Medical Negligence in Nigeria: When Hospitals Kill?

[Iris]

On October 9, 2012, Lanre Amoo-Onidundu was shot in the leg by daredevil armed robbers who attacked him as he stepped out of a bank in the Ilupeju area of Lagos. They made away with the 2.6 million naira that Amoo-Onidundu, an administrative officer, had gone to the bank to cash for the organization he worked with, leaving him in a pool of his own blood. Fortunately, some bystanders who had fled during the attack returned to rush the young man to the nearby Gbagada General Hospital. Amoo-Onidundu was thankful for the help of the good Nigerians, and even more thankful when he saw the hospital, believing it was not his day to die after all. Little did he know that he was about to enter a place that would change his life forever.

 

Immediately upon arriving at the hospital, Amoo-Onidundu got his first taste of what was to come. He was told that there was no free bed, so he was “admitted” to the bare floor of the emergency section of the government hospital. But this was just the beginning of his ordeal. He lay on the floor for hours, bleeding, without receiving any treatment, not even basic first aid. After several hours, he was finally placed on a gurney, and a medical doctor examined him there in the emergency room.

 

The doctor felt the area around the gunshot wound to see if there were any bullet fragments in the leg. Then he gave Amoo-Onidundu an injection to help relieve his pain, and lacking any proper dressing, wrapped the wounded leg with brown carton paper. That was all the first aid he would receive at that time, though they did eventually extract the bullet, which was lodged in his thigh slightly above the knee, and sewed him up: job complete. The medical staff did not examine his injury with a CT scan or imaging technology to verify the extent of the damage or what to fix. Amoo-Onidundu remained at the hospital for days, receiving no treatment other than the usual daily dressing of his gunshot wound. The condition of his leg deteriorated.

 

Finally, on October 25, sixteen days after he was admitted to the General Hospital, Amoo-Onidundu’s relatives moved him to a private hospital in Abule-Egba, another area of Lagos. Here a CT scan confirmed that his attackers’ bullet had pierced his right thigh just above the knee. The scan also showed that the bullet had broken the thigh bone and severed the main femoral artery, cutting off the blood supply to the lower part of the leg.

 

The doctors at the general hospital would have seen this had they ordered a CT scan, and they would have had a fighting chance to save the leg.

 

But now it was too late. The blood supply to the lower part of the leg had been cut off for too long, causing tissue death. The wound was also infected, so the leg had to be amputated before the infection spread to other parts of his body. Today Amoo-Onidundu lives in Germany, his prosthetic limb a constant reminder of his misadventure at the Gbagada General Hospital. He pays the price for medical negligence every day.

 

On June 7, 2011, Juwura Amoo-Onidundu entered the maternity ward of the University College Hospital in Ibadan to deliver her second baby by elective caesarean section, after having suffered complications during her prior delivery.

 

According to her husband, Banji, she was wheeled into the operating theatre at 9:00 a.m., and the baby was brought out of the theatre around noon. Juwura was wheeled out at ***:00 p.m. The average caesarean section takes about 45 minutes, but Juwura’s C-section was not average: her left fallopian tube had been punctured and subsequently removed during the procedure.

 

After the operation, Juwura’s packed cell volume (PCV) dropped significantly, indicating severe blood loss. She was given a blood transfusion, but instead of stabilizing, her PCV kept dropping. A normal PCV ranges from 34 to 38; Juwura’s plummeted from 37 before surgery to 22 after surgery. Even after the transfusion, her PCV fell to 20, then to 17. Finally, she went into shock. She had been transfused with the wrong blood type. Juwura Amoo-Onidundu died on June 8, 2011, leaving behind her newborn baby, her two-year-old child and her husband.

 

 

The Negligence Epidemic:

 

A study in the current issue of the Journal of Patient Safety suggests that each year between 210,000 and 440,000 American patients who go to the hospital for care suffer some type of preventable harm that contributes to their death, making medical errors the third-leading cause of death in America after heart disease and cancer. If America suffers from this degree of medical negligence, even with its more highly developed and sophisticated health care system, then it follows that Nigeria, with its weaker health care infrastructure and under reporting of medical negligence cases, is even worse off. And while there is no incontrovertible data on the actual number of medical negligence cases in Nigerian hospitals, patients and medical practitioners alike acknowledge that number to be very high.

 

There are many reasons that medical negligence occurs in hospitals. Dr. Biodun Ogungbo, a neurosurgeon who also writes a medical column for a national newspaper, believes that some of these factors are cultural in nature. The Abuja-based doctor says that medical negligence is rife in Nigeria because of the impunity in the society itself, which he says is also manifest in many Nigerian hospitals. “In our society, people do things that they don’t get punished for,” he observed, adding, “If they were punished for it – once, twice – all these kinds of things would stop, but because there is no punishment, it will continue to happen.”

 

Juwura’s husband, Banji Amoo-Onidundu, agrees: “It [the medical system] is structured in a way to build mediocrities and to build people that are arrogant and bigger than the job. They do whatever they like and they get away with it. That is what has destroyed the fabric of our society.” Put simply, medical negligence thrives in a society where medical personnel are not held responsible for their actions. And this lack of accountability fits in all too well with the image of medical doctors as infallible.

 

Laolu Osanyin, a Lagos-based lawyer who specializes in medical law, suggests that this myth of infallibility lies at the base of the problem. Osanyin believes that the national medical negligence problem can be connected to the way that many Nigerians perceive medical doctors and “situate” the responsibility for medical harm. “Historically, the Nigerian doctor was equated to the status of a healer or a priest who could do no wrong,” says Osanyin. “Those days, if anything untoward occurred in the treatment of a patient, the doctor was usually the last person to be held accountable. The Nigerian patient or their families will locate someone in the village who they can hold responsible for the problem; if they find no one to drop the problem at their doorstep, they say it is destiny.”

 

 

“Not Enough Anything”:

 

All of the blame for incidences of medical negligence cannot be laid solely at culture’s door. The dearth of resources in many Nigerian hospitals – especially the government-owned ones, where the doctor-to-patient ratio is extremely high – is also complicit in this problem. “In some parts of the world, yearly a neurosurgeon will treat about 5,000 people. In Nigeria, one neurosurgeon treats about 5 million people,” says Dr. Ogungbo, exaggerating to drive home his point. “Many public hospitals are overwhelmed, just overwhelmed. Not enough doctors. Not enough nurses. Not enough drugs. Not enough anything,” he says, exasperated.

 

According to the Nigerian Medical Association website, there are over 40,000 medical doctors in Nigeria serving a population of about 160 million Nigerians. Douglas Okor, a Nigerian-trained neurosurgeon in Britain, says, “There is an estimated 1 doctor per 5,000 Nigerians, compared to 1 doctor per 242 in the UK. Most of these medics in Nigeria are in teaching hospitals, federal medical centres and general hospitals in the cities. A rough estimate of the number of medical doctors in a teaching hospital like the University of Benin Teaching Hospital, Benin City, is 600-700.” This high doctor-to-patient ratio affects the number of cases a doctor can take on, how quickly he can respond to them, and the quality of the services rendered.

 

Laolu Osanyin agrees, pointing to a shortage of both resources and personnel: “There is a lack of major facilities. There are, for instance, ten people waiting to be operated on. Meanwhile, there is only one theatre which takes one patient at a time. What will the doctor do?” Often doctors will select the most urgent cases, leaving the other patients to wait for longer periods. Osanyin says that the shortage of personnel in most hospitals leaves room for medical negligence to occur. “A doctor would tell you that between 10:00 a.m. and 12:00 midnight, he has done 14 caesarean sections. Definitely there will be a margin for error. So at some point, he will forget something; at some point in time, he will be tired.”

 

Dr. Ogungbo once worked at the National Hospital, Abuja, which is Nigeria’s premier government hospital. “There were times when someone would rush from the ICU to the ward and say, ‘Do you have this drug?’ For God’s sake, you are the ICU – that is where people should be coming to get this kind of drug!

But you find out that they have to write a list of what patients have to go and buy outside the hospital.” Ironically, the ICU is the “intensive care unit,” whose name alone should suggest the most capable, well-equipped unit in a hospital.

 

 

A Culture of Cover-Up:

 

A common contributing factor to incidences of medical negligence is greed. According to Dr. Ogungbo, doctors will sometimes take on cases outside of their areas of specialization – cases they are not qualified to handle, cases they cannot handle. He notes that this happens more often in private hospitals, where many doctors believe that they can do everything. “A gynecologist doing orthopedics, an orthopedist who says, ‘I’ve seen a doctor deliver babies before, don’t worry’ (I want the money, I will deliver the baby). In fact, there is a new [private] hospital just built and you have a list of all the specialties in the world. Well, you are trained in one thing, why not just do what you are trained in?” he asks.

 

Then there is the challenge of transparency with regard to deaths in many Nigerian hospitals. After a death occurs, there is hardly an investigation into the cause of death, nor are procedures created to prevent such deaths in the future. Dr. Ogungbo speaks of an experience at a hospital in Bangkok: “They have on their notice board something called ‘medication errors.’ All the staff, especially the nursing staff, are sensitized that they are monitoring errors: injection errors, whatever errors that had been made. So each month, they are looking to see what has happened wherever.” This type of monitoring has become standard practice in hospitals worldwide.

 

But Dr. Ogungbo says that such transparency is not the case in Nigeria. “Our own problem is that it is not open; there is a lot of cover-up. Even though we do what we call ‘morbidity and mortality’ every month, stating the number of people who died and why they died, nobody actually says, ‘This must never happen again and these are the things that we will need to put in place.’ Deaths are happening. We talk about it. But it is just that no one is saying, ‘Listen, we want sanctions.’”

 

 

The Patient’s Role:

 

Medical negligence is not always the fault of medical personnel, however. There are times when negligence originates with the patient, through the lack of full disclosure to doctors, ignorance about medical conditions or even a lack of interest in treatment. Dr. Ogungbo gives an example: “You find a diabetic patient under treatment who continues to take soft drinks. Or a patient whose injury was being treated who was going around the ward with a glass of vodka – the glass was transparent. Of course, his condition did not improve.”

 

Dr. Ogungbo says these are some of the ways that patients can contribute to negligence during medical treatment. He emphasizes the importance of full disclosure of information to the doctor. “If you don’t give us the pieces of the puzzle, we can’t piece it together to see the picture. Patients – especially patients infected with HIV – leave out the fact of their diagnosis, but that is a critical piece of information. If they don’t tell us that, we are scratching in the dark, scratching our heads. It delays things, but once you say this, there are a lot more things that we can do. However, patients withhold that kind of information and it doesn’t help.”

 

Osanyin echoes the sentiment that it is important for patients to come clean about their medical history with their doctors: “Patients contribute sometimes by withholding information or confusing issues. Don’t forget, most of them may come when things are a bit too late because they have been to the herbalist, to the chemist and the pastor. And they’ve treated malaria. And the last resort is the hospital.”

 

Perhaps if Nigerian patients become more proactive in their health and medical treatment, if medical personnel take more responsibility for the cases that they handle, and if the government begins taking health more seriously by building more hospitals and better equipping the existing ones, then we may finally begin to see a decline in cases of medical negligence. But until then, we are left waiting and wondering why, as medical negligence cases in the average Nigerian hospital continue to escalate, so few cases are reported, and even fewer prosecuted.

 

But that is a story for another day.

 

Has your life or the life of a loved one been affected by medical negligence? Share your story with us.

[Hawken]

Yup. A nurse dropped my cousins baby and fled... The child died from complications resulting from trauma to the head... She hasn't had a child in Nigeria since then.

[Hawken]

Sad stuff our hospital system, really sad.

[dequeen]

This is disastrous. What a shock.

[Iris]

Continued-

 

*Ruth’s Story:

 

 

In December of 2012, Ruth went into labour with her first child at a private hospital in the Iyana-Iba area of Lagos. She was in labour for twenty-two hours. She says that when her daughter was eventually born, the baby was in distress but did not cry.

Ruth alerted the doctor. “I asked the doctor to see my baby because I did not hear her cry. He replied jokingly: “take cane and flog her now,” she recalls.

 

 

In addition, Ruth was not lactating after delivery, though the hospital had advised breastfeeding exclusively. The doctor told her that her baby had been given glucose and water; she remained on glucose and water for three days.

“I started complaining to them when, on the third day, she was not making any sounds. The hospital staff said she was fine.” But on the fourth day, Ruth’s daughter had a seizure.

 

 

“The doctor could not tell what was wrong. He referred us to a government hospital.” Ruth visited the newly commissioned Mother and Child Hospital in Lagos. There, her daughter was rushed into emergency and given an anti-seizure injection. A brain scan at Yaba Psychiatry showed that Ruth’s daughter suffered from primary generalised epilepsy. She was placed on daily medication to lessen the frequency of the seizures.

 

 

After consulting with several medical experts, Ruth learned of two likely causes for her child’s condition. “First, by not crying immediately after birth, a part of her brain did not take in oxygen. Second, she also had hypoglycemia – low blood sugar. Her blood sugar level was 15. It is not supposed to be lower than 40 for a newborn.” With this discovery, Ruth became angry at the hospital, and at the doctor for being careless.

 

 

Ruth pays the price of that carelessness daily. The drugs her daughter needs cost ₦2, 050 per bottle, and she buys a new bottle every 10 days. During her daughter’s most recent seizure, Ruth turned to check on her in the backseat on their way to the hospital and drove into an electricity pole. Fixing the pole cost her ₦90, 000; repairing the car, ₦180, 000.

 

 

But even these staggering financial costs do not begin to compare with the emotional burden of raising a chronically ill child. “[The seizures] can happen anytime, anywhere, so you have to be on the lookout,” she says, adding that people have advised her to visit prayer mountains for solutions.

 

 

Ruth says that she is considering pressing charges against the hospital, but worries that it will be too hectic. Raising a child who may suffer a seizure at any time is difficult enough for the mother of two, and she worries that legal proceedings might be too much to bear.

 

 

What is Medical Negligence?

 

 

Laolu Osanyin, a lawyer specializing in medical cases, says that three factors must be in place in order for a case to be considered medical negligence in the eyes of the law.

“The first thing is that there must be a doctor-patient relationship, which you can also call a duty of care. Then, there must be a breach of that duty.

 

 

Essentially, the doctor must have fumbled. The third thing that must be in place is that harm must occur. The patient must suffer some kind of harm for negligence to occur.”

One cannot help but wonder how harm is defined here. Is the loss of a leg considered enough harm? And must the harm be physical in nature?

 

 

Lawyer Deji Olunlade says that the harm does not necessarily have to be physical, nor does it have to involve the loss of a body part. He gives an example of a patient left untreated upon admission to the hospital because the doctor on duty is not around. Eventually the patient is transferred to another hospital where he is treated.

“It may not lead to death,” says Olunlade, “but the patient has suffered some form of loss even though he got transferred to another hospital and survived.”

 

The Paths to Justice:

 

Court is one of the channels for reporting medical negligence, but there are others. Laolu Osanyin brings up another option: the Medical and Dental Council of Nigeria (MDCN).

 

 

“The patient who is suspicious of negligence has a right to petition the MDCN to report a case of negligence against the Nigerian doctor. The MDCN decides to investigate. They have an investigative panel that looks into the matter, that looks at the side of the patient. So, the investigative panel sends their findings to the medical tribunal.”

 

 

According to Osanyin, the MDCN’s tribunal has the power to do three things: 1) suspend a doctor’s license;

2) admonish a doctor; or ***) withdraw a doctor’s license to practice.

 

 

The MDCN can be considered first level of punishment, although the MDCN cannot issue compensation. Osanyin says that if a patient is still displeased with the MDCN’s decision, he can proceed to the High Court to sue for negligence and to claim damages. This is considered the second level of punishment. “The doctor’s license has been withdrawn and there is compensation that has to be paid,” says Osanyin.

 

 

There are still third and a fourth levels of punishment, according to Osanyin, all of which have been meted out in Nigeria.

 

 

“Recklessness is a criminal aspect of negligence. Negligence is the civil aspect. When it is grievous or serious enough, that is called recklessness. So, the doctor can be charged to court for a crime of medical recklessness – homicide, attempted murder or attempted homicide. The doctor can now be sentenced. So, one single negligent action, three layers of punishment. There is another fourth layer: if the doctor, for example, works with the civil service, the civil service can sack him, so he has lost his job, lost his license.”

 

 

The Case for Settling:

 

 

Many cases of medical negligence never even make it to court; instead, they are settled out of court. Deji Olunlade and Laolu Osanyin, both lawyers themselves, believe that settling out of court is better than going the route of court proceedings.

Osanyin points out, “All over the world, medical malpractice occurs. But there is a phrase we use: ‘All malpractice action should end at the door to the court room.’ Why will the patient sue you if you can restitute him?”

 

 

He emphasizes the importance of professional indemnity insurance to doctors, because with it, it is easy to settle with aggrieved patients and negotiate compensation. Of course, it is better to avoid such cases in the first place, but if negligence occurs, it is better handled by insurance companies.

 

 

Osanyin gives an example of a person whose leg was wrongly amputated. “They say okay, we are sorry, but the doctor has insurance coverage for about 50 million? So, let us pay 7 million naira, buy a prosthetic leg, give him some money to move around or buy a vehicle that can move around, give the vehicle corporate insurance and some extra change for discomfort.” Osanyin does say, however, that few Nigerian lawyers are well trained in medical laws and medical insurance.

 

 

Olunlade warns families to be well informed when taking this route. “As far as the settlement is concerned, once you settle, you sign and it has been adopted as judgment, that is the end of the case.”

[savvy]

Can't speak againt my kind...so I'd rather just shush it

 

Bt we'all know,these stories ain't always as they seem

[Hawken]

Can't speak againt my kind...so I'd rather just shush it

 

Bt we'all know,these stories ain't always as they seem

 

Ehenn? Better speak to your kind. Before we make the streets unsafe for you and your kind:mellow:/>

[savvy]

Ehenn? Better speak to your kind. Before we make the streets unsafe for you and your kind:mellow:/>

Hahaha...heard u ma'm,we dnt want no street thug all up in our biz :P