After obtaining a guardianship that a judge ordered the defunct Caprecom to perform bariatric bypass surgery in 2016, a woman who was morbidly obese managed to lose 51 kilos after this procedure.
However, after losing all that weight the citizen was left with flaccidity and excess skin, Therefore, as part of his comprehensive treatment and recovery, his specialist doctor ordered three surgeries: a bilateral breast reconstruction with flaps, a functional circle abdominoplasty, and a bilateral brachioplasty.
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After Caprecom was liquidated, the woman was subscribed to the EPS Ana Wayuu EPSI, which has coverage in 9 municipalities of La Guajira. But that EPS refused to perform the procedures, stating that they were surgeries for cosmetic purposes. that could not be covered with public health resources, so if he wanted to access them, he had to pay for them with his own money.
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But when reviewing a guardianship of the user, the Constitutional Court has just agreed with the woman and ordered the EPS to carry out the procedures that she needs for her recovery.
The high court recalled that EPS cannot classify a plastic surgery as aesthetic or cosmetic without first doing an analysis of the particular case, and the physical, psychological and functional conditions that correspond to each patient.
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When an EPS wants to deny a procedure of this type – pointing out that it is not covered by the Health Benefits Plan – it must demonstrate with a medical support that the services they are requesting have the sole purpose of beautification.
Thus, the Court said, there are certain occasions in which some procedures that in principle could be seen as aesthetic, in reality they are not because they fulfill functional reconstructive purposes, that is, they improve the health of a citizen.
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And it is that health, recalled the high court, ranges from physical to psychological components, which implies that those procedures that allow a person to lead a decent life also have to do with health.
With all these elements, when evaluating the particular case of the La Guajira patient, the Court said that the surgeries ordered by her doctor should be performed because they seek to correct problems generated by the morbid obesity she had.
For the Court, the duty of the public health system with the patient did not end with the bypass, as it had to guarantee all the procedures that she needs, since, as stated in his guardianship, he has had to wear girdles to facilitate his mobility and carry out his daily tasks, and he has also been psychologically affected by the excess skin that remained after the surgery.
For this reason, the Court gave the EPS 48 hours to authorize and carry out the procedures on the patient (Read: Why did the Court drop the energy surcharge for strata 4, 5 and 6?).
Other decisions about procedures that EPS had denied, classifying them as aesthetic
In 2018, in another ruling, the Constitutional Court also ruled on this type of denied services, by ordering Military Health andngiving a man a green lens because although his eyes are that color, after suffering from glaucoma they had given him a brown lens, what affected their self-esteem and their rights.
And in 2019 the high court also ruled on the issue by ensuring that the breast reconstruction procedure, after suffering breast cancer, It cannot be considered by the EPS as an aesthetic service, for which they are obliged to perform these surgeries on women who request them.
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In that case, the Court said, it is clear that breast reconstruction seeks rehabilitation to recover a part of the body that was affected by a disease, which is why it ordered EPS Cosmitet Ltda. To perform this procedure on a user.
The Constitutional Court has had a different position in relation to prosthetic changes stating that the end of the useful life of these implants must be assumed and paid for by whoever undergoes this surgery.