23 74. In its report of August 22, 2000, the Committee concluded that: […] having taken the decision to perform a caesarean section due to the aforementioned complications (adhesions), at that point the surgeon takes the decision to consult the patient, who was conscious (epidural anesthesia) regarding a bilateral tubal ligation, because of the risk to her life if she had to undergo another similar operation. The mother, who was awake, gives the corresponding authorization for that procedure; this reply is confirmed and was witnessed by the members of the surgical team, third-year resident Rodrigo Arnez and the person responsible for preparing the operating theater, María Modesta Ticona. A request was also made to find the husband to give his authorization, but he could not be found at that time. C.2 Second medical audit 75. The second medical audit was conducted by the Departmental Medical Audit Committee of the La Paz Departmental Health Service (SEDES).63 This committee prepared a report of “Final conclusions” dated March 9, 2001, based on unspecified documents and I.V.’s medical record.64 76. The Committee concluded that “the bilateral tubal ligation procedure was performed prophylactically and to safeguard the mother's future wellbeing.” It also stated that it “fully support[ed] the report prepared by the Medical Audit Committee (Women’s Hospital).”65 C.3 Third medical audit 77. The third medical audit was conducted by the Medical Audit Decisions Committee of the General Directorate of Health Services of the Ministry of Health and Social Services. 66 The report to determine the reasons and circumstances under which a tubal ligation was performed during a caesarean section operation was prepared by an audit team and then submitted to the Medical Audit Decisions Committee on March 13, 2001.67 78. The conclusions of this report established that errors were made when drawing up the case history, in the progress notes, and in the Hospital’s records, and also indicated that I.V.’s life was not in danger and, consequently, found that the sterilization of I.V. was not justified based on the health norms in force. Specifically, the Committee concluded that: [...] 3. As regards the bilateral tubal ligation, we consider that carrying out that surgical procedure is not fully justified, because the existence of multiple adhesions does not constitute a risk to the life of the patient and, in addition, since adhesiolysis was performed during the surgical procedure, the problem was apparently being resolved.. 4. In addition, corporal longitudinal hysterotomy in no way justifies peri-operative performance of tubal ligation. Standards in Force for Maternal-Child Care, p. 202. 5. There was no written and signed pre-operation consent for said surgery: bilateral tubal ligation. In no way 63 Consisting of representatives of medical associations and health-related scientific committees. Cf. Final conclusions of the medical audit by the Departmental Medical Audit Committee of March 9, 2001 (evidence file, volume VII, annex 2 to the submission of the case, folio 2118). 64 Final conclusions of the medical audit by the Departmental Medical Audit Committee of March 9, 2001 (evidence file, volume VII, annex 2 to the submission of the case, folio 2118). 65 Consisting of members of the Committee and the Audit team: the Director General of Health Services; the Head of the National Health Care Unit; the Head of the National Basic Health Care Insurance Unit; the Head of Development of the Health Services Network; a lawyer with experience in malpractice; a member of the Quality and Regulation Technical Group; the Coordinator and External Auditor; a doctor representing the SBS, and a specialist in obstetrics/gynecology. 66 Cf. Report issued by the Medical Audit Decisions Committee of March 13, 2001 (evidence file, volume VII, annex 3 to the submission of the case, folio 2120). 67