the one hand, in the Polyclinic of the Guayas Traffic Commission and, on the other, in the Minchala Clinic in Guayaquil. a) The medical services provided in the Polyclinic of the Guayas Traffic Commission 140. The Court observes that the Guayas Traffic Commission, a State entity, provided medical care to Melba Suárez Peralta as part of a benefit granted to the family members of its employees, one of whom was Melba Suárez Peralta’s husband. Thus, the Court understands that this State entity offered and provided health care services through Emilio Guerrero, and this was announced by its authorities on June 1, 2000 (supra para. 39). In the course of providing this care, Emilio Guerrero diagnosed appendicitis and indicated that it was urgent that Melba Suárez Peralta undergo an operation (supra para. 40); this was performed on July 1, 2000, in the Minchala Clinic, a private institution (supra para. 41). 141. According to the facts of this case, it has been proved that Emilio Guerrero had not carried out the official procedure to obtain approval for his employment activities from the Assistant Secretary for Employment of the coastal sector (supra para. 48); furthermore, he had not complied with the registration procedure ordered by the applicable law with the National Higher Education Council, the Ministry of Public Health, and the Guayas Provincial Health Directorate, 189 necessary requisites for exercising his profession in Ecuador (supra paras. 136 and 137). In this regard, the Court observes that the State has not contested the fact that it failed to verify whether Emilio Guerrero had complied with the procedures and registrations that domestic law established as a requisite for the exercise of the profession of doctor and surgeon. 142. The Court takes note that the State provided an unsigned certification issued by the National Sub-secretariat for the Supervision of Public Health on February 8, 2013, which indicates that, on that date (2013), Emilio Guerrero was registered with the former Coastal and Insular Regional Health Sub-secretariat. 190 However, the Court observes that this certification contains no information relating to the era of the facts, or when the registration was carried out, contrary to the evidence that can be inferred from the judicial case file (supra para. 48) In this regard, the Court required the State to clarify whether, at the time of the facts, Emilio Guerrero was authorized to practice as a doctor and surgeon, and to submit evidence on the supervision that the State’s competent authority may have exercised over the Polyclinic of the Guayas Traffic Commission and/or Dr. Emilio Guerrero; 191 however, this was not provided to these proceedings. 143. Consequently, the information disseminated by the Guayas Traffic Commission regarding the medical care that Emilio Guerrero provided in the Polyclinic of this State entity, as a benefit for its employees and also for their family members (supra para. 39), 192 189 Article 174 of the Health Code stipulates that: “[e]xercise of the profession of doctor or surgeon […] requires having obtained academic qualifications granted or revalidated by universities, specialized technical institutes, or other duly authorized training centers; these qualifications must be registered with the National Higher Education Council (CONESUP), in the National Register of Medical Professionals of the Ministry of Public Health, and with the Provincial Health Directorate of the geographical district where the profession will be exercised” (file of annexes to the answering brief, folio 2411) 190 Response issued by the Ministry of Public Health on February 8, 2013 (merits file, folio 759). The Court notes that this certification only includes an electronic signature. 191 Question by Judges Roberto Figueiredo Caldas and Manuel Ventura Robles during the public hearing held in this case; and request for helpful evidence (merits file, folios 771 to 775). 192 In addition, the Court observes that, at the time of the facts, the Scientific and Technical Cooperation Agreement in the area of Health was in force between the Ministry of Public Health of the Republic of Ecuador and 42