravio en estudio.

XXIV.TERCERO. Acorde a lo expuesto en la contestación de la demanda, imágenes de la 29 a la 38 del expediente judicial electrónico, la apoderada general judicial de la CCSS alegó y solicitó que su mandante no debía ser condenada al pago del daño moral subjetivo. Ello, pese a lo resuelto por la Sala Constitucional, porque, en su criterio, a la amparada no se le negó el acceso a los servicios de salud, menos la atención médica. Además, según señaló, el diagnóstico de la amparada no era urgente. La amparada, expuso, no explicó en qué consistía el daño moral. Es decir, la ejecutante no cumplió con lo previsto en los ordinales 163 y 180 del CPCA. De igual manera, no acreditó el nexo causal entre lo que consta en el expediente y la situación fáctica en la que pretende fundamentar dicho daño. Es decir, no lo probó. Tampoco existen criterios técnicos que demuestren su existencia. Ergo, dicho rubro debía ser rechazado. Por su parte, el Juez de Ejecución, en la sentencia cuestionada, acorde a la transcripción efectuada en el apartado V de esta sentencia, estimó la procedencia del daño moral subjetivo, en virtud de su demostración “in re ipsa” con base en los hechos que sirvieron de base para el acogimiento del recurso de amparo. De conformidad con su prudente arbitrio, y a los principios de razonabilidad y proporcionalidad, fijó el monto en ₡50.000,00. Lo antes expuesto quiere decir, distinto a lo argüido por la casacionista, que la oposición planteada por la apoderada general de la CCSS resultó infructuosa. El Juzgador, se reitera, determinó la existencia del daño moral subjetivo en virtud de los hechos que sirvieron de base para el acogimiento del recurso de amparo, lo cual fue avalado por esta Cámara, según se expuso. Además, fijó su cuantía, como se indicó, acorde a su prudente arbitrio y al amparo de los principios indicados de razonabilidad y proporcionalidad, lo cual también fue compartido por esta Cámara. De igual manera, se otorgó el monto peticionado por costas personales del recurso de amparo. Asimismo, se concedieron los réditos legales sobre los montos concedidos y las costas del proceso de ejecución, tal y como se solicitó. Corolario, distinto a lo expuesto por la recurrente, y como bien fue resuelto, se imponía condenar al pago de las costas del proceso de ejecución, según lo dispone el canon 193 del CPCA, al no concurrir ninguno de los motivos de exoneración previstos en esa norma. CUARTO. Tal y como se apuntó en el apartado XXI de esta sentencia, lo indicado por la impugnante, tocante a la existencia de justicia restaurativa y la inexistencia de urgencia en la cita de la amparada, el haberse consentido en la espera y la improcedencia del otorgamiento de una indemnización por concepto de daño moral subjetivo, ya fue objeto de análisis en los apartados del VIII al XIII de esta sentencia, por lo que, a fin de evitar reiteraciones innecesarias, se remite a lo ahí expresado.

XXV.En mérito de las razones expuestas, se impone el rechazo del recurso interpuesto. De conformidad con lo expuesto en el artículo 150 inciso 3) del CPCA, al no considerar esta Sala que al ente casacionista le asista motivo suficiente para recurrir, por las razones expuestas al analizarse cada agravio, se le impondrá el reconocimiento de las costas del recurso de casación, las cuales deberán liquidarse en la fase de ejecución de la sentencia, a fin de garantizar el derecho de defensa de la parte ejecutada, dándosele la audiencia respectiva de la liquidación que se presente (artículos 41 y 153 de la Constitución Política).

XXVI.VOTO SALVADO DE LA MAGISTRADA ROJAS MORALES. Me apartó del criterio de mayoría, en cuanto estima procedente condenar a la demandada al pago del daño moral subjetivo en la suma de ¢50.000,00. Respecto de los daños y perjuicios que se derivan de un fallo de la Sala Constitucional, al declarar con lugar un recurso de amparo, conviene tener presente que, dada su naturaleza este tipo de sentencias contienen una condenatoria en abstracto, sin ninguna consideración fáctica, no prejuzga, por no haber sido objeto de análisis, sobre su existencia, ni su nexo de causalidad o cuantificación. Dicho Tribunal se limita a determinar la violación constitucional. Al ejecutar esos extremos debe establecerse la relación de causalidad entre lo declarado en abstracto y el asunto concreto. Así las cosas, el hecho de que la Sala Constitucional condene en abstracto al pago de daños y perjuicios, no trae aparejada una condenatoria automática a ejecutar, como mal parece entenderlo el Juez Ejecutor. Corresponde a los jueces encargados de resolver sobre la liquidación, valorar en cada caso concreto la existencia de mérito suficiente para conceder la indemnización peticionada. En esa dirección han de analizarse: las circunstancias particulares del caso, la posición de las partes, naturaleza, objeto y finalidad del resarcimiento, así como, los principios constitucionales de razonabilidad y proporcionalidad. Además, cuando el asunto verse sobre un supuesto daño moral subjetivo sufrido por una persona que enfrenta una falta de atención médica, como sucede en la especie, deviene indispensable el examen de aristas adicionales. En primer término, ha de valorarse el factor: urgencia, pues resulta evidente que no se encuentra en igual situación quien requiere, una atención urgente por parte de la CCSS, por ejemplo: aquel administrado que padece de un cáncer el cual avanza de manera irremediable, a quien presenta una dolencia, le ha sido prescrita una intervención quirúrgica o una cita médica sin carácter apremiante, en ambos casos el tiempo de espera para recibir el servicio médico no tiene el mismo resultado. Así tampoco, la afectación moral será de igual intensidad. Por otra parte, debe analizarse la inactividad del paciente por el trascurso del tiempo en la lista de espera (canon 30 inciso ch) de la Ley de la Jurisdicción Constitucional -LJC- y 38 del Código Procesal Contencioso Administrativo), la cual cesa cuando acude en amparo ante la Sala Constitucional o bien, a los tribunales de justicia, para reclamar la atención o el tratamiento médico que necesita (actividad administrativa). Tómese en cuenta, el trascurso del tiempo sin gestionar tiene en el ordenamiento jurídico costarricense consecuencias claras sobre la caducidad de la acción, aspecto valorable de oficio. No puede derivarse una ventaja pecuniaria de la inactividad, pues ello se enfrenta al principio de proporcionalidad en sentido estricto. En tercer lugar, ha de ponderarse la satisfacción que tiene la orden de un tribunal de justicia, mediante la cual se dispone la práctica de un acto médico o la entrega de medicamentos (aún sí surge en razón de una medida cautelar). Incluso, la más reciente jurisprudencia de la Sala Constitucional ha valorado la satisfacción generada a partir de la notificación del curso del amparo. Se trata de aquellos casos en que, con ocasión del amparo y al margen del tiempo trascurrido entre la interposición del recurso y la respuesta administrativa recibida, la autoridad recurrida reconoce al administrado la atención médica requerida (otorgando fecha cierta para una cirugía o consulta médica, brindando el medicamento necesitado, reprogramando una cita, etc). Casos, de última resolución vinculante erga omnes (según ordinal 13 de la LJC), en los que los Juzgadores Constitucionales han considerado improcedente condenar en costas, daños y perjuicios, resolviendo incluso sin condenatoria en esos aspectos; los que deben ser valorados por esta Cámara al pronunciarse sobre los procesos en curso. En ese sentido pueden consultarse, entre otras, las sentencia números: 2024-000017 de las 9 horas 15 minutos del 9 de enero de 2024, 2024-000026 de las 9 horas 15 minutos del 9 de enero de 2024 y 2024-006673 de las 9 horas 15 minutos del 8 de marzo de 2024. Valga destacar, otorgar el servicio médico requerido constituye una manifestación de justicia restaurativa, la que este Órgano Decisor debe valorar. La indemnización otorgada en infracción de los razonamientos enunciados se torna irrazonable y desproporcionada, máxime cuando en un sistema de seguridad social universal, como el costarricense, tales indemnizaciones las pagan todos los asegurados, inclusive aquellos desplazados por la ejecutante. Al examinar los aspectos descritos y el caso particular de la señora María de los Ángeles Carmona Castillo, deviene improcedente indemnizar la afectación anímica concedida en sentencia. Consta en autos, el 15 de noviembre de 2022, el Servicio de Ginecología del Hospital Maximiliano Peralta Jiménez de Cartago, le expidió a doña María de los Ángeles solicitud de hospitalización para cirugía, fecha a partir de la que ingresó a lista de espera. El 16 de mayo de 2023 acudió en amparo ante la Sala Constitucional, es decir; durante aproximadamente seis meses se mantuvo a la espera que se le programara la intervención. Hay que tomar en cuenta las posibilidades de la seguridad social en un área como la de Cirugía General, en que no hay suficientes especialistas que atiendan la población, máxime que la cantidad de personas que requieren intervención en esa área va en aumento. Por otra parte, interesa advertir, aun y cuando el Hospital Maximiliano Peralta Jiménez de Cartago le extendió orden de hospitalización para cirugía, no lo hizo con carácter urgente (así indicado en el informe técnico no. HMP-DG-1915-2023). Aunado a lo anterior, consta en Expediente Digital Único en Salud, a la ejecutante le fue satisfecho el requerimiento de atención médica, toda vez que la cirugía se realizó el 13 de setiembre de 2023, lo que implica una atención en un plazo razonable, dadas las condiciones apuntadas. Véase, el tiempo de espera que soportó doña María de los Ángeles para recibir la atención necesitada fueron alrededor de cuatro meses, contados desde que interpuso el recurso de amparo el 16 de mayo de 2023 y hasta que fue intervenida quirúrgicamente el 13 de setiembre siguiente. Incluso, el plazo es menor si se toma en cuenta que el fallo ejecutoriado se notificó el 5 de junio de 2023. Plazos de suyos razonables desde el punto de vista de la prestación de un servicio no urgente y ante la necesidad de cumplir los requisitos preoperatorios que trae aparejada toda intervención quirúrgica. Téngase presente, a partir de la interposición del amparo la ejecutante nunca fue sometido a una espera prolongada o indefinida. La atención médica la recibió en un plazo más que razonable (inclusive menor a los periodos de atención en la medicina privada). Sin obviar, que la cirugía le fue programada sin carácter de urgencia. Lo anterior dice de la inexistencia del daño liquidado. Valga acotar, en casos como el de estudio, no cabe duda, la satisfacción de la usuaria ya se generó, por lo tanto, deviene contrario a derecho otorgar una indemnización adicional a la recibida (valoración médica en derogación singular de la lista de espera). Lo anterior, lejos de causarle una afectación moral a la ejecutante, le otorgó un privilegio sobre los demás asegurados, lo cual desmerece el reclamo por daño moral planteado. Resulta irracional imponerle al fondo de contribución tripartito de la seguridad social y, a los demás asegurados beneficiados con dichos fondos, una indemnización adicional a quien ha recibido por tutela judicial la atención médica requerida. Por las razones indicadas, la indemnización concedida no se ajusta a criterios de razonabilidad y proporcionalidad (fijados por la propia Sala Constitucional). En mérito de lo expuesto, estima la suscrita, lo procedente era acoger los agravios primero y segundo del recurso interpuesto y en consecuencia, anular el fallo impugnado -solo- en cuanto reconoció el monto de ¢50.000,00 por concepto de daño moral subjetivo, para en su lugar, fallando por el fondo, rechazar dicho extremo.

POR TANTO

Por mayoría, se declara sin lugar el recurso, con sus costas a cargo del ente casacionista, Caja Costarricense de Seguro Social, las cuales se liquidarán en la etapa de ejecución de sentencia. La magistrada Rojas Morales salva el voto para acoger el recurso en virtud de haberse configurado la justicia restaurativa.

Luis Guillermo Rivas Loaiciga Rocío Rojas Morales Damaris Vargas Vásquez Jorge Leiva Poveda Carlos Guillermo Zamora Campos Documento Firmado Digitalmente -- Código verificador -- 