The alarming rate at which Medical inadequacies cause a lot of havoc in the Nigerian health care system is one major issue that hardly becomes news. Many of the deaths and medical errors that lead to medical complications are what caregivers would be careful enough to consider if there is proper implementation of policies, access to justice, and importantly if there is enough sensitization that allows an average patient to know the rights they are entitled to. Truth be told, does Nigeria in any way appreciate the rights of patients? or are there required duties that a caregiver owes to their patient? If yes, are there ways to regulate these relationships? This and other curious thoughts have brought about the necessity that births the need for this topic.
Medical law is one of the most important aspects of checks and balances in the Nigeria Health Care system, yet one of the less focused areas for a Nigeria legal professional. The concept of Medical law is a process of determining the structure, organisation and even the relationship of law with caregiving through the use of regulations and expected professional standards. The concept also extends to every action relating to health, in managing the relationship between health professionals and their patients.
In the healthcare system, it is well established that in exercising skills and competence, a health practitioner is expected to exercise the duties with utmost care. In considering the relationship between the caregiver and patient, Aderemi JCA noted that the relationship between a doctor and his patient is one of trust and confidence; a relationship where one has the power and the duty to treat and restore the other to mental and physical well-being.
Medical law cover a wide range of issues which include errors in administering medications, therapeutic errors, error at diagnosis stage, neglecting warning signs, untimely discharge of patients, complications of health situation resulting from error in treatment procedures, other issues as a result of unhealthy care environment (i.e infections), errors in referal or referral without adequate provisions or first aid, amongst whatnot. These errors though may arise as a result of facility management, simple accidents and other incidents like mistakes in recent times are not disclosed to the patients, on the harms they have caused them or to their relatives in instances of death, for guidance against being sued. The awareness of these rights within the Nigeria setting is really low. Medical errors do not necessarily constitute unethical behaviour but failure to disclose error may which has made issues more complicated in getting the actual causes of medical errors.
In a system like Nigeria, the health care system rather than deeming care giving a duty consider it more of favour to their patients, which has however reduced the standard of care required resulting in thousands of deaths on yearly basis, especially with blames on lack of functional systems and poor database. In considering the estimate of the World Health Organisation Global Health as of 2020, which listed the 10 leading causes of death globally to include Ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, neonatal conditions, trachea, bronchus, lung cancers, Alzheimer’s disease and other dementias, Diarrhoeal diseases, diabetes mellitus and kidney disease.
Contrary to this statistics, it is estimated that 251,000 people die annually as a result of medical errors, which in 2016 according to a study notes how medical error is the 3rd leading cause of death in the United State, but never appeared in the statistics for that year. Though this data proportion has been countered by many as inadequate, there is still some iota of truth, as many unreported cases like situations in Nigeria with poor databases might skyrocket the global figures or even lessen it. The point is that we can’t totally shy away from the fact that thousands of people die annually as a result of avoidable errors by health practitioners which has caused, and is still causing havoc to the lives of person’s that should be protected, yet cases of which are less attended to and under reported.
In Nigeria particularly, using the studyconducted in Abia state as an example, showing the prevalence of medical errors which was 42.8%. The three most common errors committed by the participants were an error of medication prescription (95.2%), error of radio-laboratory investigation ordering (83.9%), and error of physician diagnoses (69.4%). 62% of the participants who committed medical errors had a negative attitude to error disclosure to the patients and their families. And out of the 62 participants who committed medical errors, 33.8% were depressed, and among them that committed the medical errors, none was involved in a lawsuit. This finding is in contrast to what is obtained in advanced countries where malpractice suits for medical errors have been reported. Like in a survey of physicians in the United States of America, where 42.2% of the practitioners were involved in at least one medical litigation. However, research studies have shown that the majority of medical errors are unreported and medical practitioners breach the standard of professional and ethical practice.
What are the rights of a Patient?
The rights of patients range widely, though endless, in that it basically results in all the duties that will be necessary for attending to a patient’s well-being. The rights that patients are generally entitled to include but are not limited to:
- Right of Autonomy: This right is one that gives patients freedom in making decisions on how they want to be treated and the restriction to this right is in law; in that, a patient can’t desire their treatment to be outside what the law prescribes.
- Right to Medical care and Human treatment: Considering Nigeria’s constitutional right to life and also the right to dignity of the human person, every individual is entitled to medical care no matter who they are and their positions at the time. Human treatment also includes mutual respect and a patient has the right to be treated with utmost care and respect.
- Right to Privacy and Confidentiality: In care, as much as the concept of privacy and confidentiality might look related, and can be used interchangeably, they are still distinct ideas, in that privacy has to do with protection against public interference. A right that differs from confidentiality which is more of an agreement that deals more with the protection of a person’s information from others, a kind of fiduciary relationship.
- Right to give consent: Consent is a major right that a patient has in accepting the treatments suggested by their caregiver after fully understanding the essence of such care and why. Though some consent might be gotten impliedly but it is not in all cases that implied consent is enough.
There are other specific rights that have been recognized in Nigeria’s Patients Bill of Rights which gives an aggregate of rights from the Nigeria constitution, Consumer Protection Act, Child Right Act, Freedom of Information Act, National Health Act, the Hippocratic Oath, and from other professional ethical codes and sundry regulations. These rights are sub-headed under Access to information, Patient Related Information, Fee-related information, Confidentiality, Quality of Care, Patients dignity, Access to Emergency Care, Visitation, Patients Refusal of Care, Interruption of Service by Provider, and Complaints.
These rights in detail include:
- Access to all relevant information in a language the patient understands.
- Access to full participation in implementing the treatment plan and decision-making.
- Access to records as regards to the range and scope of services available.
- Access to caregiver’s records as regards to their identity, skills, and credentials.
- Full disclosure of cost or estimation of recommended treatment.
- Transparent and itemised billing.
- Privacy and Confidentiality of all information except in instances where disclosure becomes relevant.
- Access to a clean, safe and secure healthcare environment.
- Access to equitable quantity care and caregivers, irrespective of Disability.
- Right to be treated with respect and dignity, without prejudice.
- Right for wishes of a patient or their next of kin to be fully respected at the time of the patient’s death.
- Patients Right to urgent, immediate and sufficient intervention and care in emergency situations over other factors (cost, payment, etc).
- Right to receive visitors, including religious in accordance with facility regulations.
- Right to decline care.
- Right to give consent or decline participation in medical research, experiments, etc.
- Right to be informed of disengagement or any interruption of service of a patient’s caregiver and such methodical and practical transition of treatment.
- Patient’s have the right to express their dissatisfaction about services, modes, charges or abuse.
As beautiful as these rights are, they are not automatic in the sense that there are other stated responsibilities that a patient has to fulfil before they can say their rights are being denied, this include that:
- A patient is expected to seek all necessary information from their caregiver and understand their treatment plan.
- A responsibility to update the caregiver about any changes occurring from time to time.
- A patient is expected to report dissatisfaction through appropriate channels provided by the facilities.
- A patient is also expected to pay bills or make provisions through demonstration of abilities or intention in any case of emergency and others.
- A patient also has the responsibility to fully disclose their medical history, medication and complaints to the authorised and attending caregiver.
- A patient is also expected to give explanations during treatment where such is necessary.
- A patient also has a duty not to constitute nuisance or endanger others.
- Patients are also expected to consider others right and treat everyone with respect without consideration.
- A patient is also expected to have the knowledge that emergency treatment and prioritisation does not amount to waiver of obligation to pay.
- The patient should also be aware that there are times caregiver might breach or bend rules justifiably, in maintaining decorum, and also ensuring the security of other patients and caregiver, but such modification is still required to be done with reasonable notice.
- A patient is responsible for adhering to rules and regulations, and also directives, advice and instructions of attending professionals.
- In respect to continuing a patient’s care, he/she has to inquire about a contingency plan and other suitable alternatives.
- Patients are also expected to give sufficient details in expressing their dissatisfaction and also do this by complying with the facilities redress facility.
- When dissatisfied with the facility redress, you can then proceed to report such outcome to regulatory authorities.
This bill, launched in Nigeria in 2018 as though an outright innovation of ideas on how the healthcare system should be shaped, still leaves us with the question of whether the enactment of this bill is an outright solution to medical error, or it will end up like every other Nigeria law without proper implementation plans. Funnily in 2022, the awareness of the existence of the Nigeria Patients Bill of Right is still low amongst stakeholders, gatekeepers, health practitioners and legal practitioners, who are still ignorant of the existence of such provision. Leaving with the assertion that these rights only exist in black and white and not in reality as it has hardly had an effect on our healthcare system.
What are the required duties that a caregiver owes to their patient?
Considering the rights that patients have under the law, it is also expedient for us to consider the duties caregiver owe to their patients if any, and also see the correlation or disagreement otherwise that might be an issue for conflicting obligations in caregiving. Also in the Nigeria Patients Bill of Right and the Rules of Professional Conduct for Medical and Dental Practitioners, there are specific health providers responsibilities that has been outlined which include to:
- Inform patient about all available services and option
- Inform patient about the intention of a treatment
- Answer patients question and give detailed information about risk and alternative
- Keep and provide patients medical records on request and in accordance with prevailing laws.
- Conspicuously display scope of practice and available services; and customer care contact details
- Communicate clearly with patients and make provisions for interpreter if necessary
- Be responsible that patients process and well understands information
- Provide sufficient identification when on duty
- In events of emergency, should provide immediate and sufficient intervention and care with priority, where the caregiver has the right to use legal means to recover fees owed.
- Respect and maintain patients dignity in relating with patients
- A practitioner is also expected to keep all their practise document and licence
- Expect to adopt clinical governance standards and provide best care, also protecting patients from harm and abuse.
With all these clearly stated and even more, it is so sad that policies in Nigeria are evidently not being implemented, if this has not in any way amount to a major transition in the Nigerian health care system after almost 5years of the Nigerian Patients Bill of Right.
What are the available laws and whose duty is it to regulate the relationship in the healthcare system?
The right of someone who has suffered as a result of Medical error is a Personal right and as such, only the person who is affected directly is entitled to sue, but in cases where the patient died or the patient is a minor, there will be justification if such action is brought by their next of kin or loco parentis. There is robust evidence showing that our practitioners have a negative attitude toward the issue of minimising medical error in the Nigeria Healthcare system.
However, the main body saddled with the responsibility of regulating the Nigeria Healthcare system is the Medical and Dental Council of Nigeria (MDCN) – the professional health regulatory agency for the professions of Medicine, Dentistry and Alternative Medicine in Nigeria, where we have others that include Criminal Code Act Cap C38 LFN 2004, Treatment of Gunshot Victims Act 2017, the National Health Acts 2014, e.t.c. This Council body is empowered by the Section 5 of the Medical and Dental Practitioners Act, Cap 221, Laws of the Federation of Nigeria, (1990) to regulate the medical profession in Nigeria, where the Medical Practitioners in Nigeria owe allegiance to the Medical and Dental Council of Nigeria, and the Nigeria Medical Association.
The laws that guide Registered practitioners clearly state to ensure that professional practice doesn’t turn into a hide-out for criminals. A breach of this ethic, either by omission or commission constitutes infamous conduct in a profession. In every such case where the guilt of the practitioner is pronounced by the Medical and Dental Practitioners Disciplinary Tribunal, the sentence that is pronounced shall be published in the Gazette of the Federal Republic of Nigeria and also as a paid advertisement in each of four national newspapers. Notification of the publication shall be duly deposited with the permanent secretaries of the Federal and all the State Ministries of Health, and the National President of the Nigerian Medical Association (if a medical practitioner) or the Nigerian Dental Association (if a dental surgeon).
In the order of action, the first thought that comes to our mind in cases of Medical misconduct is to complain to the Medical and Dental Practitioners Council of Nigeria, following the Medical and Dental Practitioners Acts, which provides for an Investigation Tribunal, and where misconduct has been ascertained, there will be a suspension of the Medical Practitioners for a period of 6 months or revocation of their Medical licence depending on the gravity of misconduct when such person has been found guilty. As encapsulating as this may sound, there are other remedies that benefit persons that have suffered damages as a result of Medical errors directly.
A victim of Medical error can bring an action in court to prove negligence when the action of the caregiver has caused them actual damage, they can also seek redress via Alternative Dispute Resolution (ADR). To avoid duality of the same process, it is essential to note that instituting an action for Medical error in the High court is said to be at per with complaining to the Disciplinary Tribunal which means that, when a case is instituted in court, there is no necessity of proceeding investigation or trial by the Disciplinary Tribunal.
Effectiveness of Regulatory Bodies
If the Medical and Dental Council in Nigeria are effective in checking the activities of health practitioners, it would have really made a serious turnaround in the Nigeria Health System. Considering the earlier data collated in Abia state, cited earlier, It shows how out of 62 persons who committed medical misconduct, none faced disciplinary action or got involved in a lawsuit. Another evidence to the fact that the Medical and Dental Council have hardly been effective is how they hardly make it to the news or even get their existence noticed.
To show how less the regulatory council has been a bottleneck to the problem of medical law in Nigeria is how you will hardly find any research on their effectiveness or pitfalls, not out of perfection but the fact that they have been less impactful. There are also other provisions of the Ethical Code that preserve the medical profession over the patient, like where if a doctor advises a patient to take action against their colleague, they have committed an offence against ethical conduct. When the awareness and existence of this right is hardly known, who then is ready to take up the responsibility when it is obvious this body in its existence rather than to regulate the relationship that exists between Professional-Patient, are seeking to protect the interest of the medical profession more.
To buttress this is the Lack of visible and responsive feedback, in cases of dissatisfaction, especially in public hospitals where their response channels are hardly available. From personal experience at the Ekiti state teaching hospital Ado Ekiti, I had a frustrating experience getting my medical report at the final signature stage where I was delayed from making the test almost useless as people who didn’t even do the test but got reports were almost mocking me for being patriotic, out of this frustration, I saw a small sign on the hospital wall saying if dissatisfied with our service call this number, only to realize the number wasn’t even available. This and more contribute to the lack of effectiveness of the regulatory bodies in the Nigerian health system.
The parity between Medical law and the reality in what truly exists in the Nigeria healthcare system is a situation far beyond the mere implementation of policies, but root down to awareness of remedies to individuals in the real sense, the act of caregivers making caregiving feels like an act of kindness has brought about the unconscious adaptation and also the mentality of lack of a reliable judicial system which has not in any way made the system better. To make the Nigeria Healthcare system better, it starts with a mind-shift process through creating awareness and synergizing especially with the medical professionals, legal professionals, and the personnels saddled with the responsibility of regulating the healthcare system in Nigeria. Truly there will never be justice in ignorance.
 Abatan v Awudu,  10 NWLR (Pt. 829) 451 C.A.
 Dovey SM, Phillips RL, Green LA, Fryer GE. ‘Types of medical errors commonly reported by family physicians’  67 Am Fam Physician; 697.
 Sweet MP, Bernat JL. ‘A study of the ethical duty of physicians to disclose errors’  8(8) J Clin Ethics; 341
 World Health Organization, ‘The top 10 causes of death’ (9 December 2020) <The top 10 causes of death (who.int)> accessed 20, June 2022
 Anderson J.G and Abrahamson K, ‘Your Health Care May Kill You: Medical Errors’  234 Studies in Health Technology Informatics 13-17; National Library of Medicine; National Center for Biotechnology Information <Your Health Care May Kill You: Medical Errors – PubMed (nih.gov)> accessed 20 June 2022
 Martin A Makary, Michael Daniel, ‘Medical error—the third leading cause of death in the US’ (03 May 2016 ) <https://www.bmj.com/content/353/bmj.i2139>accessed 15 June 2022
 G. U. Pascal Iloh, Abali C. and A. N Amadi ‘Medical errors in Nigeria: A cross-sectional study of medical practitioners in Abia State’ <Medical errors in Nigeria: A cross-sectional study of medical practitioners in Abia State Iloh GU, Chuku A, Amadi AN – Arch Med Health Sci (amhsjournal.org)> accessed 15 June 2022
 A. Kachalia and others ‘Liability claims and costs before and after implementation of a medical error disclosure program’  153(2) Ann Intern Med 13-21
 C. Krupa, ‘Medical Liability: By Late Career, 61% of Doctors Have Been Sued’ American Medical News (16 August, 2010) <Medical liability: By late career, 61% of doctors have been sued – amednews.com> accessed 20 July 2022
 University of Exeter – ‘Ethical decision making in Care’ Future learn <https://www.futurelearn.com/courses/ethical-decision-making-in-care-exeter/1> accessed 10 June 2022
 Lawpadi ‘How to sue for Medical Negligence’ <How to sue for medical negligence in Nigeria – LawPàdí (lawpadi.com)> accessed 19 July 2022
 Taiwo Ijadunola, ‘Medication Error in Nigeria: The Negative Attitude of Healthcare Practitioners towards it’ Monitor Healthcare (15 March, 2019) <MEDICATION ERROR IN NIGERIA: THE NEGATIVE ATTITUDE OF HEALTHCARE PRACTITIONERS TOWARDS IT – Monitor Healthcare> accessed 19 July 2022
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<An Overview of Medical Negligence in Nigeria and its legal implications (judy.legal)> accessed 21 July 2022
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 G. U. Pascal Iloh & others. op.cit
Interesting piece and very revealing.
Insightful and informative piece, Simi. As you have said, awareness is greatly important; knowledge in the place of the patient, and also professionalism in the place of the caregiver.
We’ll get there.
Insightful piece Simi. We can always be better.
Wao this is so detailed and informative 👌 👏 kudos let the awareness spread. Moreover does the law has any space for caregiver bcos the way humans (nigerian) see and understand things is quite different, in other to make a clear point of view, so that no body will enter hospital and start claiming right up and down every body has right and medical error does not say the person(caregiver) is bad because the rate of under staffing and renumeration of care givers is totally too bad in which the work load is like hell and d demand is cumbersome. More so the caregiver as not the only one involved in this while some times patients are involved because it is there health, so always try to be involve to make a good call, don’t judge with your grandparents view, medicine evolves everytime and don’t shift the blame to the hospital I think there’s still a lot more in the diary of medical errors to unravel and Nigeria health care system although people are coming to knowledge……. the rate of medical errors in Nigeria n developing countries is under report which some healthcare worker are seeing it the right (normal) thing which is wrong and way too high
Death is inevitable sha
This is interesting and informative one. Well done Ma’am! Lookijg forward for more of this piece
Well done Similoluwa this uncommon area of specialisation in Nigeria which we need to develop more
Interesting and educating
Quite precise and informative. Thanks Simi
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נערות ליווי תל אביב – את המפגשים השווים האלו אי אפשר לשכוח, פתאום באמצע החיים
מגיע נערת ליווי מתל אביב ומספקת את תשובת
התשובות- בילויים מדהימים ולוהטים עם בחורה מדהימה ושווה במיוחד.
Sitara – סיטארה סוויטת יוקרה פרטית – Sitara
– סוויטת יוקרה פרטית הממוקמת בגליל העליון במושב דלתון, מול נוף מדהים ועוצר נשימה, סוויטה יוקרתית לזוג בלבד עם בריכה צלולה,
גקוזי ספא, עיצוב יוקרתי ומרשים, למידע נוסף
היכנסו.. אם תחשבו על זה, כל מה שאתם צריכים בכדי להתפנק בעיסוי הוא לפנות בלוח הזמנים שלכם
שעה או שעתיים בלבד. לפני שיתחיל
כל טיפול של עיסוי מגבר לגבר בחולון,
המעסה, על פי בירור זה הוא יבנה תכנית טיפולים אשר תתאים לכם, ולכם בלבד.
הם מוצאים את הדברים החשובים ביותר- את הרוגע, אבל לא מתפשרים על הפרטיות שלהם.
איך מוצאים נערות ליווי באשקלון בתל-אביב צפון?
היו כנים ושקופים כבר במעמד השיחה – ספרו לאותה נערת ליווי למה אתם מזמינים את השירות שלה, למה אתם
מצפים והאם יש לכם דרישות מיוחדות ממנה.
לכן, אם יש לכם דרישות נוספות, כדאי שתוודאו כמה
הבחורה גובה עליהם ותכינו את סכום הכסף המתאים מראש.
אבל, אם יש לכם דרישות לגבי המראה שלהם, לגבי השירותים אותם היא מציעה,
או לגבי כל נושא אחר אשר קשור אליה או
לשירותים שלה, חשוב שתקפידו להזמין אותה מראש, מה שיאפשר לכם לבחור את הבחורה המתאימה ביותר ולוודא שהיא תהיה
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