48 G) Casa de Reposo Guararapes (Guararapes Rest Home) Casa de Reposo Guararapes (Guararapes Rest Home) was a private 112(55) hospital owned by Sérgio Antunes Ferreira Gomes, which was contracted by the State to provide psychiatric services under the direction of the Sistema Único de Salud (Single Health Care System) and operated as a public health care unit in the name and on behalf of the State. In October 1999, approximately 54 inpatient beds of said hospital were affiliated with the Sistema Único de Salud and the people occupying those beds were patients of the public health care system. It was the only institution, public or private, offering inpatient or outpatient services for persons with mental disabilities in the region of Sobral; a city located 200 km from the city of Fortaleza, capital city of the state of Ceará.90 112(56) At Casa de Reposo Guararapes (Guararapes Rest Home) there was an atmosphere of violence, aggression, and maltreatment, where many inpatients frequently suffered injuries to their upper and lower extremities, which were inflicted by the employees of Casa de Reposo Guararapes; nurses’ aides and security guards used patients to restrain others; applied the “gravata” (a restraint method which carries the risk of asphyxiation) to some patients, who thought that such practice “was the law” or was intended “to maintain order”; physical restraint was indiscriminately used, regardless of whether such procedure had been ordered by the physician in charge, and physical confrontations between patients were encouraged.91 II, pages 2548 and 2549); and report of the autopsy (exhumation) conducted by Dr. Walter Porto MedicoLegal Institute on the body of Mr. Damião Ximenes-Lopes on April 6, 2002, supra note 48. 90 Cf. Administrative Resolution No. 026 issued by the Secretaría de Salud y Asistencia Social del Municipio de Sobral (Health and Social Services Bureau for the Municipality of Sobral) on March 2, 2000 (record of appendixes to the application, appendix 2, pages 76 to 81); Administrative Resolution No. 113 issued by the Secretaría de Salud y Asistencia Social del Municipio de Sobral (Health and Social Services Bureau for the Municipality of Sobral) on July 10, 2000 (record of appendixes to the application, appendix 3, pages 82 and 83); statement made by Francisco Ivo de Vasconcelos before the Tercera Sala del Juzgado de Sobral (Third Chamber of the Trial Court in and for Sobral) on August 16, 2000 (record of appendixes to the application, appendix 4, pages 84 to 89); and brief filed by Sérgio Antunes Ferreira Gomes with the Tercera Sala del Juzgado de Sobral (Third Chamber of the Trial Court in and for Sobral) on March 26, 2001 (record of appendixes to the application, appendix 7, pages 95 and 96). 91 Cf. report issued by the Grupo de Acompañamiento y Evaluación de la Asistencia Psiquiátrica Hospitalaria (Hospital Psychiatric Care Support and Evaluation Group) on November 5, 1999 (record of appendixes to the application, appendix 18, pages 118 to 146); report on the Administrative Investigation prepared at the request of the Coordinadora Municipal de Control, Evaluación y Auditoría de la Secretaría de Salud y Asistencia Social (Control, Evaluation and Audit Municipal Coordinator for the Health and Social Services Bureau), issued on February 18, 2000, supra note 43; statement made by Francisco das Chagas Melo before the Tercera Sala del Juzgado de Sobral (Third Chamber of the Trial Court in and for Sobral) on February 16, 2001, supra note 62; and statement made by Carlos Alberto Rodrigues dos Santos before the Tercera Sala del Juzgado de Sobral (Third Chamber of the Trial Court in and for Sobral) on April 24, 2000 (record of appendixes to the application, appendix 12, pages 108 to 110); and record in the Daily Log Book of Casa de Reposo Guararapes (Guararapes Rest Home) of December 29, 1999 (record of appendixes to the application, appendix 13, page 111).