In saner climes, the natural thing to do when a patient dies or suffers greater bodily harm due to a doctor’s negligence is to seek redress in a court of Law. But the compassionate and sometimes passive attitude of Nigerian families to always resign to fate and leave everything in God’s hands, have ensured that this ugly situation persists. Medinat Kanabe, who spoke to victims and families of such unfortunate neglect and misconduct, explores the situation.
Precious Itua (not real name) was a very strong woman, easy going and much liked by her neighbours. She was 38 and had been married for 7 years without a child. This worried her and her husband so much so, that they decided to visit a clinic to see what the problem was.
It was discovered that she had fibroid and with the doctor’s assurance that she would be fine once she went through a surgery to remove the unwanted growth, she decided to go for it.
As a way of preparing for the operation, she cleaned her home and filled her kitchen with foodstuff she presumed would serve her husband during the time she figured she would not be available or fit to do the usual market rounds. And then she went for the surgery.
“It was a success,” the doctor announced to her husband, “and she would be discharged soon.”
True to the doctor’s words, she was discharged after some days and was able to go home to be with her husband. But exactly two weeks after, she developed some complications. Suddenly, she could not move around, and neither could she sit in one place. She was going through excruciating pains and had to place an urgent call to the doctor.
Since it was a Thursday, the doctor told her to come to the hospital on Monday, but by Sunday, she felt like the world was coming to an end and somehow found her way to the clinic. Yet she wasn’t given much attention until the next day, Monday.
By this time, her stomach was swollen but the doctor told her husband it was just gas. Even as a layman, her husband wondered how she was defecating and urinating easily, if it was indeed “just gas;” but kept quiet, since the doctor was supposed to know best.
The doctor who is a gynaecologist, had invited a surgeon from another hospital to help carry out the surgery, and so called on the surgeon once again. Somehow, it took him till the next day to arrive, leaving the patient without any proper medical care.
The surgeon examined the patient and called a senior consultant, who also took another day to arrive. The senior consultant examined the patient and began asking the doctors questions. According to an eye witness, they answered in the negative to all the questions, an indication that they didn’t do the necessary things they should have done.
By this time, it was already three days since the patient came to the hospital and she had become really weak, since the doctor made sure she wasn’t fed anything through the mouth.
The senior consultant then suggested a second surgery, since, according to him, there were complications with the first. He said there was a leakage, a consequence of the first operation, leading to a situation where the operated part refuses to heal.
There and then, our source – who is sister to the patient, revealed that she “didn’t have any choice but to go in for another operation.”
“After the operation, the surgeon, who carried out the first surgery came to me and said ‘it seems your sister had diabetes.’ I was furious at him. Why would a doctor say that after carrying out a surgery?
A while later, the doctor who owns the hospital also came to tell us that they had detected a cancer. Again I wondered why they had to be saying all these after a second surgery.”
By this time the family suspected strongly they weren’t quite telling the truth. They were trying to push blames in case she doesn’t survive.
By 3.00am that third night, she woke up, called the name ‘Jesus’ three times and gave up the ghost.
That was the end, as no further investigation was pursued to know the exact reason for which she died. Like the average Nigerian family, they concluded without much ado that no further action, not even pursuing justice, in case she had died out of the doctors’ negligence, could bring their beloved back.
Fatima Kannike was travelling with a friend when they got involved in an accident on the Lagos Ibadan Expressway. They were quickly taken to a nearby private hospital where the doctor on ground attended to them.
After some checks, the doctor diagnosed her of ulcer without carrying out an X-ray. He said the ulcer was very serious, which was why she was going through so much pains. He said if the pains continued, she would have to be operated upon. He ruled out any form of fracture because she was able to walk around little by little by herself.
Her family took her out of the hospital to Unity Hospital, Ikeja, where an X-ray was immediately carried out. But the result was not clear enough, so another X-ray was carried out. As they waited for the X-ray results, the doctor on duty told Kannike to wait for the orthopaedic doctor to come around, but because of the assurance she had gotten from the first doctor, she decided to go home and come back the next day to see the doctor.
When she got home, Kannike began to experience even more excruciating pains and was rushed back to Unity Hospital early the next morning, where she was told that the second X-ray result revealed a pelvic fracture.
Shocked, the Orthopaedic doctor wondered why she had been moving around with such a fracture. Didn’t she visit any hospital after the accident? Of course, she narrated to him her experience with the first doctor.
The doctor expressed his disappointment and told her family not to allow her to move for the next six weeks because of the fracture, but he didn’t assure them of her getting better soon enough, having moved around too much after the accident.
It is now over six weeks, and Kannike has gone back to the doctor for an examination, but the sad news is that they discovered that the fracture is still there.
At the moment, her family is confused. They are hoping that the mistake of the first doctor will be corrected by the new doctor. The patient, Mrs Kannike is wishing that the first doctor had made her do an X-ray immediately after the accident and told her not to move around; they are all wishing she had been made to stay in a position from the onset, as this would have prevented an aggravation and aided quicker recovery.
Again it’s all wishes and regrets on the part of the patient and family. The negligent doctor is not being called to question; neither is any action or redress being taken. They are living everything in the hands God and hoping that God aids her quick and total recovery.
As for Mr and Mrs George Bolatito, the way their six months-old child died could have been prevented, if only the doctor on duty hadn’t removed him from the oxygen that kept him alive.
Baby Bolatito had developed a fever at home and was rushed to Alimosho General Hospital in Lagos by his parents. As they arrived the hospital, the baby began to jerk.
The Nation journalist who was at the hospital at the time of this incident said the doctors and nurses who were handing over duty hinted those taking over that a patient had died in the night, leading to them being queried, and as such all cases should be referred to the Lagos State University Teaching Hospital, LASUTH, Ikeja, Lagos.
“When the couple arrived with their baby, the doctor took a look at the baby and said he needed oxygen. The parents hurriedly ran around to get everything needed for the oxygen and the baby was soon put on oxygen. After a while, the same doctor came to tell them that he needed to refer the case to LASUTH because there was no space for the baby. He wrote the referral letter, removed the baby from the oxygen and handed him over to his parents.
“The confused parents dashed out of the hospital, leaving everything they had bought in preparation for the oxygen behind. But lo and behold, the baby gave up before they even got to the gate of the hospital.” The eye witness said.
The parents ran back into the hospital and told the doctor that their baby wasn’t moving anymore. The doctor carried the baby immediately, called other doctors and tried to resuscitate the child, but it was a bit too late, as the child had died.
The visibly angry journalist said, even while all these was unfolding, a nurse who works in the hospital came in with her child, whom she said had acute malaria and needed to be admitted, and immediately a space was found and the child was admitted.
She said: “When I took my child upstairs for injection, I heard a doctor shouting and berating them, and literally wondering why a child with malaria would be admitted, when there were several other children with severe sicknesses who could not be admitted. Had that child not been removed from oxygen, he probably would have survived,” she lamented.
Again, Mr and Mrs Bolatito went home mourning their loss. No subsequent action was taken, other than to bury their six month old baby.
Yomi, Dega and Folarin also had their shares of doctors’ negligence. While Yomi is alive today, Dega is crippled, while Folarin is dead. The three boys were taken by their mothers to a private clinic at different times to treat them for malaria. The three women and children met at the hospital for the first time. The boys were between the ages of 5 and 6.
A nurse injected them on the instruction of the doctor, who knew very well that the nurse was new and still learning. She injected the three boys wrongly, and it affected them negatively. Yomi could not walk well for more than 3 weeks, but fortunately for him, he recovered. But for Dega and Folarin, theirs are sorry cases.
Another sad story of doctors’ negligence would be that of a young lady, Funmi, as told by her family friend. He said “Funmi graduated in 2007 from Babcock University, where she studied Nursing as Best Graduating Student. She went ahead to do her Masters’ Degree programme with an intention to go for her PhD in the United States.
“She got married in 2010 and had a child. She was pregnant for her second child when she applied for PhD in a university in the US. She had not seen the letter when she went into labour last month and was rushed to the hospital for delivery. Nevertheless, she was very happy about the news and couldn’t wait to get over the childbirth. But alas, she never saw the letter, as she died in the course of giving birth.”
According to the family friend, the anaesthetist gave her an overdose of epidural injection on the wrong vein.
Another victim, Rita Biose narrates to The Nation: “I was in labour and needed urgent attention, but there was only one doctor on duty attending to ante-natal patients. I had to wait for him to finish with them before attending to me. He realised the baby was distressed out of the long wait and so I needed to be operated upon. The anaesthetist wasn’t around. It took him over 30 minutes to come before I was operated upon. I was in labour from about 8pm till the following morning into the evening; everywhere had become dark and the only form of light for us was a local lantern in the hospital.
I suffered serious mosquito bites and heat, which added to my suffering. After all this, I still had to pay a whooping N220, 000 as delivery fee because I had a caesarean session which could have been avoided. This is a private hospital that has been in existence for over 30 years. I also ended up with a weak child that needed urgent medical attention,” she said.
A Doctors’ defense
Defending the doctors, Dr Femi Adedugbe, a General Medical Practitioner and Managing Director Lives Fountain Medicare, Ilasa, Lagos said doctors are humans too and can make mistakes. Apart from that, he said there are many other challenges facing today’s doctors.
One of the major challenges according to him is the content. “It is so much; that is why we have a lot of specialisations today, so that doctors are able to focus on one aspect of medicine, unlike before when a doctor was supposed to know everything because there wasn’t too much content. The information on malaria alone today is two times what it used to be. Here in Nigeria, we still do the general practise, unlike in the developed countries where they specialise.
“I am not holding brief for anybody, but doctors are humans and can make mistakes. For those who don’t do what they are supposed to do and at the end there is a mistake, or you don’t have the capability or necessary equipment and then it leads to death, that doctor should face the law.”
He pointed out that another problem the doctors now have to deal with, is the strike actions that characterise the teaching hospitals. He said the students who are supposed to spend 6 years are spending 8 years and they still let them go.
“Some patients can’t afford even the government hospitals, so they stay at home rather than go to the hospitals. Because of this, some of these students don’t get to encounter some of these cases until they leave school, and there is a big difference between what happens in a teaching hospital and private hospital. In a teaching hospital there are serious cases, cases that are beyond us here (in private hospitals).
“So when these young doctors come out, and they have to work in rural areas or in the private sector, you find out that the things they see in the teaching hospital, they are not seeing there.
“The common sicknesses are malaria, respiratory tracks infection, which they don’t see in teaching hospital, because nobody will admit a child with malaria or those common sicknesses in a teaching hospital, except the difficult cases like the cancers, difficult labour, perforation and other serious cases. But you as a doctor should know when something is beyond you, you can call in someone.” He said.
Dr Adedugbe who has been practising for 33 years, added that doctors are in fact more careful nowadays because of the possibility of litigation, but noted that the above challenges are there, including a short fall in the specialist doctors.
“We have a short fall in the medical institutions that are available, that so many times, they are overwhelmed. Take for example the government hospitals. Because of the free health, the doctor comes in the morning and sees over 40 patients waiting for him, and you expect that doctor to be thorough whilst seeing all the patients!
“Or if a doctor working in a teaching hospital has six working hours in his shift and he resumes to find four patients waiting for CS, and one CS takes about 1hour 30 minutes. How do you think he will manage the four of them without making a mistake at some point?”
He therefore reiterated that the honest fact is that doctors are humans, and sometimes that extra care is not taken because there is just so much to do.
He further explained that limited training is another cause of negligence as he added that in his own days when he left school in 1982, they were less than 50 students that graduated. “As a medical student, I had about three beds that were my patients, if I was going through medical rotation, the three beds were my own; patients on admission on those beds were my patients. I will be the first to clack them and do the necessary things and make presentations. But as it is now, we have about 250 students coming out in a set, so it is difficult for one student to have one patient to himself. So now, we have about three students sharing one patient. For example, there is a woman on admission, I come to her to clack her, my colleague too comes to clack her and another colleague comes again; the woman will become angry. So what will happen is that the three of us will make arrangement to meet and go together to see the patient. When we go, one of us may be more intelligent and do most of the talking; it doesn’t really mean that the other two are good. Tomorrow, when we are going to do the presentation, three of us will also come out for presentation, you could just be lucky again that the same person will talk and the three of you will take the glory… until examination day when you present alone.
“So in my own days, you have no other person but you and you must make your presentation yourself without the help of anybody. All these factors come in. Even the residence that are undergoing training, for quite a number of months in a year, there is one strike or the other, and these don’t make them undergo the right training. Although they try to make it up, but is it really possible to make up for the strike? Maybe they will also say, let them do a crash programme; but it doesn’t help. The training and exposure is not enough for the students. Doctors undergoing post graduate studies are also not excluded.
“Let me tell you something: In the olden days, when you are doing your masters works, you do research works; now they allow literature review, where you don’t really have to do any research. You just review some other works that have been done before. In those days, you must work from the scratch.”
He defended the doctors again, saying he is sure that no doctor will use an unaccepted method to treat a patient. Using himself as example, he said he has been in practise for 33 years, but there are some things he still doesn’t know, because they are not in his area of specialization; and so he must refer such cases. “An ophthalmologist who started five years ago is an authority in his area, so whatever he says, I must listen. And whenever I see a case that is for him, I must refer to him.”
He also said there are some things that are not allowed, which some people are doing and getting away with.
“An example is the gynaecologists who run away from doing hysterectomy for a woman that has fibroid during delivery, because they believe that the woman will bleed and might die as a result. It does make sense for a doctor to do a CS for a woman and decide to remove the fibroid, instead of opening her again in future. But they won’t because they say, ‘she will bleed and nearly die.’
“But I know a consultant in the University of Benin Teaching Hospital, UBTH who does it and says ‘Don’t mind them, they don’t know what to do.’ Yet 80 percent will not do it, but this doctor does it and succeeds.
“Now, if a doctor tries to do it too and something goes wrong after many successes, he will be punished because that is against the norm.”
He said it is very much impossible to do many things that are done in the US in Nigeria because the gadgets and equipments are not available. “If I want to do a procedure, I send my specimen to the lab, and probably will not get the result until tomorrow; while I am waiting, the patient may die. But in the US, the result will be ready within 30 minutes to 1 hour in an average health care centre.
“So over there, the doctors have become lazy because they have everything, but here we have learnt to develop our sixth sense because we can’t afford to wait every time for those tests results. So we tend to learn over the years.
“I don’t even know whether they have enough cadavers (dead bodies) now to learn with. In my set, we had 12 people to one cadaver. But now in a class of two hundred, you have about 30 people crowding a body. How will they be able to learn the anatomy? So all these factors together, come into play.”
The doctor also said that experience in medicine is very important; as he pointed out that the probability that an experienced doctor will make a mistake is far less than that of a new doctor. “There is a tendency that over the years you have come across more cases than the doctor that started practise five years ago.”
Asked if it is possible for a medical student to pay his way through school, he said no, because according to him, the examinations are not only written. “Every student will be given a patient during examination to clack; a presentation is also made and there is always an external examiner. So it is very impossible for one to pay their way through school.
“There is written, oral, essay and Multiple Choice Questions, and this MCQ covers all aspects of what you are studying. You will be asked to choose options A, B, or C or say true or false, but is covers a large area of medicine.”
Another thing, he said, is that the profession is not such that yields so much income, but many doctors want to make quick money because their mates in school who studied other courses are now very rich.
“They go ahead to admit patients that should ordinarily be referred and call in experts to attend to them so that they can get a share from whatever the patients pays. Sometimes they even try to attend to the patients themselves because they have seen someone treat the same sickness before, but what if something goes wrong?
“A doctor can slump in the middle of an operation; the patient may also die because the doctor may be the only expert around. But when it is a bigger hospital, there are other doctors who can take over.”
He said, “Doctors even work in two or more places now to make extra cash.”
While saying he cannot rule out the possibility of some doctors being drunk sometimes, said the profession is such that after spending so many years in school, a doctor does not want to rubbish himself. “It is just that a doctor can be off duty, go to a party and take a bottle of alcohol, in the course of which he is called for an emergency; under that circumstances, he might get there drunk.”
As a word of admonition, Dr Adedugbe advised fellow doctors to constantly update their knowledge and skills, and above all, know their limits.
The legal perspective- Can victims’ families seek redress?
Renowned lawyer and activist, Dr Fred Agbaje, said doctors like every other professional, holds the duty of care to their patient or client.
He said they must exercise extreme caution, which translates to applying best practises in ensuring that the life of the patient is secured.
“If there is a breach of this duty of care, and the patients suffer any consequences, the patient will have a cause of action against such a doctor. A patient has every right against a negligent medical doctor; because there are cases where a doctor has forgotten scissors and other equipment in the tummy or body of patients. Such a doctor ought to be stripped of his license because he is careless about the patient’s life and I am very happy that that the Medical and Dental Disciplinary Council, does not joke with such act of great negligence.”
