ON MEDICAL NEGLIGENCE, BY KAMSA

Anyone who has lost a loved one in hospital knows that it is a most painful experience. I lost my own mother in a hospital, so I know. In my profession of communication, we have been taught that it’s no news if a dog bites a man; the news is when, and if, a man […]

Anyone who has lost a loved one in hospital knows that it is a most painful experience. I lost my own mother in a hospital, so I know. In my profession of communication, we have been taught that it’s no news if a dog bites a man; the news is when, and if, a man bites a dog! It so goes without saying that if hundreds of thousands of patients – day and boarding (or what they call outpatients and inpatients) – go to hospitals such as Aminu Kano Teaching Hospital of Bayero University, Kano (BUK?AKTH) and get healed, they are not usually reported; for that is what hospitals are, healing houses. True, once or twice a spectacular operation or procedure is hailed and some medical personnel celebrated, but the real news out of hospitals is when the unfortunate happens and, via an accident of omission or commission, a patient is lost. That gets attention, and it’s only natural because it is unnatural.
Many people have lost relatives at places they expect them to get well. Genuine mistakes may occur, but medical negligence is a major culprit. That is why I was impressed recently when the Kano State Medical Students Association (KAMSA) beamed the searchlight onto themselves and their teachers and professional colleagues at a Symposium titled “Professional Negligence Among Health Workers and Its Consequences” where the Association unveiled its Annual Journal. The Guest Lecturer was Dr. Shehu Muhammad Yusuf, an Associate Professor and Consultant Dermatologist (the branch of clinical medicine that deals with skin, hair and nail conditions) in BUK/AKTH. In the utilitarian tradition of this Column of bringing something useful to readers, your correspondent was there. The following are excerpts from Dr. Yusuf’s paper. Enjoy:
A professional is a person formally certified by a professional body of belonging to a specific profession by virtue of having completed a required course of study. A medical doctor is an example of such professional.  Therefore the expectation is that such a professional is sound in knowledge and skillful in his area of specialty. He should therefore be responsible and respectful. It is not expected that such a professional can knowingly cause harm to his patient either because of carelessness, recklessness or negligence.
Harm to a patient can occur from an act of commission or omission, or by malpractice. A medical professional is guilty if he performs his duties in a way that deviates from the accepted medical standard of care, causing injury or death, while malpractice on the other hand is an improper or unethical conduct by the professional.  According to the Supreme Court of Nigeria, “Negligence is lack of proper care and attention; careless behavior or conduct; a state of mind which is opposed to intention; the breach of duty of care imposed by common law and statute resulting in damage to the complainant.”
In spite of a high percentage of death rates in public hospitals, many of which may be attributable to professional negligence, one wonders why there are only a few reports of litigations by the relatives of such lost persons. For instance, only 92 petitions were filed during the period between 1963- 1999. The reason for this is not far-fetched – most of the patients who patronize the public hospitals are the less-privileged or the average Nigerians who are either poor or ignorant of the provision for litigation, or else they have mistrust and apathy for the courts, leading to lack of faith in the judicial process.
More so, religious belief in the fact that whatever befalls a person is classified as “Act of God” (and, for such calamities under discussion, “Kwana ya kare” – ‘his days have been exhausted’) has prevented many from reporting cases of negligence by medical professionals.  But with the dawn of the century, this trend is gradually changing. There is a steady growth of medico-legal awareness; for instance, there were a total of 190 litigations of professional negligence against medical professionals during the period between 2000 and 2007, compared to only 92 in the previous 36 years to the end of the last millennium. This has now signaled that the era of assumed immunity from liability by medical personnel is about to be over.
The health professional plays a major role in negligence – take an instance where a medical doctor who works in a government public hospital owns his private hospital or goes to several hospitals on locum. What do you expect will be the quality of care of patients in the public hospital where the doctor is always in a rush to attend to other patients in his private outfit? Malpractice or negligence can occur when there is a delay in the diagnosis or where the patient’s condition is misdiagnosed. Providing incorrect medication, choice of the wrong drug treatment or failure to refer for appropriate treatment are other factors. In addition, failure to ensure adequate sterilization or failure to spot the warning signs of infection and premature discharge of patients from hospital may contribute to suffering or death.
A medical practitioner who fails to listen and act on the complaint of complications made by a patient shall also be liable to negligence. By the same token, if a patient does not give consent to treatment which eventually results in injury or harm, it can also constitute a negligence. The system can also aid medical malpractice in a situation where clear policy and guidelines are lacking. Where there is inequitable distribution of healthcare facilities and where adequate and competent manpower is lacking or where there are inexperienced medical staff can all lead to medical negligence.
The policy of pay-before-service by some medical centres has resulted in fatalities as was recently circulated on the social media where a pregnant woman in labour died in front of a public hospital in an East African country because she could not put down money before treatment. That was a very despicable and condemnable act of medical negligence. Another pathetic story was that of the death of a doctor and a nurse who died after operating on a pregnant woman who had Lassa Fever simply because there was no personal protective equipment in the general hospital. A very sad, lamentable but preventable incident.
Professional negligence can significantly reduce if caregivers can endeavor to keep their professional knowledge and skills up to date and can regularly take part in activities that maintain and develop their competence and performance. Health professionals must recognize and work within the limits of their competence and refer a patient to another practitioner when this serves the patient’s needs. If a patient poses a risk to one’s health or safety, one should take all available steps to minimize the risk before providing treatment or making other suitable alternative arrangements. Of paramount importance, one must work collaboratively with colleagues, respecting their skills and contributions.
Government on its part should ensure that both private and public hospitals are    effectively monitored. Those hospitals under its care should be adequately funded, equipped and provided with competent and skilled manpower. Government should ensure that medical certifying bodies provide or show that the recipient of such certification have proven or demonstrated integrity, competence and professionalism in the medical profession.
At the end, there was a robust discussion by senior professionals such as Dr. Idris Abubakar, Professor Isa Abubakar, Dr. Sani Balarabe and other young medical practitioners. KAMSA JOURNAL was eruditely reviewed by Dr. Rabi’u Ahmad Rufa’i. What I took away from the event is the fact that professionals such as them do not sit down to look for defensive ways to ward off issues as medical negligence, but come together to frankly engage and discuss. Patients and relatives should be the better for it. May Allah save us from negligence, medical or otherwise.