and as a consequence of her deteriorating health, she suffered the amputation of one of her
legs and loss of sight, which resulted in her physical and sensory disabilities.
184.
According to the standards described in the previous section and specified further
on, persons deprived of liberty who suffer serious, chronic or terminal illnesses should not
remain in prison establishments, unless States can ensure that they have adequate medical
facilities to provide adequate specialized care and treatment, including areas, equipment and
qualified staff (medical and nursing). In such cases, the State must also supply adequate food
and the specific diets prescribed for persons who suffer certain types of diseases. Prison
system staff must monitor nutrition processes, based on the diets prescribed by the medical
personnel and on the minimum requirements for their supply. In all cases, but especially
where an individual is clearly ill, the States have an obligation to ensure that a record or file
is kept on the state of health and treatment of every person who enters prison, either in the
prison itself or at the hospitals or health centers where they will receive treatment.
185.
In this case it is pertinent to determine whether or not the State provided the
alleged victim with the necessary treatment in an effective, adequate, continuous manner, by
qualified medical staff, and supplied the required medicines and food, either within or outside
the prison, for her various illnesses or ailments and throughout the time that she was
incarcerated. Similarly, it is pertinent to determine whether the State adopted adequate
measures when her health deteriorated.
186.
The alleged victim suffered from diabetes mellitus, a disease that required a
specific treatment and diet. Likewise, Mrs. Chinchilla suffered various other illnesses or
ailments related to the progression of that disease, particularly arterial hypertension, occlusive
arteriosclerotic disease and diabetic retinopathy, 284 which is consistent with the World Health
Organization’s (WHO) description of the effects of “diabetes.”285 The WHO has indicated that
“hypertension and diabetes are closely linked, and one cannot adequately control one of these
afflictions without treating the other.”286
Security Institute before she was admitted to the COF. However, the State did not explain how such treatment was
provided within the prison system (or specifically in COF) to give continuity to the treatment supposedly provided by
another State institution until then. In other words, the State did not provide specific information about the procedures
or practices used to transfer medical files or information (of a public or private nature) about an individual who is to
be admitted to the detention center, to the prison’s clinic or, if appropriate, to the hospital responsible for his care,
so as to follow up on a previous diagnosis or to continue with a certain treatment, as appropriate. Therefore, the
information was not relevant if another State institution had diagnosed or treated her prior to her incarceration.
The statement of the Judiciary´s medical examiner of August 29, 2003, noted that the deterioration in her
state of health was fundamentally due to the fact that “[she suffers] […] DIABETES MELLITUS” and “presented all the
complications of this disease, [which are] arterial hypertension, […] occlusive arteriosclerotic disease of the lower left
limb, […] diabetic retinopathy, also the fact that she had already suffered the amputation of her lower right leg […]”.
Likewise, the Prison Service’s Coordinator of Medical Services explained that Mrs. Chinchilla required sub-cutaneous
insulin for her diabetes “which is the cause of all the metabolic problems she suffers.”
284
It states that the evolution of uncontrolled diabetes results in hyperglycemia “that seriously damages many
organs and systems over time, especially the nerves and blood vessels.” These effects may include: “foot ulcers that
can lead to gangrene and amputation”; “diabetic retinopathy […], a major cause of blindness”; “renal insufficiency”;
“diabetic neuropathy”; risk of death “at least twice as great as people without diabetes”. See: World Health
Organization, Diabetes. Fact Sheet No. 312. January 2015. Available at:
285
http://www.who.int/mediacentre/factsheets/fs312/es/index.html
World Health Organization, General Information on Hypertension in the World, World Health Day 2013, Page
24. Available at:
286
http://apps.who.int/iris/bitstream/10665/87679/1/WHO_DCO_WHD_2013.2_spa.pdf?ua=1
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