## Facts

- Rural Psychiatric Institute Virgen del Rosario, Inc., and several other psychiatric institutes (collectively, the institutes) provided residential psychiatric care to chronically mentally ill people from rural areas who had low or no financial resources.
- The institutes provided this care through contracts with Venezuela’s minister of health and social welfare (the minister), under which the state funded placements of indigent patients in the institutes’ facilities.
- Many of the patients stayed in the institutes for extremely long periods, including lifelong residence, because of the chronic nature of their conditions and the lack of family or community resources.
- Beginning in 1992, the minister renewed the institutes’ contracts each year, allowing the institutes to continue providing care with state payment.
- In 1998, the minister did not renew the contracts when renewal was due, initially citing lack of funds.
- According to the institutes, the contracts still were not renewed even after funds became available.
- The institutes continued housing and caring for the patients during the lapse, asserting that they could not realistically discharge or refuse patients who were already institutionalized and dependent on ongoing care.
- The institutes filed a petition for a writ of constitutional protection (amparo), alleging that the minister’s failure to renew the contracts and failure to remove or relocate patients forced the institutes to provide uncompensated services.
- The petition also asserted that the minister’s inaction placed the patients’ rights to life and health at risk by threatening continuity and adequacy of psychiatric treatment.
- The record summarized in secondary materials indicated there was evidence that some patients were not receiving optimal care at certain facilities, raising additional concerns about patient welfare during the funding interruption.

## Issues

1. Whether the minister’s failure to renew the institutes’ annual contracts, while leaving indigent, chronically mentally ill patients in the institutes’ custody, violated constitutional protections connected to the patients’ rights to life and health by jeopardizing continuity of essential psychiatric care.
2. Whether the same failure to renew the contracts, coupled with leaving the patients in place, infringed the institutes’ property interests by imposing ongoing, unfunded obligations to house and treat patients.
3. Whether constitutional protection (amparo) can be used to require executive authorities to take timely measures—funding, renewal, or an alternative care plan—so that withdrawal of state support does not result in abandonment or dangerous interruption of long-term institutional care.

## Decision

- Based on the available secondary summary, the court granted constitutional protection in substance.
- The court treated the minister’s failure to renew (and related conduct that would end or sharply reduce funded placements without safeguards) as unconstitutional insofar as it endangered the life and health of the institutionalized, indigent psychiatric patients.
- The court required the state, through the competent authorities, to ensure continued, adequate psychiatric care for the affected patients and not to withdraw support in a way that left them without effective protection or treatment.
- The court rejected the idea that budgetary or administrative choices could justify leaving a highly dependent, vulnerable patient population without a viable continuity plan.
- To the extent the institutes were compelled to keep patients without payment, the court recognized the dispute as having constitutional dimensions beyond ordinary contract enforcement because the state’s action (or omission) directly affected fundamental rights and imposed burdens on the providers tied to a public service function.

## Legal Principles

- The rights to life and health can impose affirmative duties on the state, especially when the affected persons are highly dependent and cannot secure care on their own.
- When the state has arranged essential medical services through private contractors, the state remains responsible for ensuring that those services continue in a way consistent with constitutional rights; contracting out does not transfer away constitutional obligations.
- Executive decisions about contract renewal, funding, or restructuring of public health services are constrained where the foreseeable result is interruption of life-sustaining or essential care for a vulnerable group.
- Amparo is available to challenge governmental action or inaction that threatens immediate or serious harm to fundamental rights, including where the threatened harm arises from the withdrawal of state-supported medical care.
- In assessing constitutionality, courts may look to whether the government acted with a workable plan to protect patients during transitions, rather than abruptly cutting support without arrangements for transfer, funding, or equivalent care.

## Conclusion

Rural Psychiatric Institute Virgen del Rosario, Inc., and other institutes sought amparo after the health minister failed to timely renew annual contracts that funded long-term residential care for indigent, chronically mentally ill rural patients, leaving the institutes to continue care without payment and placing patient continuity of treatment at risk; on the available secondary account, the court granted protection, holding that the state could not withdraw or delay support in a manner that threatened the patients’ rights to life and health and had to ensure ongoing, adequate psychiatric care.


Rural Psychiatric Institute Virgen del Rosario, Inc., et al. v. Minister of Health and Social Welfare, Exped. No. 14695 (1998)