Case T-095/04

Colombia; Constitutional Court; Sentencia T-095/04.
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Mrs. Torres Puerta (the “Patient”) was affiliated with E.P.S. Coomeva, a Health Providing Entity. (Note: in Colombia, Health Providing Entities are in charge of providing healthcare services to employees, who must subscribe to one of such entities and pay a monthly fee which their employer deducts from their salary). In 2002, The Patient received authorization from her doctor to undergo two exams to diagnose the disease she was suffering from. Despite the fact that the Patient had obtained this authorization from her doctor, E.P.S. Coomeva refused to authorize these exams, arguing that such exams were not covered by Colombia’s mandatory health insurance program, and, as such, were not to be paid for by the Health Providing Entity but by the Patient herself.

The Patient filed a constitutional rights claim, alleging violation of her fundamental right to health. She obtained a negative response in the first ruling from the civil judge who determined that the Patient´s health and life were not in danger and that the Patient had not proven the economic insolvency she claimed in order to obtain payment for expensive health tests which were not included in her mandatory health program and E.P.S. Coomeva  service agreement.  This decision was confirmed by the second instance judge.

The Constitutional Court reviewed Coomeva E.P.S. service agreement to understand the denial in first instance to perform the health tests, and found that i) the lack of proceedings prescribed by the doctor put the Patient’s health and life at risk; that ii) there was no alternative test within the mandatory health program which could replace the originally-ordered test, iii) the evidence provided by the Patient to prove her economic insolvency and incapability to pay for the tests was acceptable, and iv) the doctor who treated the Patient was subscribed to Coomeva E.P.S.,  and thus authorized to request the health test. The Court considered that the diagnostic tests which were ordered for the Patient could not be rejected by Health Providing Entities because the success or failure of an appropriate health treatment and procedure derived from such diagnostic tests. Thus, the Constitutional Court considered that the Patient’s constitutional rights were being violated, and that the tests must be carried out by the Health Providing Entity.

“Diagnosis tests may not be disesteemed by entities in charge of the healthcare of the nation’s inhabitants, for the success or failure of a treatment and procedure to recovers a patient’s health is dependent on said tests”.

“Las pruebas diagnósticas no pueden desestimarse por las entidades que tienen acargo la salud de todos los habitantes del país, pues de ellas depende el éxito oel fracaso de los tratamientos y los procedimientos para recuperar la salud delpaciente”