Authored By: FARINDE Ayomide Abidemi
ABSTRACT.
Medical negligence remains a pressing challenge in Nigeria, worsened by the realities of an under-sourced healthcare system characterized by poor infrastructure, limited funding, inadequate staffing, talent flight, and outdated technology. This article interrogates the balance between care and legal consequences in the medical profession, with particular attention to whether the standard of care should be adjusted to reflect local realities. Drawing from judicial precedents such as Donoghue v. Stevenson, Edward Okwejiminor v. G. Gbakeji and Nigerian Bottling Co ltd. and Bolam v. Friern Hospital Management Committee, this article outlines the core elements of medical negligence that is: duty of care, breach of duty, and resultant harm. While situating these within Nigeria’s socio-economic and legal context. It highlights the regulatory framework provided by the Medical and Dental Practitioners Act, the Code of Medical Ethics, and the National Health Insurance Scheme Act as mechanisms for accountability. The article further examines systemic deficiencies, including government negligence, brain drain, and cultural factors, which directly influence healthcare delivery and malpractice claims. This article argues for a context-sensitive standard of care that does not absolve practitioners of responsibility but considers resource limitations and the realities of emergency improvisation in underserved settings. Recommendations are made for judicial sensitivity, improved government investment, and the adoption of alternative dispute resolution to protect both patients’ rights and practitioners’ integrity.
INTRODUCTION.
Currently in Nigeria, there is incessant increase in the level of medical negligence and this is as a result of the under-sourced healthcare systems, that is , limited technology resources, poor infrastructure, low funding and low staffing mostly due to talent flight. These are the major causes of medical negligence in Nigeria and can be traced to the bad system of government and poor economic situation. Medical negligence undermines the right to life of Nigerians and should not be swept away. Currently, there are lots of reports on social media and newspapers of harms incurred by patients as a result of the negligent care provided by medical practitioners1. This essay focuses on the balancing of care and consequences in the Healthcare Profession. It also answers the question on whether or not the standard of care in medical negligence be adjusted to reflect the local realities in under-sourced healthcare systems.
Medical practitioners have the responsibility of performing their task which is basically the dealing with the health of their patients with care so that it doesn’t result in any injury or fatalities. A professional is a person who possesses specialist skills acquired by intellectual and practical training. Medical practitioners are regarded as professional.
In Nigeria, healthcare delivery is severely constrained in many rural and semi-urban areas due to infrastructural deficits, limited manpower, and uneven resource distribution. This article critically evaluates whether the standard of care in medical negligence should be adjusted to reflect these local realities, drawing on judicial reasoning and policy considerations within the Nigerian context. It argues for a cautious contextualization of the standard, without undermining patient rights or lowering expectations to the point of injustice.
OVERVIEW OF MEDICAL NEGLIGENCE.
Medical Negligence is hinged on the tortious principle of negligence as propounded by Lord Atkin in the 1932 case of Donoghue V. Stevenson2.
Medical negligence can be defined as the act or omission which falls below the accepted standard of care expected of a medical practitioner resulting in injury or death of the patient. The case established a general duty to take reasonable care to avoid foreseeable injury to another and thus, to establish a case in negligence, it must be shown that a duty of care was owed; there had been a breach of that duty; and that damage or injury was suffered as a direct result of a breach of the duty owed. In medical negligence and going by the definition above, medical practitioners who undertake the care and treatment of patients owe a duty of care to such patients. It should be noted that acts which constitute negligence need to be proven with evidence or proof of damage.
ELEMENTS OF MEDICAL NEGLIGENCE.
In order to establish medical negligence, a plaintiff must prove the following three general conditions in order to succeed in an action of negligence against a medical practitioner; (a) That the doctor owed the patient a duty to use reasonable care in treating him or her. (b) That the doctor failed to exercise such care, that is, he was in breach of that duty. (c) That the harm which the patient complained of was caused by that breach of duty
Duty of Care.
A medical practitioner can only be held liable for negligence when there is an established relationship between him and the patient, hence if this is proven, a duty of care is established. Negligence occurs where a general duty of care arises and there is a failure to take a precaution by reason of which damage occurs3. Where a medical practitioner observes the required duty of care, he will not be liable. A duty of care is necessarily implied when a patient is registered and being treated in a hospital. Duty of Care can be seen in the case of Edward Okwejiminor v. G. Gbakeji and Nigerian Bottling Co ltd4, the Supreme Court after taking a magisterial analysis of the appeal affirmed that there was a duty of care imposed on the respondents to the appellant by law, the breach of which entitled the appellant to reparation from the respondent even in the absence of a clearly defined privity of contract Nexus between them.
Breach of Duty.
After duty of care has been established, the next line of action is to ascertain that the duty has been breached, that is, the medical practitioner has failed to discharge the duty of care. The plaintiff has the duty to prove those acts or omissions that he claims amounts to negligence5. A breach of duty is established where a medical practitioner’s actions have failed to meet an appropriate professional standard. In the case of Bolam V. Friern Hospital Management Committee, the court was of the view that it suffices, if a doctor acted in accordance with a practice that was considered acceptable by a responsible body of doctors6.
A junior doctor’s obedience to manifestly wrong instruction given by a superior may be construed against the junior doctor as negligence. This is obviously because the junior doctor is deemed to have been in a position to reasonably foresee that harm or injury will be caused. The operative word here is ‘manifestly’ wrong. Ordinarily, where specific instructions are given to a junior doctor by his consultant, he ought not to depart from such instructions and departure must be reasonably justifiable. In cases where a junior doctor chooses to depart from his superior’s instruction, without reasonable justification, he will be solely held liable if his actions resulted in negligence. His superior may only be liable vicariously where negligence can be established on his part as a result of not giving adequate supervision to his junior.
Damage/Injury Suffered.
After it has been proven that a legal practitioner has breached his duty of care, it must also be proven by sufficient evidence that the patient has sustained injury, casualty or damage as a result of the breach. The fact that the Claimant’s injury was caused by the medical practitioner is crucial to establish negligence. However, if the plaintiff is injured by a physician’s procedure, but it is not clear that the physician was negligent, then there is no malpractice.
LEGAL FRAMEWORK OF MEDICAL NEGLIGENCE IN NIGERIA. The Medical and Dental Practitioners Act33 established the Disciplinary Tribunal and charged them with the duty of considering and determining any case referred to it. According to section 16 of the Medical and Dental Practitioners Act, where a medical practitioner has been found guilty of a misconduct that is incompatible with the status of his profession, the tribunal shall either admonish the practitioner; suspend him from medical practice for a period not exceeding six months or strike his name off the relevant register7.
Also, the Code of Medical Ethics36, which is the Code of Conduct for the practice of the medical profession in Nigeria, states that when a doctor is found guilty of a recurrent professional negligence he or she shall be suspended from practice for a period not less than six months. His name could also be struck off the register if he has been habitually negligent.
Furthermore, section 26 of the National Health Insurance Scheme (NHIS) Act establishes arbitration boards for each state of the federation and the Federal Capital Territory with the responsibility of considering complaints made by an aggrieved party against an organization or health care provider.
Local Realities in Under-sourced Healthcare Systems.
Local Realities in Under-sourced Healthcare Systems” refers to the actual challenges faced by healthcare providers and patients in regions where medical resources, that is, human, material, infrastructural, and financial are insufficient to meet healthcare needs. In Nigeria, this often includes but not limited to the following;
- Poor Infrastructure: This includes health facilities with poor electricity, water supply and access to necessary facilities. This often contributes to medical negligence.
- Scarcely Trained Manpower: As a result of the poor economic situation of Nigeria, the medical profession now experiences talent flight or brain drain, this however contributes greatly to medical negligence as a result of inadequate staffing.
- Limited Medical Supplies and Equipment: Lack of adequate medical supplies, dependence on manual methods instead of advanced medical technology and the use of outdated equipment are the major causes of medical negligence in under-sourced healthcare systems.
- Cultural and Educational Factors: The low level of health literacy affects patient compliance and timely healthcare service. The cultural preferences for traditional medicine, sometimes delaying effective treatment.
- Government negligence: Yes, negligence is not only limited to the medical profession alone but also falls on the part of the government. When the government shows a lackadaisical attitude towards the needs of the healthcare profession, this leads to a lot of calamities which is often tagged as medical negligence.
Recommendation.
There’s an obvious disparity in the under-sourced and well sourced health care system. However, should the standard of care be the same? Or should it be adjusted to reflect local realities in the under-sourced healthcare? Yes. The answer is yes because the access to resources and manpower of these two health care resources are different. The standard of care in the Under-sourced Healthcare Systems should be adjusted to reflect local realities.
One approach could involve developing a context-sensitive standard not to lower expectations arbitrarily, but to assess whether the practitioner did what a reasonable counterpart would have done in similar circumstances. This would require courts to consider:
- 1.The availability of medical resources.
- The level of training and support for the practitioner.
- Whether the practitioner followed any local protocols or improvised responsibly in emergencies.
The government should also improve the health care systems of Nigeria in order to improve the standard of service and mitigate medical negligence. Modern technological tools and machinery are to be provided by the government in the public medical centers and also the private hospitals should be checked and scrutinized often in order to ensure that they meet the requirements needed for establishing a medical center; the ministry of health in Nigeria should also make sure that qualified and competent manpower should are employed and there should be specialization.
CONCLUSION.
In determining the issue of medical negligence, the availability of resources, both equipment and manpower should be considered. There should also be an alternative Dispute Resolution for patients. The government also should invest more in the healthcare system so as to improve the service and the medical practitioners should be more accountable. However, they can’t be held accountable for medical negligence when the fault is for the government. The legal practitioners should also protect the rights of medical practitioners and patients. By implementing these suggestions, medical negligence will be mitigated Ultimately, adopting a nuanced, context-sensitive approach to the standard of care grounded in local realities and supported by strong regulatory oversight offers the most balanced path forward for justice in medical negligence claims in Nigeria.
Bibliography.
Bisola Ogundare, Medical Negligence in Nigeria.
I.A. Adejumo, Law and Medicine Lecture Note.
O.O. Olusegun, Resolving medical negligence claims in Nigeria through ADR Mechanisms I.A. Adejumo and O.O. Olusegun, Law and Medicine.
Nigeria Weekly Law Reports
1 Bisola Ogundare, Medical Negligence in Nigeria: A Quick Guide on Liabilities and Remedies, accessed at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3476524
2 O.A Adejumo, Law and Medicine Lecture Note, “Medical Negligence”.
3 Clark v Maclennan [1983] 1 ALL ER 416 at 427
4 Okwejiminor v. Gbakeji (2008) 5 NWLR (Pt. 1079) 172 (SC)
5 Ashcroft v Mersey [1983] 2 All ER 245
6 Also upheld by the Nigerian Supreme Court in Okonkwo V. MDPRT (1999) 6 NMLR PT 7867 Sec 16(1) and (2), Medical and Dental Practitioner‟s Act
