Liability for Patient Fatality in Nigeria: Legal and Ethical Considerations

Patient fatality remains a significant concern in Nigeria’s healthcare system. Confidence in the Health sector continues to ebb with stories of avoidable deaths due to healthcare providers actions or inactions. The reality of which is underlined by key fatality statistics such as:

• Healthcare-associated infections at 10.1% prevalence;
• Maternal mortality ratio at 615 deaths per 100,000 live births;
• Under-5 mortality rate at 117.2 deaths per 1,000 live births, etc

Patient fatality in Nigeria raises critical questions about healthcare provider liability and highlights the need for effective regulation, reliable reporting processes and accountability and most of all progressive policies.

CAUSES OF PATIENT FATALITY

The leading causes of patient fatality in Nigeria includes:

• Medical Errors and Negligence: 27.9% of patient fatalities in Nigerian hospitals are due to medical errors. 43.8% of medical errors are caused by inadequate training and staffing while 21.1% result from inadequate equipment and infrastructure.

• Inadequate healthcare infrastructure: 34.6% of patient fatalities in Nigerian hospitals are due to inadequate infrastructure, 40% of hospitals lack functional emergency departments, 25% of hospitals lack adequate water supply.

• Delayed or inaccurate diagnoses: 15.6% of patient fatalities in Nigerian hospitals are due to diagnostic errors. 40% of which are the result of inadequate laboratory facilities.

• Medication errors: 12.5% of patient fatalities are due to medication errors. 30% of medication errors result from inadequate pharmacy staffing

• Infection Control lapses: 23.4% of patient fatalities in Nigerian hospitals are due to healthcare-associated infections.
• Substandard care and treatment
• Inadequate training and staffing

LEGAL FRAMEWORK FOR HEALTHCARE PROVIDERS LIABILITY IN NIGERIA

The laws that provide the framework for holding healthcare workers and hospitals responsible for negligence, malpractice, or breach of duty resulting in harm to patient includes the National Health Act 2014 and the Medical and Dental Practitioners’ Act.

National Health Act (2014): Establishes the standard of care expected from healthcare providers, the rights of patients as well as the obligations of doctors, nurses, and hospitals.

1. Section 20: Establishes standards for healthcare services and provider obligations.
2. Section 21: Requires healthcare providers to ensure patient safety quality care.
3. Section 22: Mandates informed consent for treatment.
4. Section 23: Regulates medical records and confidentiality.
5. Section 24: Provides for investigation and disciplinary action against healthcare providers.

Medical and Dental Practitioners Act (2004): Regulates medical practice as a professional discipline and provides guidelines for professional conduct and ethics. The Nigerian Medical Association Act similarly makes provisions for ethical and professional conduct.

1. Section 16: Defines professional misconduct and negligence.
2. Section 17: Establishes disciplinary procedures for healthcare providers.
3. Section 18: Requires healthcare providers to maintain professional standards.

In Ogunyinka v Lagos University Teaching Hospital, The Court of Appeal, Lagos Division, delivered a landmark judgment. The case involved a medical negligence claim against Lagos University Teaching Hospital (LUTH) resulting in the death of a patient.

The patient’s family alleged that Hospital staff delayed surgical intervention, inadequate post-operative care was provided and medication errors occurred. The patient eventually died due to complications.

The Court of Appeal rejected LUTH’s defence of contributory negligence and overturned the lower court’s decision, ruling in favor of the plaintiff. The court held that:

1. LUTH breached its duty of care to the deceased.
2. The hospital’s negligence led to the patient’s death.
3. The hospital failed to provide adequate care, including delayed surgical intervention and inadequate post-operative care.

ETHICAL CONSIDERATIONS

The foremost consideration is the patients’ fundamental right to life and dignity, enshrined in the Nigerian Constitution and international human rights instruments. Healthcare providers have a moral and professional obligation to respect this right, ensuring that patients receive quality care and treatment.

There are also principles or pillars of medical ethics by which medical personnel must abide in the discharge of their professional duties. In the context of patient fatality, these principles are:

1. Respect for autonomy: Patients, their families or representatives must be fully informed and involved in care decisions, including end-of-life care.
2. Beneficence: Healthcare providers must prioritize patient well-being, providing compassionate care.
3. Non-maleficence: Providers must minimize harm and avoid actions that may exacerbate patient suffering.
4. Justice: Healthcare resources must be allocated fairly, ensuring equitable access to quality care for all.
5. Veracity: Honest disclosure of adverse events, near misses and transparent communication are essential to preservation of patient relationships and informed care.

Professional codes of conduct, such as the Nigerian Medical Association’s Code of Ethics and the Nursing and Midwifery Council of Nigeria’s Code of Conduct, provide additional guidance. International guidelines and standards, including the World Health Organization’s Patient Safety Guidelines and the International Council of Nurses’ Code of Ethics, also inform ethical decision-making.

CONCLUSION

Liability for any harm to patients is understandably sensitive for healthcare providers. The relationship between healthcare workers and their patients is a special one which requires trust,  confidentiality, and many times subjective judgment on the part of healthcare Practitioners. Conflicts between the parties concerning care rendered and its results should therefore not be subject to the same standards as other torts. Some countries, such as the Netherlands, have developed systems and protocols for healthcare liability which protects the information of the patient as well as the professional reputation of the doctor, nurse, or hospital. Others encourage resort to Alternative Dispute Resolution methods in settling the grievances of the parties.

In any case, Nigeria still has a long way to go in terms of progressive healthcare policy and dispute resolution.  Stakeholders must take positive hints from medically advanced nations to make sorely needed progress in the Nigerian health sector.

REFERENCES

1. Nigerian Journal of Clinical Practice (2018). Patient fatalities in Nigerian hospitals.
2. Journal of Healthcare Quality Research (2019). Medical errors in Nigerian hospitals.
3. Nigerian Ministry of Health (2020). Hospital infrastructure assessment report.
4. Journal of Infection Prevention (2019). Healthcare-associated infections in Nigeria.
5. African Journal of Critical Care Medicine (2020). Sepsis in Nigerian intensive care units.
6. World Health Organization (2020). Maternal mortality.
7. Journal of Infection Prevention (2019). Healthcare-associated infections in Nigeria.
8. World Bank (2020). Mortality rate, under-5.
9. Ogunyinka v. Lagos University Teaching Hospital (2017) LPELR-42351(CA).