179 b. The Health Code approved by Supreme Decree No. 188 on February 8, 1971, articles 168 and 169 of which indicated that: “[t]he health authority shall establish the norms and the requirements that health care facilities must meet, and shall inspect and evaluate such facilities periodically […]. Health care facilities shall submit their annual programs and their regulations to the health authority for approval”; 179 c. Regarding the exercise of the medical professions, article 174 of this Code determined the requisites for providing such services, and also established that professionals must be registered in various public registers. 180 In addition, its article 179 stipulated that: “[t]he health authority must investigate and punish the illegal exercise of medicine and related branches of science, without prejudice to the action of ordinary justice, when appropriate” and, to this end, established a procedure for imposing fines on offenders; 181 d. The Law of the Ecuadorian Medical Federation, approved on July 17, 1979, which created the Ecuadorian Medical Federation as a “private legal entity” with competence “to defend the professional rights of its members and to monitor compliance with their obligations” (article 3). The same law also envisaged the existence of a disciplinary tribunal to examine the conduct of doctors and to apply sanctions when appropriate (articles 22 and 25). 182 e. Other legal provisions regulated patients’ rights in relation to health care centers and health care services provided by doctors; they included the Medical Deontology Code of August 17, 1992, 183 and the Patients’ Rights and Protection Act of February 3, 1995, later amended by Law No. 77 published on December 22, 2006. 184 In addition, the Organic Law of the Ombudsman’s Office approved on February 20, 1997, created this public entity, the functions of which included “[t]o defend and to promote, ex officio or at the request of a party, when necessary, the observance of fundamental individual and collective rights.” 185 Health Code, 1971 (file of annexes to the answering brief, folio 2411). 180 Article 174 of the 1971 Health Code established that: “[e]xercise of the profession of doctor or surgeon […] requires having obtained academic qualifications granted or revalidated by universities, specialized technical institutes, or other duly authorized training centers; these qualifications must be registered with the National Higher Education Council (CONESUP), with the National Register of Medical Professionals of the Ministry of Public Health, and with the Provincial Health Directorate of the geographical district where the profession will be exercised,” supra, folio 2411). 181 Health Code, 1971, supra, folios 2412, 2415 and 2416. The sanction procedure was established in articles 213 to 230; it was initiated by a complaint and conducted before the Health Commissioner, who issued a decision that could be appealed before the Ministry of Public Health. 182 Law of the Ecuadorian Medical Federation (file of annexes to the final arguments, folios 3032 to 3043). 183 Article 15 of the Medical Deontology Code stipulated that: “The doctor shall never perform surgery without the prior authorization of the patient, and if the latter is unable to give this, the doctor shall seek the authorization of his or her representative or a member of the family, unless the patient’s life is in imminent danger. In all cases the authorization shall include the type of intervention, the risks and the possible complications” (file of annexes to the final arguments, folios 3019 to 3030) 184 Article 1 of the Patients’ Rights and Protection Act indicates that “Polyclinics” are considered to be legally established health care centers that, therefore, belong to the public or private health care system (file of annexes to the answering brief, folios 2388 to 2391). 185 Cf. Arguments of the State (merits file, folios 877 and 878), and Information provided by the Ombudsman’s Office (file of annexes to the final arguments, folios 3207 to 3216). 40