33.
There is no dispute about the start of the litigious stage that triggered two consecutive
proceedings: one through a judicial action for protection, the other through a claim to the Superintendency of
Health, which are described in detail hereinbelow. It should be noted that the protection action ended with the
ruling of the CSJ of May 9, 2011, in which the termination of the RHD was validated. 30 Subsequently, the
proceeding before the Superintendency concluded on August 27, 2012, with the decision of the Superintendent
to resume RHD for Martina.31 In summary, the Commission observes that the family of the alleged victim was
involved in litigation from October 13, 2010 to August 27, 2012.
34.
After the CAEC was activated, Martina received three years, or contractual cycles, of RHD. That
regime was lifted for the reasons explained above and reinstated as a result of a proceeding before the
Superintendency, which meant that from May 9, 2011 to August 27, 2012, the family "was forced to restrict to
a minimum the elements that enabled Martina to survive and pay for them by means of solutions that came at
a struggle."32
35.
In economic terms, the petitioners said that the monthly cost of the basic health plan is USD
203.00 and the annual cost of the CAEC is USD 4,887.00. After the ruling of the CSJ, and the withdrawal of the
RHD, Martina’s coverage was restricted to USD 92,192.00 per year, that is, USD 7,682.00 per month. According
to the information provided, the monthly cost of RHD is USD 12,392.00. The Commission finds the arithmetic
difference between the cost of RHD and the coverage after the withdrawal of the CAEC to be USD 4,710.00. The
petitioners said that that difference was covered by a special benefit granted by Mr. Vera’s employer, on
condition that he stayed in that job and that it would be for a limited duration.33 State did not provide any
information in that regard.
36.
According to the petitioner, the Martina’s health worsened during the aforementioned period,
as manifested by an "increase in the frequency and duration of respiratory obstructions that she suffered,
which [were] increasingly hard to control; a dangerous decrease in her digestive processes; a clear regression
in her limited powers of communication and relationship with her surroundings." 34 The petitioners also
provided a comparative chart of lost and reduced health services at the different stages of the litigation, as a
result of which, they said, the family had to assume coverage of the expenses on medicines and medical and
paramedical instruments, as well as having to buy the equipment (ventilator, aspirator, pediatric resuscitator,
and saturator). State did not provide any information in that regard.
3.
The action for protection
37.
The information provided by the parties indicates that after being notified of the suspension
of the service, Martina’s family decided to bring an action for protection on October 26, 2010,35 for the violation
of the rights to property, to life, and humane treatment. The Isapre answered the suit, stating that the change
in the modality of provision of the CAEC was lawful and that, based on the expert opinion of Dr. Vargas
indicating that Martina’s condition was progressive and irreversible, RHD was not applicable as the disease
was a chronic condition. The Isapre also pointed out that the CAEC had not been completely deactivated, but
only that RHD was excluded; and that access to the CAEC is not a “vested right," given that access to it is renewed
annually.36
38.
On January 26, 2011, the Court of Appeals of Concepción (hereinafter "the CAC") returned its
decision granting the family’s claim, taking into consideration that hospital treatment brings risks of
intrahospital infections, and therefore, that there was “no rational explanation” for the change in modality of
care; that the ISAPRE should not consider it appropriate to exclude RHD in the case of chronic diseases, as
30 .
31.
2017.
32.
33.
34.
35.
36.
2017.
Annex X, Judgment of the CSJ of May 9, 2011. Petitioners’ brief of March 6, 2017.
Annex X, Appeal Judgment of Judge-Arbitrator Romero Stroy of August 23, 2012. Appended to the petitioners’ brief of March 6,
Petitioners’ brief of March 6, 2017.
Petitioners’ brief of March 6, 2017.
Petitioners’ brief of March 6, 2017.
The IACHR places on record that application for the action for protection is not part of the record.
Annex X. Answer of the Isapre to the action for protection, November 15, 2010. Appended to the petitioners’ brief of March 6,
7