63. In view of the fact that Mrs. Chinchilla suffered a progressive deterioration of her health due to her diabetes, the State should have taken stronger measures to ensure that her health did not deteriorate, bearing in mind that, after the amputation of her leg, she faced physical limitations. Thus, for example, the State had a duty to ensure that the procedure for authorizing medical appointments was not complex or lengthy. For this reason, the requirement to submit a request eight days in advance of each appointment was disproportionate, given her situation of vulnerability, especially in emergency situations. In addition, the vehicle that would have taken her to hospital to receive medical service should have been adapted to her needs. 64. The fact that a person is in the custody of the State serving a custodial sentence supposes a clear disadvantage for that person vis à vis the punitive power of the State; if to this is added the poor medical care that caused Mrs. Chinchilla disabilities, which worsened as the years passed, we observe the intersection of two or more categories protected by the American Convention in Article 1(1). In this case, the State’s actions and omissions produced specific discriminatory impacts, effects that could clearly have been prevented by adapting its obligations to the notion of the right to health. IV. THE IURA NOVIT CURIA PRINCIPLE AND THE DIRECT JUSTICIABILITY OF THE RIGHT TO HEALTH IN THE INSTANT CASE 65. I have previously expressed my opinion on the powers of this International Court to apply the iura novit curia principle in matters related to the right to health. In the case that concerns us, the Inter-American Court declared the State’s international responsibility for: a) the lack of adequate medical care for Mrs. Chinchilla Sandoval’s diabetes and other ailments, during the time she was deprived of her liberty; and b) the failure to make reasonable accommodation so that Mrs. Chinchilla could have adequate access the enjoyment of her right to health, and be able to move around within the COF’s facilities. Accordingly, there are statements that directly address the right to health in the following terms: a) in relation to the violation of Articles 4 and 5 of the Convention on the State’s duty to provide adequate treatment to the victim for her diabetes and related ailments after she was deprived of her liberty, the Court considered that the State had not fulfilled its international obligations to guarantee the rights to personal integrity and to life given that the appropriate diet and medications were not provided regularly by the State and the procedures established for hospital outpatient appointments were not sufficiently flexible to allow for timely medical treatment. 86 b) regarding the violation of Article 5 in relation to Article 1(1) on the State’s response to Mrs. Chinchilla’s disability, the Court considered that the rights of persons with disabilities were violated because the State did not ensure accessibility to persons with disabilities deprived of their liberty in accordance with the principle of non-discrimination and the interrelated elements for the protection of health (availability, accessibility, acceptability and quality), including the provision of reasonable accommodation.87 Cf. Case of Chinchilla Sandoval v. Guatemala. Preliminary objection, merits, reparations and costs. Judgment of February 29, 2016, Series C No. 312, para. 199 and 200. 86 24