for the rights of insureds, due to the special importance of the matters they address, are part of the State’s
obligations to create conditions that ensure medical assistance in the event of serious illnesses. The
Commission finds that the State has not managed to demonstrate that the system of challenges formally
available is designed to respond to situations of the sort that arose in this case in keeping with international
standards on the rights to health and social security, including special decisions adopted in individual cases
involving possible situations of extreme vulnerability like that of Martina.
78.
In this regard, the Commission notes that the decision of the Isapre to withdraw RHD, as well
as the rules governing the granting of that regime, do not stipulate any safeguard in relation to the rights of
Martina Vera Rojas as a girl with disabilities. In that regard, the IACHR notes that the CAEC was not totally
suspended, but that RHD changed to regular hospitalization as necessary. Thus, as a child with disabilities, the
Commission considers that Martina Vera Rojas had the right that her insurance coverage perforce take into
account her best interests, her need for support, and her growth in the family environment, not merely the
chronicity or otherwise of her condition. In issuing its verdict validating the decision of the Isapre, the CSJ
offered no considerations about Martina’s particular situation arising from her disability. Likewise, the IACHR
cannot help but notice that the reinstatement of RHD, in accordance with the ruling of the Superintendency of
Health, was not informed by the best interests of a girl with disabilities and her need to grow in her family
environment; rather, it was an economic calculation that is analyzed in depth below.
79.
In addition to the foregoing, the Commission notes that when the Isapre suspended RHD, the
family accessed most of the health services through arrangements and procedures that they undertook
themselves. The family purchased some of the equipment and paid from their own funds for medicines and for
medical and paramedical instruments; however, they lost the ability to access an air ambulance if Martina
needed to be transported to Santiago. Thus, the Commission considers that although Martina was able to access
self-managed treatments to maintain the highest attainable standard of health for her, their continued
availability was uncertain, wreaked havoc on the family economy, and placed Martina’s fragile life and integrity
at risk.
4.
Conclusion
80.
In light of the aforesaid, the State’s lack of proper regulation, control, and adequate systems of
challenges to control decisions to withdraw RHD from patients with serious and costly diseases, coupled with
the lack of protection for the victim in its capacity as guarantor of children’s rights, placing her life and health
at risk, the Commission concludes that the State is responsible for violation of the rights to health, social
security, life, humane treatment, and special protection recognized in Articles 4(1), 5(1), 19, and 26 of the
American Convention, taken in conjunction with the obligations established in Articles 1(1) and 2 of the same
instrument, to the detriment of Martina Vera Rojas.
D.
Right to a fair trial104 and judicial protection105 (Articles 8[1] and 25[1]) and rights of
the child (Article 19) of the American Convention in connection with Articles 1(1) and
2 thereof
1. General Considerations
81.
The Commission has underscored that the obligation of the States to act with due diligence
includes enabling access to suitable and effective remedies when human rights are violated. 106 In the case of
104
Article 8 of the American Convention provides: 1. Every person has the right to a hearing, with due guarantees and within a
reasonable time, by a competent, independent, and impartial tribunal, previously established by law, in the substantiation of any
accusation of a criminal nature made against him or for the determination of his rights and obligations of a civil, labor, fiscal, or any other
nature.
105
Article 25 of the American Convention states: 1. Everyone has the right to simple and prompt recourse, or any other effective
recourse, to a competent court or tribunal for protection against acts that violate his fundamental rights recognized by the constitution
or laws of the state concerned or by this Convention, even though such violation may have been committed by persons acting in the
course of their official duties.
106
IACHR, Access to Justice for Women Victims of Violence in the Americas, OEA/Ser. L/V/II. doc.68, January 20, 2007.
17