{
  "id": "nexus-ext-1-0007-127981",
  "citation": "Res. 02580-2009 Sala Constitucional",
  "section": "nexus_decisions",
  "doc_type": "constitutional_decision",
  "title_es": "Amparo por reprogramación de cirugía ante falta de camas hospitalarias",
  "title_en": "Amparo for repeated surgery postponement due to lack of hospital beds",
  "summary_es": "La Sala Constitucional conoce un recurso de amparo contra el Hospital Max Peralta de Cartago por la reprogramación reiterada de una cirugía programada para extirpar un tumor benigno en la glándula salival izquierda. La recurrente alega que desde abril de 2008 se le ha reprogramado en cuatro ocasiones, sin que se haya realizado la intervención, aduciendo falta de camillas. La Sala recuerda su jurisprudencia consolidada: el derecho a la salud, derivado del artículo 21 constitucional, obliga a los servicios públicos de salud a ser eficientes, eficaces, continuos, regulares y céleres, y la carencia de recursos materiales, humanos o presupuestarios no es excusa válida para incumplir esa obligación. En el caso concreto, tras más de nueve meses de espera injustificada, se constata la lesión del derecho a la salud. Se ordena a las autoridades del hospital realizar la cirugía en la fecha de la última reprogramación (17 de febrero de 2009) y se condena a la Caja Costarricense de Seguro Social al pago de costas, daños y perjuicios.",
  "summary_en": "The Sala Constitucional hears an amparo against Hospital Max Peralta in Cartago for persistently rescheduling a surgery to remove a benign tumor in the left salivary gland. The plaintiff claims that since April 2008 the surgery has been postponed four times due to lack of beds. The Chamber reaffirms its settled case law: the right to health, derived from Article 21 of the Constitution, requires public health services to be efficient, effective, continuous, regular, and swift; a lack of material, human, or budgetary resources is no valid excuse for non-compliance. In this case, after more than nine months of unjustified delay, the Chamber finds a violation of the right to health. It orders the hospital to perform the surgery on the last rescheduled date (February 17, 2009) and imposes costs, damages, and compensation on the Costa Rican Social Security Fund.",
  "court_or_agency": "Sala Constitucional",
  "date": "2009",
  "year": "2009",
  "topic_ids": [
    "_off-topic"
  ],
  "primary_topic_id": "_off-topic",
  "es_concept_hints": [
    "CCSS",
    "amparo",
    "recurso de amparo",
    "Sala Constitucional",
    "camillas",
    "listas de espera",
    "condena en costas, daños y perjuicios"
  ],
  "concept_anchors": [
    {
      "article": "Art. 21",
      "law": "Constitución Política"
    },
    {
      "article": "Art. 199",
      "law": "Ley General de la Administración Pública"
    },
    {
      "article": "Art. 190",
      "law": "Ley General de la Administración Pública"
    }
  ],
  "keywords_es": [
    "amparo",
    "derecho a la salud",
    "cirugía reprogramada",
    "falta de camas",
    "CCSS",
    "eficiencia servicio público",
    "lista de espera",
    "Sala Constitucional",
    "recurso de amparo",
    "voto 02580-2009",
    "condena en costas"
  ],
  "keywords_en": [
    "amparo",
    "right to health",
    "postponed surgery",
    "lack of beds",
    "CCSS",
    "efficiency of public service",
    "waiting list",
    "Sala Constitucional",
    "amparo appeal",
    "decision 02580-2009",
    "award of costs"
  ],
  "excerpt_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.\n\nEs reiterada la Jurisprudencia de este Tribunal la cual ha señalado enfáticamente que la carencia de recursos humanos y materiales, así como de presupuesto, no es argumento válido que exima a las autoridades de brindar un servicio de salud eficiente.",
  "excerpt_en": "The public bodies and entities that provide public health services have the imperative and non-deferrable obligation to adapt them to the particular and specific needs of their users or patients, especially 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 that obligation.\n\nIt is settled case law of this Tribunal that the lack of human and material resources, as well as budget, is not a valid argument to exempt authorities from providing an efficient health service.",
  "outcome": {
    "label_en": "Granted",
    "label_es": "Con lugar",
    "summary_en": "The amparo is granted for violation of the right to health; Hospital Max Peralta is ordered to perform the surgery rescheduled for February 17, 2009, and the CCSS is ordered to pay costs, damages, and compensation.",
    "summary_es": "Se declara con lugar el amparo por violación del derecho a la salud; se ordena al Hospital Max Peralta realizar la cirugía reprogramada al 17 de febrero de 2009 y se condena a la CCSS al pago de costas, daños y perjuicios."
  },
  "pull_quotes": [
    {
      "context": "Considerando V",
      "quote_en": "The lack of human and material resources, as well as budget, is not a valid argument to exempt authorities from providing an efficient health service.",
      "quote_es": "La carencia de recursos humanos y materiales, así como de presupuesto, no es argumento válido que exima a las autoridades de brindar un servicio de salud eficiente."
    },
    {
      "context": "Considerando III",
      "quote_en": "Public entities, bodies, and officials owe themselves to users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence.",
      "quote_es": "Los entes, órganos y funcionarios públicos se deben a los usuarios con una clara e inequívoca vocación de servicio, puesto que, esa ha sido la razón de su creación y existencia."
    },
    {
      "context": "Considerando V",
      "quote_en": "The time elapsed without the authorities being able to coordinate accordingly […] is clearly excessive and violates her fundamental rights.",
      "quote_es": "El tiempo transcurrido sin que las autoridades hayan sido capaces de coordinar lo correspondiente […] resulta a todas luces excesivo y violatorio de sus derechos fundamentales."
    },
    {
      "context": "Considerando III",
      "quote_en": "Any delay by hospitals […] can negatively impact the preservation of the health and life of their users.",
      "quote_es": "Cualquier retardo de los hospitales […] puede repercutir negativamente en la preservación de la salud y la vida de sus usuarios."
    }
  ],
  "cites": [],
  "cited_by": [],
  "references": {
    "internal": [],
    "external": []
  },
  "source_url": "https://nexuspj.poder-judicial.go.cr/document/ext-1-0007-127981",
  "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.- Objeto del recurso. La recurrente acude a esta\r\nSala, acusando que desde el veintitrés de abril del año anterior, se le\r\nprogramó cirugía en el Hospital recurrido, a fin de operarse de un tumor\r\nbenigno en su glándula salival izquierda. Señala que en cuatro ocasiones se le\r\nha reprogramado la cirugía con la justificante de que no hay camillas, de tal\r\nforma que a la fecha de interposición del amparo, no ha sido operada. \n\r\n\r\n\nIII.- Sobre el derecho 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. \n\r\n\r\n\n IV.- 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\nV.- Caso\r\nConcreto. Tal y como ha quedado debidamente acreditado, a la recurrente se\r\nle programó cirugía para el veintitrés de abril del dos mil ocho, con el fin de\r\neliminarle un tumor benigno en su glándula salival izquierda. Sin embargo,\r\ndesde ese día, se le ha venido reprogramando la cirugía con el argumento de que\r\nno hay camas disponibles. Por su parte las autoridades recurridas informaron\r\nque en el Hospital se ha estado dando un grave problema en cuanto a la gran\r\ndemanda de cirugías programadas y la cantidad de camillas existentes. Considera\r\nesta Sala que si bien existe un faltante de camillas en el Hospital, ello no da\r\nrazón para que luego de más de nueve meses transcurridos desde que se programó\r\nla cirugía, esta no se haya llevado a cabo. Es reiterada la Jurisprudencia de\r\neste Tribunal la cual ha señalado enfáticamente que la carencia de recursos\r\nhumanos y materiales, así como de presupuesto, no es argumento válido que exima\r\na las autoridades de brindar un servicio de salud eficiente. Por otro lado,\r\nnótese que no se trata de que a la amparada se le haya puesto en lista de espera,\r\nsino que su cirugía ya se encontraba programada y reprogramada en tres\r\nocasiones luego de la primera vez. En este sentido este Tribunal verifica la\r\nlesión al derecho a la salud de la recurrente toda vez que el tiempo\r\ntranscurrido sin que las autoridades hayan sido capaces de coordinar lo\r\ncorrespondiente así como de adoptar las medidas necesarias a fin de operar a la\r\namparada dentro de las fechas programadas al efecto, resulta a todas luces\r\nexcesivo y violatorio de sus derechos fundamentales. \n\r\n\r\n\nVI.- En\r\notro orden de ideas, según el informe rendido bajo juramento por las\r\nautoridades recurridas, la última reprogramación de la cirugía de la paciente\r\nestá para el diecisiete de febrero del dos mil nueve, razón por la cual,\r\ncorresponde ordenar a las autoridades médicas del Hospital Max\r\nPeralta de Cartago, realizar a la cirugía ese día, tal y como esta programado,\r\npara con ello, no causar mayor perjuicio a la amparada.”",
  "body_en_text": "“…**II.- Purpose of the remedy (amparo).** The petitioner comes before this Chamber, alleging that since April twenty-third of the previous year, surgery was scheduled at the respondent Hospital in order to operate on a benign tumor in her left salivary gland. She states that on four occasions the surgery has been rescheduled with the justification that there are no gurneys available, such that as of the date of filing this amparo, she has not been operated on.\n\n**III.- On the right to health.** The right to life recognized in Article 21 of the Constitution is the cornerstone upon which the rest of the fundamental rights of the inhabitants of the republic rest. Likewise, the right to health finds its basis in that provision of the political charter, since life is inconceivable if minimum conditions for an adequate and harmonious psychic, physical, and environmental balance are not guaranteed to the human person. Evidently, any delay by the hospitals, clinics, and other healthcare units of the Caja Costarricense del Seguro Social can negatively impact the preservation of the health and life of its users. Public entities, bodies, and officials owe themselves to the users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence.\n\n**IV.- Efficiency, Effectiveness, Continuity, Regularity, and Adaptation in Public Health Services.** The public bodies and entities that provide public health services have the imperative and unpostponable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those who demand immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling such obligation. From this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social are under the duty to adopt and implement organizational changes, to hire medical or auxiliary staff, and to acquire the materials and technical equipment required to provide efficient, effective, and prompt services. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious care for patients, the problem of “waiting lists” for surgical interventions and the application of certain specialized examinations, or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and swift manner. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics belonging to it are under the duty and, consequently, are personally responsible—under the terms of Article 199 and following of the Ley General de la Administración Pública—for adopting and implementing all administrative and organizational measures and actions to definitively put a stop to the delayed provision—which, on occasions, becomes negligent due to its consequences—of health services, a situation that constitutes, clearly, an unequivocal lack of service that can give rise to the patrimonial administrative liability of that entity for the unlawful injuries caused to the administered parties or users (Articles 190 and following of the Ley General de la Administración Pública).\n\n**V.- Specific Case.** As has been duly accredited, surgery was scheduled for the petitioner on April twenty-third, two thousand eight, for the purpose of removing a benign tumor in her left salivary gland. However, since that day, her surgery has been repeatedly rescheduled on the grounds that there are no beds available. For their part, the respondent authorities reported that the Hospital has been experiencing a serious problem regarding the high demand for scheduled surgeries and the number of existing gurneys. This Chamber considers that while there is a shortage of gurneys at the Hospital, this does not justify that, after more than nine months have elapsed since the surgery was scheduled, it has not yet been carried out. The jurisprudence of this Court has been reiterated, emphatically stating that the lack of human and material resources, as well as budget, is not a valid argument to exempt the authorities from providing efficient health service. On the other hand, it should be noted that this is not a case where the protected party was placed on a waiting list, but rather that her surgery was already scheduled and rescheduled on three occasions after the first time. In this sense, this Court verifies the violation of the petitioner's right to health, since the time elapsed without the authorities having been able to coordinate the corresponding actions and adopt the necessary measures to operate on the protected party within the dates scheduled for that purpose is clearly excessive and violates her fundamental rights.\n\n**VI.-** In another vein, according to the report rendered under oath by the respondent authorities, the last rescheduling of the patient's surgery is set for February seventeenth, two thousand nine, for which reason it is appropriate to order the medical authorities of the Hospital Max Peralta de Cartago to perform the surgery on that day, as scheduled, in order to avoid causing further harm to the protected party.”\n\nThe appellant comes before this Chamber, alleging that since April twenty-third of the previous year, surgery was scheduled for her at the respondent Hospital in order to operate on a benign tumor in her left salivary gland. She states that on four occasions her surgery has been rescheduled with the justification that there are no stretchers (camillas), such that as of the date of filing of the amparo, she has not been operated on.\n\n**III.- On the right to health.** The right to life recognized in Article 21 of the Constitution is the cornerstone upon which the rest of the fundamental rights of the inhabitants of the republic rest. Likewise, in that provision of the political charter the right to health finds its footing, since life is inconceivable if the human person is not guaranteed minimum conditions for an adequate and harmonious psychic, physical, and environmental balance. Evidently, any delay by the hospitals, clinics, and other health care units of the Caja Costarricense del Seguro Social can negatively impact the preservation of the health and life of its users. Public entities, bodies, and officials owe themselves to users with a clear and unequivocal vocation of service, since that has been the reason for their creation and existence.\n\n**IV.- Efficiency, Effectiveness, Continuity, Regularity, and Adaptation in Public Health Services.** The public bodies and entities that provide public health services have the imperative and non-deferrable obligation to adapt them to the particular and specific needs of their users or patients and, above all, of those who demand immediate and urgent medical attention, without the lack of human and material resources being legally valid arguments to exempt them from fulfilling such obligation. From this perspective, the services of the clinics and hospitals of the Caja Costarricense de Seguro Social are under the duty to adopt and implement organizational changes, to hire medical or auxiliary personnel, and to acquire the materials and technical equipment required to provide efficient, effective, and rapid services. The heads of the Clinics and Hospitals cannot invoke, to justify deficient and precarious patient care, the problem of “waiting lists” for surgical interventions and the application of certain specialized examinations or the lack of financial, human, and technical resources, since it is a constitutional imperative that public health services be provided in an efficient, effective, continuous, regular, and expeditious manner. The heads of the Caja Costarricense de Seguro Social and the Directors of the Hospitals and Clinics belonging to it are under the duty and, consequently, are personally responsible—under the terms of Article 199 et seq. of the Ley General de la Administración Pública—to adopt and implement all administrative and organizational provisions and measures to put a definitive stop to the delayed provision—which, on occasion, becomes omitted due to its consequences—of health services, a situation that constitutes, by all lights, an unequivocal failure of service that may give rise to the patrimonial administrative liability of that entity for the anti-juridical injuries caused to the administered parties or users (Article 190 et seq. of the Ley General de la Administración Pública).\n\n**V.- Specific Case.** As has been duly accredited, surgery was scheduled for the appellant on April twenty-third, two thousand eight, for the purpose of removing a benign tumor in her left salivary gland. However, since that date, her surgery has been repeatedly rescheduled on the grounds that there are no beds available. For their part, the respondent authorities reported that the Hospital has been experiencing a serious problem regarding the high demand for scheduled surgeries and the number of stretchers (camillas) available. This Chamber considers that, although there is a shortage of stretchers (camillas) at the Hospital, that does not justify the fact that more than nine months after the surgery was scheduled, it has not yet been carried out. The jurisprudence of this Court is reiterated, having emphatically stated that the lack of human and material resources, as well as of budget, is not a valid argument that exempts the authorities from providing an efficient health service. On the other hand, it should be noted that this is not a case where the protected party was placed on a waiting list, but rather that her surgery was already scheduled and rescheduled on three occasions after the first time. In this regard, this Court verifies the injury to the appellant’s right to health, since the time elapsed without the authorities having been able to coordinate what is required and to adopt the necessary measures to operate on the protected party within the dates scheduled for that purpose is by all lights excessive and violative of her fundamental rights.\n\n**VI.-** In another vein, according to the report rendered under oath by the respondent authorities, the latest rescheduling of the patient’s surgery is set for February seventeenth, two thousand nine, for which reason it is appropriate to order the medical authorities of the Hospital Max Peralta in Cartago to carry out the surgery on that day, as scheduled, so as not to cause further harm to the protected party.”"
}