21 the neonatologist had taken the newborn, I.V. underwent a bilateral tubal ligation using the Pomeroy technique.51 Both surgical procedures were performed while the patient was under epidural anesthetic.52 65. Prior to the surgical procedure, I.V.’s husband, J.E., had signed a form entitled “Family authorization for surgery or special treatment,” in relation to the caesarean section.53 This form was not signed by I.V. During the peri-operative period, the obstetrician-gynecologist asked someone to fetch I.V.’s husband so that he could authorize the tubal ligation.54 They were unable to find J.E.55 66. The record of the surgical procedure performed on I.V. contained the following information: (1) Patient lying on her back under anesthesia; [...] (4) medium infra-umbilical incision as far as the cavity; (5) multiple adhesions visible between the parietal visceral peritoneum (illegible) and intestines, making it difficult to see the lower segment of the uterus (illegible). A hysterotomy is performed along the body's longitudinal axis because it is not possible to do it in the lower segment; [...] (7) Surgical delivery; [...], (10) due to the presence of the aforementioned multiple adhesions, [illegible] is performed in insufficient parietal peritoneum, it is decided, because of the multiple adhesions to perform a Pomeroy bilateral tubal ligation through the incision in the womb to safeguard the future life of the mother; she is informed of this in the perioperative period and she gives her verbal consent. The tubal ligation is performed with difficulty because of the adhesions [...].56 67. Two days after the operation, the resident doctor made the following annotation on the patient’s progress record: 3/07/00. Yesterday, the patient was told that a bilateral tubal ligation had been performed owing to medical necessity; this was accepted by the patient who understood that a future pregnancy posed a danger to her life. Dr. Vargas.57 68. I.V. has consistently denied before the domestic courts, during the procedure before the Commission and also before this Court that she gave verbal consent for the tubal ligation procedure. file, volume X, annex 17 to the State’s answering brief, folios 3652 to 3659). Cf. Record of the surgical procedure transcribed by the Women’s Hospital (evidence file, volume VII, annex 8 to the submission of the case, folio 2138). 51 Cf. Record of the surgical procedure transcribed by the Women’s Hospital (evidence file, volume VII, annex 8 to the submission of the case, folio 2138); Affidavit prepared by Marco Vladimir Vargas Terrazas on April 28, 2016 (evidence file, volume XI, affidavits, folio 3937), and Statement made by Edgar Torrico Ameller before the Inter-American Court during the public hearing held on May 2, 2016. 52 Cf. Family authorization form for surgery or special treatment (evidence file, volume X, annex 18 to the State’s answering brief, folio 3661), and Resolution issued by the Second Trial Court of the La Paz Judicial District on November 18, 2002 (evidence file, volume X, annex 17 to the State’s answering brief, folio 3654). 53 Cf. Affidavit prepared by Marco Vladimir Vargas Terrazas on April 28, 2016 (evidence file, volume XI, affidavits, folio 3937); Statement made by Edgar Torrico Ameller before the Inter-American Court during the public hearing held on May 2, 2016, and Report of the Audit Committee on the case of patient I.V. of August 22, 2000 (evidence file, volume VII, annex 4 to the submission of the case, folio 2136). 54 Dr. María del Rosario Arteaga Méndez stated that she had not taken part in the operation and that, at the request of several nurses, on the day of the incident, she when to look for I.V.’s husband, without knowing why he was required and without being able to find him in the hospital. Cf. Statement made by María del Rosario Arteaga Méndez on August 17, 2000, according to the medical record of the surgical procedure performed on I.V. issued by the Medical Audit Committee of the Women’s Hospital (evidence file, volume VII, annex 1 to the submission of the case, folio 2115), and Statement made by María del Rosario Arteaga Méndez on July 29, 2004, according to the record of the oral hearing issued by the Copacabana Trial Court (evidence file, volume XII, annex 1(d)) to the State’s final arguments, folio 4826). 55 Record of the surgical procedure transcribed by the Women’s Hospital (evidence file, volume VII, annex 8 to the submission of the case, folio 2138). 56 57 2140). Progress report of I.V. of the Women’s Hospital (evidence file, volume VII, annex 9 to the submission of the case, folio