Sala IV Orders CCSS To Buy Expensive Medications
The Sala Constitucional (Constitutional Court) or Sala IV as it often known as, has been very busy these past few weeks. From having to decide on whether two young girls should have the right not to be visited by their grandparents, to the Zapote annual fair, the Sala IV touches the lives of every Costa Rican.

The latest decision by the magistrates of the Sala IV obligates the Caja Costarricense de Seguro Social (CCSS) to provide costly treatments to patients at a cost of ¢472 million colones (us$916.500 dollars) or 1% of its medical purchases budget, to purchase medication for 31 patients .

The CCSS argues that with that money it could do much more. However, the president of the Sala IV, Luis Fernando Solano Carrera, defends the decision by saying that the Court has the responsibility to defend the rights of those seeking health benefits.

"We have not only intervened with medications, but also with surgeries and medical examinations", said Carrera.

More and more Costa Ricans are presenting "recursos de amparo" (appeals) before the Court in all types of cases where rights are being trampled.

In the case of the CCSS, this year alone there have been 326 appeals against the institution, 82% more than the same period in 2005. Court records indicate that the last 91 appeals are for medication that patients are demanding the CCSS to provide.

Of the 31 cases that the Constitutonal Court has gone against the CCSS, 22 are in favour of women who the Sala IV is obligating the CCSS to provide special quimotherapy using the drug Herceptin. In each of the 22 cases, the CCSS will be investing ¢16 million colones (us$31.000).

Albin Chaves Matamoros, director of medications at the CCSS, sustains that the number of appeals to the Sala IV is low compared to the mumber of patients visitng the clinics and hospitals run by the CCSS. Chaves said that the number of appeals per 100.000 consultations are less that 0.05% and all for medications. However, the cost of providing the medication is impacting on the CCSS, said the director.

For the patients, the reasoning behind the CCSS using alternate and cheaper medications isn't justified and neither does the the Sala IV from its recent decisions.

Magistrate Carrera said that it is a contradiction that a medical doctor prescribe a medication and then later denied by the CCSS authorities. However, Chaves does not agree and says that the Constitutional Court makes its decision without technical criteria and obligates the CCSS administer medications in the short term with high risk to the patients.


Many countries, like Costa Rica, do not have separate constitutional courts, but instead delegate constitutional judicial authority to their Supreme Courts. Nonetheless, such courts are sometimes also called "constitutional courts".

In Costa Rica, the Sala Constitucional was established by the "Ley de la Jurisdicción Constitucional", ley No. 7135 of October 11, 1989 and reformed on November 7, 1990, and deals specifically with the rights of citizens, guaranteeing the rights and liberties provided under the Constitución Política (Political Constitution) and the human rights recognized by the Derecho Internacional Vigente in Costa Rica.

The Constitutional Court deals with resolving conflicts between the powers of the state and the rights of the public, which can include conflicts at the municipal level, government institutions, including the Tribunal Supremo de Elecciones and the la Contraloría General de la República.

For example, some have called the Supreme Court of the United States "the world's oldest constitutional court" because it was the first court in the world to invalidate a law as unconstitutional (in Marbury v. Madison), even though it is not a separate constitutional court.

Austria established the world's first separate constitutional court in 1920 (though it was suspended, along with the constitution that created it, from 1934 to 1945); before that, only the U.S. and Australia had adopted the concept of judicial review through their supreme courts.

Some countries that have separate Constitutional Courts include, Colombia, Germany, Italy, Russia and Spain.