such, the representatives expressed that, “in the case under review, the confinement conditions without the rendering of adequate control and medical care to the gunshot wounds [Mr. Vera Vera had] suffered, lead to the deterioration of his physical condition, eventually causing him […] severe pain and physical and mental suffering, without the authorities considering his case in a timely manner.”24 Based on the foregoing, the representatives argued the existence of a violation of Articles 4 and 5 of the American Convention, to the detriment of Pedro Miguel Vera Vera. 36. The State noted that “in no way” could it be declared that it had incurred international responsibility, as “it provided abundant medical care to Mr. Pedro Vera Vera” by means of its agents “[…] at the Santo Domingo Hospital, in the [P]rovisional [D]etention [C]enter and in the Eugenio Espejo Hospital in the city of Quito.”25 Moreover, it argued that “[i]t is likely [that] the medical care provided […] was inefficient or negligent, but this cannot [be] determined without there being an examination [or] proceeding that […] produces a result[. I]f these agents did their job poorly, it cannot be said that the State is responsible, as it provid[ed] the victims the means with which to challenge and be a part of the proceeding.” It noted that given that the case does not involve a “violent death,” but rather an “inflammation that grew complicated,” it could not assume that if a citizen cared for by several doctors dies in an operating room, this is due to [their] noncompliance with their duty.” According to the State, the death should have been denounced “and the claim should have been prosecuted in order for it to be said that the State has not complied with its mission in regard to the case[,…] as it is the role of a domestic judge to determine the existence of poor medical practices.” As such, the State considered that it is not responsible for the violation of the rights recognized in Articles 4 and 5 of the American Convention, in relation to Article 1(1) thereof. 37. From the arguments presented by the parties, the Court notes that there is no controversy regarding the facts related to Mr. Pedro Miguel Vera Vera's persecution on April 12, 1993, when he was allegedly surprised in the commission of an armed robbery, received a gunshot wound at the time of the persecution, and died on April 23, 1993, while under State custody. Nevertheless, the State argued that it cannot be deemed responsible for Mr. Vera Vera's death, given that his case does not involve a “violent death” but 24 The representative indicted that “despite the order of the Eleventh Criminal Judge of Pichinca [requiring] that Pedro Vera undergo surgery, that order was not obeyed by authorities, both at the jail and at the Hospital of Santo Domingo, and he only received that treatment […] when he was transferred to the city of Quito. [However,] due to the delay and advanced state of the illness, the medical intervention was ineffective.” According to the representative, “it is evident that the gunshot wound and his grave state of health prevented the victim from carrying out his basis necessities on his own, requiring him to constantly seek the assistance of third parties, which necessarily [produced] feelings of inferiority and great suffering in him which constituted degrading treatment that was incompatible with his dignity[.]” 25 The State highlighted that the alleged victim “received emergency care” from the doctors on duty at that hospital. These “carried out the procedures that they, in their professional opinion, th[ought] were those appropriate for treating [Mr. Vera Vera's] wounds.” Additionally, the doctor at the Provisional Detention Center in Santo Domingo “agreed with the opinion” of the Hospital doctors and decided that Mr. Vera Vera should continue “with the medication prescribed and remain in observation.” Finally, when the victim’s situation “grew complicated,” the State transferred him to “a much larger hospital” and “exhausted all efforts to safeguard […his] rights[.]” 16