Region: Americas
Year: 2010
Court: Constitutional Court
Health Topics: Child and adolescent health, Disabilities, Health care and health services, Health systems and financing, Mental health, Poverty
Human Rights: Freedom from discrimination, Right to bodily integrity, Right to education, Right to health
Tags: Access to health care, Access to treatment, Child development, Children, Disabled, Health expenditures, Health funding, Health insurance, Low income, Mental retardation, Minor, Out-of-pocket expenditures, Pediatric health, Physically challenged, Poor, Subsidies, Underprivileged
The applicant, a Colombian woman, tutela action (appeal for legal protection) on behalf of her daughter against EPS Coomeva, a health care provider in Colombia. The child was diagnosed with cognitive disabilities, which required, according to the Fundación Integrar de Medellín, an institution specialized in the care of patients, that the child receive special education at an inclusive institution and with an integral program of therapy and special education. The applicant argued that EPS Coomeva violated her underage daughter’s fundamental rights to health, development, and bodily integrity in denying a child with a disability the comprehensive care that she required. EPS Coomeva denied the request alleging that it is the state’s responsibility to give educational services and that special education is not a health service but an educational one and that the applicant is charged in accordance with her means to pay and the payments could be reduced only if her economic situation changed.
The District Court ruled in favor of protecting the rights of the child. The Court ordered that a medical study be realized to see if EPS Coomeva could provide the necessary services instead of having to resort to Fundación Integrar. It ordered EPS Coomeva to also conduct a specialized study to see what services were necessary for the child, as well as which were medical and which were educational. The Court also held that the applicant should not be exempted from her payments as these did not go against any fundamental rights. EPS Coomeva appealed the decision, arguing that Fundación Integrar was an educational institution and that EPS Coomeva could not be obligated to pay for their services. The applicant appealed on the grounds that it was necessary for Fundación Integrar to provide the services as EPS Coomeva did not have institutions with such a specialization and qualities required by the child. The District Court of Appeals affirmed the decision.
The Court found that EPS Coomeva was violating the child's right to health by refusing to provide comprehensive treatment and was therefore under the obligation to provide the child with all the necessary treatment to manage the disability and better her life.
The Court held that children are subject to a special constitutional protection and that this protection is reinforced further with regards to children with disabilities. The Court further held that disabilities and poverty needed to be addressed to protect the rights to health, education, and freedom from discrimination. For vulnerable population groups, such as persons with disabilities, health providers needed to provide comprehensive care including services not included in the state's mandatory plans.
The Court further found that the right to health for children with disabilities could contain educational services, seeing as they are part of the patient’s rehabilitation process and comply with the principle of comprehensiveness of the health system. The Court concluded that education for people with disabilities should preferably be inclusive and special education should be a last resort but a necessary one if the same level of education cannot be provided at regular institutions.
Regarding the state’s obligation to provide education, the Court found that the local governments have to guarantee availability, access, permanence, and quality while providing education. The Court further held that in most cases, the right to education and the right to health are protected in an independent manner, but that in this case, education can contain aspects that better the child’s health.
"En resumen, la Corte Constitucional ha protegido el derecho fundamental a la salud de los niños y niñas con discapacidad, aduciendo que este derecho preferente puede contener ingredientes educativos, los cuales se entiende que hacen parte del proceso de rehabilitación del paciente, con base en el principio de integralidad del sistema de salud." Sec. 5.4.
"Como se anotó anteriormente, la integralidad del servicio de salud abarca la posibilidad de mejorar las condiciones de vida de la persona, en este caso particular la EPS debe brindar a la hija de la actora el tratamiento integral que ésta requiera para el manejo de la discapacidad cognitiva que tiene y, consecuentemente, en aras de mejorar su calidad de vida." Sec. 6.3.1.