Case 03/2011

The claimant, Mr. Oscar Fontes, brought a protection action against the Ministry of Public Health (the “Ministry”) for its failure to provide him with the drug Cetuximab, as prescribed by his doctor for treatment of colon cancer. The drug was not included on the Therapeutic Drug Registry, and the Ministry denied his request. The claimant however argued that the Ministry of Public Health voluntarily provides the drug to patients with the same illness, and therefore its decision to deny the drug in his case was discriminatory.

The lower court found for the claimant, and ordered the respondent to provide him with the drug.

The Court upheld the lower court’s decision to grant the protection action.

The Court first dismissed the Ministry’s argument that the claimant had not claimed with particularity that the drug be included Therapeutic Drug Registry, noting that factually there was no other way to read the claimant’s petition. The Court also dismissed the Ministry’s argument that the Ministry was not in the legal position to provide medication but only to update the Therapeutic Drug Registry, noting that the basis of the claim was the Ministry’s failure to update the Therapeutic Drug Registry and that the Ministry had provided the drug to other patients in similar situations.

Referring to “the existence of the fundamental right to health of all persons”, the Court determined that, although the Therapeutic Drug Registry was supposed to be adjusted annually, such time period should not be interpreted to bar the inclusion of new drugs on the registry, as needed.  Here, the Court noted the “clear indifference” on the part of the committee tasked with updating the registry and confirmed the unlawfulness of its actions which resulted in a delay without justification.

The Court also determined that the Ministry’s decision not to provide the drug was a violation of the principle of equality, given that the drug had been provided to another patient in similar circumstances.

“…the claim does not lie in a duty to provide assistance, as the appellant would have it, but instead in a duty that arises from the right to equality that the State guarantees to all citizens. State institutions must therefore provide the same treatment to individuals in similar circumstances.” English translation, page 4.

“…el petitum no finca en un deber de asistencia como lo presenta el apelante, sino es un deber que emerge del derecho a la igualdad de todo habitante frente al Estado, quien debe comportarse en forma idéntica en iguales circunstancias.” Original Spanish, page 6.

“…we must begin from a point of acknowledging the existence of the fundamental right to health of all persons, and that such right must be protected by the State using all available means and in order to benefit all persons, and that the State must guarantee all persons equal access to the necessary treatment in accordance with each individual’s state of health, and, particularly, the right to access to necessary medication. These elements form an essential part of the right to health.

These rights are substantive principles that broadly define the legal framework of a rule of law state, and, like the principle of non-discrimination and other fundamental rights, broadly limit and bind the executive power by excluding or imposing certain content from or on its regulatory actions.” English translation, page 4.

“…es indiscutible partir del reconocimiento de la existencia del derecho fundamental a la protección de la salud de las personas; que éste debe ser puesto en práctica por el Estado a través de todos los medios disponibles y en beneficio de todas las personas; que se debe garantir el igual acceso de cada persona a los cuidados necesarios de acuerdo con su estado de salud y, particularmente, el derecho de acceso a los medicamentos necesarios forma parte esencial del derecho a la salud.-

Tales derechos conforman la legalidad en sentido amplio del Estado constitucional de derecho como normas sustanciales y al igual que el principio de igualdad y otros derechos fundamentales, de mododiverso limitan y vinculan al poder administrador excluyendo o imponiéndole determinados contenidos.” Original Spanish, page 7.

“…the respondent Administration must respond to  petitions that new drugs be included in the FTM without delay, in a period that may vary according to the circumstances, but always in accordance with the governing principle of reasonability, which should be in line with the seriousness of the case at hand.” English translation, page 6.

“…la Administración demandada frente al requerimiento de inclusión de nuevos medicamentos en el FTM debe pronunciarse sin dilaciones, en plazo que puede ser variablesegún las circunstancias y siempre en función del supremo principio de razonabilidad, que debe estar acompasado con la gravedad del objetivo.- Original Spanish page 9.

“The First Chamber of the TAC’s conclusion in Decision 93/2010, which this Court has cited to multiple times already, is therefore pertinent, in that it states that, ‘The decision to authorize [a drug] in one case and deny it in another—under similar circumstances—indicates that the respondent’s conduct has violated the constitutional principle of equality. This results in discrimination, given that the Ministry of Public Health has given no reasons that justify its contradictory actions, which are therefore unjustified and manifestly unlawful…’” English translation, page 7.

“Resulta entonces trasladable la conclusión del TAC 1º en la multicitada Sentencia Nro.93/2010, en que se expresó: “...La decisión de otorgarlo en un caso y negarlo en otro -cuando median circunstancias similares- torna al comportamiento de la recurrente como violatorio del principio constitucional de igualdad y genera discriminación al no indicarse por parte del Ministerio de Salud Pública razones que justifiquen su contradictoria actuación, la cual surge como injustificada y manifiestamente ilegítima...”.Spanish original, page 12.