Case “Special Care Unit 13” (Pabellón 13) regarding patients with HIV-AIDS brought against the National Institute of Respiratory Diseases (INER) and other authorities (AR 378/2014)

On December 20, 2012, three patients of the National Institute of Respiratory Diseases “Ismael Cosío Villegas” (INER) brought the indirect amparo action 1669/2012 against various authorities held responsible, including  the National Commission of Social Protection in Health, the Technical Committee of the Trust for the System of Social Protection in Health and the National Institute of Respiratory Diseases “Ismael Cosío Villegas” (INER), for the failure of said authorities to take all necessary measures to guarantee and implement the patients’ right to the enjoyment of the highest attainable standard of physical and mental health. In concrete terms, this manifested as the failure to execute the construction of Special Care Unit 13 (Pabellón 13).

The aforementioned amparo action was initially resolved by the Third District Court on Administrative Matters at the Federal District with the ruling made on June 21, 2013 to deny the amparo to the claimants. However, as they were unsatisfied with the decision, they filed writ of appeal 231/2013 on July 9, 2013 against the ruling made by the District Judge.  The resolution of writ of appeal 231/2013 was to be determined by the Tenth Collegiate Tribunal on Administrative Matters at the Federal District. In the session held on February 20, 2014, this tribunal ruled to send the appeal to the Supreme Court of Justice of the Nation (SCJN). The Second Chamber of the SCJN exercised its authority to assert jurisdiction (217/201), in processing and ruling on amparo action 378/2014 under review.

INER treats the greatest number of people living with HIV/AIDS in Mexico, offering active, hospital and outpatient care to patients. At INER, almost all of the patients hospitalized with HIV are experiencing advanced stages of the disease and are admitted for pulmonary illnesses and compromised respiratory capacity, conditions which require intensive care. This group of individuals accounts for the greatest number of deaths, indicating that AIDS is the primary cause of death at INER related to infectious disease for people between 18 and 45 years old.

The complications experienced by people living with HIV/AIDS require facilities that are designed to foster a balance between the specialized clinical care offered and the appropriate control of microorganisms through containment measures. These measures should be developed on the following different levels: the physical separation of those rooms used for patients who are highly susceptible to infection, the isolation of microorganisms directly at their source via ventilation and air filtration systems, the removal of contaminated air, periodic decontamination, the use of personal protective equipment, as well as others.

As such, in 2007, INER authorities started trying to initiate the procedures necessary to renovate “Clinic 4” of INER. The goal was to make changes that would lead to improvements in the quality of medical care being provided to patients with AIDS. After plans for the possible expansion and remodeling of Clinic 4 were developed as part of an executive project, INER health authorities concluded that the needs of patients with AIDS treated in Clinic 4 would not be met through renovations of the facility. Instead, they stressed that there must be infrastructure designed to prevent and minimize co-infection of patients via air-borne diseases. Ultimately, it was recognized that INER patients with HIV/AIDS required specialized clinical care.

It was, in fact, INER authorities who decided that it would be better to undertake the construction of a new building. Their logic was that it would be more advantageous to design the spaces required, rather than trying to modify the facilities that already existed. Hence, the original project for the renovations of Clinic 4 was cancelled, and instead, there was approval of a new project called
Construction and of the Clinical Care Unit for Patients with HIV/AIDS and Co-infection through Airborne Diseases”. This project, which became known as the construction of Special Care Unit 13, was intended to treat patients with HIV/AIDS, as well as those suffering co-infection through airborne diseases, with the goal of providing better and more appropriate medical care and services. 

In order to do so, a new executive project was developed and the process began to obtain the various forms of permission and fulfill the requirements necessary to build Special Care Unit 13, and to be eligible to receive resources for infrastructure and equipment from the Budgetary Provision Fund. In March 2012, however, INER authorities informally reported to the president of the “Committee of HIV/AIDS patients using INER Health Services” (“USINER”) that the construction of Special Care Unit 13 had been cancelled without giving any justification.

The Supreme Court of Justice ruled in October 2014 that INER, in coordination with other authorities "must take all necessary measures to safeguard plaintiffs’ human right to the highest attainable standard of health, considering that they carry HIV [...] ". The enforcement of the sentence implies that the authorities should consider whether it is more appropriate health wise to reshape the hospital where patients are currently treated or construct a new hospital wing.