{ "id": "nexus-ext-1-0007-127041", "citation": "Res. 00457-2009 Sala Constitucional", "section": "nexus_decisions", "doc_type": "constitutional_decision", "title_es": "Derecho a la salud y eficiencia en servicios médicos de la CCSS", "title_en": "Right to Health and Efficiency in CCSS Medical Services", "summary_es": "La Sala Constitucional conoció un recurso de amparo contra la Caja Costarricense de Seguro Social por la falta de citación oportuna para exámenes preoperatorios a un paciente con prostatismo y dolor pélvico, referido al Hospital San Juan de Dios. La Sala determinó que la omisión de programar debidamente la cita lesionó el derecho fundamental a la salud, tutelado en el artículo 21 de la Constitución. Se reiteró que los servicios públicos de salud deben prestarse con eficiencia, eficacia, continuidad, regularidad y celeridad, sin que la carencia de recursos humanos o materiales justifique su incumplimiento. Asimismo, se recordó la responsabilidad personal de los jerarcas institucionales, conforme los artículos 190 y 199 de la Ley General de la Administración Pública, por la falta de servicio y los daños causados. Se declaró con lugar el amparo, ordenando al hospital coordinar de inmediato la atención prioritaria requerida y condenando a la CCSS al pago de costas, daños y perjuicios.", "summary_en": "The Constitutional Chamber heard an amparo action against the Costa Rican Social Security Fund (CCSS) for failure to timely schedule preoperative exams for a patient with prostatism and pelvic pain referred to Hospital San Juan de Dios. The Chamber found the omission violated the fundamental right to health enshrined in Article 21 of the Constitution. It reaffirmed that public health services must be provided with efficiency, effectiveness, continuity, regularity, and speed, and that lack of human or material resources does not excuse noncompliance. It also recalled the personal liability of institutional heads under Articles 190 and 199 of the General Public Administration Act for deficient service and resulting damages. The amparo was granted, ordering the hospital to immediately coordinate the required priority care and condemning the CCSS to pay costs, damages, and losses.", "court_or_agency": "Sala Constitucional", "date": "2009", "year": "2009", "topic_ids": [ "_off-topic" ], "primary_topic_id": "_off-topic", "es_concept_hints": [ "amparo", "CCSS", "lista de espera", "falta de servicio", "responsabilidad patrimonial", "Ley General de la Administración Pública" ], "concept_anchors": [ { "article": "Art. 21", "law": "Constitución Política" }, { "article": "Art. 190", "law": "Ley General de la Administración Pública" }, { "article": "Art. 199", "law": "Ley General de la Administración Pública" } ], "keywords_es": [ "amparo", "derecho a la salud", "Caja Costarricense de Seguro Social", "CCSS", "Hospital San Juan de Dios", "listas de espera", "eficiencia", "falta de servicio", "responsabilidad administrativa", "daños y perjuicios" ], "keywords_en": [ "amparo", "right to health", "Costa Rican Social Security Fund", "CCSS", "Hospital San Juan de Dios", "waiting lists", "efficiency", "lack of service", "administrative liability", "damages and losses" ], "excerpt_es": "Los jerarcas de las Clínicas y Hospitales no pueden invocar, para justificar una atención deficiente y precaria de los pacientes, el problema de las “listas de espera” para las intervenciones quirúrgicas y aplicación de ciertos exámenes especializados o de la carencia de recursos financieros, humanos y técnicos, puesto que, es un imperativo constitucional que los servicios de salud pública sean prestados de forma eficiente, eficaz, continua, regular y célere. Los jerarcas de la Caja Costarricense de Seguro Social y los Directores de Hospitales y Clínicas que les pertenecen están en el deber y, por consiguiente son los personalmente responsables -en los términos del artículo 199 y siguientes de la Ley General de la Administración Pública-, de adoptar e implementar todas las providencias y medidas administrativas y organizacionales para poner coto definitivo a la prestación tardía –la cual, en ocasiones, deviene en omisa por sus consecuencias- de los servicios de salud, situación que constituye, a todas luces, una inequívoca falta de servicio que puede dar lugar a la responsabilidad administrativa patrimonial de esa entidad por las lesiones antijurídicas provocadas a los administrados o usuarios (artículos 190 y siguientes de la Ley General de la Administración Pública).", "excerpt_en": "Heads of Clinics and Hospitals cannot invoke, to justify deficient and precarious patient care, the problem of 'waiting lists' for surgical interventions and certain specialized tests or the lack of financial, human, and technical resources, because it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and swift manner. The heads of the Costa Rican Social Security Fund and the Directors of its Hospitals and Clinics have the duty and, consequently, are personally responsible—under the terms of Article 199 and following of the General Public Administration Act—for adopting and implementing all administrative and organizational measures to definitively end the delayed provision—which at times becomes effectively omitted due to its consequences—of health services, a situation that clearly constitutes an unequivocal lack of service that may give rise to the entity's administrative patrimonial liability for the unlawful harm caused to the administered parties or users (Article 190 and following of the General Public Administration Act).", "outcome": { "label_en": "Granted", "label_es": "Con lugar", "summary_en": "The amparo was granted for violation of the right to health due to failure to timely schedule preoperative exams, ordering immediate coordination of priority care and condemning the CCSS to pay costs, damages, and losses.", "summary_es": "Se concedió el amparo por violación al derecho a la salud debido a la falta de citación oportuna para exámenes preoperatorios, ordenando coordinar la atención prioritaria y condenando a la CCSS al pago de costas, daños y perjuicios." }, "pull_quotes": [ { "context": "Considerando III", "quote_en": "Public bodies and entities providing public health services have the imperative and unpostponable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those requiring immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling that obligation.", "quote_es": "Los órganos y entes públicos que prestan servicios de salud pública tienen la obligación imperativa e impostergable de adaptarlos a las necesidades particulares y específicas de sus usuarios o pacientes y, sobre todo, de aquellos que demandan una atención médica inmediata y urgente, sin que la carencia de recursos humanos y materiales sean argumentos jurídicamente válidos para eximirlos del cumplimiento de tal obligación." }, { "context": "Considerando III", "quote_en": "Heads of Clinics and Hospitals cannot invoke, to justify deficient and precarious patient care, the problem of 'waiting lists' for surgical interventions and certain specialized tests or the lack of financial, human, and technical resources, because it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and swift manner.", "quote_es": "Los jerarcas de las Clínicas y Hospitales no pueden invocar, para justificar una atención deficiente y precaria de los pacientes, el problema de las “listas de espera” para las intervenciones quirúrgicas y aplicación de ciertos exámenes especializados o de la carencia de recursos financieros, humanos y técnicos, puesto que, es un imperativo constitucional que los servicios de salud pública sean prestados de forma eficiente, eficaz, continua, regular y célere." } ], "cites": [], "cited_by": [], "references": { "internal": [], "external": [] }, "source_url": "https://nexuspj.poder-judicial.go.cr/document/ext-1-0007-127041", "tier": 2, "_editorial_citation_count": 0, "regulations_by_article": null, "amendments_by_article": null, "dictamen_by_article": null, "concordancias_by_article": null, "afectaciones_by_article": null, "resoluciones_by_article": null, "cited_by_votos": [], "cited_norms": [], "cited_norms_inverted": [ { "doc_id": "norm-13231", "norm_num": "6227", "norm_name": "Ley General de la Administración Pública", "tipo_norma": "Ley", "norm_fecha": "02/05/1978" }, { "doc_id": "norm-38533", "norm_num": "7135", "norm_name": "Ley de la Jurisdicción Constitucional", "tipo_norma": "Ley", "norm_fecha": "11/10/1989" }, { "doc_id": "norm-871", "norm_num": "0", "norm_name": "Derecho a un ambiente sano y ecológicamente equilibrado — Artículo 50 de la Constitución Política", "tipo_norma": "Constitución Política", "norm_fecha": "07/11/1949" } ], "sentencias_relacionadas": [], "temas_y_subtemas": [], "cascade_only": false, "amendment_count": 0, "body_es_text": "“…II.- Derecho fundamental a la salud. El derecho\r\na la vida reconocido en el numeral 21 de la Constitución es la piedra angular\r\nsobre la cual descansan el resto de los derechos fundamentales de los\r\nhabitantes de la república. De igual forma, en ese ordinal de la carta política\r\nencuentra asidero el derecho a la salud, puesto que, la vida resulta\r\ninconcebible si no se le garantizan a la persona humana condiciones mínimas\r\npara un adecuado y armónico equilibrio psíquico, físico y ambiental.\r\nEvidentemente, cualquier retardo de los hospitales, clínicas y demás unidades\r\nde atención sanitaria de la Caja Costarricense del Seguro Social puede\r\nrepercutir negativamente en la preservación de la salud y la vida de sus\r\nusuarios. Los entes, órganos y funcionarios públicos se deben a los usuarios\r\ncon una clara e inequívoca vocación de servicio, puesto que, esa ha sido la\r\nrazón de su creación y existencia. (Sobre el particular, bien se puede\r\nconsultar la sentencia N°2007-07486 de las 16:55 hrs.\r\nde 29 de mayo de 2007). \n\r\n\r\n\nIII.- Eficiencia, eficacia, continuidad,\r\nregularidad y adaptación en los servicios públicos de salud. Los órganos y\r\nentes públicos que prestan servicios de salud pública tienen la obligación\r\nimperativa e impostergable de adaptarlos a las necesidades particulares y\r\nespecíficas de sus usuarios o pacientes y, sobre todo, de aquellos que demandan\r\nuna atención médica inmediata y urgente, sin que la carencia de recursos\r\nhumanos y materiales sean argumentos jurídicamente válidos para eximirlos del\r\ncumplimiento de tal obligación. Desde esta perspectiva, los servicios de las\r\nclínicas y hospitales de la Caja Costarricense de Seguro Social están en el\r\ndeber de adoptar e implementar los cambios organizacionales, de contratar el\r\npersonal médico o auxiliar y de adquirir los materiales y equipo técnico que\r\nsean requeridos para brindar prestaciones eficientes, eficaces y rápidas. Los\r\njerarcas de las Clínicas y Hospitales no pueden invocar, para justificar una\r\natención deficiente y precaria de los pacientes, el problema de las “listas de\r\nespera” para las intervenciones quirúrgicas y aplicación de ciertos exámenes\r\nespecializados o de la carencia de recursos financieros, humanos y técnicos,\r\npuesto que, es un imperativo constitucional que los servicios de salud pública\r\nsean prestados de forma eficiente, eficaz, continua, regular y célere. Los\r\njerarcas de la Caja Costarricense de Seguro Social y los Directores de\r\nHospitales y Clínicas que les pertenecen están en el deber y, por consiguiente\r\nson los personalmente responsables -en los términos del artículo 199 y\r\nsiguientes de la Ley General de la Administración Pública-, de adoptar e\r\nimplementar todas las providencias y medidas administrativas y organizacionales\r\npara poner coto definitivo a la prestación tardía –la cual, en ocasiones,\r\ndeviene en omisa por sus consecuencias- de los servicios de salud, situación\r\nque constituye, a todas luces, una inequívoca falta de servicio que puede dar\r\nlugar a la responsabilidad administrativa patrimonial de esa entidad por las\r\nlesiones antijurídicas provocadas a los administrados o usuarios (artículos 190\r\ny siguientes de la Ley General de la Administración Pública). \n\r\n\r\n\nIV.- Caso concreto. De la relación de hechos\r\nprobados de esta sentencia, como del informe rendido por las autoridades\r\nrecurridas, se tiene por demostrado que el amparado fue atendido por Yesenia María Madrigal Mora, Médica del Área de Salud Puriscal-Turrubares, por prostatismo y dolor pélvico. En la última ocasión, por\r\ntratarse de tejido incógnito, hemograma normal, dolor\r\nno aliviado completamente con analgésicos y hematuria macroscópica, refirió al\r\nrecurrente a emergencias quirúrgicas del Hospital San Juan de Dios.\r\nPrecisamente, el 5 de junio de 2007, el accionante\r\nfue atendido en Consulta Externa del Servicio de Urología del Hospital San Juan\r\nde Dios, ocasión en la que el médico tratante, Dr. Orlando Ordóñez, ordenó\r\ntrámites preoperatorios. Sin embargo, a la fecha en que las autoridades\r\nrecurridas rindieron los informes de ley, en el expediente médico del\r\nrecurrente no existía documento alguno que acreditara si había asistido o no a\r\nrealizarse los exámenes preoperatorios. Ante tal situación, la Sala concluye que\r\nal amparado no se le ha citado de la manera debida para que se practique los\r\nexámenes en mención, a pesar de que su caso amerita tratamiento prioritario.\r\nTal situación lesiona el derecho constitucional a la salud, motivo por el que\r\neste proceso de constitucionalidad deviene del todo procedente. Ahora bien,\r\ndado que las autoridades médicas aseguran que con posterioridad a la\r\ninterposición del amparo, infructuosamente han tratado de localizar por\r\nteléfono al reclamante a fin de tramitar la atención debida, se advierte a los\r\nrecurridos que en este amparo, el petente señaló como\r\nmedios para localizarle los números telefónicos 88540928, 83412549 y 24165582,\r\nasí como el fax número 24166073 y el Bufete Morelli y\r\nAsociados, ubicado 75 metros al\r\nnorte de la esquina noreste del Edificio de la Corte Suprema de Justicia.”", "body_en_text": "“…II.- Fundamental right to health. The right to life recognized in numeral 21 of the Constitution is the cornerstone upon which the rest of the fundamental rights of the inhabitants of the republic rest. Likewise, in that article of the political charter, the right to health finds its basis, since life is inconceivable if the human person is not guaranteed minimum conditions for an adequate and harmonious psychic, physical, and environmental balance. Evidently, any delay by the hospitals, clinics, and other healthcare units of the Caja Costarricense del Seguro Social can negatively impact the preservation of the health and life of its users. Public entities, organs, and officials owe themselves to the users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence. (On this matter, one may well consult judgment N°2007-07486 of 16:55 hrs. of 29 May 2007).\n\nIII.- Efficiency, efficacy, continuity, regularity, and adaptation in public health services. The public organs and entities that provide public health services have the imperative and unpostponable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those who demand immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling such obligation. From this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social have the duty to adopt and implement organizational changes, to hire medical or auxiliary personnel, and to acquire the materials and technical equipment that are required to provide efficient, effective, and fast services. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious care of patients, the problem of “waiting lists” for surgical interventions and the performance of certain specialized examinations or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and swift manner. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics belonging to it have the duty and, consequently, are personally responsible —in the terms of Article 199 and following of the Ley General de la Administración Pública— for adopting and implementing all administrative and organizational measures and provisions to put a definitive end to the late provision —which, on occasions, becomes negligent due to its consequences— of health services, a situation that constitutes, by all accounts, an unequivocal lack of service (falta de servicio) that can give rise to the patrimonial administrative liability of that entity for the unlawful injuries caused to the administered parties or users (Articles 190 and following of the Ley General de la Administración Pública).\n\nIV.- Specific case. From the list of proven facts of this judgment, as well as from the report rendered by the respondent authorities, it is deemed demonstrated that the petitioner was attended by Yesenia María Madrigal Mora, Physician of the Puriscal-Turrubares Health Area, for prostatism and pelvic pain. On the last occasion, due to it being unknown tissue, normal hemogram, pain not completely relieved with analgesics, and macroscopic hematuria, she referred the petitioner to surgical emergencies of the Hospital San Juan de Dios. Precisely, on 5 June 2007, the complainant was attended in the External Consultation of the Urology Service of the Hospital San Juan de Dios, on which occasion the treating physician, Dr. Orlando Ordóñez, ordered preoperative procedures. However, as of the date when the respondent authorities rendered their statutory reports, in the petitioner's medical file there was no document whatsoever accrediting whether or not he had attended to undergo the preoperative examinations. In view of this situation, the Chamber concludes that the petitioner has not been properly summoned to undergo the examinations in question, even though his case warrants priority treatment. Such a situation injures the constitutional right to health, for which reason this constitutional proceeding is entirely admissible. That being so, given that the medical authorities affirm that after the amparo petition was filed, they have unsuccessfully tried to locate the complainant by telephone in order to process the due care, the respondents are advised that in this amparo petition, the claimant indicated as means to locate him the telephone numbers 88540928, 83412549, and 24165582, as well as the fax number 24166073 and the Bufete Morelli y Asociados, located 75 meters north of the northeast corner of the Building of the Corte Suprema de Justicia.”\n\nFrom this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social are duty-bound to adopt and implement organizational changes, to hire medical or auxiliary personnel, and to acquire the materials and technical equipment that are required to provide efficient, effective, and swift benefits. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious patient care, the problem of “waiting lists” for surgical interventions and the application of certain specialized examinations or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided efficiently, effectively, continuously, regularly, and speedily. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics that belong to it are duty-bound, and consequently are personally responsible —pursuant to Article 199 and following of the Ley General de la Administración Pública— for adopting and implementing all administrative and organizational measures and steps to definitively put an end to the delayed provision —which, on occasion, becomes negligent due to its consequences— of health services, a situation that constitutes, by all appearances, an unmistakable lack of service that may give rise to the administrative pecuniary liability of that entity for the unlawful harm caused to the administered parties or users (Articles 190 and following of the Ley General de la Administración Pública).\n\nIV.- Specific case. From the recital of proven facts of this judgment, as well as the report provided by the respondent authorities, it is established that the protected party was attended by Yesenia María Madrigal Mora, a physician of the Puriscal-Turrubares Health Area, for prostatism (prostatismo) and pelvic pain. On the last occasion, due to unknown tissue, normal complete blood count (hemograma), pain not completely relieved by analgesics, and macroscopic hematuria, she referred the appellant to surgical emergencies at Hospital San Juan de Dios. Specifically, on June 5, 2007, the plaintiff was seen in the Outpatient Clinic of the Urology Service of Hospital San Juan de Dios, on which occasion the treating physician, Dr. Orlando Ordóñez, ordered preoperative procedures. However, as of the date the respondent authorities submitted the legal reports, there was no document whatsoever in the plaintiff’s medical record that certified whether or not he had attended to undergo the preoperative examinations. In view of this situation, the Chamber concludes that the protected party has not been duly summoned to undergo the aforementioned examinations, even though his case merits priority treatment. This situation violates the constitutional right to health, which is the reason this constitutional process is entirely appropriate. Now, given that the medical authorities assure that subsequent to the filing of the amparo petition, they have unsuccessfully tried to locate the claimant by telephone in order to process the due care, the respondents are advised that in this amparo petition, the applicant provided as means of contacting him the telephone numbers 88540928, 83412549, and 24165582, as well as the fax number 24166073 and the Bufete Morelli y Asociados, located 75 meters north of the northeast corner of the Edificio de la Corte Suprema de Justicia.”" }