35 inadequacies of these institutions. Information was also lacking which might show there was a regulatory framework establishing safe transfusions by the health entity receiving blood products, before proceeding with a transfusion. In effect, the Commission notes that the Health Code does not make any reference to Blood Banks nor to transfusion services. The available information demonstrates that it was only recently, in the 2006 Organic Health Law, that the exercise of supervision and actual control over the workings of these entities by the Ministry of Health was established. Therefore, the Commission considers that the State did not prove compliance with its obligation to regulate the functioning of the blood banks. 175. As regards the functioning itself of the two institutions in question, various elements emerge from the evidence, demonstrating deficiencies in their functioning. 176. In the case of the Azuay Red Cross Blood Bank, it has been established that at the time of the events, it did not possess a reliable registry system allowing for verification of the origin of the blood products donated, nor express indication that the respective security measures, including a serum test, had been completed. As the expert witnesses indicated, the few registers – which did not include the Blood Bank’s procedures during night hours – showed irregularities. The situation of an absence of registers is compounded by the precarious procedures of the Azuay Red Cross Blood Bank at the time of the events. This may be seen in the lack of a minimum staff to safely attend to the needs of the daily transfusions of an entire area, as well as the lack of certainty in the serum tests available at the institution in comparison to those available in other areas. 177. In the case of the Humanitarian Clinic, where the transfusion was administered, the Commission observes that at the time of the events, there were no corroboration or registration requirements in order to verify both the origin of the blood to be used in the transfusion or whether all the respective tests had been done. The Commission emphasizes that the staff themselves in charge of supervising TGGL’s transfusion stated that they were unaware of the origin of the blood and that it was an established practice to fully trust the products sent by the Blood Bank. 178. The Commission notes that the absence of registry and documents of the blood given to each persons with an specific indication of the negative results of the HIV tests, the scarcity of the functioning of the Blood Bank and the absence of any verification in the health facilities receiving the blood coming from the Red Cross, constitute structural deficiencies or, at least, rooted in the practice of the institutions. Therefore, the Commission understands that the instant case is not an unfortunate event that took place exceptionally, but the result of a situation of risk that could have been prevented by the State with an adequate regulatory framework of the blood banks and, specially, with the periodic supervision and inspection of its functioning. 179. In view of the deficiencies of a structural nature or, at least, ingrained in the practice of the institutions, there is no indication from the State or any evidence showing that the State, through the competent health authorities, undertook any supervision or control of the procedures of the Azuay Red Cross Blood Bank or Humanitarian Clinic. The use of practices that in themselves fail to satisfy minimum standards of safety reveals the omission of the State in relation to its duty to ensure the right to physical integrity vis-àvis the right to health. 180. All these omissions by the State created a situation of risk in the procurement and transfusion of blood, which materialized with TGGL’s infection with HIV and the consequent impact on her personal integrity and health. As a result, the Commission concludes that the State of Ecuador is responsible for the failure to fulfill its duty to ensure the right established in Article 5.1 of the American Convention, in relation to the obligations established in Articles 1.1 and 19 of the same instrument. B. The Right of TGGL to Personal Integrity and to a Dignified Life after Infection (Articles 4, 5, 19, and 1.1 of the American Convention) 181. Article 4 of the American Convention establishes, where relevant: