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For The Right To Life Of Children With Cancer In Colombia

Original Language Title: Por el derecho a la vida de los niños con cáncer en Colombia

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1388 OF 2010

(May 26)

Official Journal No. 47.721 of 26 May 2010

CONGRESS OF THE REPUBLIC

For the right to life for children with cancer in Colombia.

Effective Case-law

COLOMBIA CONGRESS

DECRETA:

CHAPTER I.

OBJECT, DEFINITIONS, INTEGRAL MODEL BENEFICIARIES OF CARE AND INSURERS.

ARTICLE 1o. OBJECT OF THE LAW. Decrease significantly, the rate of mortality from cancer in children and persons under 18 years, through the guarantee by the actors of social security in health, of all the services they require for their early detection and comprehensive treatment, application of standardized protocols and guidelines and with the infrastructure, endowment, human resource and technology required, in Specialized Centers enabled for this purpose.

PARAGRAFO. The Ministry of Social Protection with the National Institute of Cancerology Advisory and the Colombian Association of Hematology and Pediatric Oncology (ACHOP) will design, update, and/or improve, according to the Technical Annex of this Law, the essential requirements of the Centers for Care, the protocols and the guidelines, for the most frequent causes of childhood cancer in Colombia, within a maximum period of 12 months.

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ARTICLE 2o. BENEFICIARIES. They are beneficiaries of this law:

1. The population under 18 years of age who has been confirmed, through the relevant studies, the diagnosis of cancer in any of its stages, types or modalities, certified by the Pediatric On-hematologist, duly accredited to the exercise of their profession, in accordance with the current regulations and the technical annex.

2. The population under 18 years of age with a confirmed and certified diagnosis by the Pediatric Onco-hematologist of Medular Aplasia and Medular Failure Syndromes, Hereditary Hemorrhagic Disorders, Congenital Hematologic Diseases, Histiocytosis, and Hispanic Disorders

3. The population under 18 years of age, where the general practitioner or any specialist in medicine, has suspected cancer or diseases listed in the numeral 2 of this Article and requires specialised examinations and procedures, until the diagnosis is not discarded.

PARAGRAFO. When the treating physician, regardless of his or her specialty, presumes the existence of cancer or the pathologies mentioned in the numeral 2 of this article, he must refer the patient to the unit of cancer in the area, without prejudice to the ordering of all diagnostic support tests and specialised procedures that are considered essential until the diagnosis is discarded.

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ARTICLE 3o. GUARANTEE OF CARE. The Ministry of Social Protection, in a term of 6 months, will regulate the creation and implementation of a database for the agility of the care of the child with Cancer.

So that the doctor who has the diagnostic presumption of Cancer in a minor, beneficiary of this law, will include it in this database, which can be consulted in real time and that will allow the EPS, ARS or Territorial Entity to According to the health social security systems in force in the country, the patient will be in the system.

In this database it will be specified that each beneficiary of this law, will count, from that moment and until the diagnosis is not discarded, with the authorization of all the procedures, in an integral and immediate way.

PARAGRAFO. These procedures will be understood as all elements and services that are required for the attention of the beneficiaries of this law as consultations, diagnostic support exams, medications, surgical interventions and follow-up to the patient.

All procedures will have an equivalent handling of the services included in the Mandatory Health Plan, POS, by the insurer or territorial entity.

If the patient belongs to the group of the so-called linked to the social security system in health, he will be affiliated immediately, to a Health Promoter Company of this regime. If this is not possible, for any cause, it will continue to receive this comprehensive care, in charge of the territorial entity.

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ARTICLE 4. INTEGRAL MODEL OF CARE. From the confirmation of the diagnosis of Cancer and until the treatment concludes, the insurers will authorize all the services that the minor requires, immediately. These services will be provided in the Child Cancer Care Unit, according to the criteria of the treating physicians in the different specialties, respecting the times, for confirmation of diagnosis and initiation of treatment that establish the care guides, regardless of whether they have a direct relationship with the main disease or that correspond to other levels of complexity in the health care models of the insurers.

In case the Unit does not have this service or does not have the available capacity, it will be sent to the center that it is selecting, without being a limiting, the payment of Copagos or the Moderating quotas, nor the periods of lack, irrespective of the number of weeks listed.

When the child has to be transferred to another Child Cancer Unit, this will be done in a coordinated manner between the remisora and the receiving entity, or the territorial entity and the EPS, and the first one must provide all the necessary information for the Treatment of the child is continued without any stumble.

PARAGRAFO 1o. It will be the Child Cancer Unit who supplies the best quality medicines, and who invoiced them to the corresponding EPS, according to the requirements set by it. Likewise, the application of preventive treatments, such as annual vaccination against Influenza, should be guaranteed to receive the children's relatives and cohabitants, which will be provided in the Children's Cancer Unit, according to the guide. attention and protocols; this, in order to prevent the lack of these preventive measures, endanger the effectiveness of the treatment of the child.

PARAGRAFO 2o. The insurer or the territorial entity, according to the current rules and those defined by the Health Regulatory Commission, may repeat against the Solidarity and Guarantee Fund, Fosyga, the value of the services that are not included in their respective Benefits Plan and have been provided to the child of Cancer. In any case, the beneficiaries of this law are not subject to the periods of absence or to the Copagos or the Moderator quotas. The Ministry of Social Protection shall regulate within a period of six months, the procedure for carrying out this procedure in an agile manner.

PARAGRAFO 3o. Any care or service formulated to the child with cancer shall be supported by the protocols and guidelines referred to in the first article of this law and in the technical annex and while These are elaborated, in the criterion of the specialist responsible for their treatment.

PARAGRAFO 4o. The insurer or the territorial entity that does not comply with the provisions of this article, will delay, hinder or hinder the immediate access of the child to the services it requires, will be punished with a fine up to 200 SMMLV. The Superintendence of Health and the Department, District and Municipal Health Departments, in exercise of their powers will be the entities in charge of the Inspection, Surveillance and Control.

CHAPTER II.

OF SERVICE PROVIDERS.

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ARTICLE 5o. THE CHILDREN ' S CANCER CARE UNITS (UACAI). As of the entry into force of this Law, the Children's Cancer Care units in Colombia will be located in hospitals or clinics of level III and IV of complexity. for children with or with a level III or IV pediatrics service and comply with the requirements laid down in Resolution 1043 of the Ministry of Social Protection, the Technical Annex, or other regulations which are intended to optimise the provision of services to children suffering from cancer.

PARAGRAFO 1o. The Ministry of Social Protection will be responsible for sectorizing care taking into account the needs of the demand so that its geographical location is rational.

PARAGRAFO 2o. The Ministry of Social Protection within a maximum of 6 months will regulate the essential requirements of the Child Cancer Care Units, as well as the number of Units per territorial entity, compliance with the demand, with the advice of the National Institute of Cancerology and the Society of Pediatric Onco-Hematology, and such requirements will be required to all the Institutions of Health Services that offer any service of care for children with cancer referred to in this law.

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ARTICLE 6o. OF THE DEADLINES FOR FULFILLING THE BASIC CONDITIONS OF THE CHILD CANCER CARE UNIT. The Health Services Institutions, IPS, which comply with the provisions of this article, regarding the level of complexity, which in the are currently providing services to treat children with cancer, will have a maximum period of two years to enable the requirements set out in the technical annex, taking into account the following priorities:

a) Immediate: Specific and exclusive delimited area for the Children's Cancer Unit, with exclusive staff. Minors will not be scattered throughout the Hospital in both inpatient and outpatient chemotherapy wards;

b) Central cyststatics preparation, in a term of 12 months;

c) To 24 months the construction and architectural adequacy of the unit.

PARAGRAFO. Within a maximum period of 6 months, the Ministry of Social Protection will review the economic feasibility of the current tariffs covering the investment of infrastructure and endowment of the Children's Cancer Unit, within a maximum of 10 years and shall propose, if necessary, the necessary adjustments to the competent regulatory body.

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ARTICLE 7o. OF THE SERVICE OFFER. As of the current law, the Assured of the contributory and subsidized health regime, will have among its network of providers, the Children's Cancer Units of the areas or regions where they have beneficiaries, in accordance with the availability and in accordance with the population parameters set out in the Technical Annex and defined by the Ministry of Social Protection.

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ARTICLE 8o. TIMELY DIAGNOSIS AND EARLY REFERENCE BY GENERAL PRACTITIONERS OR OTHER SPECIALISTS. The physician-general or specialist (pathologists outside the cancer unit, among others), must have the guidelines they allow, without any procrastination, referring to the minor with a diagnostic impression of Cancer, or the diseases mentioned in paragraph 2 of Article 2or this law, to a Child Cancer Unit, either enabled or in the process of enabling, of the III or IV level of complexity, to be practiced, in a timely manner, all required tests to confirm or reject the diagnosis.

PARAGRAFO. Within a term of six (6) months from the enactment of this law, the Ministry of Social Protection shall draw up the guidelines referred to in the previous article and promote the actions of the training, which is necessary, so that the general practitioner and other specialists can provide adequate and timely management to children who suffer or are suspected of being able to suffer from any of the diseases covered by this law.

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ARTICLE 9o. OPPORTUNITY AND EFFECTIVENESS OF HISTOPATHOLOGICAL SAMPLES OF CHILDREN WITH CANCER. As of the entry into force of this law and without prejudice to the requirements presented in the technical annex and the guidelines, the pathologists outside the Cancer Unit, they will have to process the corresponding biopsy, in a maximum time of 7 days or less, according to the Care Guide and in view of the suspected Cancer, they must report it to the Cancer Unit for the location of the patient and the patient. recording on the system, including in addition to the written report, the data for the location of the patient and the histological preparations or the paraffin block of the original tumor.

PARAGRAFO. Failure to comply with this article will be sanctioned in the terms set forth in paragraph 4 of article 4or this law.

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ARTICLE 10. TUMOR COMMITTEE. Since the management of a child with cancer imposes the need for multidisciplinary and interdisciplinary work, as of the entry into force of this law, the Health Services Institutions with Child Cancer Care units, enabled or in the process of enabling, will have a Committee of Tumors for the purpose of developing a coordinating, control and advisory activity on the disease within the PSUR. The Committee shall have the functions set out in the Technical Annex.

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ARTICLE 11. CHILDREN ' S CANCER CARE UNIT NETWORK. As of the current law, the Child Care Units, which are either enabled or in the process of enabling in the country, will be organized into a virtual network, which in addition to facilitating the mutual support contributes to the management of knowledge, dissemination of good practice, conduct of scientific studies and research on the pathologies of this law, and on others which, according to the practice and development of medicine, come to belong to this group.

PARAGRAFO. The Ministry of Social Protection, within a term of 6 months, from the entry into force of this law, will regulate the criteria for the formation of the Network of Cancer Care Units in the country.

Matches

CHAPTER III.

OF INFORMATION, REGISTRATION AND INVESTIGATION.

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ARTICLE 12. NATIONAL REGISTER OF CHILDHOOD CANCER. For the development of the guarantee provided for in Article 3or this law, the National Register of Child Cancer is created, with the purpose of carrying out in real time, the recording of the diagnosis, monitoring and evolution of the treatment of the patient, with the information that allows for quality care and the conduct of scientific studies. The minimum information required to be collected by this system appears in the technical annex. This registry will be part of the Sipolían and will be of mandatory notification in real time by the social security actors in health, without prejudice to optimize the data, according to the new information system that provides for the Law 1122 2007.

PARAGRAFO 1o. Within a period of not more than one year, the Ministry of Social Protection and the National Institute of Health, with the advice of the Colombian Association of Hematology and Pediatric Oncology (ACHOP), and the Councils Advisors on the subject, will make the necessary adaptations to the current Sipolís, for the capture, processing, archiving and consultation of the information of the children with cancer.

This registration will be completed in real time and will be a basic requirement for the legalization of the invoice by the IPS of the services provided, without prejudice to the requirements laid down in the rules. A single mandatory adoption software will be developed for the Units and will be mandatory adoption by the providers of these services.

PARAGRAFO 2o. The Ministry of Social Protection, in a term of 6 months, will regulate the creation and implementation of the database for the agility of the child's attention with Cancer that the article deals with href="ley_1388_2010.html#3"> 3or this law.

PARAGRAFO 3o. Create the National Unique Number for the beneficiaries of this law. This National Unique Number will serve as a mechanism to reliably record, deaths, dropouts and other information that facilitates the monitoring of patients and the conduct of studies and research, according to methodology that in A maximum of one year is implemented by the Ministry of Social Protection, as part of the National Register of Child Cancer.

CHAPTER IV.

OF COMPREHENSIVE CHILD SUPPORT WITH CANCER.

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ARTICLE 13. SOCIAL SUPPORT SERVICE. As of the validity of this law, the beneficiaries of this law will be entitled, when required by the treatment or diagnostic tests, to have the services of a Home of Pass, payment of the cost of displacement, psychosocial and school support, according to their needs, certified by the Social Worker or responsible for the Care Center of the child.

PARAGRAFO 1o. Within a maximum of six months, the Ministry of Social Protection will regulate the procedure and cost of the support services, taking into account that these will be free of charge for the less and at least one family member or acutente, who will be their companion, during the practice of the diagnostic support tests.

The treatment, or administrative procedures, as well as the source to defray the same, based on the resources that are not executed from the Fosyga or the financial returns of the same.

PARAGRAFO 2o. Within a maximum period of six (6) months, the Ministry of Education will regulate the special academic support in the Institutions of Health Services that offer any service care for the beneficiaries of this law, so that the absences at the school due to the treatment and consequences of the disease do not significantly affect their academic performance. The Ministry of Education will also ensure that public and private schools develop and implement an emotional support plan for the beneficiaries of this law and their families.

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ARTICLE 14. NATIONAL CHILD CANCER ADVISORY COUNCIL. Create the National Child Cancer Advisory Council, as the body responsible for monitoring and monitoring the implementation of this law, as well as national policies and plans that It will be derived, and will propose, if necessary, the necessary adjustments.

The National Advisory Council will be composed of: The Minister of Social Protection or his delegate, the Director of the National Institute of Cancerology, the president of the Colombian Association of Hematology and Pediatric Oncology, Director of Colombian Family Welfare Institute, EPS representative, representative of the IPS, a representative of the Non-Animo Organizations of Lucro or Foundations dedicated to the support of children suffering from Cancer and a representative of the parents of family.

PARAGRAFO. The Advisory Board, among others, will have the following functions:

a) To monitor and monitor the implementation of this law;

(b) Advise the Ministry of Social Protection in the development of the regulations deriving from this law;

c) Propose policies, plans and strategies aimed at improving the overall care of the child with cancer and reducing the mortality rates of this population;

d) Propose the necessary adjustments to the current regulations, including this law;

e) Velara for the effectiveness of the National Information System;

f) It will set goals for continuous improvement in the management of Colombian minors who suffer from Cancer and who are beneficiaries of the law;

g) Propose mechanisms and adjustments to improve the overall care model for the child with cancer;

h) Establish priorities for the conduct of scientific studies and research related to the child's CA;

i) Analyse the evolution of the indicators of the Child CA, proposing goals in this respect;

j) Support the management of all types of resources in support of the child's care with Cancer.

k) Will advise the Ministry of Social Protection, the Health Regulatory Commission, and other entities that so require, in terms of fees, costs, procedures and other issues that will improve the overall care of the children, girls and boys, beneficiaries of this law;

l) Submit an annual report to the Congress of the Republic, detailing its work and activities;

m) Generates your rules of procedure.

PARAGRAFO 2o. Within 6 months after the publication of this law, the Ministry of Social Protection shall regulate all matters concerning the National Council of Advisors in Child CA, the election of its members, the periodicity of their meetings and other aspects to ensure their optimal functioning.

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ARTICLE 15. ADVISORY DEPARTMENTAL COUNCILS. In each department of Colombia, the departmental councils of the advisory departments in child CA will be organized, as organs of support for the implementation, monitoring and continuous improvement of the present law, integrated by: Departmental Secretary for Health, Secretary of Education, Director of the Child CA Unit entitled or in the process of enabling in the Department, President of the Social Policy Council, Director of the ICBF, representative of an organization Non-profit, representative of the EPS of the jurisdiction, representative of the parents family and a representative of the community.

The departmental councils will assume the functions described in the previous literals, in the area and competences of the territory.

PARAGRAFO 1o. Within 6 months after the publication of this law, the Ministry of Social Protection shall regulate all matters concerning the National Councils and Departmental Advisors in CA. Children, the choice of their members, the periodicity of their meetings and other aspects that guarantee their optimal functioning.

Final Provisions

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ARTICLE 16. VALIDITY. This law governs from its sanction and publication, repealing all those provisions that are contrary to it.

The President of the honorable Senate of the Republic,

JAVIER CACERES LEAL.

The Secretary General of the honorable Senate of the Republic,

EMILIO OTERO DAJUD.

The President of the honorable House of Representatives,

EDGAR ALFONSO GOMEZ ROMAN.

The Secretary General of the honorable House of Representatives,

JESUS ALFONSO RODRIGUEZ CAMARGO.

COLOMBIA-NATIONAL GOVERNMENT

Publish and comply.

Dada in Bogotá, D. C., on May 26, 2010.

ALVARO URIBE VELEZ

The Minister of Finance and Public Credit,

OSCAR IVAN ZULUAGA ESCOBAR.

The Minister of Social Protection,

DIEGO PALACIO BETANCOURT.

CONSTITUTIONAL COURT

General Secretariat

Bogotá, D. C., twenty-seven (27) April two thousand ten (2010)

Non-CS-112 Office

JAVIER CÁCERES LEAL

President

Senate of the Republic

Reference: Expedient OP-116 Statement C-850/09. Bill of law number 336 of 2008 Chamber, 094 of 2007 Senate, for the right to life of children with cancer in Colombia. Magistrate Judge Nilson Pinilla Pinilla.

Dear Doctor:

Comedies and in accordance with article 16 of Decree 2067 of 1991, I allow you to send you a copy of the 2009 C-850 Judgment of the twenty-five (25) November of two thousand nine (2009), proffered within the reference process.

In time, I refer you to the constant legislative record of 328 foles.

Cordially,

MARTHA VICTORIA SACHICA MENDEZ,

General Secretariat.

Attachment copy of the Statement with 52 Foles.

CONSTITUTIONAL COURT

-Full Room-

2009 C-850 STATEMENT

Reference: Expedient OP-116.

Presidential Objections to Bill No. 094 of 2007 Senate, 336 of 2008 House, for the right to life of children with cancer in Colombia.

Speaker: Nilson Pinilla Pinilla

Bogotá, D. C., November twenty-five (25) two thousand nine (2009).

The Full Court of the Constitutional Court, in compliance with its constitutional powers and the requirements and procedures laid down in Decree 2067 of 1991, has proposed the following

STATEMENT

I. BACKGROUND

By way of office received on January 26, 2009 at the General Secretariat of the Constitutional Court, the President of the Senate of the Republic referred to the Bill number 094 of 2007 Senate, 336 of 2008 Chamber, for the right to The life of children with cancer in Colombia, objected by the Executive for reasons of unconstitutionality, being established as the Expediente OP-116.

In providence of February 5 of the current year, it was decided to set the matter on the list and the Secretaries-General of the Senate of the Republic and the House of Representatives were ordered to officiate, so that they would send information about the act submitted to the constitutional judgment.

February 9 of this year, the Chief of the Law Section of the Senate of the Republic requested the return of the legislative file, " the approval procedure for the report of objections to the House of Representatives was left pending ... ", the above " ... in order to have this procedure surfed ".

In order of February 18 of the current year, the Plena Room of this corporation arranged to abstain from deciding on the presidential objections to the draft law of the reference and ordered to return the Speaker of the House of Representatives legislative file to comply with article 167 of the Political Constitution.

With April 3 of the year, the President of the Senate of the Republic referred again to the bill, including the approval of the report on the objections in plenary session of the House of Representatives.

Fulfilled the aforementioned procedure and received the concept of the Attorney General of the Nation, it is then up to this Court to rule on the presidential objections.

II. BILL TEXT

The text of the bill objected by the government is then transcribed:

" Law No.

'for the right to life for children with cancer in Colombia'

The Congress of Colombia

DECRETA:

Object, definitions, integral model of care beneficiaries, and insurers

Article 1o. Object of the law. Decrease significantly, the rate of mortality from cancer in children and persons under 18 years, through the guarantee by the social security actors in health, of all the services they require for their detection Comprehensive treatment, application of protocols and standardized care guidelines and with the required infrastructure, endowment, human resource and technology, in Specialized Centers enabled for this purpose.

. The Ministry of Social Protection with the Advisory Office of the National Institute of Cancerology and the Colombian Association of Hematology and Pediatric Oncology (ACHOP) will design, update, and/or improve, according to the technical annex of this law, the essential requirements of the Centers for Care, protocols and guidelines, for the most frequent causes of childhood cancer in Colombia, within a maximum of 12 months.

Article 2o. Beneficiaries. They are beneficiaries of this law:

1. The population under 18 years of age who has been confirmed, through the relevant studies, the diagnosis of cancer in any of its stages, types or modalities, certified by the Pediatric On-hematologist, duly accredited to the exercise of their profession, in accordance with the current regulations and the technical annex.

2. The population under 18 years of age with a confirmed and certified diagnosis by the Pediatric Onco-hematologist of Medular Aplasia and Medular Failure Syndromes, Hereditary Hemorrhagic Disorders, Congenital Hematologic Diseases, Histiocytosis, and Hispanic Disorders

3. The population under 18 years of age, where the general practitioner or any specialist in medicine, has suspected cancer or diseases listed in the numeral 2 of this Article and requires specialised examinations and procedures, Until diagnosis is not dropped.

. When the treating physician, regardless of his or her specialty, presumes the existence of cancer or the pathologies mentioned in the numeral 2 of this article, he must refer the patient to the cancer unit corresponding to the area, without the damage to order all diagnostic support tests and specialized procedures that are considered indispensable until the diagnosis is discarded.

Article 3o. Guarantee of care. The Ministry of Social Protection, in a term of 6 months, will regulate the creation and implementation of a database for the agility of the care of the child with Cancer.

So that the doctor who has the diagnostic presumption of Cancer in a minor, beneficiary of this law, will include it in this database, which can be consulted in real time and will allow the EPS, ARS or Territorial entity in charge, according to the Health Social Security Regulations in force in the country, to find the patient in the system.

In this database it will be specified that each beneficiary of this law, will count, from that moment and until the diagnosis is not discarded, with the authorization of all the procedures, in a comprehensive way and immediate.

. These procedures will be understood as all the elements and services that are required for the attention of the beneficiaries of this law as consultations, diagnostic support exams, medications, surgical interventions and the follow-up to the patient.

All procedures will have an equivalent handling of the services included in the Mandatory Health Plan, POS, by the insurer or territorial entity.

If the patient belongs to the group of the so-called Social Security System in Health, he will be immediately affiliated to a Health Promoter Company of this regime. If this is not possible, for any cause, it will continue to receive this comprehensive care, in charge of the territorial entity.

Article 4o. Integral Model of Care. From the confirmation of the diagnosis of Cancer and until the treatment concludes, the insurers will authorize all the services that the minor requires, immediately. These services will be provided in the Child Cancer Care Unit, according to the criteria of the treating physicians in the different specialties, respecting the times, for confirmation of diagnosis and initiation of treatment that establish the care guides, regardless of whether they are directly related to the main disease or that correspond to other levels of complexity in the health care models of the insurers.

In case the Unit does not have this service or does not have the available capacity, it will be sent to the center that it is selecting, without being a limiting, the payment of Copagos or Moderators, nor the periods of lack, regardless of the number of weeks listed.

When the child is to be transferred to another Child Cancer Unit, this will be done in a coordinated manner between the remisora and the receiving entity, or the territorial entity and the EPS, with the first one supplying all the information necessary for the treatment of the minor to continue without any stumble.

1o. It will be the Children's Cancer Unit who supplies the best quality medicines, and who invoiced them to the corresponding EPS, according to the requirements set by it. Likewise, the application of preventive treatments, such as annual vaccination against Influenza, should be guaranteed to receive the children's relatives and cohabitants, which will be provided in the Children's Cancer Unit, according to the guide. of care and protocols; this is intended to prevent the lack of these preventive measures from endangering the effectiveness of the treatment of the child.

2o. The insurer or the territorial entity, in accordance with the rules in force and those defined by the Health Regulatory Commission, may repeat against the Solidarity and Guarantee Fund, Fosyga, the value of the services that are not included in its Benefit Plan and have been supplied to the child of Cancer. In any case, the beneficiaries of this law are not subject to the periods of absence or to the Copagos or Moderator quotas. The Ministry of Social Protection shall regulate within a period of 6 months, the procedure for carrying out this procedure in an agile manner.

3o. Any care or service formulated to the child with cancer shall be supported by the protocols and guidelines referred to in Article 1 of this Law and in the Technical Annex and, as long as they are prepared, in the specialist responsible for your treatment.

4o. The insurer or the territorial entity that does not comply with the provisions of this article, will delay, hinder or hinder the immediate access of the child to the services it requires, will be sanctioned with a fine of up to 200 SMMLV. The Superintendency of Health and the Departments of Health, District and Municipal Health, in exercise of their competencies will be the entities in charge of Inspection, Surveillance and Control.

CHAPTER II

Of service

Article 5o. The Child Cancer Care Units (UACAI). As of the entry into force of this law, the Children's Cancer Care units in Colombia will be located in hospitals or clinics of level III and IV of pediatric complexity or with service of pediatrics of level III or IV and comply with the requirements set out in Resolution 1043 of the Ministry of Social Protection, the Technical Annex, or other regulations that are intended to optimize the provision of services to children suffering from Cancer.

1o. The Ministry of Social Protection will be responsible for sectorizing care taking into account the needs of the demand so that its geographical location is rational.

2o. The Ministry of Social Protection within a maximum of 6 months will regulate the essential requirements of the Child Cancer Care Units, as well as the number of Units per territorial entity, according to the demand, counting with the advice of the National Institute of Cancerology and the Society of Pediatric Onco-Hematology, and such requirements will be required to all the Institutions of Health Services that offer any service of attention to minors with cancer referred to in this law.

Article 6o. Of the Plazos to meet the basic conditions of the Child Cancer Care Unit. The Institutions of Health Services, IPS, which comply with the provisions of this article, regarding the level of complexity, which currently are providing services to treat children with cancer, will have a period of time. maximum of two years to enable the requirements set out in the technical annex, taking into account the following priorities:

a) Immediate: Specific and exclusive delimited area for the Child Cancer Unit, with exclusive staff. Minors will not be scattered throughout the Hospital in both inpatient and outpatient chemotherapy wards;

b) Central cyststatics preparation, in a term of 12 months;

c) To 24 months the construction and architectural adequacy of the unit.

. Within a maximum period of 6 months, the Ministry of Social Protection will review the economic feasibility of the current tariffs covering the investment of infrastructure and endowment of the Child Cancer Unit, in a maximum term of 10 years and propose to be the case, the necessary adjustments to the competent regulatory body.

Article 7o. From the Service Offering. As soon as this law is in force, the contributory and subsidized health insurance companies will have among their network of providers, the Children's Cancer Units of the areas or regions where they have beneficiaries, according to the with the availability and in accordance with the population parameters set out in the Technical Annex and defined by the Ministry of Social Protection.

Article 8o. Timely Diagnosis and Early Reference by General Practitioners or other Specialists. The general practitioner or specialist (pathologists outside the cancer unit, among others), must have the guidelines that allow, without any delay, to send the child with a diagnostic impression of Cancer, or the diseases mentioned in the paragraph 2 of Article 2 of this Law, to a Child Cancer Unit, entitled or in the process of enabling the III or IV level of complexity, to be given, in a timely manner, all the necessary tests to confirm or reject the diagnosis.

. Within a term of six (6) months from the enactment of this law, the Ministry of Social Protection shall draw up the guidelines referred to in the previous article and promote the necessary training actions for the General practitioner and other specialists can provide appropriate and timely management to children who suffer or are suspected of being able to suffer from any of the diseases covered by this law.

Article 9o. Opportunity and effectiveness of histopathological samples of children with Cancer. As of the entry into force of this law and without prejudice to the requirements presented in the technical annex and the guidelines, the pathologists outside the Cancer Unit shall process the appropriate biopsy in a maximum time of 7 days or less, according to the Care Guide and in the event of suspected Cancer, should report it to the Cancer Unit for the location of the patient and the registry in the system, including in addition to the written report, the data for the location of the patient and the histological preparations or the parafine block of the original tumor.

. Failure to comply with this article shall be punishable under the terms set out in paragraph 4 of Article 4 of this Law.

Article 10. Committee of Tumors. Since the handling of a child with cancer imposes the need for multidisciplinary and interdisciplinary work, from the entry into force of this law, the Health Services Institutions with Care Units Children's Cancer, enabled or in the process of enabling, will have a Committee of Tumors for the purpose of developing a coordinating, control and advisory activity on the disease, within the PSUR. The Committee shall have the functions included in the Technical Annex.

Article 11. Network of Child Cancer Care Units. As of the current law, the Child Care Units, which are enabled or in the process of enabling in the country, will be organized into a virtual network, which in addition to facilitating mutual support will contribute to the management of the knowledge, dissemination of good practice, studies and scientific research on the pathologies of this law, and on others which, according to the practice and development of the median, will belong to this group.

. The Ministry of Social Protection, within a term of 6 months, from the entry into force of this law, will regulate the criteria for the formation of the Network of Cancer Care Units in the country.

CHAPTER III

Of information, logging, and research

Article 12. National Child Cancer Registry. For the development of the guarantee provided for in Article 3 of this Law, the National Register of Children's Cancer is created, with the purpose of carrying out in real time, the record on the diagnosis, monitoring and evolution of the treatment. of the patient, with the information that allows for quality care and the realization of scientific studies. The minimum information required to be collected by this system appears in the technical annex. This registry will be part of the Sipolían and will be of mandatory notification in real time by the social security actors in health, without prejudice to optimize the data, according to the new information system that provides for the Law 1122 2007.

1o. Within a period of not more than one year, the Ministry of Social Protection and the National Institute of Health, with the advice of the Colombian Association of Hematology and Pediatric Oncology (ACHOP), and the Advisory Councils on the subject, will carry out the Necessary adaptations to the current Sipolían, for the capture, processing, archiving and consultation of information for children with cancer.

This registration will be completed in real time and will be a basic requirement for the legalization of the invoice by the IPS of the services provided, without prejudice to the requirements laid down in the rules. A single mandatory adoption software will be developed for the Units and will be mandatory adoption by the providers of these services.

2o. The Ministry of Social Protection, in a term of 6 months, will regulate the creation and implementation of the database for the agility of the child's care with Cancer that is dealt with in article 3o of this law.

3o. Create the National Unique Number for the beneficiaries of this law. This National Unique Number will serve as a mechanism to reliably record, deaths, dropouts and other information that facilitates the monitoring of patients and the conduct of studies and research, according to methodology that in a A maximum of one year is implemented by the Ministry of Social Protection as part of the National Register of Child Cancer.

CHAPTER IV

support for the child with cancer

Article 13. Social Support Service. As soon as this law applies, the beneficiaries of this law will be entitled, when required by the treatment or diagnostic tests, to have the services of a Home of Pass, payment of the cost of displacement, support psychosocial and school, according to their needs, certified by the Social Worker or responsible for the Care Center of the child.

1o. Within a maximum period of six months, the Ministry of Social Protection shall regulate the procedure and cost of the support services, taking into account that these will be free of charge for the child and at least one family member or acudente, who will be your companion, during the practice of diagnostic support exams.

The treatment, or administrative procedures, as well as the source to defray the same, based on the resources that are not executed from the Fosyga or the financial returns of the Fosyga.

2o. Within a maximum period of six (6) months, the Ministry of Education will regulate the special academic support in the Institutions of Health Services that offer any service to the beneficiaries of the This law, so that the absences in the school due to the treatment and consequences of the disease do not significantly affect their academic performance. The Ministry of Education will also ensure that schools develop and implement an emotional support plan for the beneficiaries of this law and their families.

Article 14. National Child Cancer Advisory Council. Create the National Advisory Council for Children's Cancer, as an entity responsible for monitoring and monitoring the implementation of this law, as well as for the national policies and plans that follow, and propose, to be required, any adjustments required.

The National Advisory Council will be composed of: The Minister of Social Protection or his delegate, the Director of the National Institute of Cancerology, the president of the Colombian Association of Hematology and Pediatric Oncology, Director of the Colombian Family Welfare Institute, representative of the EPS, representative of the IPS, a representative of the Non-Animo Organizations of Lucro or Foundations dedicated to the support of children suffering from Cancer and a representative of parents.

. The Advisory Board will have the following functions:

a) You will monitor and track the implementation of this law;

b) Advise the Ministry of Social Protection in the development of the regulations deriving from this law;

c) Propose policies, plans and strategies aimed at improving the overall care of the child with cancer and reducing the mortality rates of this population;

d) Propose the necessary adjustments to the current regulations, including this law;

e) Velara for the effectiveness of the national information system;

f) Will set goals for continuous improvement in the management of Colombian children suffering from Cancer and who are beneficiaries of the law;

g) Propose mechanisms and adjustments to improve the overall care model for the child with cancer;

h) Set priorities for conducting studies and scientific research related to child CA;

i) Analyse the evolution of the Child CA indicators, proposing goals in this respect;

j) Support management of all types of resources in support of child care with Cancer;

k) Assessor in need, the Ministry of Social Protection, the Health Regulatory Commission and other entities that so require, in terms of fees, costs, procedures and other issues that will improve care integral to children and young people, beneficiaries of this law;

1) You will present an annual report to the Congress of the Republic, detailing your work and activities;

m) You will generate your internal rules.

2o. Within 6 months after the publication of this law, the Ministry of Social Protection shall regulate all matters concerning the National Council of Advisors in Child CA, the election of its members, the periodicity of its members meetings and other aspects to ensure their optimal operation.

Article 15. Advisory Departmental Councils. In each department of Colombia, the Department of Advisory Councils in children's CA will be organized as organs of support for the implementation, monitoring and continuous improvement of this law, integrated by: The Departmental Secretary of Health, Secretary of Education, Director of the Child CA Unit, or in the process of enabling the Department, President of the Social Policy Council, Director of the ICBF, representative of a non-profit organization, representative of the EPS of the jurisdiction, representative of the parents and a representative of the community.

The departmental councils will assume the functions described in the previous literals, in the territory and competencies of the territory.

1o. Within 6 months after the publication of this law, the Ministry of Social Protection shall regulate all matters concerning the National Councils and Departmental Advisors in Child CA, the election of its members, the periodicity of their meetings and other aspects that ensure their optimal functioning.

Provisions

Article 16. Effective. This law governs from its sanction and publication, repealing all those provisions that are contrary to it. "

III. NATIONAL GOVERNMENT OBJECTIONS

For the Government the draft law objected to the article 152 of the Political Constitution, which mandates that the statutory law be subject to the law of fundamental rights, It regulates the right to health of children suffering from cancer, which by the express mandate of article 44 of the Constitution and the case law of this Court (C- 463 and T-760 of 2008), holds that character, not only for its connection with others rights of the same stretch, but to derive directly from the principle of universality of social security enshrined in the article 48 above.

States that the bill is contrary to the Political Constitution, because by establishing restrictions that prevent the State from overcoming the flaws in the comprehensive and articulated regulation of the Social Security System in Health, it directly affects rights to health and life and, in general, the rights of children. In this regard, it explains that the project interferes in the adoption of the measures aimed at correcting the regulatory failures analyzed by the Court in Case T-760 of 2008, which translates into an obstacle to guarantee the fundamental right to the health and other related fundamental rights, such as those provided for in Articles 11 and 44 above.

considers that the correction of the regulatory measures must be analyzed integrally from the universe of pathologies that must be addressed, as well as from the different groups and, in general, from the entire population, in addition to considerations on the available resources, as highlighted by the Court in that statement.

In this sense it indicates that for this Court the provision of health services to the population must be the result of the adoption of a public health policy, which takes into account in a comprehensive and comprehensive manner the benefits that can grant, given limited resources, a task that corresponds to the National Government, the National Council of Social Security in Health and the Commission on Health Regulation CRES, as provided for by Law 1122 of 2007.

Expresses that the objection is not intended to ignore the health protection of children, in particular those suffering from cancer, but to ensure that legislative activity is consistent with the integral and universal nature of this fundamental right which, In its opinion, it can only be achieved through the analysis by the bodies that have the information and have the competence to define the scope and the real possibilities of the health system, which does not exclude the elaboration and presentation by the National Government of bills for this purpose.

Manifests that public health policy cannot be configured in a dispersed manner through different bills, that by regulating various pathologies they will define the contents of the plan of benefits, since it is a matter that requires the prior analysis of its relevance and integration into a system whose content should be defined on the basis of the assessment and definition of a sustainable financing scheme over time, allowing effective access to the benefits that grants.

In particular, he comments that the legislator is head of the National Council for Social Security in Health, and later in the head of the CRES by Law 1122 of 2007, the competition to define the contents of the Mandatory Health Plan and the value of the Payment Per Capitation Unit, for the purpose of ensuring the financial viability of such benefits.

In his opinion, the problem described is a current legislative practice, as evidenced by the bills that deal with various contents and very broad or unlimited health issues, such as fetal alcoholism, anemia Sickle cell disease, dwarfism, obesity, ocular prostheses, epilepsy, vasectomy and tubal ligation, among others, that currently make transit through the Congress of the Republic.

Expresses that for the Social Security Council in Health and, at the time, for the CRES, the comprehensive and sustainable definition of health benefits would be impossible, which is why it should be understood that for the determination of the The policy in this field must be in a harmonious way, according to its competences, different instances of the State, including the legislative one, as a result of a preliminary and comprehensive analysis, that allows to define clear limits to the benefits for the purpose of ensuring their viability on the basis of the available resources.

Maintains that the Ministers of Social and Finance Protection and Public Credit in communication sent to Congress during the passage of the bill indicated that any pathology should have adequate and timely treatment in the system. General of Social Security, where the attention of children's cancer is contemplated; likewise, they expressed that the definition of the contents of the POS by legislative means the design of the system created by the same legislator, warning that also that in recent years the General System of Social Security in Health presents an increase in the number of members, thanks to the increase in the number of insured under the subsidized regime, while the contributory regime has remained almost stable, as confirmed by the study carried out in 2007 by the Fundación Corona, the University of of the Andes, the National Department of Planning and the University of the Rosary.

It is important to highlight the effort involved in the creation of the Commission on Health Regulation, CRES, in Law 1122 2007, as a technical body to which the functions of the define and modify the Mandatory Health Plans; define and review, at least once a year, the list of essential and generic drugs that will be part of the Benefit Plans and define the value of the Payment Unit for the each regime, among others.

States that in the mentioned communication the ministers also stated that it is not appropriate to leave the attention of certain diseases and to generate preferential treatments for pathologies or sectors on others, as well as could be justified, at the time of issuing regulations in this matter all sick or age group would claim for theirs clinging to their specialty, nature and conditions, among other reasons.

Reiterates that through initiatives such as the one objected, the General System of Social Security in Health loses its general character, by proliferating subsystems with special attention schemes, losing interrelation between the parts that make it and The Court of Justice of the Court in Case T-760 of 2008, has ordered, among other measures, to review the contents of the POS, to update and to unify the plans of benefits for the children of the Contributory and the subsidized regime, taking into account the financial sustainability and keeping in mind of the CRES the technical competence to define the contents of the POS, in harmony with the epidemiological needs of the population and the availability of resources.

Exposes that currently the CNSSS advances studies and analyses to achieve the objectives outlined by the Court, which requires a review of the way in which the various diseases, among them the high cost, must be integrated into the POS. as cancer, without prejudice to the financial sustainability of the benefit plan that I have agreed to approve.

States that as currently the General System of Social Security in Health guarantees the population access to cancer treatment, in terms of the resources available in the country and in the same System, both for the Contributory Regime As for the Subsidiary, it is necessary to review not only the benefits provided for the care of this disease, but those that exist and/or will be granted for the care of the other pathologies, starting with those of the population of less than 12 years.

It is appropriate for the legislative body to take into account that according to the guidelines of Case T-760 of 2008, the CRES or, failing that the CNSSS, has competence to define hedges, visualizing the general picture of the system and the financial sustainability of it, based on the resources that the State and the people with the capacity to pay can be applied rationally, and the draft law is therefore not the population to which it benefits, in a factor of disarticulation in the face of the decisions that the judgment points out.

Another objection that the executive branch makes against the bill is that its procedure has been broken down by article 7or by the Organic Law 819 of 2003, which requires Congress to carry out the fiscal impact study. of initiatives on public spending, as in his opinion some articles of the project that include expressions such as ... the authorization of all the procedures, in an integral and immediate way ... (paragraph 3); "... all the elements and services required ...", "... may repeat against the Fosyga, the value of the services not included in their respective profit plans ..."; " ... the beneficiaries shall have ... to count on the services of Hogares de Paso, payment of the cost of the displacement psychosocial and school support, according to the needs, certified by the Social Worker ... " (article 4 (o)), it is possible to deduce that technology is involved for the treatment of the disease, as well as quality conditions other than those currently available to finance the General System of Social Security.

Maintains that articles 3o, 4, and 13 of the draft law provide access to services and benefits, solely and exclusively based on the existence of the disease, without regard to criteria of efficiency and rationality in the The Court has recommended special care, since the resources of the General System of Social Security in Health and those of the General System of Participations must cover benefits not included in the plans of benefits, to the extent that no payment capacity is available.

Because of the above, the government finds that the bill produces fiscal impact, since both the contributory and the subsidized regime increase the financial needs of the system with the expansion of the benefits that are grant, as they require greater resources to finance the services in an undetermined amount, generating unquantifiable contingencies in the case of the contributory scheme, and additional considerable tax expense, in the subsidized scheme, without the project providing for or establishing the source of additional funding for the Executive allow to assume those higher expenses.

Argues that since the 2003 Law 819 an organic standard, its lack of knowledge carries the unconstitutionality of the project in opposition to the article 151 of the Political Constitution, which points out that the rules of that category condition the legislative activity in the subject that they regulate and concludes that the objectionable initiative is not consistent with the Medium Term Fiscal Framework, because it is not properly funded with available resources, promoting the imbalance in the General System of Social Security in Health, given that it does not have a source of funding that will allow the benefits to be addressed.

Insists that for the revision of the contents of the POS, both the Ministry of Social Protection and the CNSSS, or the CRES, must analyze various aspects, such as the technology available in the country and the epidemiological profile of the population, among other aspects, with the aim of bringing forward analysis and technical-scientific studies that will allow the selection of services, actions, activities, medications, inputs, that will better cover the health needs of the Colombian population and present more effectiveness, decisions that must also consult the balance financial system, according to medium-and long-term sustainability projections.

Assures that in order to carry out the task entrusted by this Court in terms of the redesign of the contents of the POS, it is neither convenient nor feasible for the legislator to establish and/or include procedures, activities, interventions and medications to increase the benefit plans, as well as to do so without any delimitation or considering the needs of the population and the availability of resources of the General System of Social Security in Health, since it not only endangers the financial balance of the system also but also health care for the rest of the population that presents other needs other than cancer, which ultimately ends up affecting the general interest.

Warns that the resources to finance both the Contributory and the subsidized regime remain the same, that is, contributions in the contributory regime (11 percentage points of the current 12.5) and solidarity resources (1.5 points). from the contribution of the contribution regime) and tax resources, in the subsidized regime and recalls that Law 715 of 2001, assigned to the Municipalities, Districts and Departments, the management and financing of the health services of the poor population not covered with demand subsidies, for which, while achieving universal coverage, must bear in mind that while they have resources from the General System of Participations and Fosyga, as relevant, in any case their resources are limited and, therefore, they would not be in conditions for providing comprehensive care, as it would affect territorial finances.

Concludes that the extension of the Mandatory Health Plan, POS, in both regimes, as a consequence of the approval of the proposed bill, which did not take into consideration criteria such as the existence of resources that finance it, the cost-effectiveness, the attention of the most relevant risks of the population and the average quality and technology available in the country, among others, affects the balance of the General System of Social Security in Health, which is precarious in the case of the Contributory, since the resources raised by the Compensation Sub-account barely cover the annual expenditure represented in the UPC to be recognized by each affiliate and in addition to the expenditure represented by the recoworkers by means of tutoring and Scientific Technical Committees, which significantly compromise the availability of the resources of the Fosyga.

Finally, as far as Article 5 of the project ordering restructuring of the Child Cancer Care Unit is concerned, it considers that the measure does not know the right to free enterprise of private PSUR, in establishing All of the III or IV level must proceed to conform these units, ignoring that they may not be interested in their implementation and may instead concentrate their efforts on the attention of the another type of pathologies; in addition a decision like that, adopted without further analysis, in his opinion It is against the constitutional principle of efficiency in the provision of health services.

IV. INSISTENCE OF THE CONGRESS OF THE REPUBLIC

The chambers insisted on the passage of the bill under review, in accordance with the text approved by them, initially calling attention to the fact that the presidential objections are also signed by the Finance Minister and Credit Público, a body that does not have jurisdiction in its opinion on matters other than its portfolio, a situation that in its opinion " confirms the clearly-financed criterion with which the serious problem is analyzed. of health in the country ".

Reject the objection for alleged violation of article 152 of the Political Charter, considering that in Judgment C-581 of 2008, with the presentation of Dr. Manuel José Cepeda Espinosa, the Court It has established that a social security standard should not necessarily be the subject of statutory law; the argument outlined by the government is also invalid because it does not know doctrine and jurisprudence according to which the procedure is not necessary. legislative laws in those areas where, although it is true they touch Fundamental rights issues are not affected by the essential core of these rights.

They state that if the object of the project is to decrease the mortality rate for cancer in children and adolescents under 18 years of age, it should be concluded that it is in no way intended to affect or modify the nucleus. It is essential to the fundamental right of health but, on the contrary, to adopt a legal tool that seeks to guarantee its effective enjoyment to a group of people who are not being guaranteed this right, which is why its procedure corresponds to that of an ordinary law.

They indicate that in the explanatory statement there is statistical information showing that countries with similar levels of development to ours have achieved strong results in the treatment of childhood cancer, only through instruments such as those provided for in the draft law, where certain requirements for mandatory compliance with the detection, treatment and monitoring of this pathology are considered.

In its opinion, the government interprets isolated and decontextualized paragraphs of the 2008 T-760 judgment, to object to the bill, which in its opinion is not in accordance with the essence of that statement, which is only to be protected. has effects inter parties and consider "funny" that the government invokes judicial providences that condemn the state for its inefficiency, negligence or inoperative. They estimate that this sentence is completely in harmony with the objectives of the bill, because there are recognized "in a broad but general way", all the shortcomings in the application of the current regulations on Social security in health, which are reflected in cloths that are constantly being interposed by the users, in whose favor the delivery of integral treatments is ordered.

They do not accept the objection that the project prevents or interferes in the adoption of measures aimed at correcting regulatory failures, because in its opinion, although a comprehensive approach is necessary, there are priority pathologies, such as childhood cancer, whose regulatory delay is motivating at least two children to die a day for basically administrative errors in the detection and treatment of the disease.

El Comercio] For the legislative chambers, the bill is not modifying the social security benefits plans in health, nor have the Constitutional Court rulings that mandate comprehensive care have been made in their judgment. medicines, treatments or procedures excluded from such plans and add that the Scientific Technical Committees operating in the EPS, try to fill this gap, with the severe limit, in the cases of children with cancer, that the terms that imposed to adopt their decisions and the subsequent requirements and formalities, effectiveness of treatment.

They state that there is a consensus among the physicians who advised the drafting of the bill, that users after interposing with them, raising petition rights, presenting interviews with the Scientific Technical Committees, CTC, etc. the approval of the treatments and/or medicines formulated, but to the detriment of the opportunity of care.

Indicate that the bill does not provide for a basket of infinite services either, as it is "normalizing" the timely supply of the medications and/or procedures that the treating physicians formulate, according to criteria of rationality and quality, but in specialized centers and with expert staff in the care of this pathology, which in children is presented in a different way.

Justify the financing of the nursing home, because it has been shown to be fundamental for minors to remain in treatment, especially those who live in the country's remote areas or regions, support that they provide, or the same "Families carrying out collections to obtain the indispensable money, which does not guarantee the proper attention of minors," are complicated with the greatest economic cost, or die with the immense social cost that the loss of a child causes ".

They equate that service with the "care at home" or "palliative care" of terminal patients, which is being supplied by some EPS, with the difference that for the treatment of With cancer, this service increases the guarantee of success, because it is a care center specially equipped for this purpose, where with comprehensive and timely care and the appropriate socio-affective support, they can be reached (i_aj"> "survival rates of over 80% and in many cases the total cure of the disease" .

They point out that in developed countries, 33,000 cases of childhood cancer occur annually and in the underdeveloped countries there are 180,000; in the first 100% of the children have access to the treatments, while in the second, only the 20%, on average; therefore, it is not surprising that the total cure rate in the rich countries reaches 75% and that of the poor countries barely 2.5%, on average, projections showing the sad outlook to 2010, when the rates of life will be, 90% and 20% for developed and non-developed countries, respectively, a situation which requires Public policies that challenge this trend, "like several countries similar to ours, have done so".

for the legislative chambers, these studies also indicate that despite the structural factors that condition the behavior of the indices in our country, it is feasible to improve them significantly if the models of the attention, as well as the endowment, human talent and technology, as it happens in the Hospital of Recife, in Brazil, where it went from an abandonment rate of 16% to one of just 0.5%; and from an over-life, free of event from 32% to 63%, in approximately 12 years, due to the transfer of the children to a Maternal Children's Hospital with a permanent pediatric oncologist trained staff, rapid access to pediatric intensive care and adequate psychosocial support; they also mention the experiences of Guatemala, Nicaragua, and Mexico, countries that improved their models of care and treatments for these diseases, in appropriate centres.

Argue that the bill would have required statutory law if it regulated the fundamental right to health in a structural, full and complete way, which does not happen, because what the bill seeks is not to modify the law. conditions for the provision or guarantee of this right, but, on the contrary, to extend its cash and enjoyment, after analyzing administrative factors that are affecting the high mortality rates that Colombia presents in these pathologies, which are practically curable in many countries of the world.

They argue that Law 972 of 2005, which adopts rules to improve the care of the population suffering from ruinous or catastrophic diseases, especially HIV/AIDS, was dealt with as ordinary and asked by What reason the Executive Branch does not want to give the same prerogatives to thousands of children resident in Colombia who die from cancer.

They express that while the Ministry of Social Protection issued Resolution 1043 of 2006, for the improvement of the quality of care for children with cancer, it is insufficient " and does not guarantee comprehensive services, relevant and effective that they truly impact on the mortality, survival and abandonment rates of patients ", since to apply chemotherapy, the only requirement that requires care centers is to have a pharmacy and a chemical It does not set a minimum standard according to the number of patients, thus opening up the possibility To recruit onco-hematologists to "availability"; nor does it require pediatric oncology units to have psychosocial support and confuses the health care requirements of minors with older ones, among others. serious fallencies.

The legislative cells also do not accept the objection regarding the definition of the contents of the POS by means of legislation, since in their opinion it is necessary to make adjustments to the model of care of children with cancer so that they do not continue dying in Inconceivably percentages and say that the initiative is not being "parceling" the care of the sick, because it precisely pursues that it is integral, to improve its effectiveness.

They also reject the objection to the alleged imbalance that national finance would cause the bill in the medium term, since in its opinion from the Constitution of 1991 the enjoyment of a fundamental right cannot be be subject to conditions of no kind and much less financial, although it does not mean that there should be no proper articulation between the budget and the planning of the general health social security system.

They argue that while it is true that the executive branch is empowered to object to a bill, if its reasons collide with the guarantee of an essential end of the state, or with a fundamental right, such attribution must yield " the imperative work of the public authorities to ensure the effective enjoyment of such rights under the rule of law ".

There is no explanation for the fact that guarantee of the fundamental right to the health of minors is hindered by "purely economic reasons"; in this regard, they consider that the objection should have been raised in In addition to the constitutional terms, the way in which the freedom of Congress is based is not known to regulate the social security and the benefits of invalidity, old age, and death, which the rights limit fundamental, but not in fiscal or economic aspects.

They refer to the solidarity responsibility of the different agents of the social security system, among them the State, in order to guarantee the due enjoyment of the fundamental right to health and point out that the treatments of childhood cancer In Colombia they are financially guaranteed, but what is required is to adapt the models of care, to improve administrative aspects as to the opportunity of the authorizations, to supply quality medicines, Standardize protocols and ensure that the Care Units are adequate.

They express that the bill does not require state-of-the-art technology, but standardization, application and supervision of care guides, as well as comprehensive treatments performed by professionals who are suitable for the subject, provided in a timely manner and in specialized sites for this purpose, such as hospitals of III or IV level of complexity; in this sense, they point out that the comprehensive treatment of 1200 children diagnosed who annually need it to survive cancer, will not break the Social Security System in Colombia, even more so the vast majority of requirements are content in the benefit plans.

Aluden to the observations made by the medical community that contributed to the structuring of the bill, according to which much of what is said "investing" in childhood cancer is nothing other than wasting resources in inadequate, incomplete and with disastrous results, which is why it was proposed to pay attention to guidelines or protocols, which necessarily involves analyzing factors such as cost-effectiveness and technology available, which would avoid the cost of the current bad attention.

They explain that the project aims to reorganise what is being spent and how it is spent and claim that the only "additional cost" is the home of passage, which helps save the majority of 30% of patients who drop out of treatment, Those who do so die irremediably; they also argue that while the cause of this abandonment is multifactorial, it has been shown that the highest percentage of people thus act for reasons attributable to the health system.

Assert that to cover the costs of a household of passage or home, and the displacements of minors with a relative to receive treatment in an uninterrupted, timely and effective manner in the Cancer Units, it is proposed that they be used of the resources of the Solidarity and Guarantee Fund, Fosyga, whose collections are not fully implemented for every term, according to the study of the Ministry of Social Protection.

They point out that when analyzing the income and expenditures of the Fosyga, in the period 2003-2007, the income exceeds the expenditures and leaves room to finance the minimum logistic requirements that children suffering from cancer need, to improve the effectiveness of the treatments and impact on their recovery, thus impacting mortality rates for this cause and estimate that the need for resources to cover these expenses would amount to approximately $2.8 billion annually.

They indicate that 1,200 children are currently receiving cancer treatment in Colombia and of that total, approximately 400 would need the support provided by the project, in terms of Home of Passage and displacements, since the rest are In the departmental headers that would have a cancer unit, or would belong to socioeconomic strata that can afford these costs, they argue that each child would require an average of $7,000,000 a year and that the use of this support should be regulated by the Ministry of Social Protection, so that it can reach the population that requires it.

As for article 5 of the bill, the legislative chambers consider that there is a misunderstanding in interpreting that the standard is forcing all of the IPS level III and IV attention to enable the Children's Cancer Unit, Thus, contrary to what the Minister of Finance expresses, the measure seeks to ensure that those PSUR who want to offer pediatric onco-hematology must be of the III or IV level of complexity, since they have the right to offer their right to free enterprise. According to studies, 40% of children need Intensive Care Unit.

They express that according to the criteria of specialists, currently there are proliferating clinics type "garage" that offer services of pediatric onco-hematology, but they offer no guarantee of adequate attention to the children suffering from the cancer, seriously attacking their lives; however, they accept that it could be written differently from the article objected to make it clear that the requirement to conform Cancer Units in hospitals of the III and IV level of complexity, does not imply an obligation for those institutions to offer such service, if they are not interested.

V. INTERVENTION OF THE COLOMBIAN ASSOCIATION OF INTEGRAL MEDICINE COMPANIES, ACEMI

The Chief Executive of Acemi intervened in the process of the reference to challenge the bill objected by the government, considering that it affects the financial balance of the General System of Social Security in Health, by extending the Mandatory Health Plan, POS, of the contributory and subsidized regimes, " by including the comprehensive and unlimited treatment for cancer, without considering the scarce resources that finance it, the criteria of cost-effectiveness for the inclusion of care benefits in the POS, the most relevant to the population, not the average quality and technology available in the country ".

Maintains that the provision of all the services required, implies the introduction of state-of-the-art technology, which affects the sustainability of the initiative objected to a greater degree and adds that by establishing inclusions in the POS by way of the law, the agency responsible for updating it (National Council for Social Security in Health, CNSSS, while the Commission on Health Regulation, CRES) becomes operational, is impossible to reduce them, when this is required according to the epidemiological profile of the Colombian population, and according to the criteria of cost-effectiveness to be taken into account for the development of any social security system.

States that users of the General System of Social Security in Health, SGSSS, who suffer from high-cost diseases other than cancer, will get care with lower-paying content given to patients suffering from cancer, as well. There are technical reasons to tell the agency responsible for updating the POS that attention should be given to other diseases other than that disease.

Notes that in Case T-760 of 2008, this Court analyzed the structural failures of the General System of Social Security in Health and in evidencing the lack of clarity in the definition of the contents of the POS, as well as deficiencies in its update, ordered the National Council of Social Security in Health, update and unify the plans of benefits, establishing to the effect a methodology that incorporates, among other aspects, the financial balance.

considers that through the draft law of the reference Congress defines part of the POS, including comprehensive and unlimited cancer care for those under 18 years of age, without taking into account the methodology outlined by the Constitutional Court, " since there was no involvement of the medical community and users suffering from diseases other than cancer, and the analysis of the financial sustainability of the General System was not carried out. Health Social Security ".

Notes that the project violates the principle of efficiency enshrined in the higher 48 and 49 articles, as it affects the balance The General System of Social Security in Health, by extending the Mandatory Health Plan, POS, of the contributory and subsidized regimes by including the comprehensive and unlimited treatment for childhood cancer in Colombia, Furthermore, it is inconvenient to be legislated for a single pathology, .

In this regard, it is important to note that, in addition to establishing an unlimited content of benefits, the draft law does not indicate the additional source of resources to pay for the benefits it imposes and does not define the resources. to fund ambulance services, comprehensive rehabilitation with a comprehensive and multidisciplinary approach, palliative care to provide support from the start of treatment and achieve the best quality of life of the patient and his family, which must be different from those that the General System of Social Security in Health suffers.

Assures that the National Council of Social Security in Health, and in the near future the Commission of Health Regulation, are the competent authorities to define the Plans of Benefits and to quantify the Unit of Payment by Capitation, UPC, thus to reduce or exclude some of the benefits of the POS, having as limiting the inclusions contained in the object project, precisely because it comes directly from the law, situation that in the criterion of the intervener, .

Asserts that the contested bill also violates the principle of universality, enshrined in Articles 48 and 49 of the Charter, to the affect the resources that finance the General System of Social Security in Health, restricting the expansion of the coverage of the Subsidized Regime, for by pressing the increase in the cost of the POS, the available money would not allow to expand it Non-protected persons and will prevent the improvement of the benefit plan in both schemes.

Manifests that the bill also violates article 333 of the Constitution, which enshrines the freedom of enterprise, by obliging health service providers to have Child Cancer Care Units, without regard to the A specialty of services that they have been willing to offer on the market.

In this regard, it notes that, in accordance with the case-law (Case C-616 of 2001), when the legislature allows individuals to participate in the provision of the health service, it must guarantee them the conditions of freedom of enterprise, offering them commercial conditions and advantages which they consider to be the essential core of free competition.

In this regard, it states that the draft law of the reference, affects the essential core of the freedom of enterprise, in so far as it compels the providers to have infrastructure to offer services that they do not consider opportune, "either due to lack of economic capacity, or simply because they do not wish to offer them in the health services market", which is in their view more serious in cases where they do not wish to offer cancer services.

Argues equally that the limitation does not comply with adequate and sufficient grounds to justify it, since the obligation to have such units does not have a causal link with the achievement of the proposed objective, since the (a) to extend its infrastructure, but not to establish the resources to ensure that the benefits provided in the law are realized, ", therefore, significant economic damage will be generated to the providers, who do not will have the expected return ".

In its opinion, the measure does not respond to the criterion of proportionality either, because the benefit does not compensate for the sacrifices that the measure entails, because it implies a defunding of the General System of Social Security in Health that reflect on the revenue to be provided by providers to meet the requirements of infrastructure enshrined in the bill.

Notes that the bill also infringes Article 151 of the Constitution, in so far as it is not subject to the provisions of Article 7 of Law 819 of 2003, according to which the tax impact of any initiative must be explicit, and should be included both in the explanatory statement and in the papers, their tax costs and the source of additional income generated for the financing.

Exposes that the bill transgresses Article 13 above that enshrines the right of equality, " to the extent that it disproportionately favors the children who are suffering from cancer in the face of users suffering from other diseases. high-cost diseases affecting the Colombian population "; nor did it include within its scope of projection, the comprehensive care of high-cost diseases other than cancer, without there being any reasons not to give the The same legislative treatment for those who suffer them.

In his view, there is another alternative legal measure that protects the right to a better degree and favors the realization of the end of the provision with the same intensity, since the Law 100 of 1993, as amended by Law 1122 of 2007, empowers the CNSSS, As the CRES enters into operation, to define and update the POS's lending content, in accordance with the health needs of the Colombians and the financial balance of the system, it must be borne in mind that " Unlimited coverage does not exist in any country of the world, in attention to the economic resources which finance such a service are scarce ".

Expresses that while the aim of the project is laudable, to seek the unlimited attention of cancer patients by unbalancing the Social Security System in Health does not compensate for the sacrifices imposed on other users, who will see reduced the benefit plan, which " is detrimental to the same cancer patients, to the extent that the imbalance that the measure entails, would mean in the medium term, the failure and the total cracking of the model of social security established by the Political Constitution ".

VI. CONCEPT OF THE NATION ' S ATTORNEY GENERAL

El Nacion] The Attorney General asks the Court to declare the presidential objections to the bill unfounded, while estimating, first of all, that the Congress did not violate Article 152 of the Constitution when it discussed and approved it. as ordinary law, since in its criterion the initiative does not regulate in a comprehensive way the right to health, and therefore does not affect its essential core ... nor is it inferred from the a structural modification in the delivery of the service the existing plans, limiting themselves to the treatment of a particular disease, the cancer, and for a specific population of special constitutional protection in accordance with the provisions of Article 44 above: children ".

Expresses its departure from the considerations set out by the National Government to refrain from sanctioning the draft law submitted to the study, in which it considers that it is directed to attend to the children's population, subject to special protection that The disease is classified as catastrophic and high cost, offering comprehensive and timely care with a view to providing greater guarantees for the preservation of the right to the life of children.

Adduct, which according to statistics presented in the explanatory statement, childhood cancer affects about 1,200 children each year, with that disease one of the leading causes of death in that population, " but in turn, it is a of which recovery is best offered in the face of early detection, timely diagnosis and appropriate treatment, so comprehensive and timely care in cancer treatment offers patient improvement prospects ".

Maintains that the project, far from knowing the Constitution and the case law, gives fulfillment to the exhorts that have been directed to the government and the legislator in the health issue in Colombia, to meet the standards. International, in particular, General Observation 14 of the Committee on Economic, Social and Cultural Rights.

For the Attorney General, the project also makes effective the constitutional principles of effectiveness, efficiency, universality, continuity and legitimate trust, since by not distinguishing between children and children suffering from the disease, I_aj"> "surrounds the law of a full universality that guarantees the equality of patients."

Considers that subjecting the sick child and family members to the realization of "red tape, legal struggles, and additional economic wear"affects the quality of life of the patient and his/her environment, .

States that the initiative mandates, clarifies and facilitates access to health for the child population suffering from the painful illness, addresses the citizen and judicial complaints that asked the legislator to address this problem with answers that They really consult the social reality of the country and also fulfill the commitment of comprehensive health care, in the way that the Constitutional Court has understood.

The attorney general points out that the legislator has wide freedom of legislative configuration, which allows him to pass laws on health issues and on exclusive competence to regulate the fundamental right to health in the head of the organs. The Committee considers that while its role is important in providing cohesion to health care, it provides guidelines for the extension of the plans and the inclusion of medicinal products in each of the schemes. that the Congress " , discuss, study and approve the laws that it considers relevant to addressing the treatment of certain diseases which, as in this case, are of the utmost importance ", which is why the objection is to be declared unfounded.

Finally, it expresses that in the explanatory memorandum, information shows that rather than increasing the state's expenses, the bill seeks to order them, as it is currently the attention of children suffering from catastrophic diseases, As the cancer, it is provided in compliance with guardianship rulings from the Fund of Solidarity and Guarantee, Fosyga, and in this sense, in the opinion of the Procurator the project does not represent fiscal imbalance, because of the resources of that fund satisfy the tax requirements that will be required by law enforcement, so that there is no Lack of knowledge of Article 7o of Law 819 of 2003 on the analysis of fiscal impact.

VII. CONSTITUTIONAL COURT CONSIDERATIONS

First. Competence

The Constitutional Court is competent to decide definitively on the objections raised by the National Government, as provided in Articles 167 and 241-8 of the Political Constitution.

Second. Legal problems

It is up to the Court to determine whether, as the National Government points out, the draft law is unconstitutional because it has been dealt with as an ordinary law when, for its content, it is related to the guarantee of the right to the life of children with cancer, should have received the statutory law, in accordance with the provisions of Articles 152 and 153 above.

It should also establish whether the contested initiative violates the general and universal character of the right to social security (Article 48 Const.), by establishing limitations that prevent the failures of the integral and articulated regulation of the Social Security System in Health, revealed by this corporation in Case T-760 of 2008, to the detriment of the rights to the health and the life of the children.

Likewise, it must examine whether in the process of the bill Congress broke the mandate of article 7o of Law 819 of 2003, which obliges it to carry out the analysis of fiscal impact of initiatives on public expenditure, in accordance with the Framework Medium-term Fiscal.

Finally, it should determine whether Article 5 of the project does not know the right to free enterprise of the Health Care Institutions -IPS-private-by forcing them to implement Children's Cancer Care Units, UACAI.

Third. Verification of the processing of objections to the bill under review

Before addressing the substantive study of presidential objections, this Court must verify whether its processing complies with constitutional budgets, for which it will recall that according to the case-law[1] the jurisdiction to decide On the subject of the exequability of the projects objected to by the National Government, it is not only substantial but also procedural, as it includes the verification of the procedure imparted with respect to the constitutional and legal norms that the regulate[2].

In the present case, the procedures followed after the approval by the Congress of the Republic of the draft law of the reference, are summarized as follows:

1. By trade of November 12, 2008, received on the 20th of the same month and year (f. 47 cd. In the correspondence office of the Presidency of the Republic, the Secretary General of the Senate referred the bill to the President of the Republic, for executive punishment.

2. In writing on November 27, 2008, received the following day at the General Secretariat of the Senate of the Republic, through a memorial that also subscribes to the Minister of Finance and Public Credit, the President of the Republic returned to the Congress, without executive sanction, the aforementioned bill, in objecting to unconstitutional all of its articles (fs. 24 to 46 ib.).

In this regard, it should be noted that under Article 166 of the Political Constitution, developed by Article 198 of Law 5 of 1992, the has six days to return with objections. any project where it does not consist of more than 20 articles; ten days, when the project contains twenty-one to fifty articles; and up to twenty days when the articles are more than fifty. "

Constitutional jurisprudence has pointed out that the days referred to by these provisions are both business and non-calendar[3]; this being the case, this Court warns that as the draft law under review consists of less than twenty articles, the term to raise objections on November 28, 2008, which was met by the government, as they were presented on the same day.

3. On 16 December 2008, the Senate of the Republic, in plenary session, approved the report presented by the members of the Accidental Commission (f. 27 cd. ppal.), where he recommended to declare unfounded the objections raised by the National Government. In the same sense, the House of Representatives was delivered in plenary session on 24 March 2009 (f. 2 ib., where it erratedly scored "2008").

4. The announcement prior to the vote on the report that declared the presidential objections unfounded was carried out by the Senate of the Republic on 15 December 2008, according to the certification of the Secretary General of that corporation (f. 27 ib.). In the House of Representatives it was held on March 18, 2009, according to the Minutes of Plenum number 162 of that date.

To examine the validity of these notices, the Court must take into account its case-law[4], regarding the requirement referred to in Article 8 of Legislative Act 01, 20035], and must comply with the notice. Following requirements[6]:

-You must give it the chair of the chamber or the commission, either directly or on its own instructions, in a separate session and prior to the one in which the vote of the project is to be carried out.

-The date of the vote must be true, that is, determined or, at least, determinable.

-A bill cannot be voted on in a session other than the one for which it has been announced, unless it is not done for that purpose.

-There is no sacramental formula or textual phrase to be used in Congress to make the notice.

-The use of the expression "ad", to refer to the project notices that will be "considered" or "discussed" in other sessions, should be understood as revealing the the intention to vote such projects and, therefore, to comply with the requirement of Article 160 of the Constitution.

-The context of discussions and discussions can be used as a validation reference, to determine whether an announcement actually was made, whether it included the intention to debate and vote on the announced project and, finally, whether the session for the what was announced the vote is a determinable date.

-The context of which validation criteria can be extracted is not limited to the one in which the announcement was made, but may include other sessions, including those in which the vote took place.

4.1. Regarding the announcement of the House of Representatives, the Court observes that it was produced in the following terms, as stated in the Minutes of Plenary Session "162 of the ordinary session of the day of Wednesday, March 18, 2009" (Congress Gazette number 245, April 24, 2009, pp. 29 y ss., cd. House tests):

" Address of the Session by the Presidency, Dr. Fabio Raul Amin Salame:

Lord Secretary, announce the projects for the next Session.

Secretary General, Dr. Jesus Alfonso Rodriguez C.:

Projects for the next Session on which bills or legislative acts are discussed.

Secretary General, Dr. Flor Marina Daza Ramirez:

... ...

Objections

... ...

336 of 2008 House, 094 of 2007 Senate, for the right to life (sic) children with Cancer in Colombia.

... ...

Secretary General, Dr. Jesus Alfonso Rodriguez C.:

... or legislative act. Mr. President, the Secretariat informs you that the projects are announced.

of the Session by the Presidency, Dr. Fabio Raul Amin Salame:

Lord Secretary, please certify quorum.

Secretary General, Dr. Jesus Alfonso Rodriguez C.:

The Secretariat reports, that the vote throws, that the decision-making quorum has been disintegrated. No decision quorum exists.

of the Session by the Presidency, Dr. Fabio Raul Amin Salame:

Close the record, Mr. Secretary.

Secretary General, Dr. Alfonso Rodriguez C.:

It closes, Mr. President. We have a deliberative quorum, Mr. President if you authorize can be done ...

... ...

The Plenary Session was lifted at 7:15 p.m. M., and was convened for the day Tuesday, March 24, 2009 at 3:00 p. m. " (textual transcript).

Having regard to the foregoing, the announcement of the bill made by that legislative corporation fulfilled the conditions set out in the case-law, as soon as it was prepared and held in a different and prior to the voting session, made on 24 March. March 2009, the date on which the report was voted and approved the report to the presidential objections, as stated in the Minutes of Plenary Session "163 of the Ordinary Session of the day Tuesday 24 March 2009", as follows (transcript textual, Congress Gazette number 265 April 29, 2009, pp. 32 y ss., cd. House tests):

" Address of the Presidency, Dr. Miguel Amin Escaf:

Next report on objection, Mr. Secretary.

Secretary General, Dr. Jesus Alfonso Rodriguez C., reports:

Doctor Hernan Andrade, President of the Senate, Dr. German Varon Cotrino, report of objections on the bill for the right to life of children with cancer in Colombia, published in the Congress Gazette 942 of the 2008, announced in March 18, 2009.

passage omitted] (El Comercio, 6 March)We Are Allowed to Continue to Discuss the Objections to Unconstitutionality and Convenience Proposed by the National Government through the Ministry of Finance and Public Credit to justify the non-sanction by the government. President of the Republic the bill for the right to life of children with cancer in Colombia, for the transcendence of this project we present our answers within the legal, medical, scientific and human.

For the above reasons we do not accept the objections presented by the National Government through the Ministry of Finance and Public Credit, on Bill 336 of 2008, 094 of 2007 Senate, for the right to life of children with cancer in Colombia.

Firman Nestor Ivan Moreno, Jorge Morales Gil.

The objections report has been read.

of the Presidency, Dr. Miguel Amin Escaf:

In consideration of the proposal with which the report on objections that has just been read ends, its discussion is opened, the discussion is closed, the discussion closes, and the plenary of the Corporation has asked. Do you approve of the proposition with which the report on objections ends?

Secretary General, Dr. Jesus Alfonso Rodriguez C., reports:

Approved President ".

4.2. The announcement in the Senate of the Republic, consists in the Minutes of Plenary "36 of the ordinary session of the day Monday, December 15, 2008", thus (Gazette of the Congress number 223 of April 21, 2009, pages. 116 y ss., cd. Senate tests):

" By Secretariat the projects that will be discussed and approved will be announced at the next session.

Mr. President, the following are the projects to discuss and vote on in the next plenary session:

... ...

With objections report

94 of 2007 Senate, 336 of 2008 House: for the Right to Life of Children with Cancer.

... ...

Being 9:40 p. m. The Presidency lifts the session and convenes for Tuesday, 16 December 2008, at 10:00 a.m. m. " (is in bold in the original text).

Also in the Senate, the bill's announcement was made in a previous and different session than the one indicated for voting and approval of the report that declared the presidential objections unfounded, as stated in the Act " 37 of the ordinary session of the day Tuesday, December 16, 2008 ", namely (Congress Gazette number 224 of April 21, 2009, pp. 47 y ss., cd. Senate tests):

IV

Objections by the President of the Republic, to projects approved by Congress

No. 094 of 2007 Senate, 336 of 2008 House, for the right to life of children with cancer in Colombia.

... ...

The Presidency opens the discussion of the report in which the Objections presented by the Executive are declared unfounded and, closed the discussion, it gives its approval unanimously.

... ...

For all of the above, we do not accept the objections presented by the National Government, through the Ministry of Finance and Public Credit, on Bill 336 of 2008 House, 094 of 2007 Senate, for the right to life of children with cancer in Colombia. " (It is in bold in the original text).

5. Finally, by trade received by the General Secretariat of the Constitutional Court on April 3, 2009, the President of the Senate of the Republic, in compliance with the order of Chamber Plena A-084 of the current year, referred the bill to at the insistence of the Congress of the Republic, the Court proceeds to decide definitively on the constitutionality of the standard objectionable, in accordance with Articles 167 and 241, numeral 8, of the Constitution and 32 of Decree 2067 of 1991.

6. In this context, it is noted that the process that is being analyzed, completed in the Congress of the Republic and by the National Government on the presidential objections and the congressional insistence, has been adjusted to the procedure established in the Political Constitution and the law; thus, there is no doubt about the due fulfillment of the formal procedure of the objections, the Court goes on to examine in depth the objections to the draft law of the reference.

Fourth. Material analysis of presidential objections

4.1. On the alleged lack of knowledge of the statutory law procedure

For the Executive, the bill under review is contrary to the Political Charter, because it was approved as an ordinary law, and the process of a statutory law should have been imposed, since it develops the right to the health of the children suffering from cancer, which, by the express mandate of the article 152 superior and the case law of this Court, has a fundamental character, and therefore its regulation must be subject to the legislative procedure of that kind of law.

The chambers insist on the sanction of the bill, considering that it is not necessary to provide the statutory law to those proposals whose subject matter, while it is related to fundamental rights, does not affect the essential core of the In the present case, the object of the contested initiative is not intended to restrict the provision of the health service to minors but, on the contrary, seeks to extend its coverage. decreasing the rate of cancer mortality in children, girls, and adolescents.

Before analyzing the objection, the Court should warn that, as the government's approach is generic and covers the whole project, the statement it will make will have the same character, as soon as it will be limited to that alleged vice of Moreover, in such an event, " the effects of the res judicata must be understood related only with the reasons set forth by the Government to object, with the constitutional precepts regarding which the confrontation and with the aspects that have been the subject of the explicit analysis carried out by the Cut "[7].

According to the case-law[8], in order to determine whether a particular case requires a statutory law procedure, it should be addressed, preferably, "the material criteria on the purely formal or nominal"; and therefore, "if a rule does not integrally regulate a right but if it affects its essential core, it must be statutory law"; and in relation to the matters set forth in Article 152 above, which must be submitted mandatory to the statutory law referred to in Article 153 ibidem, is The Court has stated that a restrictive interpretation must be made, "to avoid eliminating the general competence granted by the same Charter to the ordinary legislator in Article 150 above"[9], a task in which it is Apply the following traditional criteria to determine whether a rule is subject to statutory law reserve[10]:

(i) When the matter concerns a fundamental constitutional right and not a right of another nature;

(ii) When by means of the rule is regulated and complements a fundamental right;

(iii) When such regulation touches the minimum conceptual and structural elements of fundamental rights, and

(iv) When normativity has a claim to integrally regulate the fundamental right.

Likewise, it has pointed out this corporation that in order to establish whether a given matter should have been dealt with by statutory law, it is not enough to determine if its object has any relation with a fundamental right, " since it will also be necessary to ascertain whether the normative content expressed by the law from the material point of view, regulates elements that are close and around the essential content of a fundamental right, and in case of restrictions, limits or conditions on these, must be verified if they have a character proportional and constitutionally reasonable " [11].

According to the case law of this Court[12], dealing with fundamental rights and duties (lit. (a) the criteria for determining whether a particular provision which the rules must be dealt with as a statutory law are as follows: (i) that the matter is indeed a matter of fundamental rights and duties; (ii) develop structural elements and basic principles of the right or duty in question; (iii) which relates to content close to the core of the law; (iv) to regulate aspects inherent in the exercise of the right; (v) to enshrine limits, restrictions, exceptions and prohibitions affecting the essential core; (vi) it is a normative body that seeks to regulate in a comprehensive, structural and complete way a fundamental right that refers to the general structure and regulatory principles, but not to the integral and detailed development; and (vii) that the provision relates to major and important aspects of such rights.

On the other hand, the Court has repeatedly stated[13] that the rules on social security "must not be part of a statutory law necessarily", a criterion that was expressed in the C-408 judgment of the Court of Justice. 1994 (September 15), M. P. Fabio Morón Díaz, who, among other determinations, declared the Law 100 of 1993, which created the System of Integral Social Security, exequible, when he deemed it unnecessary for Congress to impose the statutory law, already that its content does not correspond to the fundamental rights elements of the To submit to that legal category, among others, based on the following considerations:

" The Charter has the power of the legislator to regulate the contents of social security, understanding for such, at a time, a 'compulsory public service' and 'an inalienable right'. Technically this countenance is irreconcilable. However, the integrative interpretation of different concurrent elements in certain constitutional realities makes it possible to affirm that social security is a right of the person who materializes through the provision of a service mandatory character public.

... ...

It is clear to the Court that this normativity on social security should not be subject to regulation through the exception of statutory laws because it does not correspond to the elements of fundamental rights that He wanted the constituent to submit to this legal category, because it is an element of care that comes, in opportunities, from the existence of a labor relationship, and in others, from the simple participation in the social body, and rights free of charge on opportunities and onerous in most cases. Gratuitousness, it cannot be understood, in the headlines of these rights, as an ingredient that can mutate the nature of the same to transform them into fundamental rights; for they are nothing more than developments of the own contents of the social state right ".

Based on the above criteria, the presidential objection will be analyzed considering that the bill being reviewed is titled "for the right to the life of children with cancer in Colombia", which would suggest the statutory procedure would correspond to the statutory procedure (lit. a of Article 152 Const.), as it refers to the right to life, which is indisputably a fundamental right (Articles 11, 44 ibidem); however, leaving aside the nominative criterion and applying instead the material, one reaches a different conclusion.

In effect, in accordance with article 1o of the project under review, its object is to " significantly decrease, the rate of cancer mortality in children and persons under the age of 18, through the guarantee of on the part of the social security actors in health, of all the services they require for their early detection and comprehensive treatment, application of protocols and standardized care guides and with the infrastructure, endowment, resource human and required technology, in Specialized Centers enabled for that purpose ".

In this sense, the bill aims to guarantee the right to social security in health specifically for people under 18 years of age who have cancer (article 2o), through the following mechanisms:

(i) Guarantee of care, through the implementation of a database to speed up the delivery of the service (article 3o).

(ii) Adoption of a comprehensive model of care, which entails the obligation for insurers to authorize all services that the minor requires immediately upon confirmation of the diagnosis (Article 4).

(iii) Creation of Child Cancer Care Units, UACAI (articles 5o to 11).

(iv) Creation of the National Register of Child Cancer and National Single Number, with the purpose of taking the record on the diagnosis, monitoring and evolution of treatment in real time (articles 12, 13).

(v) Creation of the Social Support Service, which involves the provision of a home-made service, including travel expenses, psychosocial and school support (article 13).

(vi) Creation of the National Council of Children's Cancer Advisory Council and the Advisory Departmental Councils, which are responsible for monitoring and monitoring the implementation of the law (Articles 14 and 15).

As can be seen, the subject of the bill under review, although it is clearly related to fundamental rights, such as life and health, does not aim to regulate them in a comprehensive, structural and complete way, it does not develop its basic elements, nor does it refer to the content that is closest to its essential core, as it seeks to ensure that the beneficiaries of the law-persons under 18 years of age, who are in the circumstances described in Article 2o-enjoy the social security service in health in an appropriate and timely manner by the institutions In this case, it is necessary to provide assistance and the implementation of administrative and operational mechanisms.

The proposal also does not enshrine limitations that affect the essential core of the aforementioned fundamental rights, which if established would have affected the constitutionality of the project under review, since as explained, it seeks to advance in the comprehensive care of this painful disease with respect to children and children under 18 years of age, considered subjects of special protection, in order to significantly decrease the rate of cancer mortality in these persons, through the guarantee by the actors of social security in health all procedures and services that are required for their early detection and comprehensive treatment, in specialized locations that have infrastructure and technology.

Thus, article 3o of the initiative states that such procedures will be understood as all the elements and services that are required for the attention of the beneficiaries as consultations, diagnostic support exams, medications, surgical interventions and follow-up to the patient, who will have a management equivalent to the services included in the Mandatory Health Plan, POS, by the insurer or territorial entity; for their part, Article 4 or ib. provides that these services will be ordered immediately and will be provided in the Child Cancer Care Unit, UACAI, in accordance with the criteria of the treating physicians in different specialties and other criteria mentioned there, with the a warning that if the unit does not have that service or has no available capacity, it must forward it to the centre which it is selecting, without limiting the payment of copays or moderating fees, or the periods of absence, independently of the number of weeks listed; lastly, in accordance with the provisions of paragraph 1 of that paragraph Article, the UACAI must supply the best quality medicines and guarantee the application of preventive treatments, such as annual vaccination against influenza, according to guidelines and protocols, in order to avoid the lack of measure to endanger the effectiveness of the child's treatment.

In sum, as the regulation under consideration does not correspond to the elements that the Charter requires to submit to the statutory law, as far as administrative, operational and care factors are concerned, related to the obligation In order to ensure the efficient provision of the public social security service (Article 365 Const.), it does not restrict but extends and makes effective the guarantee of the fundamental right to the health of children suffering from cancer. It did not require the statutory law, which is why the presidential objection does not prosper.

4.2. On the alleged "disarticulation" of the Social Security System in Health

Maintains the Executive Branch that the proposed bill is unconstitutional, because it establishes restrictions that prevent the State from overcoming the problems of regulating the Social Security System in Health, analyzed by this Court in the This is a problem that, in its opinion, must be overcome harmoniously between different bodies and not only through legislative measures, such as those of the European Parliament, the Commission and the European Parliament. contained in the draft law objected to in its sense.

Argues also that the initiative prevents a coherent public health policy, as it defines the contents of the benefit plan, a matter for determining the National Council of Social Security in Health, CNSSS, prior to the analysis of its relevance and the assessment of a sustainable financing scheme over time, which allows effective access to the benefits it grants.

The legislative chambers insist on the initiative, considering that the delay in regulating the care of childhood cancer in a comprehensive way encourages mortality, basically due to administrative errors in the detection and treatment of children. disease; in his opinion, neither modifies the POS nor contemplates a basket of infinite services, as it seeks the timely supply of medicines and/or procedures formulated by doctors for the treatment of childhood cancer, according to criteria of rationality and quality, in specialised centres and with expert staff, subject In its opinion, it can be defined by the legislator, who, for that matter, considered it necessary to make adjustments to the model of care, in order to prevent minors from dying because of this pathology.

For this Court the objection is not called to thrive, for the following reasons:

the reproach of the executive branch seems to pose a problem that could be solved in the form of an abstract control of constitutionality, it really outlines a question of public policy related to the design and operation of the Social Security System in Health, in particular, to the scheme of child cancer care by the operators of this system, a matter on which this corporation cannot decide, since by express mandate of article 167 above, its competence rests solely on the objections raised on the grounds of This is an unconstitutionality, since those that do not have such a character only encourage the reconsideration of the issue by the plenary of the legislative cells, forcing, in the face of the congressional insistence, the presidential sanction of the bill, without a raise new objections. This is established by the above-mentioned rule that " The president will sanction without being able to object to the bill that, reconsidered, is approved by half plus one of the members of one and another House. Except where the project is objectionable as unconstitutional ".

In addition, when the Constitutional Court, in its role as guardian of the integrity and supremacy of the Charter, decides on the constitutionality of a bill objected to by the government, it can only rule on its formal validity and material (Article 241-8 Const.), for alleged contradiction with the higher order and not for other reasons such as those related to the convenience or opportunity of the measures taken by the legislator[14]; for that reason, the has pointed out that the Court's examination is circumscribed, prima facie, the analysis and decision of the objections as formulated by the Executive[15], and hence it cannot involve different aspects, that involve the solution of a problem that is not of nature constitutional.

It is different that in the face of the persistent conculcation of fundamental rights, this corporation, through its Second Chamber of Review of Tútfabrics, would have decided to analyze in Judgment T-760 of 2008 (July 31), M. P. Manuel José Cepeda Espinosa, recurrent problems in the provision of the health service, ordering the Ministry of Social Protection and the Commission on Health Regulation, the adoption of different measures on two main fronts: the benefit plans and the flow of resources to finance such a service, in order to prevent the further development of this service in the future situation.

Such determinations are a natural expression of the powers that the Charter attributes to the judges to know the action of protection (Article 86 Const.) and of the competition that the Political Charter grants to the Constitutional Court to review the judicial decisions on protection (Article 241-9 ib), in accordance with the procedure laid down in Decree 2591 of 1991, which regulates the exercise of that action.

That control, although it seems atypical, is not in fact, because unlike the abstract control of constitutionality, it is aimed at ensuring the effectiveness of fundamental rights through the verification of the rationality of politics. the government and its consistency in the light of the constitutional duties of the State, in relation to the efficient provision of the health service (Articles 49 and 365 Const.), without falling on the design and content of the same or on the mechanisms and programs developed for implementation and execution.

In application of the rule that enables the judge to establish the other effects of the guardianship ruling in order to guarantee to the aggrieved the full enjoyment of the conculcated right, maintaining the competition until the right has been restored (Article 27 Decree 2591 of 1991, final indent)[16], the Second Review Board issued 14 orders, reserving the right to follow up the implementation of the agreed measures, by requiring the the progress achieved, the establishment of concrete priorities and targets. Precisely, one of those orders is related to the unification of the plan of benefits established in favor of minors, subject to which the following was arranged:

" Twenty first. Order the Commission on Health Regulation to unify the benefits plans for children and children of the contributory and subsidized regime, as it must be adopted before 1 October 2009 and must take into account the adjustments necessary to the subsidized UPC of the children and the girls to guarantee the financing of the expansion in the coverage. In the event that the necessary measures for the unification of the child benefit plan have not been adopted by that date, it is understood that the Mandatory Health Plan of the Contributory Scheme covers children and children. the contributory scheme and the subsidised scheme.

A report on the process of compliance with this order must be sent to the Constitutional Court by March 15, 2009, and communicated to the Colombian Institute of Family Welfare and the Ombudsman's Office.

In case the Commission on Health Regulation is not integrated by November 1, 2008, compliance with this order will be the responsibility of the National Council for Health Social Security. "

As can be seen, the order is not addressed to the Congress but to an executive branch body, which does not mean that the executive branch has lost jurisdiction to regulate the health service, in the right to its proper, timely and appropriate and efficient provision, as well as the definition of the corresponding benefits, as the Government seems to suggest in its objection.

Certainly, this corporation has repeatedly pointed out that in the development of articles 48, 49, 150-23 and 365 superior the legislator enjoys freedom-which in no way is absolute-to regulate the provision of health services, is limited by respect for the values, principles and rights of higher order[17]; in this sense, it has established that the Congress has wide margin of configuration to determine, for example, which entities of the public sector or private can provide the health service, the regime to be held, the benefits and benefits and other aspects related to the same[18], as well as defining and defining the institutional mechanisms and the relevant procedures, being able to use different mechanisms and designs to develop and materialize that right[19].

However, it has insisted that such a faculty has clear constitutional limits in principles, values and higher order rights, which restrict and delimit the freedom of configuration of the legislator in this matter. Among other parameters, the legislator in regulating the right to health must take into account (i) his mandatory and inalienable character; (ii) his or her benefit as a public service whose management, organization, control and supervision is established under State responsibility; (iii) the principles of universality, solidarity and efficiency[20]; and (iv) respect for the principle of equality[21], which could be conculcated when the legislator resorts to suspicious or potentially discriminatory differentiation criteria "[22] , which involve a different treatment of similar or similar situations that merit the same treatment.

In the case under review, the Court finds that the legislature has exercised its power of configuration within the aforementioned limits, since it seeks to make the fundamental right to the health of minors a reality (Article 46). Const.), through the provision of the social security service in accordance with the principles of universality, solidarity and efficiency, by enshrining the integral care of the child suffering from cancer, regardless of whether or not he or she is affiliated with the social security, so that all the procedures you require in the Care Unit are authorized Children's Cancer, UACAI, without limiting copays or moderating fees, or periods of absence, regardless of the number of weeks listed.

Warns this corporation that the initiative far from interfering in the fulfillment of the measures adopted in the Judgment T-760 of 2008, is oriented towards the unification of the plans of benefits of the minors ordered in that providence, as far as the attention of childhood cancer is concerned, it enshrines the guarantee of comprehensive care equally for all children suffering from cancer, without regard to the kind of regime to which they belong or if are simply linked to the Health Social Security System.

In this regard, it is clear to this Court that such a measure does not entail a violation of the right to equality, since it is a breach of the mandate enshrined in Article 13 above, according to which the State must protect especially those people who, because of their economic, physical or mental condition, are in the circumstance of manifest weakness, a group that is indisputably belonging to children with cancer.

Finally, if the possibility of a pronouncement at the headquarters of abstract control on aspects relating to the appropriateness or effectiveness of the project and its implications in the configuration of the policy were accepted for the case in the case of a discussion grace. Nor could the objection be examined, since the government did not present any evidence of its claims, limiting itself to making general disquisitions on the existence of alleged "restrictions". and "obstacles" in the draft law under study, which to its The social security system is not linked to the social security system.

4.2.1. Judgment C-662 of 2009 and the principle of integrality in the General System of Social Security in Health, SGSSS

This Court, in resolving the presidential objections to Bill No. 312 of 2008 Senate, 90 of 2007 Chamber "Law Sandra Ceballos, for which the actions for the comprehensive care of cancer in Colombia are established", has determined the impossibility of issuing a statement of substance because it considers that the Executive Branch has only proposed legal repair of the project in front of the SGSSS, whose content is the potestative of the Congress according to its faculty of configuration on the (a) the provisions of Articles 48 and 49 of the Constitution. On the particular[23], he indicated:

" 3.4.2. In the judgment of the Court, the objection raised by the Executive Branch does not provide the necessary parameters for the Court to issue a substantive statement, as it does not present a contradiction between the parliamentary initiative and the Political Charter, but rather is restricted to contrasting the draft law with previous rules of a strictly legal nature. In this sense, the objection raised offers a false problem of constitutionality, founded on (i) the lack of knowledge of the control parameter for the case of presidential objections; and (ii) the wrong understanding of the principle of integrality, defined by Judgment T-760 of 2008, from the collection that this decision made of the constitutional case law on the implications, from the perspective of the Political Charter, of the public service of attention in health.

3.4.3. As stated in the legal basis 3.3. of this judgment, the content of Articles 48 and 49 C. P., the Constitution confers on the Congress the power to define the content of the SGSSS, which implies that the organ of representation It has the possibility of establishing different modalities for the provision of the health system, subject only to the material and substantial limits previously analyzed.

For the proposed case, the Executive part of a substantial budget, according to which the fact that Judgment T-760/08 would have recognized as valid, from the constitutional perspective, the institutional arrangements and As provided for in Law 100/03 and Law 1122/07, a limitation arises for the legislator with regard to the regulation of formulas other than the definition of the content of the SGSSS. Therefore, the draft law objected to, as it departs from that initial legislation and, in particular, the powers that such normativity had conferred on the CRES, violates the Constitution.

This objection does not know that the constitutional rules governing the SGSSS, state that it is up to the legislator, autonomously, to define the content of the SGSSS. This implies that the Congress, once the reasons for political and social expediency that correspond to the parliamentary work, can be modified to the health system. In this sense, the assertion that the previous legal norms set a limit for the exercise of the legislative configuration is lacking in support.

This freedom of legislative configuration, in the same way, is not limited by the recognition of the constitutional validity that this Corporation makes of a certain model of organization of the SGSSS. In this regard, it should be noted that in Case T-760/08, the Second Chamber of Review of the Constitutional Court reviewed different rulings of protection, related to failures in medical care provided by the SGSSS and ordered a series of orders. structural to the different instances of the system, aimed at correcting the main shortcomings of the system, which do not know the duties of protection, respect and guarantee of the fundamental right to health.

...

..., the Court established that the structural orders it adopted would be directed to the authorities and instances of the SGSSS, which had set the law. Consequently, it directed concrete forecasts to the Ministry of Social Protection, the CRES and the CNSSS, as institutions to which the Congress had attached competence in defining the specific content of the health system. This decision is then framed in respect of the democratic principle and the constitutional rules which confer on the legislature, and not the judges, the definition of the content of the SGSSS.

However, this decision does not mean, in any way, the petrification of the legislator's ability to establish various institutional arrangements of the SGSSS. Therefore, if the Congress in exercise of its constitutional powers and under the submission of the formal limits and materials referred to above, decides to modify this legal configuration of the health care system, such a forecast, as it happens with the proposed bill, it is a constitutionally legitimate expression of the normative configuration power.

On the other hand, it must be taken into account that the alleged disadvantages in the application of the rules of the bill, due to the collision of competences that it generates between the different institutions of the SGSSS, in particular the CRES is a matter that clearly falls within the question of the appropriateness of the legislative initiative. These matters, as derived from the provisions of Article 167 C. P., are beyond the control of constitutionality by the Court in this instance. "

This corporation emphasizes that the objection raised by the National Government, in study, is identity with that referred to in the 2009 C-662 judgment, while both assume (i) the problems of the Colombian population with cancer under a the same analysis scheme, (ii) the understanding of the principle of integrality, recognized by the Court in Case T-760 of 2008 and (iii) the conception and purposes of the General System of Social Security in Health, SGSSS, as of Health Regulatory Commission, CRES, according to the competition granted by the legislator, sufficient reason for the Court to reiterate what was stated in the ruling as a line of interpretation given to the Executive's approach, which, as it is legal, does not give notice to the mandate of Article 167 above, according to which the jurisdiction falls exclusively on objections raised on grounds of constitutionality.

For the Court the principle of integrality is related to parameters of a legal nature as a computer criterion of the General System of Social Security in Health, SGSSS, in order to guarantee to the people the treatment of health that require, and in particular whether it is a catastrophic illness or if they are committed to life or personal integrity, a system of constitutional competence of the legislator whose content and scope are not feasible to be unknown by means of objection of constitutionality. In this regard, this corporation in the 2009 Providencia C-662, concluded: " (i) recognition in a judicial decision of a certain institutional design of the SGSSS, is not incompatible with the possibility that the The law of the Member States of the European Parliament lays down new rules for regulation, which is subject only to the formal and substantive limits described above; (ii) the principle of integrality, which is based on rules adopted by the Congress in exercise of the said competition of legislative production, no duty is derived constitutional restrictions on the legislative formulas on the content of the SGSSS to only those that stipulate rules for the generality of the population subject to health care; and (iii) the objection raised establishes a false problem of constitutionality that, instead, points to the proper exercise of the competencies of appropriation and budget execution, and implementation of public policies, all of them in charge of the National Government. "

On the basis of the above considerations, the Court finds that in the present case, as in the case of Case C-662 of 2009, it is in the absence of sufficient arguments to rule on the case raised. Therefore, the Chamber will make an inhibitory decision in respect of the objection based on the "disarticulation" of the General System of Social Security in Health.

4.3. On the alleged absence of analysis of the tax impact required by Article 7o of Law 819 of 2003

El Comercio] According to the government, the bill under review presents a procedural vice that affects its constitutionality, because it believes that the Congress approved it without having previously carried out the analysis of the fiscal impact of the bill. having regard to the Medium-Term Fiscal Framework, in compliance with the provisions of Article 7o of Law 819 of 2003 and the provisions of Article 151 above, which orders to meet that requirement; it explains that the obligation imposed on insurers authorise all services requiring the child with cancer, the household of passes and the costs of displacement, psychosocial and school support, "allow to deduce that the technology is involved in the treatment of the disease", increasing the financial burdens of the system, as a result of the expansion of the benefits, both in the contributory and subsidised arrangements.

passage omitted] (El Siglo, 13 March) Congress Dismisses the Reproach Formulated By The Executive Branch -- The government believes that in the light of the Political Charter, the enjoyment of a fundamental right cannot be subject to conditions of financial order, without it implying that In addition to not being in constitutional terms, it ignores the legislator's freedom of configuration in the area of security. social.

order to resolve the government's questioning, it should be borne in mind that in accordance with article 7o of Law 819 of 2003, in the projects on public spending, the Congress must incorporate the study on the fiscal cost of the initiative and the source of additional income generated to finance it. This is established by the rule in reference:

"Article 7o. Analysis of the tax impact of the rules. At all times, the tax impact of any bill, ordinance, or agreement, which mandates spending or grants tax benefits, must be made explicit and must be compatible with the Medium Term Fiscal Framework.

For these purposes, the tax costs of the initiative and the source of additional income generated for the financing of the project should be included expressly in the explanatory statement and in the respective processing papers. that cost.

The Ministry of Finance and Public Credit, at any time during the respective procedure in the Congress of the Republic, will have to render its concept in the face of the consistency of the provisions of the previous paragraph. In no case will this concept be in the way of the Medium-Term Fiscal Framework. This report will be published in the Congressional Gazette.

Government initiative bills, which will raise additional expenditure or a reduction in revenue, will have to contain the corresponding substitute source for decreased expenditure or revenue increases, which will have to be be analyzed and approved by the Ministry of Finance and Public Credit. In the territorial entities, the procedure provided for in the preceding paragraph shall be set before the respective Secretariat of Finance or who does its own times. "

This Court has analyzed the meaning and scope of the previous provision[24], as well as the implications that its non-compliance carries on the constitutional validity of the initiatives on public expenditure. In Case C-502 of 2007 (July 4), M. P. Manuel José Cepeda Espinosa, in which he studied the constitutionality of the statutory bill number 34/05 Senate and 207/05 Camara, " for which the article 227 of the Political Constitution, in relation to the direct election of Andean parliamentarians ", has laid the following doctrine, which is transferred in extensive:

" Article 7o of Law 819 of 2003 requires that in any bill, ordinance or agreement that orders expenditures or grants tax benefits, it is made explicit what its fiscal impact is and its compatibility with the Framework is established. Medium-term fiscal year issued by the National Government. For this purpose, it has to be stated that in the project's explanatory statements and in each of the papers for debate, the tax costs of the projects and the source of additional income to cover the aforementioned costs must be expressly included. In the same way, it states that during the process of the projects the Ministry of Finance must render a concept about the tax costs that have been estimated for each of the projects, as well as the source of income to cover them and on the compatibility of the project with the Medium Term Fiscal Framework.

Evidently, the rules contained in Article 7o of Law 819 of 2003 constitute an important instrument for the rationalization of legislative activity, in order for it to be carried out with the knowledge of The tax costs generated by each of the laws approved by the Congress of the Republic. They also allow the laws to be enacted to be in harmony with the economic situation of the country and with the economic policy outlined by the authorities concerned. This certainly contributes to generating order in public finances, which has a positive impact on the country's macroeconomic stability.

In the same way, compliance with the requirements set out in Article 7o must have a favorable effect on the effective application of the laws, since the approval of the laws will only occur after the foreseeable fiscal impact and the possibilities to finance it. This indicates that the approval of the laws will not be accompanied by the permanent uncertainty about the possibility of fulfilling them or of developing the public policy in them. Thus, the instruments contained in the article 7 or analyzed can contribute to the overcoming of that existing tradition in the country-of such deleterious effects in the Social State of Law-which leads to the passing of laws without being incorporated into the design of the necessary elements-administrative, budgetary and technical-to ensure its effective implementation and to monitor the obstacles that hinder its full, timely and full compliance.

Thus, the aforementioned article 7o of Law 819 of 2003 stands as an important tool both to rationalize the legislative process and to promote the application and enforcement of the laws, as well as the effective implementation of public policies. But this does not mean that this article can be interpreted as constituting a barrier for Congress to exercise its legislative function or a procedural burden that falls on the legislature exclusively.

35. Certainly, given the current conditions in the Congress of the Republic, it is admitted that Article 7o of Law 819 of 2003 constitutes a procedural requirement, which creates an additional and exclusive burden on the Congress in training. of the bills, it means, in practice, to considerably fence the power of Congress to legislate and to grant the Ministry of Finance a sort of veto power over the bills.

On the one hand, the requirements contained in the article assume that the congressmen-or the benches-have sufficient knowledge and tools to estimate the tax costs of a legal initiative, to determine the source with which they could be financed and to assess their projects against the Medium-Term Fiscal Framework. In reality, to accept that the conditions laid down in Article 7o of Law 819 of 2003 constitute a requirement of processing that it is incumbent upon it to comply only and exclusively to the Congress disproportionately reduces the capacity of initiative The law is based on the principle of the separation of the Public Power Ramas, in so far as the autonomy of the legislature is seriously injured.

Precisely, the almost insurmountable obstacles that would be generated for the legislative activity of the Congress of the Republic would lead to the granting of a form of veto power to the Minister of Finance on the bills in Parliament. The Ministry of Finance has the necessary elements to be able to make estimates of the tax costs, to establish where the necessary resources can arise to assume the costs of a project and to determine the compatibility of the projects with the Medium Term Fiscal Framework. He would have to go to the congressmen or the benches who want to present a bill that involves spending. In this way, the Ministry would decide which requests it serves and the order of priority to do so. With this, he would acquire the power to determine the legislative agenda, in the sense of the autonomy of the Congress.

But, in addition, the Ministry could decide not to intervene in the process of a bill that would create fiscal impact or simply disregard the project's process. This could lead to the project being approved without having listened to the position of the Ministry and without knowing in a certain way whether the project is in line with the macroeconomic requirements set out in the Fiscal Framework of the Medium Term. In reality, this situation has already been presented in the case analyzed in Case C-874 of 2005, and the President of the Republic objected to the bill because the Ministry of Finance had not conceptualized the legal initiative. However, as was recalled, the Court stated that the Ministry of Finance's omission did not affect the validity of the legislative process.

36. For all of the above, the Court considers that the first three points of Article 7o of Law 819 of 2003 should be understood as parameters of rationality of the legislative activity, and as a burden initially incumbent on the Ministry of Hacienda, once the Congress has valued, with the information and the tools it has at its disposal, the tax incidents of a certain bill. This means that they are instruments to improve legislative work.

is to say, the aforementioned article should be interpreted as meaning that its purpose is to obtain that the laws that are dictated take into account the macroeconomic realities, but without creating insurmountable barriers in the exercise of the the legislative function and the creation of a legislative veto power in the head of the Finance Minister. And in that process of legislative rationality the main burden rests with the Ministry of Finance, which is the one that has the data, the officials ' teams, and the economic expertise. Therefore, in the event that the congressmen process a bill incorporating erroneous estimates on the fiscal impact, on how to deal with these new expenses or on the compatibility of the project with the Medium Term Fiscal Framework, It is up to the Finance Minister to intervene in the legislative process to illustrate to the Congress about the economic consequences of the project. And the Congress will have to receive and value the concept issued by the Ministry. Nevertheless, the burden of demonstrating and convincing the congressmen about the incompatibility of a certain project with the Fiscal Framework of the Medium Term is on the Finance Minister.

On the other hand, it is necessary to reiterate that if the Ministry of Finance does not participate in the course of the project during its formation in the Congress of the Republic, it may well mean that the legislative process is vitiated by the failure to take account of the conditions laid down in Article 7 of Law 819 of 2003. Since the main burden in presenting the tax consequences of the projects is the Ministry of Finance, the Ministry of Finance's omission to inform the congressmen about the problems presented by the project does not affect the validity of the legislative process and/or the relevant law ".

Later, in Case C-315 of 2008 (April 9), M. P. Jaime Córdoba Trivino, where the presidential objections were analyzed to the Bill of Law No. 18 of 2006 Senate, 207 of 2007 House, " for which they establish rebates In the sanctions for the remits of the compulsory military service ", this corporation synthesized the following rules, in terms of the content and scope of the forecast of the fiscal impact to the interior of the bills:

-The obligations laid down in Article 7 of Law 819/03 constitute a parameter of legislative rationality, which is aimed at fulfilling constitutionally valuable purposes, including the order of finance. public, macroeconomic stability and the effective implementation of laws. The latter as a preliminary study of the compatibility between the content of the bill and the projections of the economic policy, decreases the margin of uncertainty regarding the material execution of the forecasts legislative.

-The mandate of adequacy between the justification of the bills and the planning of economic policy, however, cannot be understood as a requirement for the approval of the legislative initiatives, whose It is only the Congress. As such (i), the Congress lacks the technical assessment bodies to determine the fiscal impact of each project, the determination of the additional sources of financing and the compatibility with the medium-term fiscal framework; and (ii) " To accept a interpretation of this nature would constitute an unreasonable burden on the Legislator and grant a correlative power of veto to the Executive, through the Ministry of Finance, in respect of the Congress ' competence to make the laws. A power of this character, which involves a barrier in the constitutional function of normative production, is shown to be incompatible with the balance between public authorities and the democratic principle.

-If this mandate is considered as a mechanism of legislative rationality, its compliance initially corresponds to the Ministry of Finance and Public Credit, once the Congress has valued, through the tools that It has at its disposal the compatibility between the expenditure generated by the legislative initiative and the projections of the economic policy outlined by the Government. Thus, if the Executive considers that the Chambers have carried out an analysis of the tax impact in error, it is up to the Ministry of Commerce to participate in the legislative procedure, in order to illustrate the economic consequences to the Congress. of the project.

-Article 7 of Law 819/03 cannot be interpreted as such that the lack of competition from the Ministry of Finance and Public Credit within the legislative process affects the constitutional validity of the procedure. respective ".

In relation to the observance of the requirement laid down in Article 7o of Law 819 of 2003, recently in Judgment C-1197 of 2008 (December 4), M. P. Nilson Pinilla Pinilla, this Court noted:

" In setting the meaning and scope of the requirement in comment, the case law has not intended anything other than to fix the roles of government and Congress in the analysis of the fiscal impact of proposals on public spending, leaving aside the It is clear that the leading role corresponds to the first, as soon as it is obliged to illustrate and to prevent it from the economic implications of the proposal, without the development of this work being a veto or obstacle in the approval of the project.

9. Thus, the Government and the Congress are called to comply with the requirement laid down in Article 7o of Law 819 of 2003, in the form set out in the case-law, and the first one must act on the basis of the proposal made by the Chambers. legislation. But in order to fulfill the requirement provided for in Article 7 of Law 819 of 2003, the Government is not enough to inform the Congress of the existence of budgetary difficulties, but it must support and quantify based on studies technical, in which it consists of the incongruity that he adduces of the bill with "the fiscal perspectives that the Nation has set for the next four-year term."

10. If the Congress does not comply with this requirement by making explicit the fiscal impact of the public spending proposal and the source of financing, in the manner indicated in that provision, ignoring the technical opinion that The Ministry of Finance and Public Credit, the Ministry of Finance and Public Credit, generates a procedural vice in the process of the bill that could eventually lead to its unconstitutionality, since it would be in the face of the non-observance of an organic standard, the condition of the legislative activity in the terms referred to in Article 151 above. "

In the case under review, this Court observes that in the explanatory memorandum of the Bill number 094 of 2007 Senate of the Republic[25], filed on October 18, 2006, before the Secretariat of that corporation (f. 454 cd. Congressman German Ivan Moreno Rojas justified the initiative aimed at guaranteeing the right to life for children with cancer in Colombia, with the following reasons for financial order:

" It is calculated that on average, the monthly cost of a minor suffering from Cancer, is in the order of $2,000,000. If we assume an incidence of 1,000 patients per year in Colombia, and an average duration of 24 months per treatment, the total cost would amount to $4 billion a month and $48 billion a year.

According to the response of the Ministry of Social Protection, Health from the Promotion and Prevention of Diseases, to the last level of care is covered by the Payment Units per Capitation, both contributive as subsidized and not covered by these by the Catastrophic Events Sub-account, ECAT, Solidarity and Guarantee Fund, Fosyga.

Consequently, we consider that the treatments of Cancer Children in Colombia are guaranteed and what is required is to adapt the models of care, administrative aspects as to the opportunity of the authorizations, the supply of quality medicinal products, the provision of the service and, above all, the Care Units, which must be appropriate according to the requirements set out in the technical annex to the draft law.

While the existing Children's Cancer Units will require adjustments and investments in infrastructure or endowment, the bill provides for a revision of the existing rates as well as the possibility, which with the support of the Advisory Councils are managed resources of national and international cooperation, to motivate the enabling of Children's Cancer Units in Colombia, according to the population needs and regionalization carried out by the Ministry of Social Protection "[26].

The bill was distributed to the Permanent Constitutional Commission of the Senate of the Republic (f. 364), which adopted it in the first debate on 13 May 2007 (f. 243. (c) (initial), based on the respective paper[27] which reproduced, in essence, the arguments entered in the explanatory memorandum, pointing out, as regards the financing of the proposal, that " is calculated to average the total cost of a child suffering from cancer is in the order of 80 million "; the plenary of that corporation in session on July 17, 2008 (f. 177 cd. The Commission approved the initiative with the same justification.

In the House of Representatives, under the number 336 of 2008, the revised draft was approved by the Seventh Commission in September 2, 2008 (fs. 110 and 111 cd. ), welcoming the approaches contained in the respective paper[28]. The project passed into the second debate in the plenary of that same legislative cell[29], being discussed and approved in the corresponding session of November 4, 2008 (f. 63 cd. ).

Within the process of the initiative, the Ministers of Social and Finance Protection and Public Credit were involved, who in communication of September 9, 2008 (f. 124 cd. The second of these dispatches was reiterated by the second of these offices by trade of October 20 of the same year (f. 67 cd. ) presented the following observations on the financial aspect of the project:

" ... while in principle it may be thought that the financial effect of the legislative initiative on this matter is neutral, it is true that from the wording and scope of the proposed articles, it cannot be reached This conclusion ... the legislative initiative not only involves state-of-the-art technology for the treatment of the disease, but also quality conditions other than those currently available to finance the System and even the country ... it is eliminated by the criterion of rationality and efficiency as to which the supply of services does not included in the POS must be accompanied by the lack of ability to pay the population, alternatives of higher cost effectiveness etc. Aspects that should also be considered, since the right to health, although fundamental, is neither absolute nor unlimited, as seems to be the case in this bill for this pathology.

...

Thus, the extension of the Mandatory Health Plan-POS, of both regimes, which is what the bill in the last generates, without regard to criteria for the existence of resources that finance it, nor the cost of effectiveness, attention to the most relevant risks of the population, quality measure and technology available in the country, among others, affects the balance of the system, equilibrium that is precarious in the case of the Contributory Regime, because the resources that raises the Compensation Sub-Account barely covers the current annual expenditure represented by the UPC must recognize for each affiliate, according to the age group, and the expense that represent the recoveries by means of tutoring and Scientific Technical Committees, that significantly compromise the availability of the resources of the Fosyga ".

It is appreciated that the government does not support or quantify, based on technical studies, what the incongruity of the bill consists of with the fiscal perspectives that the nation has set for the next four years; that is, it does not evaluate the tax impact of the initiative, but it merely states in the abstract that the draft law of the reference changes the financial balance of the Social Security System in Health, thus ignoring the obligation imposed on it by Article 7 of Law 819 of 2003, of "rendering concept" on the fiscal viability of the Nor did it offer the congressmen support and technical illustration on the economic consequences of the project, a government omission which, as it has previously said, cannot become an insurmountable obstacle to the autonomous exercise of the of the legislative function by the Congress of the Republic.

As has been stated by this Court[30], the action of the Ministry of Finance and Public Credit is enforceable and is subject to compliance with the duty laid down in Article 7o of Law 819 of 2003 to issue an opinion on the impact of the In the case of the Court of Justice, the Court of Justice has held that, in the case of the Court of Justice, the Court of Justice of the European Court of Justice, the Court of Justice of the European Court of Justice of the European Court of Justice, the initiative, both in the explanatory statement and in the papers.

It is not enough to remember that in previous opportunities where this same point was analyzed, the Court declared the Executive's objection to be unfounded when it found that the legislative chambers had justified and analyzed "expressly" the fiscal impact of the project and the government, for its part, had failed to conceptualize the economic effects of the proposal, or had intervened without providing a detailed, sustained and concrete study of this impact, how it happens in the subject that is parsed[31].

passage omitted] [passage omitted] [passage omitted] (el Comercio, 22 April) Congress Does Not Doubt Congress -- For all of the above, there is no doubt that in the approval of the bill under review, the Congress did not incur a vice of unconstitutionality for alleged failure to comply with the mandate of article 7o of Law 819 of 2003. which will dismiss the objection presented in that regard by the Government.

4.4. Objection to Article 5 of the project

According to the Government, article 5 of the draft law does not know the right to free enterprise of private PSUR (Article 333 Const.), by obliging all those belonging to levels III or IV to form Units of Cancer Care. Children, UACAI, forgetting that by their specialty they could be interested in the attention different pathologies, decision that being adopted by the Congress without further analysis, also vulnera the constitutional principle of efficiency in the delivery of the health service (Article 49 ib.)

For the Chambers the reproach lacks sustenance, since the norm does not establish an obligation for all PSUR but only in respect of those who want to offer services of pediatric onco-hematology and belong to levels III or IV of complexity, as such institutions in having intensive care units are able to ensure adequate care for children suffering from cancer.

The objection is not called to thrive, for the following reasons:

The Executive's approach does not know the constitutional basis for the provision of the health service by individuals and also the case law of this corporation that has repeatedly stated that the mixed model adopted by the legislator, In which the State and the private parties are present, it is unfolding in an environment of economic freedom where, first of all, it is sought that " the private initiative is channelled towards objectives of social interest and that the advantages of the free competence and rationality in the allocation of the own resources of a free scheme company, translate into expanding coverage and improve the quality of services " [32].

For the Court the exercise of economic freedom and free competition in health matters, " can only be given within the scope that the legislator has foreseen for the effect, and within the rigorous conditions of regulation, surveillance and control that stem from the constitutional responsibility that the State has in this social sector "[33]; therefore, it has considered that the state intervention in this field is intense and develops under the (i) the application of Article 1 (1) (a) of Regulation (EC) No 51996; State, with the corresponding limitation of economic freedom (Articles 150-21, 333 and 334 Const.), and those relating to the regulation and inspection of the professions (Article 26b), State intervention in public services (Article 6) 365 ib.) and health care in particular (articles 48, 49 ib.)[34].

According to this corporation, because it is an activity in which the General Health System's money is handled by private companies, " state control preserves public trust, because it allows these entities to count on an administrative, technical, financial and professional structure that ensures the regular, continuous and efficient provision of the health service to affiliates "[35].

As regards the meaning of the principle of efficiency in the provision of the social security service in health, the case-law has stated that this concept, " turns out to be much wider than simple efficiencies. technical and economic, since it involves the provision of an essential public service, as is health, which in turn is a constitutional right and is interrelated with other values, principles and fundamental rights. The provision of the health service in Colombia cannot be understood as a simple 'health market', governed by the laws of supply and demand. The guarantee of economic, social and cultural rights does not depend on criteria of simple utility or particular economic benefit "[36].

However, this Court has pointed out that while the freedom of enterprise admits limits imposed by the intervention in the economy that is carried out by mandate of the law for the fulfilment of the general interest that the Constitution mentions, "this intervention cannot remove from root the said freedom and must obey criteria of reasonableness and proportionality"[37]; for such reason it has considered[38] that such (i) it must necessarily be carried out by the Ministry of Law; (ii) it cannot affect the (iii) it must comply with adequate and sufficient grounds to justify the limitation of the said guarantee; (iv) it must comply with the principle of solidarity; and (v) it must meet the criteria of reasonableness and proportionality.

Under these premises, the determination contained in Article 5 cannot be found to be unreasonable, since it pursues that the activity carried out by the individuals providing the public health service, for the case of the PSUR, will comply with the In order to improve the quality of the health service (Article 49 Const.), the measure is also not disproportionate, because, as the legislative chambers explain, the obligation to provide services is not disproportionate. count on Child Cancer Care Units, UACAI, does not compromise all private PSUR This is the case for the level III or IV of complexity, which are those with intensive care units and therefore have the capacity to provide pediatric onco-hematology services to children suffering from cancer, which it fulfils the constitutional task of providing a better social security service to a vulnerable population, minors (Articles 13, 46, 49 and 365 ib).

This is a measure of intervention adjusted to the Constitution, since it is carried out by means of a law issued by the Congress of the Republic; it does not affect the essential core of the freedom of enterprise of the individuals who are IPS owners, as it has been seen, commits only those that have the technical capacity to offer cancer treatment; it is based on reasons of solidarity with regard to persons considered subjects of special protection The Constitution, the minors, to whom they must be assured with a prevalent character, among other rights fundamental, life, physical integrity, health and social security (articles 1o and 44 Const.); and finally, it serves the criterion of efficiency in the delivery of the health service, as it aims to make better use of the platform technical and scientific of the IPS on which the obligation to implement the Child Cancer Care Units, UACAI, falls.

On the basis of the foregoing reasons, this Court will declare unfounded the unconstitutionality objections raised by the National Government to Bill No. 094 of 2007 Senate, 336 of 2008 Chamber, " for the right to the Life of children with cancer in Colombia " and, consequently, will declare the referred project exequable.

VIII. DECISION

On the merits of the above, the Constitutional Court of the Republic of Colombia, administering justice on behalf of the people and by mandate of the Constitution,

RESOLVES:

First. Declare unfounded the unconstitutionality objections raised by the National Government to Bill 094 of 2007 Senate, 336 of 2008, House, "for the right to life of children with cancer in Colombia" and, consequently, exclusively with respect to them, declare exequable the referred project.

Second. Inhibit to adopt a substantive decision regarding the presidential objection founded on the "disarticulation" of the General System of Social Security in Health, due to the lack of sufficient reasons for make a judgment of constitutionality on the matter, as expressed in the fundamentals 4.2. and 4.2.1. of this providence.

Notify, communicate, insert into the Constitutional Court Gazette , and file the case. Comply.

Nilson Pinilla Pinilla, President; Juan Carlos Henao Pérez, Maria Victoria Calle Correa, Luis Ernesto Vargas Silva, Gabriel Eduardo Mendoza Martelo, Mauricio González Cuervo, Jorge Ignacio Pretelt Chaljub, Humberto Antonio Sierra Porto, Jorge Ivan Palacio Palacio, Magistrates; Martha Victoria Sachica of Moncaleano, General Secretariat. (Judgment C-850/09)

* * *

1 Cfr. C-887 of 2007 (October 24), M. P. Nilson Pinilla Pinilla, among others.

2 Cfr. C-923 of 2000 (July 19), M. P. José Gregorio Hernández; C-1249 of 2001 (November 28), M. P. Marco Gerardo Monroy Cabra and C-070 of 2004 (February 3), M. P. Clara Inés Vargas Hernández, among others.

3 Cfr. C-268 of 1995 (June 22) and C-380 of 1995 (August 30), M P. Vladimiro Naranjo Mesa; C-292 of 1996 (July 4), M. P. Julio Cesar Ortiz and C-028 of 1997 (January 30), M. P. Alejandro Martínez Caballero.

4 Auto 311 of 2006 (November 8), M. P. Marco Gerardo Monroy Cabra.

5 Article 8 of the Legislative Act 01 of 2003 provides: " No bill will be put to a vote in session other than that previously announced. The notice that a project will be put to the vote will be given by the Presidency of each chamber or commission in session other than that in which the vote will be held. "

6 C-576 of 2006 (July 25), M. P. Manuel José Cepeda Espinosa. S. V. Jaime Araujo Renteria.

7 C-256, 1997 (May 28), M. P. José Gregorio Hernández Galindo.

8 C-646 of 2001 (June 20), M. P. Manuel José Cepeda Espinosa.

9 C-687 of 2002 (August 27), M. P. Eduardo Montealegre Lynett.

10 C-646 of 2001

11 C-687 of 2002.

12 C-319 of 2006 (April 25), M. P. Alvaro Tafur Galvis.

13 C-510 of 2008 (May 21), M. P. Manuel José Cepeda Espinosa.

14 C-865 of 2001 (August 15), M. P. Eduardo Montealegre Lynett.

15 Cfr. C-650 of 2003, C-482 of 2002 and C-256 of 1997.

16 "In any event, the judge shall establish the other effects of the judgment for the specific case and maintain the jurisdiction until the right or the causes of the threat are fully restored."

17 C-1489 of 2000 (November 2), M. P. Alejandro Martínez Caballero

18 C-033 of 1999 (January 27), M. P. Carlos Gaviria Diaz; C-1041 of 2007 (December 4), M. P. Humberto Antonio Sierra Porto.

19 C-463, 2008 (May 14), M. P. Jaime Araujo Renteria.

20 C-623, 2004, M. P. Rodrigo Escobar Gil.

21 C-671 of 2002, M. P. Eduardo Montealegre Lynett.

22 C-671 of 2002.

23 C-662/09 (September 22), M. P. Luis Ernesto Vargas Silva.

24 Cfr. C-947 of 1999 (December 1o), M. P. José Gregorio Hernández Galindo; C-911 of 2007 (October 31), M. P. Jaime Araujo Renteria.

25 Published in the Congress Gazette number 406 of August 27 October 2007.

26 Congress Gazette number 406, August 27, 2007.

27 Congress Gazette number 631 December 5, 2007.

28 Congress Gazette number 256 of June 7, 2007, page 10.

29 Congress Gazette number 706 October 10, 2008.

30 C-1197 of 2008 (December 4), M. P. Nilson Pinilla Pinilla.

31 C-315 of 2008 (April 9), M. P. Jaime Córdoba Trivino and C-1141 of 2008 (November 19), M. P. Humberto Antonio Sierra Porto.

32 C-974 of 2002 (November 13), M. P. Rodrigo Escobar Gil.

33 C-616 of 2001 (June 13), M. P. Rodrigo Escobar Gil.

34 Ib.

35 Ib.

36 C-1041 of 2007 (December 4), M. P. Humberto Antonio Sierra Porto.

37 Ib.

38 C-615 of 2002 (August 8), M. P. Marco Gerardo Monroy Cabra.

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