Case 0074/2010-R

This case was an appeal of a petition for a writ of habeas corpus brought by the claimant, Eusebio Alejandro Soto, against Marcelo Cuellar Crespo, director of the San Juan de Dios Municipal Public Hospital. The claimant brought the petition against the hospital when he was detained there for failure to pay for his treatment after his discharge.

The lower court found that no public or private institution has the legal authority to detain a person for a monetary debt, and, noting that the Civil Code prohibits extra-legal remedies, therefore ordered the hospital to release the claimant. The hospital appealed, arguing that a) The act in question would not have occurred if the party responsible for the accident had complied with its duty to cover the victim’s hospital and medical expenses; b) As the hospitalized party was not insured, he was required to pay personally, given that he was not identified as an indigent patient, but as a victim of a traffic accident; c) The patient was never removed from his bed, but was kept on the unit on which he had been hospitalized; and d) The claimant tacitly recognized the debt by paying 50% of it.

The Constitutional Court upheld the lower court’s ruling, finding that no public or private hospital or health center may detain a patient for failure to pay his or her bills for medical treatment, as Bolivian law states that claims for debts are enforceable solely on the assets of the debtor. The Court recommended that the hospital put into place proper legal mechanisms to allow it to guarantee payment for services rendered, noting that such mechanisms could not include the ability to decline to admit and serve patients, under any justification, as this would result in significant harm to the fundamental rights to life and health.

“…we may conclude in respect of the case at hand that both public and private hospital facilities violate the rights to personal freedom and freedom of movement of their patients when, having formally discharged a patient, the hospital detains the patient within its facilities in order to force the patient to pay his or her bill for medical treatment or a hospital stay.” (Section III.3)

“lo mencionado nos permite concluir que, tanto los centros hospitalarios públicos como privados, lesionan el derecho a la libertad individual y de locomoción de los pacientes dados de alta o en su caso de aquellos que se nieguen a dar la alta, cuando con la retención -en sus instalaciones- pretenden coaccionar el pago de la deuda por cuentas de tratamiento médico e internación” (Sección III.3)

“While the State implements public policies that are designed to ensure that access to healthcare is completely free of charge, we must also take into account that public and, particularly, private health centers, in fulfilling their purposes and objectives of providing health services to the public, incur costs. … In order for health services to be provided without interruption and in a manner that allows for the protection of the public’s right to life and to health, which is one of the State’s main duties, there must necessarily exist a balance between remuneration contributed by the patient or by the responsible party (the insurance companies) to hospitals and health centers for services rendered.” (Section III.4)

“Mientras se implementen las políticas públicas para que el acceso a la salud sea completamente gratuito, se debe considerar que los fines y objetivos de los centros hospitalarios públicos y con mayor razón de los privados, a tiempo de prestar servicio de salud a la ciudadanía, erogan gastos, … Para que los servicios de salud sean prestados ininterrumpidamente y permitan garantizar el derecho a la vida y la salud de la colectividad, que es uno de los principales fines del Estado, necesariamente, debe existir un equilibrio en la remuneración entre el paciente o el responsable (companies de seguro) por los servicios prestados en la curación.” (Sección III.4)

“[T]his Court holds that no public or private hospital or health center may detain a patient for failure to pay his or her bills for medical treatment. The law states that claims for debts are enforceable solely on the assets of the debtor, and therefore hospitals, through their legal departments, should put into place proper legal mechanisms that allow them to guarantee payment for services rendered, keeping in mind the situation of indigence or poverty of individual patients, as well as those benefits, discounts, and aid and other programs provided by the State. This does not mean that public and private health facilities may decline to admit and serve patients, under any justification, as this would result in significant harm to the fundamental right to life, by violating the right to health, which forms an essential part thereof.” (Section III.4)

“[S]e deja establecido que ningún centro hospitalario o de salud public o privado, debe retener a un paciente que no pueda cubrir los gastos que ha demandado su curación, toda vez que la norma prevé que las obligaciones de naturaleza patrimonial deben ejecutarse únicamente sobre el patrimonio del sujeto responsable, por tanto los nosocomios a través de sus unidades jurídicas, deberán constituir mecanismos legales que les permitan garantizar el cobro de la obligación, teniendo en cuenta la situación de indigencia, pobreza, beneficios, descuentos, programas asistenciales y otros promovidos por el Estado. Sin que este entendimiento signifique que, las instituciones de salud públicas y privadas puedan negarse a atender a los pacientes que acudan a dichas instituciones bajo ningún justificativo, lo contrario significaría lesionar el derecho fundamental a la vida, adherida a su component esencial la salud.” (Sección III.4)