1. The State's obligation to regulate health services in order to protect personal integrity 134. As this Court indicated in another case, “States are responsible for the permanent regulation […] of the provision of the services and the execution of the national programs for provision of high-quality public health services, in order to avoid any risk to the right to life and to physical integrity of those subject to health care. They must, inter alia, create satisfactory mechanisms for the inspection of institutions, […] submit, investigate and decide complaints, and establish suitable disciplinary or judicial procedures for cases of inappropriate professional conduct or the violation of patients’ rights.” 174 135. The United Nations Committee on Economic, Social and Cultural Rights 175 and the European Court of Human Rights 176 have ruled similarly, considering that the State must take positive steps to protect the life of the persons subject to their jurisdiction and to ensure the quality of health care services, and that health care professional meet the necessary standards for providing these services, by means of a regulatory framework for public or private entities, as well as with regard to the activities of private individuals, groups or corporations, in order to protect the life of their patients. 136. In this regard, the Court observes that, in the instant case, the State referred to various laws and regulations designed to regulate health care facilities, which were adopted before and after the facts. On July 1, 2000, the relevant Ecuadorian regulations were constituted by the following norms: 177 a. 174 The Constitution of June 5, 1998, which entered into force on August 11 that year, and established that “[t]he State shall formulate the national health policy and shall supervise its application; [and] shall monitor the functioning of the entities in this sector” 178 (article 44); Case of Ximenes Lopes, supra, para. 99. 175 United Nations, Economic and Social Council, Committee on Economic, Social and Cultural Rights. General Comment No. 14, E/C.12/2000/4, 11 August 2000, paras. 35 and 51. This document establishes that: “[o]bligations to protect include […] to adopt legislation or to take other measures ensuring […] the quality of health facilities, […] and to ensure that medical practitioners and other health care professionals meet appropriate standards of education, skill and ethical codes of conduct.” “Violations of the obligation to protect follow from the failure of a State to take all necessary measures to safeguard persons within their jurisdiction from infringements of the right to health by third parties.” These include “such omissions as the failure to regulate the activities of individuals, groups or corporations so as to prevent them from violating the right to health of others.” 176 The European Court of Human Rights has indicated that: “[among] the basic provisions of the Convention [the States have] the obligation [… to adopt] the necessary measures to protect the life of the persons subject to their jurisdiction […]. These principles also apply in the public health sector, where the positive obligations […] entail the establishment by the State of a framework of public or private regulated entities, adopting the measures required to protect the life of their patients.” See also Case of Lazar, supra, para. 66; Case of Z v. Poland, supra, para. 76, Case of Calvelli and Ciglio v. Italy. No. 32967/96. Judgment of 17 January 2002, para. 49, Case of Byrzykowski v. Poland. No 11562/05. Fourth Section. Judgment of June 27, 2006, para. 104, and Case of Silih v. Slovenia. No. 71463/014. Judgment of 9 April 2009, para. 192. 176 Cf. Case of Z v. Poland, supra, para. 76, ECHR. Case of Calvelli and Ciglio v. Italy, supra, para. 49, and Case of Byrzykowski v. Poland, supra, para. 104. Cf., mutatis mutandi, Case of Erikson v. Italy. No 37900/97. First Section. Judgment of 26 October 1999; Case of Powell v. United Kingdom. No 45305/99. Third Section. Judgment of 4 March 2000, and Case of Silih v. Slovenia. No. 71463/014. Judgment of 9 April 2009, para. 192 177 The Court examined this normative relating to guaranteeing and supervising the health services in the Case of Albán Cornejo et al., supra, paras. 123 and 132. 178 Constitution of the Republic of Ecuador, 1998 (file of annexes to the answering brief, folio 2190). 39