Jorge Gabarrot v. The State Health Services Administration

Sentencia No. 82/2008
Download Judgment: English Spanish
Country: Uruguay
Region: Americas
Year: 2008
Court: Civil Appeals Court, 7th District [Tribunal Apelaciones Civil 7ºTº]
Health Topics: Health systems and financing, Medicines
Human Rights: Right to health
Tags: Access to drugs, Access to medicines, Health funding, Health insurance, Pharmaceuticals

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Jorge Gabarrot, the plaintiff, requested an order requiring the State Health Services Administration (the “ASSE”) and/or the National Resource Fund to carry out a special treatment with enzyme replacement in the dosages determined by the Institute of Nephrology. The lower court had dismissed the measure requested by the plaintiff, and stipulated the closure of the case without making any statement about procedural penalties.

Thereafter, the appellant appealed and the lower court’s interlocutory decision, arguing that the court had not given appropriate consideration to the preventative measure, as well as again requesting the aforementioned medical treatment.

The Court noted that, according to the Article 317 of the General Code of Procedure, an interlocutory measure must be justified by proving the possibility of a serious harm or the difficulty of repairing injury before the final deposition of the case, or to ensure the decision on the merits of the case on an interim basis. In addition, as stipulated by the Homologous Court of the Second District, the damage alleged by the plaintiff must be analyzed taking into account the specific rules which require proof of the additional injury..

Based on these rules, the Court found that the appellant  failed to prove his claim because the evidence he provided was insufficient to demonstrate such injury.  Most importantly, the Court found that the appellant provided minimal evidence with respect to his own concrete situation; he did not prove that he was not being treated, nor the risk to his life, nor could he prove to the requisite degree of certainty the need that he be be treated specifically with that requested medication. The Court also considered whether the appellant had overcome the hurdle of bilaterality required to make an effective claim against ASSE as well as the Ministry of Public Health’s argument regarding the expense and unavailability of the requested medicine.

Ultimately, the Court held that the appellant failed to prove the existence injury as a  “strong likelihood of the law” at the standard of proof required to implement the requested interlocutory measures.

“As stated there, there is a general precautionary power going beyond individual cases, for which a court can always—against the clear possibility of harm, derived from the delay in the main ruling, being caused—order preventative or protective measures aimed at removing that danger, (Tarigo, Lessons of Civil Litigation according to the New Code, T.II pg. 364, now recognized expressly in Article 317 of the General Code of Procedure).” Section III

“Como allí se expresó, existe un poder general cautelar más allá de determinados casos concretos, por el cual el cual el tribunal puede siempre - frente a una evidente posibilidad de provocarse un daño derivado del retardo en la providencia principal - disponer en víapreventiva o cautelar medida stendientes a eliminar ese peligro, (Tarigo, Lecciones de DerechoProcesal Civil según el Nuevo Código, T. II pg. 364), actualmente reconocido a texto expreso en el art. 317 del Código General del Proceso).” Sección III

“In the first place, because the argument of the claimant with regards to the effective appearance of ASSE to overcome the hurdle of bilaterality required by Article 317.2 of the General Code of Procedure, -–as the answer to a summons can hardly be included in this concept and when there exist opinions in similar circumstances, such as those of the Supreme Court that in judgment 639/2006 expressed; “…sequence that cannot, in any case, be enabled at the stage when the bilaterality, which is required to reach a decision in these type of cases, has not been completed.” (Barrios de Angelis, in Der Course. Procedural IUDP, T. II, pg. 163; Abal, op. cit. pg.80 et seq., 98 et seq.; Martinez Botos, Preventative Measures, p. 52, etc)- is questionably admissible.” Section V

“En primer lugar, porque es dudosamente admisible la argumentación del promotor respecto a la efectivacomparecencia de ASSE para superar el escollo de la bilateralida dexigida en el art. 317.2 del Código General del Proceso, pues la contestación de una intimación difícilmente puede ingresar en ese concepto y cuando existen opinion es como la de la Suprema Corte de Justicia en hipótesis similar, que en sentencia 639/2006 expresó " ...secuenciaque, en todo caso, no puede ser habilitada en la etapa cuando no se ha cumplimentado la bilateralidad que la adopción del tipo de decisiones reclama (? Barrios de Angelis, en Curso de Der. Procesal, IUDP, T. II, pág. 163; Abal, en op. cit., págs.80 y ss., 98 y ss.; Martínez Botos, Medidas Cautelares, pág. 52, etc.)"” Sección V

“In this context, even if it is true that the right to health has constitutional roots, the fact still remains that it does not appear that the patient is not being treated at all nor can be proven the life risk summarily invoked late on appeal, and beyond the issue of financial costs, what is relevant is that it cannot be perceived with a degree of certainty the need to be treated specifically with that particular medication, that the alleged benefits were derived from the treatment with the medication, and let alone that the life of the patient depends on it, a matter that was not even pleaded at the time of initiating the claim, but at the later stage of submissions. In short, contrary to the assertions by the appellant, they have failed to prove the existence of the “strong likelihood of the law” as “standard of proof” to implement measures of the nature invoked here, in terms of the doctrine quoted and mentioned above…” Section V

“En tal marco, si bien es cierto que el derecho a la salud es de raigambre constitucional, no lo es menos que en la especie no consta que el paciente no esté tratado ni resulta sumariamente el riesgo de vida tardíamente invocado al apelar y más allá del tema de costos económicos, lo relevante es que no se aprecia el grado de certeza en punto a la necesidad de ser tratado específicamente con ese medicamento puntual, que de la aplicación del mismo se deriven los beneficios alegados y menos aún, que de ello dependa la vida del paciente, tema este último que tampoco se invocó al promover la medida sino recién al expresar agravios. En suma, a diferencia de lo sostenido por el recurrente, no se logró demostrar la existencia de la "casi certeza del derecho" como "grado de conocimiento" para despachar medidas de la naturalaza de la aquí invocada, en términos de la cita doctrinaria por el mismo mencionada….” Sección V

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