INTRODUCTION
Someone, jokingly, during a conversation mentioned to me that the word “HOSPITAL” is an acronym for “Home for Sick Persons Including Treatment and Labour”. Although not the real meaning of the word, the historical meaning of “hospital” is quite different from its modern-day usage.
“Hospital” is derived from the Old French term “ospital,” which is derived from the Late Latin word “hospitale,” which means “guest-house, inn, or shelter.” The Latin adjective hospitalis (“hospitable”) and the word hospes (“guest,” “stranger,” or “host”) are the sources of this. What were referred to as “hospitals” throughout the Middle Ages were not primarily used for medical care. More akin to nonprofit organizations, they offered care and shelter to a wide range of individuals. It took some time for the definition of a hospital to change to its current connotation as a facility for diagnosing and treating patients. The phrase started to be applied especially to hospitals for the ill and injured during the 15th and 16th centuries. In the 18th and 19th centuries, hospitals transformed from charitable almshouses into centers of medical and scientific excellence.
Medical negligence, a critical aspect of healthcare law, is a growing concern in Nigeria. It refers to the failure of a medical professional to exercise a reasonable degree of skill and care in the treatment of a patient, resulting in injury, worsening of an existing condition, or even death. This article delves into the intricacies of medical negligence in Nigeria, exploring its legal framework, the essential elements required for a successful claim, and highlighting relevant judicial pronouncements.
THE CORE ELEMENTS IN MEDICAL NEGLIGENCE:
In Nigeria, the prosecution of medical negligence falls under both Civil Law (action for damages) and Criminal Law (where the negligence is gross), and Professional Disciplinary proceedings (Medical and Dental Council of Nigeria – MDCN). To establish a claim for medical negligence in Nigeria, a claimant or their representative must prove three fundamental elements, akin to general tortious negligence. In the case of Ezeani v. Anyanwu (1993) 3 NWLR (Pt. 284) 437 the court stated that the essential elements of negligence include ─ duty of care, breach, causation and damages. These elements are further elaborated below.
A. DUTY OF CARE: The first requirement is to show that the doctor had a duty of care to the patient. This commitment, which implies that the healthcare provider is dedicated to treating the patient, naturally arises once a doctor-patient connection is established. As in the case of Dr. A.N. Okoro v. Uzoka & Anor. (2000) 15 NWLR (Pt. 690) 314 (LPELR-3540) as failure to exercise reasonable care and skill in treatment would amount to negligence. Medical healthcare providers are ethically bond to behave in the best interests of their patients. In the case of Ogunleye v. University College Hospital (2015) LPELR- 24645(CA), being a landmark case involving a patient who alleged that the hospital’s negligence during childbirth led to the death of her child. The court ruled in favor of the plaintiff, highlighting the hospital’s failure to provide adequate duty of care and supervision during labor.
B. BREACH OF DUTY: Proving this is the most important and frequently difficult component. The burden of proof is to demonstrate that the healthcare provider failed to provide the level of care that would have been expected of a reasonably competent practitioner in the same field and under the same conditions. Rather than perfection, the requirement is that of a “prudent and reasonable medical professional.”The court will consider what a body of skilled professionals in that particular area would deem acceptable as seen in the case of Olatunji v. Nigerian Army Medical Corps (2009) 6 NWLR (Pt. 1137), as a soldier sued the Nigerian Army Medical Corps for negligence after undergoing surgery that resulted in severe complications. The court found that the medical team failed to adhere to standard surgical procedures, leading to the soldier’s suffering. Examples of breaches include:
- Misdiagnosis or delayed diagnosis. See the case of Dr. A.N. Okoro v. Uzoka & Anor. (2000) 15 NWLR (Pt. 690) 314 (LPELR-3540)
- Incorrect treatment or administration of wrong drugs.
- Surgical errors (leaving foreign objects in the body, operating on the wrong limb).
- Failure to obtain informed consent from the patient.
- Failure to properly monitor a patient’s condition.
- Failure to refer a patient when necessary.
C. CAUSATION: The claimant must establish a direct causal link between the breach of duty by the medical professional and the injury or damage suffered by the patient. In other words, the harm would not have occurred “but for” the doctor’s negligence. The injury must not be too remote a consequence of the negligent act. In the case of UBA Plc v. Ayodele (2007) 12 NWLR (Pt. 1049) 500, the Supreme Court’s pronouncements on the standard of proof in civil cases (balance of probabilities) are relevant to medical negligence cases, where the claimant bears the burden of proof. Therefore, the claimant must proof the damages caused, see the case of Excel-C Medical Centre Ltd & Anor v. Nneoyi & Anor (2018) LPELR-44670(CA) and Delta State Hospitals Management Board & Ors. v. Onome (2018) LPELR-46522(CA).
D. DAMAGE/INJURY: Finally, the claimant must prove that they suffered actual damage, injury, or loss as a direct result of the medical negligence. This can include physical injury, psychological distress, financial losses (medical bills, loss of income), and pain and suffering. See the case of Oke v. St. Luke’s Hospital, Anua (1974) All N.L.R. 295 and Osita Nwafor v. U.T.H.B. (University Teaching Hospital Board) (1995) 6 NWLR (Pt. 401) 321. Also the burden of proof lies solely on the complainant to proof negligence by a medical practitioner to establish damages as seen in the case of UBA Plc v. Ayodele (2007) 12 NWLR (Pt. 1049) 500.
LEGAL FRAMEWORK GOVERNING MEDICAL NEGLIGENCE IN NIGERIA
Several legal instruments and principles underpin medical negligence claims in Nigeria:
- The Nigerian Constitution 1999: While not directly defining medical negligence, it provides for fundamental human rights, including the right to life and dignity of the human person (Sections 33 and 34). A breach of duty of care leading to severe harm can be argued as an infringement of these rights.
- The Law of Tort (Common Law Principles): Medical negligence primarily falls under the tort of negligence. Nigerian courts frequently rely on common law principles established in landmark English cases like Donoghue v. Stevenson (though not a medical case, it established the general principle of duty of care) and Bolam v. Friern Hospital Management Committee, which laid down the “Bolam test” for professional negligence (though its application has seen modifications in various jurisdictions, including Nigeria, to ensure it doesn’t become a “doctor knows best” defense without scrutiny).
- Medical and Dental Practitioners Act (CAP M8 LFN 2004): This Act establishes the Medical and Dental Council of Nigeria (MDCN), which regulates the medical profession. It outlines standards of professional conduct and provides for disciplinary actions against practitioners found guilty of infamous conduct in a professional respect, which can include acts of negligence.
- National Health Act 2014: This Act aims to regulate health services in Nigeria and establish standards. While it doesn’t explicitly detail medical negligence, it emphasizes patient rights, including the right to information and emergency care, the breach of which can be foundational to a negligence claim.
- Evidence Act 2011: This Act governs the admissibility and weight of evidence in court, playing a crucial role in proving medical negligence claims, which often rely on expert testimony.
- Code of Medical Ethics in Nigeria (2008): Issued by the MDCN, this code sets out ethical standards and rules of professional conduct for medical and dental practitioners. Violations of this code can be indicative of a breach of the standard of care.
In the case of Omomofe v. Lagos University Teaching Hospital (LUTH) & Anor. (2012) LPELR-9346 (CA), the Court dealt with the issue of professional negligence in a hospital setting. It underscored the responsibility of hospitals for the actions of their staff and the need for proper facilities and management.
RECENT TRENDS AND CHALLENGES:
The English case of Bolam v. Friern Hospital Management Committee (1957) 1 WLR 582 (English Case, Persuasive Authority). Although convincing, Nigerian courts have frequently applied this approach cautiously to prevent giving physicians total immunity, highlighting the need for the practice to be responsible and reasonable. The “Bolam Test,” which was created by this frequently cited case, states that if a doctor has acted in a way that is deemed appropriate by a responsible body of medical professionals who are competent in that particular art, they are not guilty of negligence. While not Nigerian, has influenced the interpretation of the Bolam test in Nigeria. It states that the court is not bound by a body of professional opinion if it is not “reasonable” or “responsible.” This means courts can scrutinize medical practices more closely. While not explicitly adopted in a leading Nigerian Supreme Court case, it represents a more patient-centric approach that Nigerian courts might increasingly consider. In the case of Iya v. W.A.E.C (1995) 4 NWLR (Pt. 389) 293, the court emphasizes the standard of care as that of a “reasonable man” in the circumstances. In a medical context, this translates to the standard of a reasonable and competent medical professional. Some recent innovations include the following
1.ALTERNATIVE DISPUTE RESOLUTION (ADR): There is a growing recognition of ADR mechanisms, such as mediation and conciliation, as a means to resolve medical negligence disputes outside of traditional litigation, offering potentially faster and less adversarial solutions.
2. INFORMED CONSENT: The emphasis on informed consent has grown. Patients have the right to know about the risks, benefits, and alternative treatments before consenting to a procedure. Failure to adequately inform a patient can lead to a successful negligence claim, even if the treatment itself was expertly performed.In the case of Ifeanyi v. Medical and Dental Practitioners Disciplinary Tribunal (2010) LPELR- 4690(CA), thesurgeon was held guilty of negligence for failing to obtain informed consent and for not providing adequate post-operative care.
3. EVIDENTIARY CHALLENGES: Proving medical negligence remains challenging in Nigeria due to a lack of readily available expert witnesses, the complexity of medical procedures, and a general reluctance within the medical community to testify against colleagues. The doctrine of res ipsa loquitur (the fact speaks for itself) can sometimes assist, where the negligence is so obvious that it needs no further proof (e.g., leaving a swab in a patient’s body after surgery).
LAPSES IN THE PROSECUTION OF MEDICAL NEGLIGENCE
While the legal framework exists, the successful prosecution of medical negligence cases in Nigeria is fraught with challenges, often leading to a perceived lack of accountability:
- The Burden of Proof: The burden rests squarely on the claimant to prove the negligence. This is difficult because the claimant is usually a layperson challenging a specialized profession.
- Need for Expert Testimony: Proving that the standard of care was breached almost always requires an expert witness—another medical practitioner—to testify against a colleague. Securing such testimony is a significant practical hurdle.
- Data and Access to Records: Hospitals and doctors often possess the critical medical records, and securing these vital pieces of evidence can be challenging for the claimant.
- Complexity and Duration: Medical negligence cases are typically lengthy and expensive, spanning many years through the judicial process, which can discourage victims.
- Exception: Res Ipsa Loquitur (The thing speaks for itself). In rare cases, where the negligence is so self-evident that it could not have occurred without carelessness (e.g., operating on the wrong limb or leaving a foreign object in the body), the doctrine of res ipsa loquitur may apply. This shifts the evidential burden to the defendant (the professional) to prove they were not negligent.
REMEDIES
Successful claimants may obtain general damages (pain, suffering, loss of amenities), special damages (quantified losses like further treatment and lost earnings), and occasionally aggravated/exemplary damages for especially egregious conduct. Parallel professional discipline (MDPDT) or, in extreme cases, criminal negligence may arise (Criminal Code discussions often cite duties relevant to dangerous acts and gross negligence).
CONCLUSION
Medical negligence in Nigeria is a complex area of law, balancing the need to protect patients from harm with the reality of medical practice. While the legal framework is largely based on established common law principles and specific statutes, challenges in proving these cases persist. The continuous evolution of judicial interpretation, particularly concerning the standard of care and informed consent, alongside the efforts of regulatory bodies like the MDCN, are crucial in ensuring accountability and upholding patient rights within the Nigerian healthcare system. As awareness grows and legal precedents accumulate, it is hoped that medical personnels will observe the highest level of duty of care for patients to advoid breach of such duty which will result to medical negligence, and that victims of medical negligence get justice when such rights are breached.