when necessary, she requested authorization from the Second Court of Criminal Enforcement to go to medical appointments at public hospitals. 50 According to the State, there was also a possibility of being transferred to hospital in the event of an emergency, which could be authorized without the need to request permission from the judge. 44. Regarding the procedure for obtaining such authorizations, from the file it is clear that three types of situations occurred: 51 a) If Mrs. María Inés Chinchilla had a particular need to receive specialized medical care in gynecology, for example, she would ask the medical staff at the COF for a medical examination, after which the COF doctor would send an official letter to the Director of the COF recommending that, based on her symptoms, she should be examined by a specialist.52 The COF Director would then request permission from the appropriate enforcement judge who,53 prior to deciding, would order a medical examiner to provide an opinion based on an evaluation. 54 The medical examiner had to provide an Department of the General Directorate of the Prison System or, in the event of urgency or extreme shortages, procedures are carried out to obtain supplies immediately. In addition, the national hospitals sometimes provide inmates with their own medications. Likewise, the Medical Services Department forms part of the structure of this institution and is responsible for addressing any problem affecting the health of persons deprived of liberty, with medications or with the paramedic personnel assigned to prisons; therefore, there is supervision at all times to resolve any problem. […] the Prison System provided medical assistance during Mrs. Maria Inés Chinchilla Sandoval’s incarceration at the Women’s Orientation Center -COF-” (evidence file, folio 2689) In this regard, in response to questions from the Judges during the hearing as to whether there exists or existed a system of automatic affiliation to social security or to a doctor in the corresponding establishment, or some mixed or private regimen, the State explained that “medical care and the provision of medical treatment is, in the first instance, the responsibility of the prison doctor, who in turn must refer the inmate to the most suitable clinic within the public health system, if their recovery cannot be managed at the Center. This situation is regulated in Article 14 of the Law of the Penitentiary System […] Bearing in mind the foregoing, if the person deprived of liberty is not satisfied with the manner in which his or her disease or convalescence is being treated, he or she has the right to file motions before the judge of enforcement under the Code of Criminal Procedure.” Regarding the question of whether persons deprived of liberty could or can have a primary care doctor and under which circumstances, or if they must necessarily go through a public sector doctor, the State pointed out that, in cases in which the State acts ex officio to safeguard the right to health of prisoners, they are first assessed by the doctors in their own prison and, based on their recommendations, are referred for treatment to other doctors of the public health system. However, in the event of not having a specialist in the area required, the inmate is referred to a private doctor. This is regulated in Article 14 of the Law of the Penitentiary System.” 50 In its report, the Commission stated that the procedure applied was contemplated in Circular 16-02 of the Secretariat of the Supreme Court of Justice. It specified that this document had not been provided by the State and that in one of the responses to the requests, the judge required the social worker to verify the appointment at the hospital and “only then would he grant permission to treat the illness.” Cf. Merits Report No. 7/14, case No. 12.739, para. 18 (evidence file, folios 2147 -2148). This document was cited but was not provided to the Court. 51 Cf. Certification of Enforcement 429-96. Request for specialized medical care. Duty doctor of the COF. Official letter No. 006-97. February 8, 1997(evidence file, folio 108) 52 In response to the Judges’ question at the hearing concerning the authority responsible for approving, planning or scheduling medical appointments in cases of chronic disease, the State indicated that “persons deprived of liberty always attend the medical appointments ordered by the attending physicians, using vehicles of the national Prison System, coordinated and arranged by the director of each Center. As established by law, in the case of María Inés Chinchilla, the COF Director was always the person who coordinated her attendance at medical appointments, as confirmed in Annex 26 of the answering brief. Furthermore, the representation of the State reiterates that there is no record in the file showing that the inmate or her next of kin filed complaints, claims or legal remedies arguing that she had missed a scheduled medical appointment or that she had been refused permission to go whenever the COF doctor considered it necessary.” Cf. Certification of Enforcement 429-96. Women’s Orientation Center, Official letter No. 69-97, Ref. SRIA_ACF, Request of the Director of the COF for authorization to obtain specialized medical assistance outside of the COF., February 11, 1997 (evidence file, folio 107) 53 Cf. Certification of Enforcement 429-96. Judicial order. Judge of the Second Criminal Enforcement Court. February 12, 1997. (evidence file, folio 109) 54 18