25 thus, the verbal authorization that the patient allegedly gave was sufficient.74 In this regard, it indicated that what jeopardized the patient’s life was “the future risk of rupture of the uterus in another pregnancy, owing to the weakness of the uterine wall following the caesarean section procedure.”75 83. The relevant part of this report included the following conclusions: [...] 6. The bilateral tubal ligation decision had to be taken during the surgical procedure because, prior to the cesarean section, the surgical conditions or contingencies that could indicate the need for it were unknown 7. That conclusion explains why there was no specific document giving written informed consent. 8. Several people made similar statements asserting that the patient gave her verbal authorization for the bilateral tubal ligation procedure.76 84. The Ethics Tribunal recognized that there had been a lack of uniformity and coherence in the methodology used in the different audit procedures conducted up until that time, 77 and added that the different methods and contradictory results indicated structural problems in the health sector: “[t]hat difference in methodology has led to contradictory results revealing serious shortcomings in the organization of the sector’s institutions in order to implement this type of action, as well as their functional interrelationship and degrees of dependency.”78 It emphasized that the purpose of the medical audits was “to improve the quality of care in the health services” and not to conduct “an […] administrative procedure […] that could lead to sanctions.”79 Consequently, it considered that it was not appropriate to determine that the physician should be dismissed owing to his long professional career abiding by the rules of gynecology/obstetrics. Even though it did not specifically mention the norms he abided by: “[i]t seems inappropriate and unjust to sanction a specialist who has worked in an institution for more than 26 years with dismissal for performing a procedure established in the norms of gynecology/obstetrics to save a patient from potential future complications.”80 85. Lastly, it recommended that I.V. should be given a detailed explanation of everything that happened, as well as the standardization and systematic application of written informed consent in the health care services.81 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2167). Cf. Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2167). 74 Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2168). 75 Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folios 2166 to 2170). 76 77 Cf. Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2168). Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2168). 78 Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2166). 79 Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2169). 80 Cf. Report of the Ethics Tribunal of the La Paz Departmental Medical College / Case of claim by the patient I.V. of October 5, 2001 (evidence file, volume VII, annex 19 to the submission of the case, folio 2169). 81