record when testifying before the police, and (ii) the director of the San Francisco Gotera Hospital sent a report on Manuela’s medical record to the prosecutor’s office, in which he included information on the presumed victim’s sexual and reproductive life. In this regard, the Commission indicated that the inadequate regulation of medical secrecy in obstetric emergencies may result in doctors automatically reporting patients for fear of being sanctioned. On the second point, the Commission pointed out that “there is no record that the State made a comprehensive diagnosis of the presumed victim following her deprivation of liberty,” or that it had provided regular and systematic treatment to the presumed victim before her diagnosis of Hodgkin’s lymphoma in 2009. According to the Commission, these omissions gave rise to the State’s responsibility for the violation of Manuela’s right to life. In addition, it considered that “the State violated the right to judicial guarantees and judicial protection established in Articles 8(1) and 25(1) of the Convention, to the detriment of Manuela’s family as a result of the total failure to investigate and clarify her death while in custody and the relationship of this to the omissions established in this section.” 175. The representatives agreed substantially with the Commission’s arguments regarding the violation of professional secrecy. In addition, they alleged that the State had not provided Manuela with accessible, acceptable and quality health care services: (i) before the obstetric emergency; (ii) when she received emergency obstetric care in the San Francisco de Gotera National Hospital, and (iii) while she was deprived of her liberty in different detention centers. They argued that, prior to the obstetric emergency, the State had failed to take the following steps: (1) identify and make an early diagnosis of the “evident symptoms of the Hodgkin’s lymphoma from which the [presumed] victim suffered,” and (2) provide complete and detailed information to Manuela about her health situation, which constituted a violation of Article 13 of the Convention. They indicated that when the presumed victim received emergency obstetric health care in the San Francisco Gotera National Hospital, the State failed to provide accessible, acceptable and quality emergency obstetric care to Manuela because: (i) the hospital was outside the geographical scope and financial possibilities of Manuela; (ii) the doctors gave priority to questioning her rather than to treating the serious condition she was in; (iii) the medical staff “did not have adequate training or capacity to identify the cause of the numerous complications that she had suffered and, consequently, reached the conclusion that she had committed an offense without any technical basis and without making a clinical investigation of what had happened immediately before the emergency, or of her medical history,” and (iv) “when they finally began to treat her, they did so erroneously, because they endangered her health and her life.” The representatives also alleged that the State had failed to provide a prompt and appropriate diagnosis and treatment while Manuela was deprived of her liberty, which constituted a violation of Manuela’s right to life, “because the State, through its agents, was aware of the risk of her death and failed to take any effective measure to prevent this.” They also argued that the State had not investigated Manuela’s death in violation of her family’s rights to judicial guarantees and judicial protection. 176. Furthermore, they indicated that Manuela had been subjected to gender-based violence and discrimination because: (i) Manuela was reported by the doctor who received her in the San Francisco Gotera National Hospital, who violated her duty to observe professional secrecy and concluded that Manuela had committed a crime “because she was pregnant as the result of an ‘infidelity,’ which had led her to abort because she was ashamed,” and (ii) while Manuela was deprived of liberty, she was not provided with the health care she required; moreover, the “guards of the San Miguel Prison claimed that her situation was not serious and constituted a punishment for her criminal and promiscuous conduct.” According to the representatives, this discrimination was intersectional. Additionally, they argued that the State had subjected Manuela to torture when she was handcuffed during her obstetric emergency in the San Francisco de Gotera Hospital and while she was in the terminal stage of her illness in the Rosales National Hospital. 51