196. In this regard, the State pointed out that Mrs. Chinchilla received many of her treatments at public hospitals and that the COF was primarily an institution for serving a sentence and for the rehabilitation of prisoners; therefore, it was logical that a hospital would be better adapted to deal with medical emergencies, although the COF did have its own hospital area (infirmary). The Court notes that, given the progressive deterioration of her health, and based on several reports from the COF duty doctors, medical examiners and members of the COF’s “multidisciplinary team” (comprised of officials of the legal department, the labor department, the psychology department, the social worker, and the prison’s deputy director and director), it was clear that the prison did not have sufficient capacity (necessary resources, specialized staff, equipment and infrastructure) to adequately respond to her deteriorating health or, that its capacity had not been proven, particularly in relation to the provision of the required medicines or treatment. However, Mrs. Chinchilla could certainly have been examined and treated as an outpatient in public hospitals. Moreover, it was evident that at any time she could suffer a decompensation that would require hospital treatment and that her life could be at risk if that treatment was not adequate and consistent, or if her medicines were not administered regularly and appropriately. Given that the COF did not have the necessary equipment to provide emergency treatment in the event of ketoacidosis or diabetic coma, complications that could be fatal depending on the time taken to transport her to a specialized health care facility, the alleged victim had a latent risk of dying from her disease while incarcerated. Furthermore, the final reports indicate that, in addition to her disability, her mental and physical health was deteriorating rapidly, that she had general poor health, chronic adult malnutrition and severe depression with risk of suicide, with no evidence that these symptoms or ailments were being treated at any time. 197. Certainly, the judge granted permission for the alleged victim to receive treatment in hospital, on the great majority of occasions when she submitted requests. In this regard, it has not been demonstrated that the State incurred any liability in relation to the application of this procedure per se, or specifically in relation to the actual hospital care she received. However, it is clear that the procedures established for outpatient appointments at public hospitals were not sufficiently flexible to ensure effective, timely medical treatment, particularly in the event of an emergency. Nor is there any record of external mechanisms for the monitoring and supervision of the health services offered within the COF. In other words, given the nature of her health condition, there is no record to show that the authorities ensured regular and systematic medical supervision aimed at treating her illnesses and her disability and preventing their deterioration, instead of treating them symptomatically, and providing appropriate diets, rehabilitation and other specialized facilities in conditions comparable with those provided to patients not deprived of their liberty. 198. The State alleged that the presumed victim was negligent in adhering to her treatment and diet and risked her life because of her “rebellious attitude, negligence and disobedience;” her refusal to be treated by the prison’s medical staff and entrusting her treatment to her fellow inmates; and by intentionally allowing herself a free diet and eating foods that were forbidden and harmful to her health. In this regard, the Court takes note of certain comments made by the prison´s nurses or doctors during her seven years of incarceration, describing the difficulties faced in providing her treatment or her inappropriate behavior toward health workers. However, in addition to the fact that the situations alleged by the State were only confirmed on some occasions, it was not demonstrated that this would have impeded or in some way conditioned the fulfilment of its obligation to ensure adequate treatment during her incarceration. In particular, the State did not prove any causal link between the situations propitiated by the alleged victim and the deterioration of her disease or ultimately her death. 62