INTRODUCTION
In Nigeria's dynamic corporate landscape, professional negligence remains a critical issue that undermines trust, operational efficiency, and public welfare. The corporate world encompasses a broad spectrum of organisations, including private and public companies, partnerships, and institutions engaged in commercial or service-oriented activities. A company, as defined under the Companies and Allied Matters Act (CAMA) 2020, is a legal entity formed and registered to conduct business or provide services, often with a profit motive or public service objective.
Professional negligence occurs when individuals or entities within these organisations fail to exercise the standard of care expected in their field, resulting in harm or loss. While this phenomenon spans various sectors, finance, construction, and legal services, this article narrows its focus to medical negligence within Nigeria's largest hospitals and medical companies, where lapses can have life-altering consequences.
By examining the layers of negligence in these institutions and the legal framework governing them, this article highlights systemic challenges, judicial precedents, statutory provisions shaping accountability in Nigeria's healthcare sector, and recommendations to improve accountability and curb medical negligence in Nigeria's healthcare sector.
PROFESSIONAL NEGLIGENCE IN THE CORPORATE WORLD: A GENERAL OVERVIEW
Professional negligence in Nigeria's corporate world manifests across industries, from financial mismanagement in banks to engineering flaws in construction firms. It involves a breach of duty by professionals, whose actions fall below the standard expected of their peers, causing damage to clients or stakeholders. In the corporate context, negligence often stems from inadequate oversight, poor training, or systemic inefficiencies. For instance, a company's failure to implement robust internal controls may lead to fraudulent financial reporting, exposing it to legal and reputational risks. However, in no sector is professional negligence more consequential than in healthcare, where hospitals and medical companies operate as corporate entities with a heightened duty of care. The consequences of negligence in this sector, for instance, misdiagnosis, surgical errors and delayed treatment, can result in irreversible harm, making it a focal point for legal and regulatory scrutiny.
MEDICAL NEGLIGENCE IN NIGERIA'S HEALTH CARE SYSTEM
Nigeria's largest hospitals are pivotal to the nation's healthcare delivery. These institutions, often structured as corporate entities, employ thousands of professionals and serve millions of patients annually. However, they face systemic challenges, including understaffing, outdated equipment, and inadequate training, which contribute to medical negligence.
Medical negligence is defined as the failure of a healthcare professional to exercise reasonable care, resulting in harm to a patient. Common instances include incorrect diagnoses, failure to attend promptly to emergencies, and surgical errors. For example, in University of Nigeria Teaching Hospital Management Board & Ors v. Hope Nnoli (1994) 8 NWLR Pt.363 – 376, the court held that administering the wrong medication constituted negligence, emphasising the hospital's vicarious liability for its staff's actions. Similarly, in Ibokwe v. University College Hospital Board of Management (1961) W.N.L.R. 173, a nurse was instructed to keep watch over the deceased patient who, after childbirth, had suspected psychosis, but the former failed to do so. The patient jumped down from the fourth floor of the hospital and died. The court held that the hospital was liable for the negligent acts of its employees under the principle of vicarious liability, reinforcing corporate accountability.
The layers of negligence in these institutions are multifaceted. At the operational level, individual practitioners may err due to incompetence or fatigue. At the corporate level, hospital management often fails to enforce compliance with professional standards or invest in modern infrastructure. For instance, a 2024 study noted that 33.3% of Nigerian patients reported additional injuries due to medical treatment, highlighting systemic deficiencies. These issues are compounded by a lack of public awareness, poverty, and reluctance to pursue legal redress, which allows negligence to persist unchecked.
On May 14, 2021, prompted by a letter from Dr. Olisa Agbakoba SAN, senior partner at Olisa Agbakoba Legal, a coroner's inquest (Suit No. COR/APO/003/2021) was convened to investigate the circumstances surrounding the death of Mrs. Adepeju Ugboma. Her husband alleged that her death resulted from questionable circumstances and negligence by the medical staff at Premier Specialist Medical Centre. On April 25, 2021, the 41-year-old passed away at Evercare Hospital, Lagos, following a hysterectomy for fibroids performed at Premier Specialist Medical Centre. After the procedure, she experienced severe abdominal pain and low blood pressure, leading to her admission to the ICU, where her condition continued to deteriorate. Transferred to Evercare Hospital for specialised care, she arrived without a pulse, and resuscitation efforts failed. The coroner determined that Premier Specialist Medical Centre breached its duty of care to the deceased, holding the hospital vicariously liable for the negligence of its medical staff.
LEGAL FRAMEWORK GOVERNING MEDICAL NEGLIGENCE
The legal framework for addressing medical negligence in Nigeria is robust yet underutilised. The Medical and Dental Practitioners Act (MDPA) 2004 is the primary legislation regulating medical practice, establishing the Medical and Dental Council of Nigeria (MDCN). The MDCN enforces the Code of Medical Ethics in Nigeria (2008), which outlines professional standards and defines negligence, such as failure to promptly attend to a patient or making an incorrect diagnosis when clinical signs are evident. Violations may lead to sanctions, including suspension or deregistration. Additionally, the National Health Act 2014 reinforces patients' rights to quality care, while the Criminal Code Act 2004 criminalises reckless negligence causing harm, with penalties up to one year's imprisonment.
The Act also established the Medical and Dental Practitioners Investigating Panel & the Medical and Dental Practitioners Disciplinary Tribunal. The Panel is charged with carrying out preliminary investigations of any allegation of infamous conduct in professional respect made against a medical practitioner, and where such allegations have merit, the Panel forwards the case to the Tribunal for trial.
Judicial precedents further shape the legal landscape. In Bolam v. Friern Hospital Management Committee (1957) 2 All England Reports 118 at 122, adopted in Nigeria, the court established the "Bolam Test," stating that a medical professional is not negligent if their actions align with practices accepted by a responsible body of medical opinion. However, in Chin Keow v. Government of Malaysia (1964) 30 M.L.J. 322, failure to inquire about a patient's medical history led to liability, underscoring the need for due diligence. In Nigeria, the doctrine of res ipsa loquitur, meaning "the thing speaks for itself," aids plaintiffs in proving negligence when the harm implies a breach, as seen in Mahon v. Osborne (1939) 1 All ER 535, where leaving cotton wool in a patient's abdomen post-surgery warranted liability.
Despite these frameworks, challenges persist. Proving causation is difficult, especially with pre-existing conditions, and securing expert witnesses is hindered by professional reluctance to testify against peers. Moreover, cultural attitudes and poverty deter litigation, resulting in underreported cases.
RECOMMENDATIONS TO IMPROVE THE LEGAL FRAMEWORK GOVERNING MEDICAL NEGLIGENCE
- The Medical and Dental Practitioners Investigating Panel and the Medical and Dental Practitioners Disciplinary Tribunal should be led by specialised personnel possessing the necessary expertise and knowledge to effectively carry out their responsibilities.
- The Code of Ethics for medical practitioners in Nigeria should be reviewed to include stricter penalties for negligence and breaches of the duty of care to patients.
- Government agencies should increase public awareness campaigns about patients' rights in cases of medical negligence.
- Expansion of funding beyond government facilities by the state government; The state government could assist private hospitals within their domain in sourcing repayable funds for critical equipment, enabling them to provide better services to citizens.
- Adopt International Standards: Incorporate frameworks like the World Health Organisation's patient safety guidelines into Nigerian law to align with global standards.
- Mandatory Licensing and Accreditation: Enforce stricter licensing requirements for healthcare facilities, ensuring compliance with minimum standards for equipment, staffing, and protocols. Regular audits of hospitals like Premier Specialist Medical Centre could prevent substandard care.
- Continuous Professional Development: Mandate ongoing training for medical professionals to keep pace with advancements in medical practice and reduce errors due to outdated knowledge or skills.
- Streamline Coroner's Inquests: Reform the coroner system to expedite inquests into suspicious deaths, with clear timelines and mandatory reporting of findings to relevant regulatory bodies.
- Mandatory Incident Reporting: Require healthcare facilities to report adverse incidents, such as post-surgical complications, to a national database overseen by the MDCN or the Federal Ministry of Health. This would enable tracking of systemic issues and improve accountability.
- Patient Safety Standards: Develop and enforce national patient safety guidelines, including protocols for post-operative care, to prevent cases where severe complications were not adequately managed.
- Whistleblower Protections: Protect healthcare workers who report negligence or unsafe practices within their institutions, fostering a culture of transparency.
CONCLUSION
Medical negligence in Nigeria's largest hospitals and medical companies reflects broader corporate governance failures, exacerbated by systemic healthcare challenges. While the legal framework, which comprises the MDPA, National Health Act, and judicial precedents, provides avenues for redress, its effectiveness is limited by enforcement gaps and societal barriers. To address this, hospitals must invest in staff training, modern equipment, and robust compliance systems. Regulatory bodies like the MDCN should enhance oversight and transparency in disciplinary processes. Additionally, public awareness campaigns can empower patients to assert their rights. By fostering accountability and systemic reform, Nigeria's healthcare sector can rebuild public trust and align with global standards, ensuring that corporate entities prioritise lives over liabilities.
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