13. In her observations of July 23, 2012, Mrs. Cornejo stated that this obligation “has really not been met in any way whatsoever, even though almost five years have passed since the […] Judgment was delivered,” and that, essentially, the report presented by the State on June 21, 2012, reiterated a previous one, which “refers to a national health plan, but does not mention anything about the Law on the Rights and Protection of the Patient”; moreover, that the plans and programs reported by the State were not necessary to comply with the measure, because all that is required is the dissemination of the Law on the Rights and Protection of the Patient. In this regard, she affirmed that “the public is almost unaware of [the law; consequently] compliance [with this measure] is important, not as a measure of satisfaction in a specific case, but to protect and safeguard the rights of all patients.” Then, in her observations of January 18, 2013, Mrs. Cornejo indicated that the State had advised her that an extract from the Law on the Rights and Protection of the Patient had been published in issue No. 008 of the Bulletin “Mi Salud” and, according to Mrs. Cornejo, the bulletin is an “informational leaflet that promotes the efforts of the Government.” She added that, by telephone, they offered to send her two issues of the Bulletin “Mi Salud,” but they had not done so. In addition, she indicated that, on September 6, 2012, she and her husband had attended a meeting held at the Sub-Secretariat of Human Rights of the Ministry of Justice at the invitation of Felipe Azansa, legal expert, which dealt with compliance with the sixth operative paragraph of the Judgment. According to Mrs. Cornejo, during this meeting, she and her husband insisted on the realization of a “widespread campaign to disseminate” the Law on the Rights and Protection of the Patient, “using the appropriate media,” in order to comply with the terms of the Judgment. Lastly, she indicated that the Judgment had not been complied with. 14. In its observations of August 6, 2012, the Commission considered that: Despite the time that has passed, the information provided [by the State] relates to a general mention of public policies on health matters and organizational reforms of the authorities […], without indicating how these would contribute to overcoming the deficiencies verified in the case, or their specific relationship to the measure of reparation ordered. It concluded that, at that time, the State had not been able to comply with the measure ordered regarding the “distribution of informative pamphlets or the display of patients’ rights at health care centers.” In its observations of January 18, 2013, the Commission “t[ook] note of the publication [of the] extract of the Law on the Rights and Protection of Patients”; nevertheless, it considered that the State “should […] provide more information on the implementation of the measures to disseminate patients’ rights,” and mentioned several points that, in its opinion, should have been included in the report.8 15. The Court takes note of the information presented by the State, in particular, of the dissemination of an “important extract” of the Law on the Rights and Protection of the Patient. Nevertheless, based on the above and the information provided previously by the State,9 the Court notes that, although nearly five years have passed since the delivery and notification of the Judgment, the information available does not show that the measure 8 The Commission indicated that the State should provide information on “the actual situation of the execution of the Interactive Human Rights Manual and its implementation with the different public authorities: (ii) the use of different media in order to disseminate patients’ rights in accordance with international standards; (iii) the measures taken to ensure that all health care services have several copies of the Law on the Rights and Protection of the Patient and that the text of the law is visible to the public, and (iv) the measures taken to carry out a program to educate and train agents of justice and health care professionals on the laws that Ecuador has enacted with regard to patients’ rights.” 9 As indicated in the eleventh considering paragraph of the said Order of August 27, 2010 (supra note 7), “the State has advised that the Ministry of Health has prepared a leaflet on the rights of patients, which is being distributed throughout the country in different health care units.” 5