157. As for the State´s response on the day of Mrs. Chinchilla’s death, according to the Commission, no prior health tests were carried out on her various symptoms. That day she suffered a fall because of a step that prevented her from getting by in her wheelchair, due to the fact that she had no one to help her move around, a situation attributed to the State’s failure to implement reasonable modifications at the COF. The nurse who attended her did not perform a glucose test, which was essential to determine whether she was facing an emergency, and to obtain permission for her to go to hospital for treatment. After a superficial check by the nurse, she did not receive any monitoring ex officio or any kind of health care for almost one hour. Thus, she died alone and without any type of medical assistance or supervision, since there was no doctor that day; and she was denied hospital care and treatment. 158. The representatives did not present specific arguments on the alleged violation of her rights to life and personal integrity and, in general, reiterated part of what was stated by the Commission. They emphasized that the procedure for authorizing medical appointments was bureaucratic, slow and ineffective, which had a negative impact on her medical care, causing her to miss appointments and making it necessary to reschedule them, a situation that worsened in 2002. They also noted that a refrigerator was placed in her room to keep the insulin, because otherwise it would be stolen at the COF, and therefore she had to pay each month for the use of electricity. 159. The State insisted that Mrs. Chinchilla was detained at the COF because she was serving a 30-year sentence after being found guilty in criminal proceedings for the crimes of murder and aggravated larceny. It emphasized that the Commission and the petitioners had not claimed that any official was responsible for Mrs. Chinchilla’s death or had caused her injuries, and the Public Prosecution Service did not find that State agents had participated in the facts or that these had resulted from a criminal act, since the autopsy determined death from natural causes. 160. In relation to Mrs. Chinchilla’s disability, the State indicated that she was housed in the COF’s maternal area, in an individual cell, adapted and modified to her special health needs, that is, separated from the rest of the inmate population and not in overcrowded conditions. She enjoyed hygiene and personal care facilities free of charge and a toilet and washbasin were installed for her, taking into account that she was in a wheelchair. Her room did meet the relevant requirements and she made no complaint about the ventilation or the lighting in her cell. In addition, she mentioned that she was allowed to bring in electrical appliances (television and refrigerator). 161. As for the obligation to provide regular medical attention by qualified staff, the State emphasized that during her detention at the COF she was provided with medical attention free of charge according to her needs, in the COF’s own clinic. Here she received regular care by qualified medical and nursing staff, and was allowed to leave the prison to receive treatment in public hospitals; however, being incarcerated and serving her sentence, she first had to request permission from a judge. In this regard, the State noted that, out of a total of seven years of incarceration, during one year, five months and six days (622 days) the inmate received health care services at a public hospital, in addition to all the other occasions on which she was attended to in the COF’s own clinic. Thus, she received medical treatment during almost one-quarter of the time that she was incarcerated (24.34%) and only missed appointments on 11 days, because she had not carried out the established legal procedures. The State argued that Mrs. Chinchilla Sandoval’s daughter, who testified at the hearing, only visited her mother on five occasions between 2000 and 2004, and therefore could not attest to the treatment received by her mother. 49