purpose of Isapres is to finance health benefits, not provide them or participate in their administration. In short,
vertical integration is prohibited, in order to encourage free competition and avoid abuse."13
25.
Based on the information available, the IACHR does not find a context of lack of health
regulation to the widespread extent mentioned by the petitioner. However, the record suggests that, in the
event of a disagreement between an insured and an Isapre, there is a standard system of dispute settlement
envisaged in Chile that is activated by the insured against possible impairments of health care services.14 In
addition, the Commission finds that the withdrawal of the CAEC was the result of a decision by the Isapre based
on the sole determination that the illness suffered by the insured is a chronic one. The Commission finds that
in a specific situation, such as the alleged victim found herself, where the CAEC was lifted, the insured had to
invoke some kind of contentious mechanism following the termination of her health coverage.
B.
Facts in the case
1.
The girl Martina, her diagnoses, and her current situation
26.
In August 2006, the couple comprising Mr. Vera and Ms. Rojas adopted Martina Vera Rojas
when she was three months old. At the age of eight months the Vera girl was diagnosed with Leigh's syndrome.
According to the petitioners, Leigh’s syndrome is "a progressive, degenerative neurological disorder of genetic
origin, characterized by lesions in the thalamus, cerebellum, cerebral cortex and spinal cord. There is no
treatment to prevent its progression and patients who suffer from it can only receive palliative care."15 The
petitioners also said that "patients who have this disease usually die before the age of 6 [and] only 27% do not
die at an early.” That they do not is determined by "the application of kinesiological therapies, frequent
diagnoses and prolonged care which includes nutritional support, respiratory therapies, mitochondrial
cocktails, all of which must be provided by the same treatment center."16
27.
According to the most recent information about Martina, she has already lost her hearing, her
vision, her motor system is compromised, she is breathing through a tracheotomy tube, and she is administered
food and medicines through a gastrostomy tube.17 The girl Martina lives with her parents in the city of Arica, in
northern Chile. Mr. Vera says that he suffers from nocturnal hypertension, which has caused problems with his
sight, while Ms. Rojas says that the family is suffering from constant stress.18
2.
Start of the home hospitalization regimen and its removal
28.
As was mentioned, Martina’s health began to deteriorate when she was eight months old.
There is no dispute as to whether the alleged victim suffers from Leigh's syndrome, as the medical reports in
the record show.19 Martina’s father contracted health insurance with the Isapre in 2007.20
29.
After her diagnosis, the petitioners said that when her condition was most critical, she was
transferred from Arica to Santiago, where she was hospitalized and fed a special supplement that was
mislabeled, further impairing her health. 21 In September 2007, the family activated the CAEC, so the girl
13.
Annex XX. Report “La debacle financiera de Isapre MasVida y la indefensión de los usuarios del sistema” [The financial debacle of
Isapre MasVida and the defenselessness of system users] by Claudia Urquieta Chavarría. Annex to the petitioners’ brief of March 23,
2017.
14.
The Commission observes that the possibility also exists of filing an action for protection, which can be triggered by
contractual breaches related to the right to property; however, it is not a defining remedy, since it is an "emergency proceeding," as the
State indicated to the Commission in its brief of January 9, 2018.
15.
Petitioners’ brief of March 6, 2017.
16.
Petitioners’ brief of March 6, 2017.
17.
Annex X, Medical report of Dr. Rodrigo Vargas Saavedra of September 30, 2010. Appended to the petitioners’ brief of
November 4, 2010.
18.
Annex X, Psychological report of clinical psychologist Carola Fernández of March 3, 2016. Appended to the petitioners’ brief of
March 6, 2017.
19.
Annex X, Medical report of Dr. Rodrigo Vargas Saavedra of September 30, 2010. Appended to the petitioners’ brief of
November 4, 2010; Annex X, Medical report of Dr. Oscar Darrigrande of September 25, 2011. Appended to the petitioners’ brief of
November 4, 2010.
20.
Initial petition of November 4, 2011.
21.
Initial petition of November 4, 2011.
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