For Which Special Protection Measures For People With Epilepsy Are Established, Principles And Guidelines Are Issued For Comprehensive Care

Original Language Title: Por la cual se establecen medidas especiales de protección para las personas que padecen epilepsia, se dictan los principios y lineamientos para su atención integral

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ACT 1414 2010
(November 11)
Official Gazette No. 47,890 of November 11, 2010 CONGRESS OF THE REPUBLIC

By which special protection measures are established for people with epilepsy the principles and guidelines for comprehensive care are given. Effective Jurisprudence



THE CONGRESS OF COLOMBIA DECREES: CHAPTER I.

PURPOSE, PRINCIPLES, PROHIBITION AND INFRASTRUCTURE AND REGULATIONS.
ARTICLE 1o. OBJECT. This law aims to ensure the protection and comprehensive care of people with epilepsy. PARAGRAPH 1.
. To fulfill the provisions of this law, the Ministry of Social Protection, the Commission regulation Health (CRES) and the National Health, will establish the technical, scientific and human resources needed to provide holistic, continuous and permanent people suffering from this disease. PARAGRAPH 2.
. The Health Promotion Entities of both regimes, local authorities responsible in caring for the uninsured poor, states of emergency, the Service Institutions of Public and Private Health must ensure access, opportunity and quality in comprehensive care to people suffering from epilepsy in the terms defined in the Mandatory Health Plan.
Article 2.
. DEFINITIONS.
Epilepsy: Chronic disease of various causes, characterized by recurrent crises due to excessive electrical discharge of neurons, considered a neurological disorder possibly related to the implementation of this law, the following definitions shall be taken into account with various clinical and paraclinical manifestations.
Integral Attention: Set of health promotion, prevention and care (diagnosis, treatment, surgery, rehabilitation and rehabilitation), including medicines required that a person or lend them a group of epilepsy, in its biopsychosocial environment, to ensure the protection of individual and collective health.
Process Integral Attention: Any activity designed to diagnose and treat in a timely, efficient, continuous and permanent, all patients with epilepsy, to provide a multi and interdisciplinary treatment including invasive diagnostic aids, service overall, specialized and subspecialty, pharmacological and / or surgical physician, access to support groups with qualified personnel trained in handling problems of psychoneurological performance; for adaptation and rehabilitation.
As part of the process of integrated management, caregiver or family group processes access to training, education, advice and support so that it can assist the patient as first respondent will be provided.
Institutional Harmonized System: A set of public entities at the national, departmental, municipal and district levels, agencies and public and private institutions, teams of competent professionals who will integrate their activities and resources in order to ensure access to care continuous comprehensive and quality, using mechanisms and coordination systems.
Prevention: Integration of actions aimed at early detection of epilepsy control to prevent physical, mental and sensory damage, reduce the occurrence of complications or sequelae that aggravate the health situation or the patient's prognosis suffering from this disease.
It also includes and assistance and technical, scientific psychological caregiver and family as the first respondent in the initial care of patients with epilepsy, to contribute to effective and professional way their quality of life.
Rehabilitation is a process of limited duration, with a defined objective, aimed at ensuring that a person with epilepsy reach optimal physical, mental, social and functional level according to their condition.
Accessibility: No barriers. Generation and continuity conditions of maximum quality and favorability for patients with epilepsy receive needed services in the comprehensive management of their pathology, training and caregiver support for proper care that allow you to join their family, social and work environment with quality.
Activity limitation: Difficulty that a person with epilepsy can have on performance or performance of an activity or employment.

ARTICLE 3. PROHIBITION. any natural or legal person to perform or promote any act of discrimination, in any form, that during his illness, made against the person suffering from epilepsy is prohibited.


ARTICLE 4. BEGINNING. Be taken as guiding principles of comprehensive protection of people with epilepsy:
Universality: The State shall guarantee to all persons with epilepsy, access and continuity equal to comprehensive care under the definitions adopted by this law.
Solidarity: In compliance with the principle of solidarity, society in general, organizations, institutions, family and other national and international specialized agencies, will participate in joint efforts to promote, promote, educate and protect all people suffering epilepsy.
Dignity: The Government will promote favorable environments for all people with epilepsy and their families guaranteeing harmonious allowing their incorporation into society through public policies, strategies and actions to achieve the respect and implementation of human rights.
Equality: The Government will promote the conditions to make equality real and effective and adopt measures in favor of all people with epilepsy, so that they enjoy the same rights, freedoms and opportunities without any discrimination.
Integration. Health authorities, organizations that are part of the Social Security System in Health and civil society, will tend in all both public bodies and private in the patient with epilepsy is related, receive preferential treatment and quality in the the guiding framework of comprehensive care, based on respect for human rights principles.
CHAPTER II.
CRITERIA FOR PUBLIC POLICY OF COMPREHENSIVE CARE.

The 5th ITEM. POLICY GUIDELINES. In the formulation, adoption, implementation, enforcement, evaluation and monitoring of a Public Policy comprehensive care for people with epilepsy the following criteria in this chapter have taken into account, which are under the responsibility of the Ministry of Social Protection.

ARTICLE 6o. COMPREHENSIVE PROTECTION PROGRAMS FOR PEOPLE epilepsy. The Ministry of Social Protection will require all entities and health institutions in the country, the implementation of comprehensive programs to protect people with epilepsy, in which a special chapter dedicated to research, detection, treatment, rehabilitation will be included, registration and monitoring of comprehensive medical care that must be provided to people with epilepsy, for this purpose the Ministry of Social Protection regulate the matter.
PARÁGRAFO. Educational institutions, research centers, occupational health committees and other institutions that have to do with health, adopt the provisions of this Act and its regulations to give those with epilepsy and their families actions according to standards his integration into society.

ARTICLE 7. AWARENESS FOR WORKING TOGETHER. To achieve the objectives of this law, especially in compliance with the principle of solidarity, health authorities, will implement outreach programs, awareness and participation for the promotion, education and prevention to specific groups of citizens, aimed at creating awareness about the disease and warn of the need to provide comprehensive treatment and guarantee the fundamental rights of people with epilepsy.
PARÁGRAFO. Territorial Entities within the autonomy granted them by the Constitution and the law may establish special provisions and tending to integrate, protect, care and rehabilitate this vulnerable population policies.

Article 8. INTERNATIONAL COOPERATION. The Government may establish strategies for international cooperation to facilitate the achievement of the purposes of this Act and to implement mechanisms that enable the development of strategic projects with other States to promote the comprehensive treatment for people with epilepsy to this end, it will have the support and technical assistance of the International League against Epilepsy (ILAE), the Colombian League against Epilepsy, the Foundation for Rehabilitation of Persons with Epilepsy (FIRE), the National Academy of Medicine , the Associations of Neurology, Neurosurgery and Neuropediatría.


Article 9. FINANCING. The Government may create an account with different sources or contributions: private, public or resources of international cooperation for the prevention, investigation, comprehensive medical care in a timely and permanent, ensuring the availability of modern equipment, training of human resources involved in the care of patients with epilepsy.
People who are not affiliated to one of the schemes at the time of diagnosis comprehensive care will be in charge of the Nation, immediately and effectively, through the Ministry of Social Protection, meanwhile defined the affiliation of the patient. In case of default or delay of the service without just cause relevant sanctions by entities Surveillance and Control shall apply.

ARTICLE 10. The Health Regulation Commission (CRES) should be included in the benefit plans Contributory Scheme and the Scheme Subsidized coverage epilepsy, by adopting protocols that provide guidance and procedures, medications and other health services required for the treatment of this disease.

ARTICLE 11. The literal a) of Article 33 of Law 1122 of 2007 will read: National Public Health Plan. The National Government will define the National Public Health Plan for each quadrennium, which will be expressed in the respective National Development Plan. Its objective is the treatment and prevention of major risk factors for health conditions and promoting healthy lifestyles and strengthening the capacity of the community and the different territorial levels to act. This plan should include:
a) The epidemiological profile, identifying risk and protective factors determining the incidence and prevalence of major diseases that define public health priorities. For this purpose the investigations conducted by the Ministry of Social Welfare and any public or private entity shall take into account, in vaccination, sexual and reproductive health, mental health, with emphasis on domestic violence, substance abuse, suicide and the prevalence of epilepsy in Colombia.
PARÁGRAFO. The Ministry of Social Protection will coordinate with support and technical assistance of the International League Against Epilepsy (ILAE), the Colombian League Against Epilepsy, the Foundation for Rehabilitation of Persons with Epilepsy (FIRE), the National Academy of Medicine , the Associations of Neurology, Neurosurgery and Neuropediatría, prevalence studies of epilepsy in Colombia, to have clear reasons for investment, research and prevention of epilepsy.

Matches
ARTICLE 12. The National Government through the Ministry of Social Protection will undertake the necessary to comply with the object of this law, especially those that have to do with actions:
1. Generate research, teaching, information, prevention, education, promotion, diagnosis, comprehensive treatment, epidemiological surveillance systems and public health.
2. Dictating the rules from the area of ​​competence allow better fulfill the object of this law.
3. Carry out educational campaigns aimed at the general community and specific groups in particular to the patient's family.
4. Manage scientific and technical health officials of local authorities to develop their regional aid programs.
5. Promote the conclusion of international agreements, for the formulation and development of common programs related to the purposes of this law.
6. Make agreements of mutual cooperation in the field between the central government and local authorities.
7. Reassure patients lacking economic resources, without assistance, beneficiaries or no medical coverage Sisbén 1, 2 and 3; comprehensive and timely medical assistance, under the terms of this law, as well as the comprehensive treatment for free from the required medication and surgery to people who can not assume by their economic status.
8. Perform all other actions from the provisions of this Act and its regulations.
CHAPTER III.
RIGHTS AND DUTIES OF PERSONS WITH EPILEPSY.

ARTICLE 13. People with epilepsy, without distinction, have the right to life, equality, work, human dignity and Health.

ARTICLE 14. Epilepsy not be considered an impediment to the nomination, income and work, sports or school in decent conditions and fair performance.
PARAGRAPH 1.
. The occupational health program should include activities aimed at workers in general and specifically to people with epilepsy, to ensure the health, hygiene and safety during the activities they perform.

ARTICLE 15. People with epilepsy, their families and communities have the right to be adequately informed about the different aspects of their condition, receive complete and updated information, by all appropriate means, of the rights that They count.

ARTICLE 16. People with epilepsy are protected from all forms of exploitation and discriminatory, abusive or degrading nature of regulation.

ARTICLE 17. Legally established organizations of people with epilepsy may be consulted on matters related to their rights and obligations; as well as on regulatory developments that have been announced.

ARTICLE 18. The Government will ensure that people with epilepsy are integrated into and can participate in cultural, sports and recreational activities, on an equal basis.

ARTICLE 19. The National Government, through the Ministry of Social Protection, ensure adequate training of all personnel involved in the planning and delivery of services and programs for people with epilepsy.

ARTICLE 20. The person with epilepsy who refuses to accept treatment ordered by the doctor can not perform dangerous activities that pose a risk to society.

ARTICLE 21. Health Promotion Entities of the contributory and subsidized regimes, ARP and the AFP can not deny, in any case, membership in health, professional risks and pensions to people who suffer from epilepsy.
The Lending Institutions Health Service (IPS), from the second level, should have the means for the diagnosis of epilepsy, such as EEG equipment, laboratory Serum Levels, imaging equipment and trained staff for diagnosis and treatment. Epilepsy Centers authorized or officially accredited institutions will obligatorily consultants for cases of medically intractable or difficult to manage. Health posts must necessarily refer these patients to hospitals and epilepsy centers, after giving the first attention.

ARTICLE 22. Those young people who have epilepsy and are financially dependent on their parents are entitled to be beneficiaries of the health system until this condition changes.

ARTICLE 23. The Ministry of Social Protection in coordination with the Ministry of Education will design a special program to train general practitioners and teachers in early detection of symptoms that can lead to neurological disease including epilepsy.
CHAPTER IV.
MONITORING AND CONTROL.

ARTICLE 24. In case of violation of the prohibitions set out in this law, the competent authorities impose administrative, criminal or disciplinary action that may be required, without prejudice to the responsibility which is due for damage caused to physical health sanctions and psychological of the person with epilepsy and their families.

ARTICLE 25. The health authority of the respective jurisdiction, shall fulfill the functions of prevention, inspection, monitoring and control for the proper performance of the object of this law.
ARTICLE 26.
epidemiological surveillance. The National Government will establish policies to ensure the registration and reporting of all cases of epilepsy institution or the like to make the diagnosis to establish control and monitoring statistics.

ARTICLE 27. This law applies from the date of its enactment and repeal the provisions that are contrary.
The President of the honorable Senate, Armando Benedetti
Villaneda.
The Secretary-General (E) of the honorable Senate,
CRUZ SAUL BONILLA.
The President of the honorable Chamber of Representatives,
CARLOS ALBERTO DIAZ ZULUAGA.
The Secretary General of the honorable House of Representatives,
JESUS ​​ALFONSO RODRÍGUEZ CAMARGO.
REPUBLIC OF COLOMBIA - NATIONAL GOVERNMENT
published and enforced.
In compliance with the provisions of the Judgment C-398 of May 26, 2010 issued by the Constitutional Court, proceed to the enactment of the bill, since the Corporation orders the transfer of the case to Congress Republic to continue the legislative process of rigor and its subsequent delivery to the President of the Republic for purposes of the sanction.

Given in Bogotá, DC, November 11, 2010.

CALDERON JUAN MANUEL SANTOS Minister of Finance and Public Credit, Juan Carlos Echeverry
GARZÓN.
The Minister of Social Protection,
MAURICIO SANTA MARIA SALAMANCA.

COLOMBIA REPUBLIC OF CONSTITUTIONAL COURT JUDGMENT C-398
2010

-Sala fully Reference: File OP-130
Subject: Presidential Objection unconstitutional the bill number Senate 028 2007, 341 2008 House, by which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care are given. Judge Speaker
:
MARTELO GABRIEL EDUARDO MENDOZA Bogotá DC, twenty-six (26) May two thousand and ten (2010)
The Plenum of the Constitutional Court, in exercise of its constitutional and legal powers, in particular under the 8th paragraph of Article 241 of the Constitution, and the formalities and requirements of the Decree 2067 of 1991, he has issued the following JUDGMENT
I
. BACKGROUND
By filed on January 28 this year, and in accordance with Article 32 of Decree 2067 of 1991 office, the President of the Senate of the Republic referred to the Constitutional Court the bill number 028 2007 Senate Chamber 341 2008, for which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care, contested by the President of the Republic on grounds of unconstitutionality are issued.
1. legislative process of the presidential objections to the bill number 2007 028 Senate Chamber
2008 341 1.1. Through office of 3 July 2009, the Secretary General of the Senate sent the President of the Republic the bill of reference, with its annexes and legislative history, for the corresponding presidential approval.
1.2. The Presidency of the Republic received the mentioned legislative record on July 10, 2009 and decided to return it to the Presidency of the Senate on July 27 the same year [1], without the corresponding executive penalty on behalf of objections on grounds of unconstitutionality they were made.
1.3. The report of accidental commission that was appointed to substantiate the presidential objections to the bill, signed by Senator Manuel Virgüez Piraquive and the Representative Gloria Stella Diaz was asked insist objected approval [2] project.
1.4. The report was considered and approved at the plenary session of the Senate on December 14, 2009 [3] and the Plenary of the House of Representatives on December 15 the same year [4], as stated in the minutes of the plenary sessions of the Legislative Corporations.
1.5. The President of the Senate of the Republic, through office dated January 18, 2010 and filed in the Constitutional Court on 28 January 2010, he referred the project to the Corporation to decide on the constitutionality of the objections rejected by the Congress.
2. Text of Bill objected
text bill number 07 028 Senate chamber 341 2008, for which special protection measures for people with epilepsy are established, is transcribed, then they dictate principles and guidelines for comprehensive care, the subject of criticism by the President of the Republic, on the grounds of unconstitutionality:
"341 bill number 2008 CHAMBER, 028, 2007 SENATE
why establishing measures special protection for people with epilepsy, principles and guidelines for comprehensive care

the Congress of Colombia DECREES dictate:

CHAPTER I Purpose, principles, Prohibition and Infrastructure and Regulation | Article 1. ||. Object. This law aims to ensure the protection and comprehensive care of people with epilepsy.
PARÁGRAFO. To fulfill the provisions of this law, the Ministry of Social Protection, the Commission regulation Health (CRES) and the National Health, establish the technical, scientific and human resources needed to provide holistic, continuous and permanent people suffering from this disease.
PARAGRAPH 2.
. The Health Promotion Entities of both regimes, local authorities responsible in caring for the uninsured poor, states of emergency, the Service Institutions of Public and Private Health must ensure access, opportunity and quality in comprehensive care to people suffering from epilepsy in the terms defined in the Mandatory Health Plan. Article 2.
. Definitions.
Epilepsy: Chronic disease of various causes, characterized by recurrent crises due to excessive electrical discharge of neurons, considered a neurological disorder possibly related to the implementation of this law, the following definitions shall be taken into account with various clinical and paraclinical manifestations.
Integral Attention: Set of health promotion, prevention and care (diagnosis, treatment, surgery, rehabilitation and rehabilitation), including medicines required that a person or lend them a group of epilepsy, in its biopsychosocial environment, to ensure the protection of individual and collective health.
Process Integral Attention: Any activity designed to diagnose and treat in a timely, efficient, continuous and permanent, all patients with epilepsy, to provide a multi and interdisciplinary treatment including invasive diagnostic aids, service overall, specialized and subspecialty, pharmacological and / or surgical physician, access to support groups with qualified personnel trained in handling problems of psychoneurological performance; for adaptation and rehabilitation.
As part of the process of integrated management, caregiver or family group processes access to training, education, advice and support so that it can assist the patient as first respondent will be provided.
Institutional Harmonized System: A set of public entities at the national, departmental, municipal and district levels, agencies and public and private institutions, teams of competent professionals who will integrate their activities and resources in order to ensure access to care continuous comprehensive and quality, using mechanisms and coordination systems.
Prevention: Integration of actions aimed at early detection of epilepsy control to prevent physical, mental and sensory damage, reduce the occurrence of complications or sequelae that aggravate the health situation or the patient's prognosis suffering from this disease.
It also includes and assistance and technical, scientific psychological caregiver and family as the first respondent in the initial care of patients with epilepsy, to contribute to effective and professional way their quality of life.
Rehabilitation is a process of limited duration, with a defined objective, aimed at ensuring that a person with epilepsy reach optimal physical, mental, social and functional level according to their condition.
Accessibility: No barriers. Generation and continuity conditions of maximum quality and favorability for patients with epilepsy receive needed services in the comprehensive management of their pathology, training and caregiver support for proper care that allow you to join their family, social and work environment with quality.
Activity limitation: Difficulty that a person with epilepsy can have on performance or performance of an activity or employment.
Article 3o. Prohibition. any natural or legal person to perform or promote any act of discrimination, in any form, that during his illness, made against the person suffering from epilepsy is prohibited.
Article 4o. Beginning. Be taken as guiding principles of comprehensive protection of people with epilepsy:
Universality: The State shall guarantee to all persons with epilepsy, access and continuity equal to comprehensive care under the definitions adopted by this law.
Solidarity: In compliance with the principle of solidarity, society in general, organizations, institutions, family and other national and international specialized agencies, will participate in joint efforts to promote, promote, educate and protect all people suffering epilepsy.

Dignity: The Government will promote favorable environments for all people with epilepsy and their families guaranteeing harmonious allowing their incorporation into society through public policies, strategies and actions to achieve the respect and implementation of human rights.
Equality: The Government will promote the conditions to make equality real and effective and adopt measures in favor of all people with epilepsy, so that they enjoy the same rights, freedoms and opportunities without any discrimination.
Integration. Health authorities, organizations that are part of the Social Security System in Health and civil society, will tend in all both public bodies and private in the patient with epilepsy is related, receive preferential treatment and quality in the the guiding framework of comprehensive care, based on respect for human rights principles.

CHAPTER II Criteria for Comprehensive Care Public Policy
article 5. Policy guidelines. In the formulation, adoption, implementation, enforcement, evaluation and monitoring of a Public Policy comprehensive care for people with epilepsy the following criteria in this chapter have taken into account, which are under the responsibility of the Ministry of Social Protection.
Article 6o. Comprehensive protection programs for people with epilepsy. The Ministry of Social Protection will require all entities and health institutions in the country, the implementation of comprehensive programs to protect people with epilepsy, in which a special chapter dedicated to research, detection, treatment, rehabilitation will be included, registration and monitoring of comprehensive medical care that must be provided to people with epilepsy, for this purpose the Ministry of Social Protection regulate the matter.
PARÁGRAFO. Educational institutions, research centers, occupational health committees and other institutions that have to do with health, adopt the provisions of this Act and its regulations to give those with epilepsy and their families actions according to standards his integration into society. Article 7.
. Awareness for joint work. To achieve the objectives of this law, especially in compliance with the principle of solidarity, health authorities, will implement outreach programs, awareness and participation for the promotion, education and prevention to specific groups of citizens, aimed at creating awareness about the disease and warn of the need to provide comprehensive treatment and guarantee the fundamental rights of people with epilepsy.
PARÁGRAFO. Territorial Entities within the autonomy granted them by the Constitution and the law may establish special provisions and tending to integrate, protect, care and rehabilitate this vulnerable population policies. Article 8.
. International cooperation. The Government may establish strategies for international cooperation to facilitate the achievement of the purposes of this Act and to implement mechanisms that enable the development of strategic projects with other States to promote the comprehensive treatment for people with epilepsy, for this purpose, you can count on the support and technical assistance of the International League against Epilepsy (ILAE), the Colombian League against Epilepsy, the Foundation for Rehabilitation of Persons with Epilepsy (FIRE), the National Academy of Medicine, Associations of Neurology, Neurosurgery and Neuropediatría. Article 9.
. Financing. The Government may create an account with different sources or contributions: private, public or resources of international cooperation for the prevention, investigation, comprehensive medical care in a timely and permanent, ensuring the availability of modern equipment, training of human resources involved in the care of patients with epilepsy.
People who are not affiliated to one of the schemes at the time of diagnosis comprehensive care will be in charge of the Nation, immediately and effectively, through the Ministry of Social Protection, meanwhile defined the affiliation of the patient. In case of default or delay of the service without just cause relevant sanctions by entities Surveillance and Control shall apply.

Article 10. The Health Regulation Commission (CRES) should be included in the benefit plans Contributory Scheme and the Scheme Subsidized coverage epilepsy, by adopting protocols that provide guidance and procedures, medications and other health services required for the treatment of this disease.
Article 11. The literal a) of Article 33 of Law 1122 of 2007 will read: National Public Health Plan. The National Government will define the National Public Health Plan for each quadrennium, which will be expressed in the respective National Development Plan. Its objective is the treatment and prevention of major risk factors for health conditions and promoting healthy lifestyles and strengthening the capacity of the community and the different territorial levels to act. This plan should include:
a) The epidemiological profile, identifying risk and protective factors determining the incidence and prevalence of major diseases that define public health priorities. For this purpose the investigations conducted by the Ministry of Social Welfare and any public or private entity shall take into account, in vaccination, sexual and reproductive health, mental health, with emphasis on domestic violence, substance abuse, suicide and the prevalence of epilepsy in Colombia.
PARÁGRAFO. The Ministry of Social Protection will coordinate with support and technical assistance of the International League Against Epilepsy (ILAE), the Colombian League Against Epilepsy, the Foundation for Rehabilitation of Persons with Epilepsy (FIRE), the National Academy of Medicine , the Associations of Neurology, Neurosurgery and Neuropediatría, prevalence studies of epilepsy in Colombia, to have clear reasons for investment, research and prevention of epilepsy.
Article 12. The National Government through the Ministry of Social Protection will undertake the necessary to comply with the object of this law, especially those that have to do with actions:
1. Generate research, teaching, information, prevention, education, promotion, diagnosis, comprehensive treatment, epidemiological surveillance systems and public health.
2. Dictating the rules from the area of ​​competence allow better fulfill the object of this law.
3. Carry out educational campaigns aimed at the general community and specific groups in particular to the patient's family.
4. Manage scientific and technical health officials of local authorities to develop their regional aid programs.
5. Promote the conclusion of international agreements, for the formulation and development of common programs related to the purposes of this law.
6. Make agreements of mutual cooperation in the field between the central government and local authorities.
7. Reassure patients lacking economic resources, without assistance, beneficiaries or no medical coverage Sisbén 1, 2 and 3; comprehensive and timely medical assistance, under the terms of this law, as well as the comprehensive treatment for free from the required medication and surgery to people who can not assume by their economic status.
8. Perform all other actions from the provisions of this Act and its regulations.

CHAPTER III Rights and duties of persons with epilepsy
Article 13. People with epilepsy, without distinction, they have the right to life, equality, work, human dignity and Health.
Article 14. Epilepsy not be considered an impediment to the nomination, income and work, sports or school in decent conditions and fair performance. PARAGRAPH 1.
. The occupational health program should include activities aimed at workers in general and specifically to people with epilepsy, to ensure the health, hygiene and safety during the activities they perform.
Article 15. People with epilepsy, their families and communities have the right to be adequately informed about the different aspects of their condition, receive complete and updated information, by all appropriate means, of the rights that They count.
Article 16. People with epilepsy are protected from all forms of exploitation and discriminatory, abusive or degrading nature of regulation.

Article 17. Legally established organizations of people with epilepsy may be consulted on matters related to their rights and obligations; as well as on regulatory developments that have been announced.
Article 18. The Government will ensure that people with epilepsy are integrated into and can participate in cultural, sports and recreational activities, on an equal basis.
Article 19. The National Government, through the Ministry of Social Protection, ensure adequate training of all personnel involved in the planning and delivery of services and programs for people with epilepsy.
Article 20. The person with epilepsy who refuses to accept treatment ordered by the doctor can not perform dangerous activities that pose a risk to society.
Article 21. Health Promotion Entities of the contributory and subsidized regimes, ARP and the AFP can not deny, in any case, membership in health, professional risks and pensions to people who suffer from epilepsy.
The Lending Institutions Health Service (IPS), from the second level, should have the means for the diagnosis of epilepsy, such as EEG equipment, laboratory Serum Levels, imaging equipment and trained staff for diagnosis and treatment. Epilepsy Centers authorized or officially accredited institutions will obligatorily consultants for cases of medically intractable or difficult to manage. Health posts must necessarily refer these patients to hospitals and epilepsy centers, after giving the first attention.
Article 22. Those young people who have epilepsy and are financially dependent on their parents are entitled to be beneficiaries of the health system until this condition changes.
Article 23. The Ministry of Social Protection, in coordination with the Ministry of Education, will design a special program to train general practitioners and teachers in early detection of symptoms that can lead to neurological disease including epilepsy. CHAPTER IV


Monitoring and control Article 24. In case of violation of the prohibitions set out in this law, the competent authorities impose administrative, criminal or disciplinary sanctions that may apply, subject to the responsibility for originating attributable to physical and psychological health of the person with epilepsy and their families damage.
Article 25. The health authority of the respective jurisdiction shall fulfill the functions of prevention, inspection, monitoring and control for the proper performance of the object of this law.
Article 26. Epidemiological Surveillance. The National Government will establish policies to ensure the registration and reporting of all cases of epilepsy institution or the like to make the diagnosis to establish control and monitoring statistics.
Article 27 This law governs from the date of its enactment and repeal the provisions that are contrary. "
The President of the honorable Senate,
Hernán Andrade Francisco Serrano.
The Secretary General of the honorable Senate, Ramon Emilio Otero
Dajud.
The President of the honorable Chamber of Representatives, Germán
Male Cotrino.
The Secretary General of the honorable House of Representatives, Jesus Alfonso Rodriguez
Camargo.
II. OBJECTIONS BY THE GOVERNMENT
communication dated 27 July 2009, the government returned to Congress, without the corresponding executive sanction, the bill reference, with objections inconvenience and unconstitutional.
1.
Preliminary consideration An initial review of written objections can establish that questions of constitutionality that the government has against the bill number 2007 028 Senate and 341 House 2008, for which special protection measures are established for people with epilepsy, principles and guidelines for comprehensive care are taught, are structured, largely from the guidelines and orders issued by the Constitutional Court in Judgment T-760 of 2008, to address failures regulating the General System of Social Security in Health. In this context, objections revolve around the consideration that the disputed law introduces an isolated modification of the regulatory structure of health care, which has been conceived as a system, from the provisions of Law 100 of 1993 and its amendments, particularly those contained in Law 1122 of 2007.

For purposes of clarity and argumentative coherence, it shall be subdivided into headings each of the objections and arguments made, as is proposed below:
objection based on the infringement of the principle of unity of matter | || the draft law suffers objected, according to the national government, lack of unity of matter [5], as introduces a set of rules that, when broken, crack the design and structure of the General System of Social Security in Health particularly as relates to (i) the definition of conditions and phases of prevention and comprehensive care of the disease, (ii) the allocation of powers to bodies of the General System of Social Security in Health, and (iii ) the imposition on the EPS and institutions providing health services (IPS) loads and responsibilities not covered by the ordinary system and not part of the calculation of the UPC in both regimes.
On the other hand, for the government, the draft adds elements that are far from typical of the dynamics of the health system, such as the guarantee and care recreation, culture, sports and other areas concerning the lives of people with epilepsy, as well as incorporating exclusive powers of administrative sectors spring which exceed the current concept of compulsory insurance and the provision of health services included in the various benefit plans [6]. So
things, the Government considers that the fact that the draft law integrates various thematic nuclei for the benefit of comprehensive care of people diagnosed with epilepsy, behaves in practice, a negative impact on the structure and the operation of the General System of Social Security in Health.
After some theoretical considerations on the principle of unity of matter in the light of constitutional jurisprudence, the Government states that the lack of regulation project unit is seen in the fact that combines thematic nuclei that while orbiting comprehensive care of people diagnosed with epilepsy have institutional implications and various treatments, including, for example, the education, but only in the project and impact regarding the structure and operation of the General System of Social Security in Health. This, in the opinion of the government, rivaling systemic approach that has guided the legislator from Law 100 of 1993 and its amendments and "(...) introduces a 'descuadernamiento' within the scope of powers assigned to each regulatory organizations or participants in the system and endangers the balance UPC-POS.. "
1.2. The principles of Social Security System in Health: balance and sustainability.
In the notice of objections, the government warns that it is not his intention to question the wide range of configuration legislator in relation to the health service, but questions the disjointed way as, in his opinion, has legislated so sensitive a subject that affects the fundamental right to health, introducing modifications isolated "(...) the powers granted to the specialized and technical bodies systemically conceived by the legislator, while introducing imbalances between content POS and value of the UPC, plus charges and ordering costs assume the IPS (...) ". For the government, "(...) the introduction of rules fragmented and without consulting the actuarial calculations and other studies required to adjust the value of the UPC and the national and regional budgets ends unhinge the very concept of system and institutional structure or rules of the General system of Social Security in Health (...) ".
It also noted that the inclusion and prioritization of pathologies in benefit plans through ordinary law of nature, case by case, "(...) as well as other data collection mechanisms with special registers and fragmented for each pathology (...) "is diametrically opposed to the proffered by Law 1122 of 2007 and the self-interest of the Government to build an Integrated Health Information System mandate as they are" replaced the techniques and methodologies used by agencies technical and specialized conceived by the legislator, with the functions of defining the services to be authorized and included in the POS and make their costing by the respective actuarial calculation ".

For the government the bill "(...) disharmony rules governing the General System of Social Security in Health, as conceived by the legislator as an articulated set of guiding principles, rules and practices that make up a coherent and functional units and specialized organizations, both public and private institutional structure. "
Similarly, brings up the Judgment T-760 of 2008, in order to indicate that the bill objected ignores him there exposed, insofar as it disregards the definition of health priorities through citizen participation and content of benefit plans whose competence was attributed to the health Regulation Commission.
From that perspective, "(...) it is not possible to resort to this type of fragmented and partial regulation of the right to health and exercise without impacting the structure and operation of the General System of Social Security in Health. It is in this sense that the constitutional jurisprudence demand the application of the principle of integrity for the system mismatch and not lose its internal consistency and coordination mechanisms. ". Rather, "a source of imbalance is partial and fragmented regulation of the right to health, the treatment of patients with certain characteristics or conditions, as well as the allocation of resources to finance certain diseases without consulting technical criteria for defining priorities health (including direct consultation with users affected with these definitions). "
In terms referring, should be added that the bill interferes censured, not only in the adoption of measures aimed at correcting systemic failures regulation system indicated in said Judgment T-760 of 2008, but also, in the realization of the fundamental right to health and other related prerogatives. So that the legislator is compelled to adopt all regulatory measures in a comprehensive manner and in accordance with a universal vision to shelter the entire population. In other words: the structuring of public health policy, can not be configured from bills relating only to certain conditions, therefore, in any case, would be subverting the contents of benefit plans that ex-ante require the analysis because of their relevance and integration into a system with other diseases, in addition to the assessment of the funding scheme.
So pretend isolation address the problem of epilepsy, as has been tried in other areas of health such as fetal alcohol ocular prostheses, vasectomy, etc., is a clear example of a widespread practice that it has been adopted by the legislature, which brings with it a clear regulatory dispersion in the matter. And is that while you can match that in regard to the usual need for any disease is treated properly and promptly in the General System of Social Security in Health, can not be overlooked, however, that the definition the contents of the POS, through legislation, the scheme entirely dismantles Health System [7].
On that basis, for the government, would not be appropriate, "(...) parcelar attention to certain diseases and generate preferential treatment for some conditions over others, or some sectors over others that, although it could justified ", would lead to a situation from which all sick or age group demanded effective health care preferentially, which, obviously, would lead to discrimination in favor of a specific group of people, compared to others whose disease can be perceived as equal to or greater entity, in legal and financial terms for the System, physicians.

The government points out, finally in this section, the phenomenon has been describing in over presidential objections "(...) could be described as a 'crack' in the structure and operation of the General System Security social Health. "And that crack does not imply a mere dislocation in the very conception of system, but has practical implications, among which are cited to" ... create confusion in the definition of competencies, to include paragraph 1o of article 1 of the bill to the National Health, an organization established to exercise only inspection, monitoring and control system within the entities responsible for provide technical, scientific and human resources needed to provide holistic, continuous and permanent people suffering from this disease "or that has to do with" (...) the construction of the so-called medical doctrine to the extent included in the 2nd article of the draft law the definition of a pathology in this case epilepsy, which are subject to a scientific scheme and professional dialogue in the construction of definitions, which are also changing according to scientific discoveries in the field of medicine. Other definitions as the principles described in the article 4 of the bill not only reproduce the principles that guide the General System of Social Security in Health. "
1.3. Objection concerning the ignorance of the powers conferred on the Health Regulation Commission (Cres)
Draws present the Government Law 1122 of 2007 created the Health Regulation Commission, special administrative unit with full competition for, among other things, define and modify, based on technical criteria, the Mandatory Health Plan (POS) that the Health Promotion Entities ensure affiliates, according to the rules of the contributory and subsidized regimes.
For the government, the bill known, both mentioned legal authority as the adoption of the respective technical criteria for purposes of determining health services and funding, it embraces a particular sectoral and fragmented regulation that ignores the purpose of the current public health policy, which is achieving universal coverage in the service.
1.4. based on participation of users of the General System of Social Security in Health in decisions that affect them
Draws present the Government that the Judgment T-760 of 2008 prepared objection, to implement a genuine public policy in health, should be counted on the users of the system, to thereby realize the provisions in the Constitution, particularly in that related to the participation of all in decisions that affect them (Article 2 CP).
For the government, this implies that the State, from the specific constitutional mandates that encourage citizen participation in decisions that affect them (Article 2nd and 3rd CP), is obliged to ensure participation bodies in priority setting, decision-making, planning, implementation and evaluation of strategies to improve health. That scheme participation notes written objections is replicated in the Organic Budget Law and legal reforms to SGSSS by Law 1122 of 1007.
accordance with that guidance, while there is no democratic element in the planning process of health care, it would be inadmissible to accept that, by other means, to define the priorities in public health, the contents of the various benefit plans and technical components that, ultimately, are some of the aspects They are supporting the system itself.
In contravía with the above, the draft law introduces criticized several provisions to serve the population suffering from epilepsy, thus setting discriminatory treatment in respect of other diseases and people who have them.
In view of the Government, "[t] he democratic element in the planning process, the legal stature of the National Plan of Public Health and the content of that plan exclude the possibility that other means care priorities defined of health risks without the technical components and the structure of the planning process to include attention to health risks, such as epilepsy, in isolation, fragmented and without consulting criteria of integrity and financial sustainability of the system is regularly consult General Health Social Security. "

According to the statement of objections, there is a marked contrast between "(...) democratic consultation referred to by the Constitutional Court and consultation 'organizations legally constituted [sic] people with epilepsy' of which Article 17 of the draft law against regulation to be established, and mandatory consultation 'epilepsy centers' of which Article 21 of the same project in relation to the treatment of disease that make up a deal discriminatory with regard to decisions taken against other diseases and meet the people who have them. The latter provision rivaling especially with the protocols and medical guidelines for the treatment of a given pathology and introduces a foreign element as is 'mandatory' a from the 'epilepsy centers' concept to which the bill refers regarding the management of a patient whose responsibility corresponds to current standards and jurisprudence the treating physician. "
1.5. Objection related to the violation of the statutory reserve law: regulating the exercise of fundamental rights to health and equality
expresses the Government, as defined in recent constitutional jurisprudence, health, however defined in principle, as a right of prestacional nature, it constitutes a fundamental prerogative and autonomous connotation, because of the "transmutation" he has suffered. The latter, howsoever defined the precise contents of the law, being therefore due for those who belong to each subsidiado- -contributivo or subsystems.
From the above premise, the Government concludes that, while considered important, the right to health and aspects related to their effective exercise, should be regulated by statutory law, because, as noted by the constitutional jurisprudence, "(...) the regulation of aspects inherent to the exercise of rights and that means primarily the consecration of limits, restrictions, exceptions and prohibitions, whereby the essential core of the balance sheet is affected only appropriate, in constitutional terms, through the process of such a law. "
thus, the draft law has objected to a material defect related to the ordinary procedure that was given to a set of rules governing the fundamental exercise health and equality, when he had to stock up the processing of a statutory law. In particular, the Government refers to: "(i) Article 3rd of the bill that prohibits discriminatory treatment of people diagnosed with epilepsy or that suffer; and (ii) the definition of the scope of protection of the fundamental right to health by incorporating the training of medical and nursing staff, recreation, culture and sports, among other aspects, ie, regulating the core of the right and setting the field of exercise that is apparently too broad and protector but, for this reason, should be subject to discussion and processing of statutory law for the purpose of legitimizing these limits. "
1.6. Objection founded on the incompatibility of the bill with the objectives and content of the National Public Health Plan argues
According to the executive, the bill reference means emptying the powers established by Law 1122 of 2007 to National public health plan as an instrument of public policy by the Ministry of Social Protection designed to "unify the guidelines on public health" and "defining specific charge of local authorities and the promoters of shares Health". Therefore, based on the modification of the objectives and content of the National Public Health Plan it is produced by incorporating in particular Article 11 of the draft censored.
1.7. Objection concerning the fiscal impact of the bill. Failure of Law 819 of 2003 and the principle of balance UPC-POS
the foregoing explanation, the Government adds that the bill pretermitió the requirement under the 7th Article of Law 819 of 2003 -Orgánica budget-, which requires that made explicit the fiscal impact of any proposed law mandating spending or giving tax benefits, impact, moreover, must be compatible with the Medium Term Fiscal Framework. To fulfill this purpose, indicates that provision to be included in the preamble and in the papers respective process, the fiscal costs of the initiative and the source of additional revenue generated to finance the cost.

For the government, the project objected several expressions involving the use of new technologies and benefits excluded from the POS, an issue that raises the question that should be addressed issues related to the lack of payment capacity of users emerge, the existence of other therapeutic alternatives of higher cost, effectiveness, etc. Omission remaining rationality and efficiency of legislative initiative, while it incorporates a fiscal impact without sources for funding are established.
On the legislative initiative also states that "no consistency with the provisions of the Fiscal medium-term framework, on the one hand, because it is not properly funded with available resources, ignoring thereby the provisions of the Article 151, but also creates an imbalance in the General System of Social Security in Health given that it has no source of funding to meet the benefits provided to cater for the benefits granted here, on the other ".
In this regard, article 9 of the bill concerning these presidential objections contemplates the appropriation of resources not only to ensure the securing of people diagnosed with epilepsy, which at first glance may be laudable, but also for research scientific, introduction of technology (which contrasts with the average technology under Law 100 of 1993) and the training of human resources. Moreover, the bill introduces a special financing scheme of the population diagnosed with epilepsy that is not affiliated to the Subsidized Contributory Scheme or, in the terminology of Law 100 call "linked". In this case, the bill, as opposed to the provisions of Law 715 of 2001, assigns responsibilities to the nation to take responsibility for their care without indicating the source, counter to the skills and resources to territorial entities 715. Law provides for the
for the government, it is worth remembering that, in accordance with Law 715 of 2001, to the Municipalities, Districts and Departments, they have been assigned the management and financing of the provision of health services the poor not covered with subsidies to demand as well as the poor in not covered with subsidies to demand, for which, while universal coverage is achieved, it should be noted that although have resources the General System of Units and Fosyga as appropriate, in any case, their resources are limited and therefore would not be able to provide comprehensive care without being subject to rationality and availability of resources, which finances are also affected territorial.
In short, states the Government, the extension of the Mandatory Health Plan, both regimes, "(...) which is what ultimately is generated with this bill, without regard to criteria for the existence of resources fund it, or cost-effectiveness, care of the most significant risks to the population, average quality and technology available in the country, among others, affects the balance of the General System of Social Security in Health, balance is precarious in the case Contributory Scheme, as resources collected by the subaccount Compensation barely cover the current annual expenditure represented by the UPC to be recognized by each member, by age group, and spending representing recoveries on account of guardianships and Technical Committees Scientific, that compromise significantly the availability of resources Fosyga. "
1.8. additional arguments that affirm the unconstitutionality and the inappropriateness of the bill
to the objections raised against the Bill number 2007 028 Senate and 341 House 2008, for which special protection measures are established for people with epilepsy, principles and guidelines for comprehensive care are issued "on grounds of unconstitutionality, the idea behind the national government regarding the inconvenience of it. Therefore, it is appropriate to briefly brandish which, in its feel, are emerging as reasons that help to strengthen the unconstitutionality of the challenged project.
- The imposition of burdens and obligations to the institutions providing health services (IPS) public and private, regarding the deployment of services and procurement of medical equipment for the diagnosis and detection of epilepsy refers.
- The mandate of training in the diagnosis or detection of epilepsy, which contravenes the provisions of the standards of training and accreditation of human talent (Law 1164 of 2007).

- Desestimulación of private initiative and participation of individuals against insurance and health service delivery.
- The separate collection of health information, as opposed to the implementation plan of the Integrated Information System of Social Protection under the Act 1122 of 2007.
III. EMPHASIS OF THE CONGRESS OF THE REPUBLIC
Accidental Joint Commission of the Senate and House of Representatives, made to debrief about the presidential objections, proposed to insist on the approval of Bill number 2007 028 Senate 341 2008 House, by which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care are dictated, as was done at its last regular debate sustained in the following considerations: || | 1.1. First, the objections raised by the Government are identical, in essence, to those made to the Draft Law No. 312 of 2008 Senate 090 2007 Camera, accumulated Bill number 142 2007 Camera, related with the so-called Law "Sandra Ceballos," for which actions for comprehensive cancer care in Colombia are set. The aforementioned objections were examined and, in general, declared unfounded by the Constitutional Court through Judgment C-662
2009. 1.2. Secondly, the legislator considers the bill reference does not deny the principle of unity of matter, as observed in the articles of the same have adopted different measures to those related to special protection and comprehensive care people with epilepsy.
1.3. As do others challenged aspects, the legislature refers to what is stated in the judgment C-662 of 2009 and the resolution of such charges made by the Constitutional Court at the time.
With regard to the objection concerning the violation of Article 819 of the Law on the 7th 200, adds that in addition to the general considerations that the Court made in that judgment, the measures contained in the draft law does not entail additional fiscal impact, since it is aimed at rationalizing the use of existing resources in the SGSSS, in order to achieve satisfactory care for people with epilepsy and, as such, the provisions in law 819 of 2003 are not applicable to the draft law objected.
IV. CITIZEN ACTION
In order to make effective the right of citizens to challenge and defense, enshrined in Article 242 paragraph l of the Constitution, the Substantiating Justice, by order of 11 February 2010, ordered set in the list bill objected, during the period of three days, and make available to citizens a copy of the file so that it could be consulted. Within the term
fixing intervened list Mr. Jaime Fandiño Franky, acting in his capacity as a citizen and founder of the Colombian League Against Epilepsy, asking the Constitutional Court to declare the constitutionality of the bill reference . With such appended to its application several documents that support your position and address the issues of epilepsy as a disease that requires priority attention in health and legal protection strengthened, including purpose are:
- Colombian Association Neurosurgery.
- Colombian Association of Scientific Societies.
- Latin American Committee of the IBE -International Bureau For Epilepsy
-
International League Against Epilepsy refers the intervener that the writings agree that as appropriate sanction bill establishing special measures of protection for people with epilepsy, among other reasons, on the grounds that this discrimination of this population group is avoided and social integration and access, in terms of equity, health services materializes.
V. ATTORNEY GENERAL CONCEPT OF THE NATION

Attorney General's Office, in exercise of the powers provided for in Article 278-5 of the Constitution and Article 32 of Decree 2067 of 1991, took part in this process in order to ask the Court to declare unfounded the objections presidential proposals. To do so, he reiterated largely the reasons cited in the concept presented regarding the presidential objections to the Draft Law No. 094 of 2007 Senate 336 2008 House, for the right to life of children with cancer in Colombia number 312 of 2008 Senate - 90 2007 Camera Law "Sandra Ceballos," for which actions for comprehensive cancer care in Colombia are set, and number 050 of 2007 Senate 329 2008 House, through the which vas deferens ligation or vasectomy and tubal ligation tubes is promoted as ways to encourage responsible fatherhood and motherhood and encouragements for citizens established.
This, given that the common denominator of those bills has been i) timely, effective and efficient delivery of health care, in a comprehensive manner to address specific ailments; ii) implementation of advanced technology that helps detect early disease in particular and, also, provide timely and comprehensive care; and iii) coordinate the various state and private institutions for joint action in the treatment of disease; and iv) institutional spare no efforts to realize the right to life and health, certain diseases considered catastrophic and costly, according to configurative freedom under its selection criteria, establish a prioritization attention.
Likewise, the Fiscal Vista, considering the fact that the Judgment C-662 of 2009 ruled on the objections proposals to one of the bills mentioned above, where it ruled on the scope of the Judgment T-760 2008 and the definition of competence in health legislation by Congress and technical bodies such as the Commission Regulation on health and health management under the National Plan of Public health, in addition to user participation and violation of the principles of statutory reserve and comprehensiveness, believes that is configured constitutional res judicata, which will ask the Corporation be been to the resolved in the judgment of constitutionality.
Now concerning the charge brought for breach of the principle of unity of matter, Mr. Attorney is that the bill, contrary to what the Government says, does not assign new functions to the National Health, other than those already conferred by the Law 1122 of 2007, because the broad functional framework-based head of the Superintendence, "does not compete with the assignment that gives the legislature so that, in the exercise of their duties, enforce the provisions in a law governing the treatment of a particular disease, which corresponds to the strictest course of their business. "
Yet a complete reading of the bill shows that the legislator was aimed to achieve comprehensive care to a specific disease, from different perspectives such as prevention, rehabilitation and accessibility. This involves, not a break in the joint Health System, but an attempt to unite health care disease epilepsy.
As noted previously, the public prosecutor asked the Constitutional Court to declare, for the presidential objections to the bill reference, as to the charge brought by the violation of the principle of unity of matter, they are unfounded; and, with regard to other charges, be been to the resolved in Judgment C-662 2009.
V. PERFORMANCES conducted by the Constitutional Court
Once Substantiating Judge took cognizance of the reference process, decreed by order of 11 February 2010, the practice of testing necessary to verify the full process of the presidential objections the Congress of the Republic. In the above opportunity, he sets out:
"First. Assume knowledge of the presidential objections of unconstitutionality to the Draft Law No. 028 of 2007 Senate 341 2008 House, by which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care dictate, filed under number OP-130.

Second. Officiate by the Secretary of the Corporation to the general secretaries of the Senate and House of Representatives, so that, within a period of two days, submit to the Court, bound to this process, the Agreed Minutes of the meetings plenary of the respective Corporations, where stating the prior announcement and approval of presidential reference objections. "
the Secretary General of the House of Representatives sent concerning the ordinary procedure assortment by the bill of reference in the Corporation. In addition, he reported that the minutes of the plenary session of the Legislative cell of 14 December 2009, in which he made the previous announcement to vote on the report of objections reference, was in development and, for that reason, not he had published at that time. Similarly, with respect to the minutes of the plenary session of December 15, 2009, which saw the vote of the report, replied that it was under development and for that reason had not proceeded to publication.
In turn, the Secretary General of the Senate Allego documentation assortment legislative procedure regarding the draft law objected. He said that the minutes of the plenary meeting of the Corporation of 9 December 2009, in which he made the previous announcement to vote on the report of objections reference, was in development and, for that reason, had not been published in That moment. Similarly, compared to minutes of the plenary session of December 14, 2009, which saw the vote of the report, he warned that that was under development, so had not yet been published.
View of the above and given the essential nature of this evidentiary material to rule on the constitutionality of the matter under consideration, the Plenary Chamber through Auto number 041 of February 24, 2010, abstained from deciding until relatives were not such documents and substantiating the judge will verify that the tests were duly provided. The operative part of that order reads as follows:
"(...)
First. Refrain from deciding on the presidential objections to the Draft Law No. 028 of 2007 Senate 341 2008 House, by which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care are dictated " identified with the case number OP-130, while required to make constitutional and legal prerequisites are not met.
Second. Order that the present order the minutes of the plenary sessions will be brought to the attention of the Presidents of the Senate and House of Representatives, in order to be sent to the Constitutional Court, once approved, in which he announced and the report of presidential objections, necessary to determine whether approval was voted complied with the established procedure.
Third. Urge the General Secretaries of the Senate and House of Representatives to submit to this Court immediately, once approved, the minutes of the plenary sessions of the respective legislative chambers, which was announced and the report of presidential reference objections was voted.
Room. Once the Substantiating Justice verify that the above tests have been adequately provided the process of the presidential objections to the Draft Law No. 096 of 2006 Senate 153 2007 House, through which partially amending the Law 683 of 2001 will continue .
Notwithstanding the above, note that prior notification of that order, both the Senate and the House of Representatives, gathered together to this corporation the corresponding Gazettes of Congress, so the Substantiating Justice, by order of 10 May 2010, he ordered further process of review of constitutionality of the presidential objections.
VI. CONSIDERATIONS AND FUNDAMENTALS OF THE COURT
1. Competition
The Constitutional Court has jurisdiction to decide definitively on the constitutionality of the rules challenged by the National Government in accordance with the provisions of the 4th paragraph of Article 167 and in paragraph 8 of Article 241 of the Constitution.
2. The process of the objections to the bill

In law that the Court has stated that the insistence of the cameras produced under the terms of the Constitution, is a budget of the jurisdiction of the Court to decide definitively on the constitutionality of the challenged project. [8] Therefore, the study of the constitutionality of a bill contested by the President of the Republic not only deals with material matters concerning the accusations that the Government presents, but also includes analysis of the process given the objections to in light of the constitutional and legal provisions that deal with it [9].
2.1. Opportunity objections
The bill challenged in this opportunity contains more than 20 and less than 50 items, which is why, in accordance with Article 166 of the Constitution, the President of the Republic available a period of ten days to return with objections, which, according to constitutional jurisprudence, [10] is counted in business and full days, starting the day following that on which the project was received for the corresponding presidential approval .
The Presidency of the Republic received the mentioned legislative record on July 10, 2009 and returned to the Presidency of the Senate on July 27 the same year [11], which is why the Chamber finds that reference objections were filed within the period provided for the purpose by Article 166 Superior.
2.2. Process of discussion and approval of the objections
The text of the objections was received in the Senate on 27 July 2009.
The executive committees of the Senate and House accidental appointed a joint commission responsible for implementing the study and issue the respective concept about the presidential objections. The Commission was formed by Senator Manuel Virgüez Piraquive and the Representative Gloria Stella Diaz.
2.2.1. Step in the Senate
The publication of the report substantiation of the presidential objections to the bill reference in the Senate, took place in the Congress Gazette number 1265 2009.
in accordance with the evidence enacted and practiced in this process, the announcement of vote on the report of the presidential objections were made at the plenary session of the Senate of the Republic, of 10 December 2009, as stated in the Act No. 25, of the same date, published in the Gazette of the 25th Congress of 2010:
"on instructions from the Presidency and in accordance with Legislative Act 01 of 2003 Secretariat projects are announced to be discussed and approved at the next Online:
(...)
bills with objections report:
(...)
- bill Senate number 028 2007, 341 2008 House, by which establish special protection measures for people with epilepsy, principles and guidelines for comprehensive care are given.
(...)
Being 6:35 pm, the Chair adjourned the meeting and calls for Monday, December 14, 2009, at 3:00 pm "
The report was presented objections voted and approved at the plenary session of the Senate of December 14, 2009, as stated in the Act number 26 of the same date, published in the Congress Gazette number 26 of 2010. 2.2.2
. Step in the House of Representatives
The publication of the report of presidential objections to the bill reference in the House of Representatives, was held in the Congress Gazette number 1278
2009. The announcement of vote report of the presidential objections in the House of Representatives was made at the plenary session of December 14, 2009, as stated in the Act number 226, of the same date, published in the Gazette of the 89th Congress of 2009. in the minutes , reads as follows:
"projects for Tuesday 15 December or next plenary session in which bills are debated legislation or are announced.
(...)

Report Objections Bill 341 of 2008 House, Senate 028 2007, for which special protection measures for people with epilepsy are established principles dictate and guidelines for comprehensive care.
(...)
The meeting rose and convenes tomorrow at 11:00 am, Congress in plenary, and 1:00 pm to continue the study of initiatives. "

The objections submitted report was voted and approved at the next plenary session of the House of Representatives of December 15, 2009, as stated in the Act number 227 of the same date, published in the Gazette of Congress No. 46 of 2010. the report was approved by the majorities required for the effect.
2.3. The time limit for the insistence of the Chambers, as provided in Article 162 of the Constitution
According to settled case-law of the Corporation, the term that the Chambers have to insist on the adoption of a draft law challenged by the Government may not exceed the term expressly the Constitution has set for the formation of the law [12] and, therefore, the Congress must estimate or dismiss the objections within two legislatures, the first of which will be that [13] "who is studying at the time when the respective project is returned."
In the present case, the objections were filed on July 27, 2009, ie, effective in the legislature that elapses between 20 July 2009 and 20 July 2010. After the process of rigor, Congress of the Republic approved the reports of the committees appointed to substantiate the objections in the plenary of the House of Representatives on December 15, 2009 and the plenary of the Senate on December 14 the same year. It is noted, then, that the processing of objections was completed in the first period of the annotated legislature, and therefore in conformity with the provisions of Article 162 of the Constitution.
2.4. Thus, it is established that the Congress ruled on the presidential objections within a maximum of two terms and additionally meet the constitutional requirements for the discussion and adoption of the report of presidential objections. Therefore, analysis surpassed its formal aspect, the Court now turns to analyze the merits.
3. Review
material objections 3.1. The content of the draft law objected
Bill Senate 028 2007 - 341 2008 House, by which special protection measures for people with epilepsy are established, principles and guidelines are issued for comprehensive care it has the general objective, as stated in its article 1, "(...) ensure the protection and comprehensive care for people with epilepsy," to which states that "(...) the Ministry of Social protection, the Regulatory Commission in Health (CRES) and the National Health, will establish the technical and human resources, scientists needed to provide a multidisciplinary, continuous and permanent use to people suffering from this disease "and that" [l ] he Health Promotion agencies of both regimes, local authorities responsible in caring for the uninsured poor, states of emergency, the Service institutions of Public and Private Health must ensure access, opportunity and quality comprehensive care for people with epilepsy in the terms defined in the Mandatory Health Plan. "
in this context, the project contains a set of definitions to be taken into account for the implementation of the law (Article 2) and a fixed set of criteria for the formulation, adoption, implementation, enforcement, evaluation and monitoring of public policy of comprehensive care for people with epilepsy (article 5).

Among the tools the project provides for the fulfillment of its objectives, are the responsibility of the Ministry of Social Protection to require all entities and health institutions in the country, the implementation of comprehensive programs to protect people with epilepsy (Article 6); the implementation of outreach programs, awareness and public participation in relation to the disease and the rights of people with epilepsy (Article 7th); forecasting strategies for international cooperation to promote the comprehensive treatment of people with epilepsy (Article 8); aspects related to financing activities under the project and a special allocation of responsibilities to the Ministry of Social Protection in relation to people who is not affiliated to SGSSS (article 9); the duty of Cres included in the benefit plans of the contributory and subsidized treatment systems required for the treatment of epilepsy (Article 10); modification of the provisions on the National Public Health Plan to include special provisions on prevalence studies of epilepsy in Colombia (Article 11); the attribution of new responsibilities to the Ministry of Social Protection to promote specific activities in educational, training, scientific support, international cooperation and comprehensive care to vulnerable populations (Article 12); a chapter intended to define the rights and duties of people with epilepsy (Articles 13-23) and a chapter on monitoring and control, which contains the provision of sanctions for breach of the provisions of the project and the government's obligation establish specific policies epidemiological surveillance.
3.2. general consideration of the objections and fixation of reach
3.2.1. The government objections divided into seven major headings: 1. Violation of the principle of unity of matter; 2. Allocation of balance and sustainability of Social Security System in Health; 3. Institutional Mismatches in defining the Compulsory Health Plan; 4. Lack of users' right to participate in decisions that affect them in relation to the General System of Social Security in Health; 5. Need for the project had been submitted as statutory law; 6. Lack of objectives and content of the National Health Plan, and 7. Fiscal impact of the project, non-observance of the Organic Law 819 of 2003 and the principle of balance UPC-POS.
The Court considers that the general study of previous sets of objections is likely ahead in two different dimensions: On the one hand, the objections are directed generally to question the law, without referring to specific aspects of it and, secondly, the objections which, whether marginally, the government questioned specific aspects of the bill.
With regard to the first type of objection, the Court preliminarily warns that they have the problem of relying on global considerations, which do not allow pose a real problem of constitutionality. These objections can be condensed into consideration according to which the isolated and fragmented regulation of health service, a law for every disease, dismantles the General System of Social Security in Health, inefficiencies in the operation thereof, it gives rise to problems coverage and compromises their financial sustainability.
Under this first set of objections, generically considered, as containing approaches, essentially, identical to those presented against the bill number 2008 312 Senate - 90 2007 Camera Law "Sandra Ceballos, "for which actions for comprehensive cancer care in Colombia are established, the Court will reiterate the criteria laid down in the judgment C-662
2009. Nevertheless, from that general consideration of the objections is possible to conclude that, although in many cases the theoretical framework within which the government objecting is wrong, as was demonstrated in the Sentence C-662 of 2009 and as punctuate later, some of the arguments presented they can articulate a question of constitutionality different.

So, based on the considerations presented in a dispersed manner by the government in its objections can be identified constitutional issues that concern (1) breaking the systemic unit must have the health service; (2) the involvement of the principle of equality arising from fragmented regulation without valid justification, provides exceptional treatments for people with epilepsy, in connection with which they are afflicted by other diseases; (3) the existence of a deficit in the provision of health service violates that right and that results that are contrary to the Constitution the measures to obstruct or hinder the overcoming of that situation, and (4) estimates affecting the financial sustainability of Social Security System in Health.
3.2.2. As stated in the judgment C-662 of 2009, the Court ruled on the presidential objections to the draft law number 312 of 2008 Senate 90 2007 Camera, "Sandra Law Ceballos, for which the shares are set to comprehensive cancer care in Colombia, "which generally have great similarity with which the Court must address this opportunity. In that judgment guidelines for the exercise of control they sat by the Court in cases such as those here considered:
3.2.2.1. On the one hand, the Court draws attention to the fact that, although Article 166 of the Constitution does not set requirements which, from the perspective of their contents, must complete the objections of the Executive, this does not mean that, as budget for a substantive ruling by the Constitutional Court, they do not have to "... meet minimum standards of argument upon which to base an objective and verifiable opposition between the legislative initiative and the Constitution ...". For the Corporation, to the extent that, according to the Constitution, the jurisdiction to make objections for the Government, if it has no minimum arguments to support the accusation of unconstitutionality, could not the Court, without prejudice to the settlement of powers Presidential Objections that the Constitution provides assume the reasons adicionen study the proposals by the Executive. Thus, when the government objected as unconstitutional a bill, but not present the necessary support to understand that posed a problem of constitutionality, the Court must proffer an inhibitory decision.
3.2.2.2. On the other hand, in the judgment C-662 of 2009, the Court, as a starting point for the analysis of objections, referred to the wide margin of legislative configuration that emerges from the constitutional provisions in relation to the overall security system social health.
Stressed the Court, as case law has held [14], under Article 48 of the Constitution it implies that social security has dual connotation of being an inalienable right and also a public service provided under the direction, coordination and control of the State, subject to the principles of efficiency, universality and solidarity, "in the terms established by law." In line with this, Article 49 of the Charter enshrines the right to health care and the obligation of the State to organize, direct and regulate the provision of services under the same guiding principles, "in the terms and outlined conditions in the law ".
Highlighted so, the Court, that "(...) there is a specific constitutional provision, which submits to the decision of the legislature, a body par excellence of democratic representation, determination SGSSS design. However, as with any exercise of political power in the social and democratic rule of law; the power of Congress is not all-encompassing, but is subject to limits. "

In that judgment, the Constitutional Court set a jurisprudential rule which would serve as guidelines for the analysis of most of the objections raised by the Government, consideration according to which "(...) Congress enjoys, by express constitutional mandate, legislative broad freedom of configuration in terms of defining the content and institutional design SGSSS. Consequently, a legislative regulation on the matter violate the principles of the Charter when; (I) unknown materials or substantial limits listed above; (Ii) falls in a discriminatory practice that is not covered by a criterion of sufficient reason. These limits, by virtue of its generality, imply that the judgment of the Court constitutionality forward must be flexible, in order to preserve the wide margin referred to did. Otherwise, that is, apply a strict analysis on the topic, lead to the conclusion that there is a single model definition of SGSSS, a conclusion that contradicts the provisions of Articles 48 and 49 of the Constitution, which defirieron that function, prevalently , the legislator ".
3.2.2.3. Finally, warned the Court that the review of constitutionality at this time, in accordance with the provisions of Article 167 CP, limited only to the objections raised by the Government and analyzed in this decision, so that the effects of this decision they are relative res judicata.
3.2.3. Special consideration of objections
3.2.2.1. Unit of matter
Although the government has an objection violation of the principle of unity of matter and to sustain it, refer to the jurisprudence of this Court has defined profiles that institution, the fact is that the considerations presented in this section in relation to the bill are not intended to show a violation of this principle, but rather, a question that has been legislated in health in isolation, without taking into account a systemic approach the management of health services in Colombia.
In fact, according to constitutional jurisprudence, the principle of unity of matter implies that all law must be correspondence between the title and the content thereof, as well as internal connectedness between different standards within it. Thus, the Court [15] said, the Constitution establishes in Article 158 two conditions to Congress for the exercise of the legislative function, "because this is bound to define precisely, as required by the Charter, from the same project title, which they are to be the subjects in which it occupies in issuing the law, and simultaneously must observe strict internal relationship, from the point of view of substance, between the rules that will be part of the law, so that all they are related to the same matter, which, of course, must correspond to the title of that ". [16] Thus, Congress violates the constitutional principle of unity of matter "when it includes specific fees that either [not] fit into the title defining the subject matter of legislation or bear no internal relation to the overall content of the articles ". [17]
So, said the Court, "(...) to exercise judicial review for breach of the principle of unity of matter should be determined which one or thematic nuclei are a law to infer whether a specific standard has links objective and reasonable with them or if instead gravitates within the law, without links or reference axes that articulate harmonious and consistent with axes materials developed by the legislature. "[18]

In this opportunity you have to the government's arguments are not intended to show a lack of internal unity in the bill, or lack of relationship connectedness between the various issues contained in it, since what is censorship is that on the one hand, it contains a set of rules that break with the design and structure of the General System of Social Security and Health, SGSSS, in relation to specific aspects of this system, such as the definition of conditions and phases in the prevention and comprehensive care of the disease; the allocation of powers to agencies SGSSS as the Ministry of Social Protection, the Committee on Health Regulation CRES, or the National Health and imposition of charges and unforeseen responsibilities and not part of the calculation of the UPC in the contributory and subsidized regimes, EPS and Service Institutions Health - IPS. On the other hand, the project censorship outside the SGSSS incorporate aspects such as security and care recreation, culture, sports and other spheres of life of people diagnosed with epilepsy. In addition, questions that the project combines elements which, if they are well-connected with the dynamics and operation of SGSSS, such as training and medical practice and scientific and technological development, the fact is that are the responsibility of various administrative sectors that transcend the current concept of compulsory insurance and the provision of health services included in the benefit plans.
As you can see, the Government notes that the rules that are part of the project lack of connectedness relationship with the title of the law, which is "for which special protection measures are established for people with epilepsy , principles and guidelines for comprehensive care are dictated ", or some of them are divorced from the general theme contained therein, which are the criteria from which there should be an examination unit of matter.
Thus, for the Court, even though the government claims raise a charge for violation of the principle of unity of matter, actually presents considerations designed to show that the disputed project introduces a fracture in what, like SGSSS in its discretion, in accordance with the Constitution, it must be regulated systematically.
In addition, the Court must point out that, contrary to the approach presented by the Government in its objections, the disputed project is not solely thematic area health care to people with epilepsy, but in a broader conception, aims to promote comprehensive care of these people, which allows without prejudice to the principle of unity of matter, are incorporated into the same matters that take place outside the SGSSS, among which may be mentioned promotion the social inclusion of people with epilepsy or general reaffirmation of their rights. Questioning the government would go to establish a mismatch between some contents of the project and own tasks of SGSSS, unaware that the scope of the bill is not restricted to own such a system, without presenting a focused argument to establish the lack of internal consistency between the different thematic contents of the legislative initiative.
For the foregoing reasons, the Court will defer to issue a decision on the merits regarding the alleged violation of the principle of unity of matter, but address the question posed from the perspective in which the government itself presents considerations of constitutionality and that they have to do with systemic involvement of the social security service in health.
In the Judgment C-662 of 2009, generally speaking, on this point it was noted that Articles 48 and 49 of the Higher Planning follows that the Constitution gives Congress the power to define the content of SGSSS, the which means that the organ of democratic representation has the ability to set different types of performance based and institutional organization of the health system, subject only to the guidelines set directly on the Constitution and criteria of reasonableness, proportionality and non-discrimination.
He drew
present the Court that, in relation to the objection that has to do with the isolated regulation of issues affecting the General System of Social Security in Health, "(...) the Executive part of a substantial budget, according to which the fact that the Judgment T-760 of 2008 had recognized as valid, from a constitutional perspective, institutional and powers under Act 100 of 2003 and Law 1122 of 2007 arrangements, a limitation for arises legislator regarding the regulation of different formulas defining the content of SGSSS ", which would lead the project objected law, as may turn away from that initial legislation, it violates the Constitution.
For the Court, however, this objection ignores that, according to the constitutional rules governing the SGSSS, for the legislature, autonomously, defining the content thereof and therefore Congress, by social policy considerations and convenience, which are characteristic of parliamentary work, can make changes to the health system. The Court said that "[i] n this regard, lacks support the claim that the above legal rules set a limit for such exercise of legislative setting." the Court added that this freedom of legislative configuration, "(...) is not limited by the recognition of the constitutional validity that the Corporation makes a particular model of organization SGSSS".
From the above criteria, the Court concluded that "(i) recognition of a judicial decision given institutional design SGSSS, is not incompatible with the possibility that the legislature establish new forms of regulation, competition is subject only the formal and substantial limits described above; (Ii) the principle of comprehensiveness, which is based on rules established by Congress in the exercise of that right of legislative production, not a constitutional duty to restrict the legislative formulas on the content to SGSSS only those stipulating rules derived for the general population subject of health care; and (iii) the objection raised establishes a false problem of constitutionality, however, points to the proper exercise of the powers of appropriation and budget execution, and implementation of public policies, all by the National Government. "
Thus, according to the jurisprudence of the Court, the Congress of the Republic, in the light of special circumstances, such as in the case of the Judgment C-662 of 2009, was the consideration of the need to adopt measures conducive to ensuring comprehensive care for patients with cancer- can make changes that impact on SGSSS, but this is necessary to advance a comprehensive reform of it. So, to build a charge of unconstitutionality by this concept is not enough to point out that the legislature has addressed in isolation regulating a health aspect so that affects the structure, operation or content of SGSSS, but is necessary to show, specifically the reasons why such regulation contradicts mandatory rules, or is contrary to the principles of reasonableness, proportionality or equality. In the absence of these reasons, the Court should proffer an inhibitory decision.
This time that statement was reiterated and therefore does not succeed the general charge of involvement in the systematic unity of the health service because of the legislature's decision to issue an oriented regulation specifically to promote the comprehensive care of patients epilepsy, to the extent that such general objection merely questions per se, the fact that the legislature has regulated especially the care of people with epilepsy, but without being present, at that level, reason for which, in the terms set jurisprudence, articulate a charge of unconstitutionality.
Notwithstanding the foregoing, the Board notes that, in its specific content, this project has peculiarities in relation to that which was being considered by the Court in the Judgment C-662 of 2009, which, in the light of the criteria laid down there and have just reviewed, it is possible that, in connection with such content, a different approach is made, from specific observations present in the notice of objections.

While, according to constitutional jurisprudence, the broad power configuration in health legislator allows special laws issued in the field of health care, it does not deprive of sense under consideration which the health service should be regulated as a system so that the universality of coverage and efficiency can be ensured in their provision (Article 49 CP).
For the Court, in this context, would be contrary to these principles, the isolated rules are not restricted to special provisions in the light of special circumstances also, but also introduce a decontextualized way, affecting forecasts system unit without sufficient justification. Such regulation would not only be contrary to efficiency, without compromising the mandate of universality, to the extent that inefficient services are more expensive, which, in turn, affects the system's ability to gradually expand its coverage to reach the universality.
That unjustified involvement not only undermine the mandates of universality and efficiency, according to the Constitution, the regulation governing the provision of health services, but which could also violate the principle of equality when, without justification, emergency regulations that apply to people with certain diseases or medical conditions and not others that could encourage a similar claim would be established.
For the Government of the above applies to the first paragraph of article 9 of the project, as it empowers the Federal Government to create an account, the nature and scope are not required, but would have two types of objectives: On the one hand , develop prevention, research and training of human resources involved in the care of patients with epilepsy, activities, strictly speaking, they are not necessarily the responsibility of the General System of Social Security in Health, and who enroll in a purpose usually made explicit by the promoters of the initiative, to raise awareness to the community, and providers of health services in particular on the peculiarities of epilepsy and advance the understanding and the promotion of strategies approach for the problem. On the other hand, it is to ensure comprehensive and timely medical care of patients with epilepsy, as well as the availability of modern equipment for this purpose, an aspect which itself is in the field of SGSS and immediately raises questions about the extent of standard: Replace this forecast to SGSS, so that comprehensive care of patients with epilepsy would be charged to that account and not under the social security system in health? or do you have a limited scope, so that only what not cover the system is financed from that account? or, finally, refers to a set of activities within the scope of its powers, should advance the Ministry to promote the objectives referred to the standard are met within the SGSSS?
For the Court is clear that in a comprehensive interpretation of the project, nothing leads to the conclusion that the legislature intended for the care of patients with epilepsy, replace all or part of the SGSSS. To the extent that it is merely enabling the government to create a special account, arrange under the same comprehensive care of patients with epilepsy, as well as the modern equipment required for this purpose will be covered, involve subtracting those general framework of activities SGSSS, to incorporate them into one whose financing is only possible and in relation to which no resources are identified to address the responsibility of the nation. Surely this can not be the scope of the provision, which does not, or the way the Ministry would assume those responsibilities, and how the same would be articulated with SGSSS.

In previous terms, for the Court to rule in question can only be interpreted with the scope consist of a qualification for the government, so as to define the regulations, establish an account that draws with private contributions, public or international cooperation for the prevention and investigation of epilepsy, as well as for the training of human resources involved in the care of patients with this pathology. The Ministry, within the scope of its powers could finance, charged to that account, designed to promote that within the Social Security System in Health comprehensive care of patients with epilepsy compliance activities, and the acquisition of equipment specialized for effect. As the account would operate outside the General System of Social Security in Health, it is clear that private contributions provided for in the standard are essentially voluntary.
For the same reasons, the Court, the anticipation of clause 2 of article 9 of the project, under which the care of people who are not affiliated with one of the schemes at the time of diagnosis to be charge of the Nation, immediately and effectively, through the Ministry of Social Protection, meanwhile affiliation of the patient is defined can not be interpreted as meaning that it eludes people who suffer from epilepsy the general scheme under which those who are not affiliated to the General Health System in the contributory scheme, or subsidized, shall be considered linked and attention will be the responsibility of local authorities. [19] In a comprehensive reading of the bill, it must be concluded that the care of patients with epilepsy remains, in all its aspects, within the SGSSS, subject to the special responsibility of law attributes to the Ministry of Social Protection that within the scope of its powers, to take the measures necessary to ensure that those at the time of diagnosis are not affiliated to SGSSS, they receive comprehensive and timely care through local authorities.
With the above interpretative clarifications, does not appreciate the Court that the government's observations pose a real problem of unconstitutionality and objections, at this point, they shall be declared unfounded. Nor is unacceptable
consideration according to which the project attributed to the Superintendency of Health functions known their jurisdiction, not only because it is not derived, per se, a problem of unconstitutionality, but also because, it is clear that the reference to the Superintendency be understood conducted within the general framework of the functions corresponding to fulfill.
2. Affectation of balance and sustainability of Social Security System in Health
For the Government, "(...) although a subsequent law may amend a previous law ordinary, the truth is that the introduction of rules fragmented and without consulting the actuarial calculations and other studies required to adjust the value of the UPC and the national and regional budgets ends unhinge the very concept of system and institutional structure or rules of the General system of Social Security Health". In his opinion, the project objected "(...) introduces imbalances between the contents of the POS and the value of the UPC, plus charges and ordering costs assume the IPS".
For the Court this objection presents problems adequacy position, because the Government, unless a case is presented in another paragraph of objections and that the Court will refer later, unspecified, or how, or the specific provisions that would affect the project sustainability. Nor does it explain the reason why the project is involvement of the POS-UPC relationship face to the provision of Article l0 thereof, in which express reference is made to the CRES to update the POS in relation follows epilepsy, for which it must take into account the criteria and principles governing the SGSSS.
Thus we find the Court before a global position, which not only does not specify the grounds of unconstitutionality, but that does not seem consistent with provisions of the project objected that refer to the modification of the POS, an entity whose powers enrolled within the SGSSS. For these reasons the Court jurisdiction in relation to this objection.
3. institutional misalignments in the definition of Mandatory Health Plan

As was done in the judgment C-662 of 2009 in this section the Court jointly address the objections that have to do with the lack of institutional system that governs the SGSSS and with the involvement of the objectives of the National Plan of Public Health.
3.1. Although they are presented in a dispersed manner by the government, in this section can be grouped considerations that revolve around the idea that the project modify powers granted to specialized and technical systemically designed by the same legislator organs.
3.2. More specifically, for the government, while recognizing the power of legislative configuration, it must be aware that materials such as the contents of the POS or the value of the UPC to finance health services are of great technical complexity and have been delegated by the legislator in the Health Regulation Commission, providing it with the tools and technical inputs for such decisions on criteria of reasonableness, complexity and specialty materials.
Thus, when partially regulates a condition, a logical breakdown is generated in this rationality, precisely because regulation, as in this case, it would not be developed taking into account a wide landscape that make the necessary reflections and links between services and funding.
3.3. The Government makes a similar argument, in the sense that the Judgment T-760 of 2008 had recognized the importance of the National Plan of Public Health, under Article 33 of Law 1122 of 2007, as a valuable tool in the search for a system of coordinated and efficient health. Thus, partial and fragmented nature of the bill would be contrary to the purposes of the said plan.
3.4. In relation to these objections should be noted, first, that the general reference to the mismatch of the institutional framework established by the law for SGSSS, is a global position that, in principle, is not suitable to trigger a decision on the merits of the Court . Notwithstanding the foregoing, to the extent that this observation can be redirected to a specific situation, it may be under consideration by the Court and so it is with the allocation to the Ministry of Social Protection of responsibilities and powers dismantle the institutional design plans in the law for the provision of health, or the reference in the same direction, the Superintendency of health, and were subject to pronouncement in another section of this decision.
Moreover, the Court draws attention to the fact that the government has objected to the bill by ignoring the powers of the CRES, without specifying which provisions of it derives that conclusion without referring to the provision of Article 10 of the draft, which, explicitly, there is "[t] he Commission Health Regulation (CRES) should be included in the benefit plans Contributory Scheme and the Scheme Subsidized coverage epilepsy by taking guidelines and protocols that provide for procedures, medicines and other health services required for the treatment of this disease. " This discordance between the direction of the objection and content of the project, regardless of what may be the scope of the aforementioned provision of Article 10 thereof, resulting in a lack of certainty of the objection, which prevents this aspect the Court issue a decision on the merits.
Finally, as was pointed out by the Court in the Judgment C-662 of 2009, these objections incur defects which prevent the Board adopt a substantive decision on the matter. In that judgment, the Court stated that "(...) the Constitution gives the legislature the power to set, within a wide range of standard configuration, the institutional arrangement it deems appropriate for the SGSSS. The ordinary rules of repeal and reform of the legal rules that determine regulatory power has the potential to modify, delete or redefine the powers of each of these institutions. Therefore, Congress is fully entitled to separate, if deemed appropriate, in particular institutional model that he has designed, in order to meet the needs of a particular social group, whom he considers worthy of special treatment. This exercise, as has also been noted on several occasions, is confined only to the formal and material limits explained above constitutional nature ".

Except in specific aspects to which reference has been made, the government remains unclear what the institutional mismatches are introduced to the project SGSSS, nor does it explain to what extent and why these are unreasonable or disproportionate, or overflow superordinate regulatory frameworks. As stated by the Court, "[t] he mere general approach of a difference between the institutional framework of SGSSS and some forecasts, unspecified project lead, not a problem of confrontation thereof with the Constitution but with other statutory rules (...) "unknown circumstance that" (...) judicial scrutiny by the Court is limited to compare the legal norm charged with the regulations included in the Constitution and those that make up the block constitutionality. This control is not predicated of other provisions of ordinary eminently legal nature since they do not form a suitable regulatory parameter to impose limits or prohibitions on the competence of the legislator. This criterion is maintained, even when such institutional arrangements of legal origin have been found valid by decisions of this jurisdiction, as these also recognize the primal power of the legislature on the matter. Such strictures, as demonstrated in the present case, end-related reasons of political or economic expediency, aspects that prima facie escape the jurisdiction of the Court. "
He said the Court that "[t] he provisions of Law 1122 of 2007, which set both the existence and operation of the Health Regulation Commission - CRES, as the objectives of the National Plan of Public Health, not form a limit for the exercise of jurisdiction of the legislature with regard to the definition of the institutions that make up the health system. Rather, the performance of the functions of these institutions, legal lineage, must be coordinated with the subsequent forecasts of the legislature, as in this case, agree specialized for certain groups of patient care. This corresponds to Congress while, as set out above, the definition of institutions and bodies that make up the SGSSS, power is limited by the formal and substantial restrictions outlined above, as well as the prohibition of unjustified discrimination among users. These restrictions, as has been repeatedly pointed out in this decision, do not involve previous legislative decisions, because they do not make the parameter of constitutionality of ordinary laws. "
Moreover, in connection with the objection that have to do with the contents of the National Public Health Plan, whether the government makes an overall consideration of the matter, without stopping to examine specifically the issues of constitutionality that pose certain modifications thereof, reference is made to the considerations made by the Court in the Judgment C-662 of 2009, under which "(...) can not be forgotten that, as provided in Article 33 of Law 1122 of 2007, the definition of the contents of the National Public Health Plan is for the national government. [20] Therefore, it is not correct to consider, as it defends the presidential objection, that the broad discretion of the legislature to determine the content and operation of the SGSSS should be subject to the actions of the Executive, as this would mean ignoring the express constitutional mandates under Articles 48 and 49 of the Charter (...) ".
For the Court, the above means that the arguments presented by the National Government would lead to the legality of the bill, "(...) circumstances beyond the jurisdiction of the Court, under Article 167 superior, rule empowers the Court to decide on objections of unconstitutionality. This prevents the Court to rule on various issues. " Therefore, as happened in the Judgment C-662 of 2009, "(...) the Chamber refrain from taking a decision background about censorship based on the incompatibility of the project with the powers of the CRES concerning SGSSS content regulation and with the provisions of the National Public Health Plan ".
4. Recognize the right of users to participate in decisions that affect them in relation to the General System of Social Security in Health

The Government raised this objection in the same terms in which he presented against the bill number 2008 312 Senate Chamber 90, 2007, "Sandra Ceballos Law, by which the actions for establishing comprehensive care cancer in Colombia ", an issue that was addressed by the Court in the Judgment C-662 of 2009, to which reference should be made general remarks on this occasion.
For the Government, however, that in Judgment T-760 of 2008 it was decided that in developing the mandate of participation provided for in article 2 of the Constitution, to implement a genuine public health policy, should be counted with users system, in the disputed project mechanisms are established to define priorities care health risks that ignore instances of participation under the law and do not regularly consult the technical components and the structure of the planning process to include care health risks, such as epilepsy, in isolation, without consulting fragmented and criteria of integrity and financial sustainability of the General Social Security System in health.
As the Court stated in the judgment C-662 of 2009, "(...) it is clear that the proposed censorship does not meet the minimum conditions necessary to set an objection of unconstitutionality. Indeed, the argument raised by the Executive fails to indicate what normative statements of the bill impede the effective enjoyment of the right of participation of users SGSSS and how they achieve that goal alleged. In contrast, it reiterates the argument about the fragmentation of the institutional system of health care of adult patients suffering from cancer, an issue that has already been elucidated in previous sections of this ruling. "
Moreover, in this section, the Government refers to Article 17 on time and a separate article 21 of the draft, which read as follows: Article 17.
legally constituted organizations of people with epilepsy may be consulted on issues related to their rights and obligations; as well as on regulatory developments that have been announced.

Article 21. (...)
Epilepsy Centers authorized or officially accredited institutions will obligatorily consultants for cases of medically intractable or difficult to manage.
(...)
For the government "... the contrast between democratic consultation peeks referred to by the Constitutional Court and consultation 'organizations legally constituted [sic] people with epilepsy' of which Article 17 of the draft law against regulation to be established, and mandatory consultation 'epilepsy centers' of which Article 21 of the same project in relation to the treatment of disease that make up a discriminatory treatment regarding the decisions taken against other diseases and meet the people who have them. The latter provision rivaling especially with the protocols and medical guidelines for the treatment of a given pathology and introduces a foreign element as is 'mandatory' a from the 'epilepsy centers' concept to which the bill refers regarding the management of a patient whose responsibility corresponds to current standards and jurisprudence the treating physician. "
The government does not specify how a provision empowers the competent authorities to consult with organizations of people with epilepsy on matters related to their rights and obligations, as well as regulatory developments that are intended to make It should be taken as contrary to the principle of user participation SGSSS in decisions that affect them.
Neither reason nor it is seen by the government for which the aforementioned consultation and which, according to the law, must be made to epilepsy centers authorized or accredited officially explained, in relation with cases of medically intractable or difficult to manage, configure discriminatory treatment regarding the decisions taken in respect to other diseases and meet the people who have them. This consideration is not only alien to the issue of participation at issue in this apart from the objections of the government, but it raises an issue of equality without being subject to the minimum requirements for setting a charge of unconstitutionality in this field.

In effect, the government simply noted that it is discriminatory in the case of epilepsy mandatory consultation, under certain circumstances, provided specialized centers officially accredited but does not specify the reason why, in relation to other pathologies, a need of the principle of equality, a similar regulation should be established.
Finally, the government suggests that a mandatory consultation with epilepsy centers may be contrary to the autonomy of the physician in managing the patient, but not structure a charge of unconstitutionality on the matter.
For the foregoing, the Court jurisdiction in relation to this objection.
5. Need for the project had been submitted as statutory law
According to the Government, the bill is contrary to Article 152 of the Constitution, as it should have been processed as a statutory law and not according to the rules of ordinary law as indeed it happened. The Government of the premise that, according to constitutional jurisprudence, the right to health is a fundamental and autonomous right, to the extent that it is not only a right of prestacional content but also the main way, a subjective, universal and inalienable right.
Government points out that this irregularity is particularly evident in: the article 3 of the bill that prohibits discriminatory treatment of people diagnosed with epilepsy suffer or that (i); and (ii) the definition of the scope of protection of the fundamental right to health by incorporating the training of medical and nursing staff, recreation, culture and sports, among other aspects, ie, regulating the core of the right and setting the field of exercise that is apparently too broad and protector but, for this reason, should be subject to discussion and processing of statutory law for the purpose of legitimizing these limits.
The Constitutional Court, in the oft-alluded Judgment C-662 of 2009, found the objections unfounded, in very similar terms, had been raised by the government against the bill number 2008 312 Senate 90, 2007 camera, "law Sandra Ceballos, for which actions for comprehensive cancer care in Colombia are set," considering that were not present in this regulation the conditions according to constitutional jurisprudence, activate the special reserve of statutory law . This time the Court will reiterate that precedent, based on the considerations set out below:
5.1. Article 152 of the Constitution establishes the reserve of statutory law for certain matters related to (i) the fundamental rights and duties of individuals and the procedures and resources for their protection; (Ii) administration of justice; (Iii) organization and system of political parties and movements, status of the opposition and electoral functions; (Iv) institutions and mechanisms for citizen participation; (V) states of emergency; and (vi) electoral equality among candidates for the Presidency of the Republic.
5.2. The need to set a parameter to define the limits of statutory legislator, led to previous decisions of the Court, which have been repeated stably until now, have established the material characteristics of the matters subject to the reservation of statutory law.

5.3. A comprehensive summary of this doctrine is found in Case C-981 of 2005 [21], in which it was established that the reserve of statutory law was required, in the case of fundamental rights, in the event that it is before "i) rules that develop and complement the rights, ii) that regulate only the essential structural elements, iii) regulating directly exercise and development of their area from the essential core defined in the Constitution, iv) refer to the closest to the core, v) content that regulate aspects inherent in the exercise and especially what it means enshrine limits, restrictions, exceptions and prohibitions affecting the essential core vi) when the legislature take holistically, structural and complete the regulation of the right, vii) that allude to the general structure and regulatory principles but not comprehensive and detailed development, regulating the basic structure and the basic principles, and viii) that refer to laws that address major and important situations of rights ". These rules, in turn, synthesize multiple statements on the same subject, which have univocally contemplated that the reserve statutory law is predicated of rules governing with integrity, structural and comprehensive fundamental rights or duties, or covering fields own its essential core. [22]
5.4. Does not share the Court's appreciation of the Government under which the claim to ensure a comprehensive approach to the problem of people with epilepsy, involves a complete regulation of the core of the right to health, understood as a fundamental right, which makes imperative via statutory legislation. It is, rather, a set of provisions in the area of ​​comprehensive care of people with epilepsy, introduces some adjustments to SGSSS, states especially the rights of people with epilepsy, and sets guidelines for in all orders, policies adopted and the measures necessary to achieve these objectives, issues that, in that dimension, are typical of the ordinary law are taken. As noted in the judgment C-662 of 2009, in this case budgets to consider the bill censured is subject to the reservation of statutory law are not met, since it is clear that, regardless of the aroused discussion in the constitutional jurisprudence on the condition of fundamentalidad the right to health, in the case of the bill under study, partial and specific nature concerning the scope of protection of this right is an element of sufficient judgment to inscribe within the range of ordinary legislator configuration rules.
5.5. It should also be noted that in its prestacional dimension, the right to health requires legal setting, an aspect that falls within the orbit of the ordinary legislator, leaving no room noted that, because of developments around the fundamentalidad the right to health, there has been a depletion of its powers for the benefit of the statutory legislator, so that, to the future, any alteration of SGSSS Ought made in this exceptional legislative mode.
5.6. Moreover, the reiteration of constitutional provisions prohibiting discrimination, applicable law, specifically, people with epilepsy, also falls within the criteria set by case law to determine the presence of a reserve statutory law, because the rule simply states the right, but not progress, in connection therewith, in the developments referred to by the jurisprudence as determinants of the reserve, to the extent that it can not be said to be before a rule that develop and supplement the right to equality of people with epilepsy, or advance in the regulation of its essential structural elements, or regulates directly exercise, nor indeed means consecrating limits, restrictions, exceptions and prohibitions affecting the essential core. Nor is a norm in the legislature take holistically, structural and comprehensive regulation of the right to equality of persons with epilepsy.
5.7. For the foregoing, the Court declared unfounded the objections relating to the need for the project had been processed as statutory law.
6. fiscal impact of the project, non-observance of the Organic Law 819 of 2003

6.1. For the Government, the bill is objected contrary to Article the 7th of Organic Law 819 of 2003 and therefore also contrary to Article 151 of the Constitution, which enshrines the top hierarchy of organic standards. Indeed, Article on the 7th of Law 819 of 2003 states that, at all times, the fiscal impact of any proposed law mandating spending or giving tax benefits must be explicit and must be compatible with the Fiscal Framework of Medium Term effect which should be explicitly included in the preamble and in the papers respective processing fiscal costs of the initiative and the source of additional revenue generated to finance the cost.
Expresses the Government that the disputed project, however compromising public and SGSSS resources, it is not financed with available resources and also failed to comply with the procedure and the requirements established by the Organic Law 819 of 2003, knowing well the provisions of Article 151 of the Constitution.
For the government, "[a] sa corollary of the above, this bill has no consistency with the provisions of the Medium Term Fiscal Framework, on the one hand, because it is not properly funded with available resources, as he noted in Communication UJ-1012 to 1008 of June 16, 2008, signed by the Minister of Finance and sent to the then President of the Senate, honorable Senator Nancy Patricia Gutiérrez, in accordance with paragraph 3rd of article on the 7th of Law 819 of 2003, ignoring thereby the provisions of Article 151, but also creates an imbalance in the General System of Social Security in Health given that it has no funding source benefits provided to cater for granted here and not based on actuarial calculations to maintain the balance UPC-POS ".
6.2. As the Government itself is expressed, the organic law requires (i) that in the bills to order spending or grant tax benefits, the fiscal impact is presented explicitly and is compatible with the Fiscal Framework of Medium Term ; (Ii) that to fulfill that purpose both in the preamble to the project, as in the presentations of respective process, should expressly include the fiscal costs of the initiative and the source of additional revenue generated to fund such costs; and (iii) that the Minister of Finance and Public Credit, at any time during the legislative process, has the duty to conceptualise on the consistency of the reports made, a concept that can not go contravía with the medium-term fiscal framework.
As also noted by the Government to proceed the analysis of the constitutionality of a bill for infringement of the provisions in the article on the 7th of Organic Law 819 of 2003, provision should be made, (a) concerned a bill to order spending or giving tax benefits, and (b) that the project's impact on public finances is incompatible with the medium-term fiscal framework. In the absence of these prerequisites, it can not be expected that the processing of the draft Congress should have been submitted to the requirements of Article 819 of the Law on the 7th 2003.
6.3. In the report substantiation of objections in Congress, in this connection, in addition to referring to the considerations on a similar objection made by the Constitutional Court in Judgment C-662 of 2009, it is stated that the measures contained in the bill would not entail additional fiscal impact, since it aims to ensure that, with a rationalization of resources allocated to the General System of Social Security in Health (SGSSS), can achieve satisfactory care for people with epilepsy. In this sense, for Congress, the provisions of Law 819 of 2003 which refer to the Presidential Objections are not applicable objected to the draft law.
6.4. In this regard, as it became present in Judgment C-662 of 2009, the Court has elucidated the implications of the organic provision contained in Article the 7th of Law 819 of 2003, regarding the constitutionality of the legislative process. On the subject, in Case C-315 of 2008 established the following criteria:

"3.9.2.1. Obligations under the 7th Article of Law 819 of 2003 is an indicator of legislative rationality, which aims to meet constitutionally valuable purposes, including the order of public finances, macroeconomic stability and effective implementation of laws. The latter as a preliminary study of the compatibility between the content of the bill and projections of economic policy, reduces the margin of uncertainty regarding the physical implementation of legislative provisions.
3.9.2.2. The mandate of adequacy between justification of bills and planning of economic policy, however, can not be understood as a procedural requirement for the adoption of legislative initiatives, compliance with which should lie solely in Congress. This in both (i) Congress lacks the technical assessment bodies to determine the fiscal impact of each project, identifying additional sources of funding and support for the medium-term fiscal framework; and (ii) accept an interpretation of this nature would be an unreasonable burden for the Legislator and a correlative grant veto power to the Executive, through the Ministry of Finance, regarding the competence of Congress to make laws. A power of this character, which involves a barrier in the constitutional role of normative production, shown incompatible with the balance between the public authorities and the democratic principle.
3.9.2.3. If we consider this mandate as a mechanism of legislative rationality, compliance initially corresponds to the Ministry of Finance and Public Credit, once Congress has valued using the tools at its disposal, compatibility between the expenses generated by the legislative initiative and projections of economic policy laid down by the Government. Thus, if the government considers that the Chambers have carried out a fiscal impact analysis wrong, it corresponds to MOFTEC duty to attend the legislative procedure, in order to illustrate to Congress on the economic consequences of the project.
3.9.2.4. Article on the 7th of Law 819 of 2003 can not be interpreted in such a way that the lack of concurrence of the Ministry of Finance and Public Credit in the legislative process, affecting the constitutional validity of the respective procedure. "
6.5. In this context, for the Court, the first observation to be made against the objection raised by the government in this paragraph, it is that in its overall dimension, it does not meet the requirements of a position of ignorance of the provisions of Article on the 7th of Law 819 of 2003, to the extent that, except in specific aspects to the Court allude later, does not specify which provisions entail additional public expenditure unfunded are, or what provisions imply a contradiction with medium-term fiscal framework.
If the government believes that the process of the project should be subject to these provisions, you must specify which of its regulations entail additional public expenditure and which have implications that go against the medium-term fiscal framework.
As this does not happen, the Court shall decline jurisdiction to rule on this position in relation to the bill as a whole, without prejudice to the considerations made below regarding specific issues raised by the Government.
6.6. Under the general approach on the way the fragmentary regulation pertaining to health systems affects public finances and the sustainability of SGSSS issues, the Government states the following aspects of the law as a specific target of office:
- the Ministry of Social protection will require all entities and health institutions in the country, the implementation of comprehensive programs to protect people with epilepsy "[Article 6 of the bill];
- The Government may create an account with different sources or contributions: private, public or resources of international cooperation for the prevention, investigation, comprehensive, timely and ongoing medical care, ensuring the availability of modern equipment, training human resources involved in the care of patients with epilepsy.
- People who are not affiliated to one of the schemes at the time of diagnosis [sic] their full attention will be [sic) in charge of the Nation, immediately and effectively, through the Ministry of Protection social "[article 9 of the bill];

- The Health Regulation Commission (CRES) should be included in the benefit plans Contributory Scheme and the Scheme Subsidized coverage epilepsy "[Article 10 of the draft law];
- The National Government, through the Ministry of Social Protection, ensure adequate training of all personnel involved in the planning and delivery of services and programs for people with epilepsy "[Article 19 of the draft Of law];
- The Lending Institutions Health Service (IPS), from the second level, should have the means for the diagnosis of epilepsy, such as EEG equipment, laboratory Serum Levels, imaging equipment and trained staff for diagnosis and treatment "[Article 21 of the bill].
- The Ministry of Social Protection in coordination with the Ministry of Education will design a special program to train general practitioners and teachers in early detection of symptoms that can lead to neurological disorders including epilepsy "[Article 23 of the bill].
For the government, the content of the above normative propositions to point out that the legislative initiative involves technology for the treatment of disease conditions also includes training of human resources, supply and quality in health care mandatory other than those that currently can finance not only the General System of Social Security in Health but the country is also not in a position to assume and which are incompatible with the structure and operation thereof, which participate and collaborate individuals.
6.7. The Court then refers to the above specific considerations:
6.7.1. "The Ministry of Social Protection will require all entities and health institutions in the country, the implementation of comprehensive programs to protect people with epilepsy" [Article 6 of the bill];
This provision is consonant with the recognition of epilepsy as a public health problem and should be read in harmony with the standards under which the guarantee of access, opportunity and quality of comprehensive care to the population suffering epilepsy will be made in the terms defined in the Mandatory Health Plan (2nd paragraph of article 1 of the bill) and corresponds to the CRES include the treatment of epilepsy in the POS (Article 10 of the bill). It is not a mandate per se, from the law, generate a fiscal impact or costs that threaten the stability of the social security system in health, because as has been said, the incorporation into the POS must be made by the CRES in within their functions and attention to the legal parameters for the exercise of the same, which means sustainability considerations, cost-benefit, etc. It should be noted that, unlike what was proposed in one of the stages of the process of the project, the legislature chose not to incorporate directly into the POS treatments and medications for epilepsy, but established them as the responsibility of the CRES , which must be exercised within the framework of the rules governing its function.
6.7.2. The Government may create an account with different sources or contributions: private, public or resources of international cooperation for the prevention, investigation, comprehensive medical care in a timely and permanent, ensuring the availability of modern equipment, training of human resources involved in the care of patients with epilepsy.
- People who are not affiliated to one of the schemes at the time of diagnosis [sic] their full attention will be [sic] in charge of the Nation, immediately and effectively, through the Ministry of Protection social "[article 9 of the bill];
Aspects alluded to by this apart from the Government's objection were already considered in another paragraph of this ruling, which found that, according to a comprehensive interpretation of the project, it can not be concluded that they detach the allocation of a special competence to the Ministry of Social Protection for the care of patients with epilepsy, which can be derived the existence of additional public spending.

Moreover, the Court considers that the authorization for the government to create an account with different sources or contributions: private, public or resources of international cooperation for prevention, research and training of human resources involved in care integrated patient with epilepsy, while merely establishes a power, does not imply, per se, the decree of additional expenditure which would be generated only in line with the amount of resources that nurtures account.
6.7.3. "The Health Regulation Commission (CRES) should be included in the benefit plans Contributory Scheme and the Scheme Subsidized coverage epilepsy" [Article 10 of the draft law];
It is clear that the responsibility lie at the head of the CRES, the law does not know the system of joint competence, nor the general criteria governing the preparation of the POS or the inclusion or exclusion of treatments and medications in the same criteria including sustainability account. Thus it can be said that, as a direct consequence of the law, is affected by this concept, sustainability SGSSS or financial structure of public entities responsible for the provision of health services.
6.7.4. "The Government, through the Ministry of Social Protection, ensure adequate training of all personnel involved in the planning and delivery of services and programs for people with epilepsy" [Article 19 of the bill] ;
"The Ministry of Social Protection in coordination with the Ministry of Education will design a special program to train general practitioners and teachers in early detection of symptoms that can lead to neurological disorders including epilepsy "[Article 23 of the bill].
The project should be interpreted consistently with the rules establishing the structure, objectives and functions of the Ministry of Social Protection.
While it could be interpreted that the law empowers the Minister direct responsibility for staff training, as does the Government, also fits register the function in the proper powers under the Ministry, comprising policy and work coordination, promotion, regulation, monitoring and control.
Thus, the project establishes, under the Ministry, responsible for coordinating with the Ministry of Education to design a special program to train general practitioners and teachers in early detection of symptoms that can lead to a neurological disease, including epilepsy program whose implementation would have to be done at various levels of the education system and health and social security in accordance with the funding mechanisms contemplated for the effect. Similarly
it would be for the Ministry to adopt regulatory and control measures designed to ensure that all personnel involved in the planning and delivery of services and programs for people with epilepsy, has the appropriate education and training without it is apparent, as the Government seems to consider that the training of such personnel are, by virtue of the provisions of the project, a direct responsibility of the Ministry of Social Protection.
These responsibilities can be met, in principle, in the ordinary development of competencies of the Ministry, without, by legal mandate, resources are committed for which no provision for the source or manner that may be inconsistent with the framework Attorney medium term.
Moreover, it should be noted that, for the fulfillment of the purposes of the law empowers the Ministry to open a special account to be nourished with private, public and international cooperation resources and under the which will conduct activities that develop exceptional costs.
6.7.5. "The institutions providing Health Service (IPS), from the second level, should have the means for the diagnosis of epilepsy, such as equipment EEG, laboratory Serum Levels, imaging equipment and trained for diagnosis and treatment staff" [Article 21 of the bill].

The rule contains a general provision, which is in line with the recognition of epilepsy as a public health problem, and according to which the institutions providing Health Service, from the second level, should have the means to the diagnosis of epilepsy. From there one merely illustrative list of such media aspect therefore be the responsibility of the regulatory authorities, which shall specify the point according to technical considerations of epidemiological nature, incidence, financial and sustainability ago.
6.8. From the foregoing, one can conclude that in the letter of objection, or generally in relation to the bill as a whole, and especially against the concrete of which provisions the infringement preached, It states clearly that the project contemplates the implementation of additional public spending without identifying the resources needed to sufragarlo or involves an impact on public finances that are in contravía with the medium-term fiscal framework. For this reason the Court refrain from taking issue a ruling on the merits in relation to this charge.
7. As to the reasons explained in the previous legal basis, the Court finds that none of the presidential objections to the bill carried holistically question its constitutionality. Moreover, the specific questions made by the Government imposed, in certain cases, an interpretive task based on the scope which the government attributed to the law and that could pose problems of unconstitutionality are discarded. Therefore, the Court declared enforceable legislative initiative under control, but, as indicated at the beginning of this decision, it will restrict the effects of this decision to the subjects studied in this judgment.
Notwithstanding the foregoing, the Court considers the case need to call the legislature to skip regular isolation aspects that are part of the General System of Social Security in Health, not only by considerations of convenience outlined by the Government in, but because such an approach to regulating health services can lead to problems of constitutionality, that although in this case, with the interpretive clarifications that have left you outlined, did not materialize, they can possibly raise an affectation of efficiency mandates and universality that govern the regulation of the health system in accordance with Article 49 of the Constitution.
VII. DECISION
In merit to the foregoing, the Constitutional Court, administering justice on behalf of the People and by mandate of the Constitution, Resolves
:
First. Declare unfounded the presidential objections to the bill number 2007 028 Senate and 341 House 2008, for which special protection measures for people with epilepsy are established principles and guidelines for comprehensive care are given.
Second. As a result of the foregoing and exclusively on the objections raised by the Government analyzed in this decision, declaring constitutional the bill number 028 2007 Senate 341 2008 House, by which special protection measures are established for people epilepsy, principles and guidelines for comprehensive care are given.
Third. Refrain from taking a decision on the merits regarding the presidential objections based on (i) the incompatibility of the project with the principle of unity of matter, the powers of the CRES on the regulation of content SGSSS and forecasts of the National Plan Health; (Ii) infringement of the right to participation of users and (iii) the fiscal impact of the project and failure to observe the provisions of the Organic Law 819 of 2001, due to the lack of sufficient reasons to make a judgment on constitutionality on the subject.
Cópiese, report, contact the President of the Republic and the President of Congress, inserted in the Gazette of the Constitutional Court, be fulfilled and filed the record. Mauricio Gonzalez Cuervo
, President; Maria Victoria Street Correa, Juan Carlos Henao Pérez, Gabriel Eduardo Mendoza Martelo, Jorge Ivan Palacio Palacio, Nilson Pinilla Pinilla, absent in committee, Jorge Ignacio Pretelt Chaljub, with dissenting vote; Antonio Humberto Sierra Porto, Luis Ernesto Vargas Silva, OP-130/10, Judges.
The General Secretary,
MARTHA VICTORIA Sáchica OF MONCALEANO.
* * *

1 As official letter signed by the Ministers of Social Welfare and Finance which is accompanied by copy of the text of the objections received the record on that date.

2 presidential objections report was published in the Gazette No. 1,265 of December 10, 2009 (Senate) and the Gazette No. 1278 of December 11, 2009 (House of Representatives).

3 The approval of that project consists in the Plenary Act No. 26 of December 14, 2009, following its announcement in Plenary Session of December 10, 2009, Act No. 25.

4 according to the certification of the Secretary General of the House of Representatives, consists in Plenary Act number 227 of December 15, 2009, following its announcement in Plenary Session of December 14, 2009, Acta number 226. | ||
5 With respect to the infringement of the principle of unity of matter, the Constitutional Court holds that, in various statements, said that constitutes a material defect which ignores the rationalization and modernization of the regulatory process, in addition to the causal relationship connectedness , teleological, systematic thematic or those asides, segments or propositions of a law regarding the dominant material of the same. On this point, see, among others, Case C-025 1993 2001 C-586, C-995 and C-214 2001 2007.

6 To illustrate the indictment, in the letter of objections raises the Law 1164 of 2007, which provisions are issued on Human Resource in Health, which regulates in full the different aspects of education, training and accreditation of human resources in health.

7 In that regard stresses that it was the legislator who, at the same time created the General System of Social Security in Health (SGSSS), consolidated the institutions through which the benefit plans are tailored to the needs of the population, at all levels and population groups within the special protection that incorporates the constitutional order. Faculty today, lies in being head of the Health Regulation Commission (Cres), according to the voices of Law 1122 of 2007.

8 See, among others, Case C-452 2006.

9 See, among others, Judgments C-1249 2001 070 C-2004, C-819 and C-2004 531 2005.

10 Cf. Constitutional Court. Judgments C-510 of 1996, C-063 and C-068 2002 2004.

11 Under official letter signed by the Ministers of Social Welfare and Finance, which is accompanied by a copy of the text of the objections received the record on that date.

12 Cf. Constitutional Court, Judgment C-885 MP 2004. Alfredo Beltran Sierra

13 Cf. Constitutional Court, Judgment C-433 2004. MP Jaime Córdoba Triviño.

14 Cf. Constitutional Court, Judgment C-1065, 2008 (MP Clara Inés Vargas Hernández). In this decision, the Court ruled on the constitutionality of the provisions of Law 100 of 1993 which establishes the requirement for academic exclusive dedication to the under 25s have the status of beneficiaries SGSSS.

15 Cf. Judgement C-245 2004.

16 Constitutional Court. Judgment C-390 of 1996

17 Ibid.

18 Judgment C-245 2004.

19 Laws 100 of 1993 and 715 of 2001

20 That provision states:

Article 33. National Public Health Plan. The National Government will define the National Public Health Plan for each quadrennium, which will be expressed in the respective National Development Plan. Its objective is the treatment and prevention of major risk factors for health conditions and promoting healthy lifestyles and strengthening the capacity of the community and the different territorial levels to act. This plan should include:

A) The epidemiological profile, identifying risk and protective factors determining the incidence and prevalence of major diseases that define public health priorities. For this purpose, the investigations conducted by the Ministry of Social Welfare and any public or private entity shall be taken into account. In vaccination, sexual and reproductive health, mental health, with emphasis on domestic violence, substance abuse and suicide;

B) activities seeking to promote change of healthy lifestyles and integration of these at different educational levels;

C) The actions, according to their skills, you must perform the national level, regional level and insurers;


D) Financial and budget plan public health, as defined in each of the actors responsible for the General System of Social Security in Health, including local authorities, and EPS;

E) The minimum mandatory coverage in health services and interventions, goals preventable morbidity and mortality, which must be reached and reported with zero tolerance, which will be set for each year and for each period of four years;

F) The goals and responsibilities in public health surveillance and inspection activities, monitoring and control of risk factors to human health;

G) The public health priorities to be covered in the Mandatory Health Plan and the goals to be reached by the EPS, designed to promote health and control or minimize the risk of illness or death;

H) collective activities that are in charge of the Nation and territorial entities with resources to do so, should complement the actions foreseen in the Compulsory Health Plan. The Plan collective public health interventions, replace the Basic Care Plan;

I) models of care, such as family and community health, primary care and home care;

J) The national immunization plan to structure and integrate the scheme specific protection for the Colombian population in particular biological to be included and to be reviewed every four years with the assistance of the National Institutes of Health and the National Committee Immunization practices;

K) The plan must include actions to promote mental health and treatment of most prevalent disorders, prevention of violence, abuse, drug addiction and suicide;

L) The Plan will include actions aimed at promoting sexual and reproductive health, as well as measures to respond to behavior of indicators of maternal mortality.

21 MP Clara Inés Vargas Hernández.


22 Cf. Constitutional Court, Judgments 1998 C-251, C-013, 1993, 1994 C-313, C-620 and C-646 2001 2001, among others. For example, the Judgment C-646 of 2001 (MP Manuel José Cepeda Espinosa), offers similar rules as to the rules governing fundamental rights, subject to the reservation of statutory law. In this ruling, the Court stated that according to the case law and prior to this constitutional precedent, it can be concluded that such a situation occurs when (i) the matter is a fundamental right and not a constitutional right otherwise, ( ii) by means of the standard it is regulated complementing a fundamental right, (iii) such regulation touches the minimum conceptual and structural elements of fundamental rights, and (iv) where the regulations have a claim to comprehensively regulate the fundamental right. // In this vein, it can then be observed that the existence of statutory law has a dual role, especially identified by the criteria (ii) and (iii). On the one hand, allow the legislature integrate, refine, adjust and supplement standards on fundamental rights, pointing to their proper enjoyment. And secondly, to establish a constitutional guarantee for citizens against possible limits exclusively under the principle of proportionality, can establish the legislator. // 7. For the special importance of statutory laws within the system, it is necessary that the analysis on a charge reproach ignorance of the law statutory reserve also care for at least three fundamental aspects. First, keep in determining the substantive scope of the statutory law, either emptied the jurisdiction of the ordinary legislator. Second, prevent searching for the maintenance of the previous ordinary constitutional competence of the legislature, is removed the material content and the proper scope of the statutory laws. And third, prevent an interpretation of the content of the statutory laws grant them such competition in the regulation of fundamental rights, allowing them to affect their basic conceptual, without adequate prior judgment of proportionality. // Based on the above assumptions, to determine whether the accused should have been handled by standard means of a statutory law, not enough to determine whether the object of that provision has any connection with a fundamental right. It will be necessary also determine whether the normative content expressed by the law from the material point of view, regulates elements found near and around the essential content of a fundamental right, and if engaged restrictions, limits or conditions on these, you must verified if they are proportionate and constitutionally reasonableness ".


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