University College Hospital (UCH), Ibadan

When is Medical Negligence?

On June 8, 2011, life ended for Olajuwura Amoo-Onidundu at the tragically young age of 29. Already a mother of a young daughter, the birth of her son the previous day should have been a joyful occasion. Instead, less than 24 hours later, it heralded her journey into the hereafter. The family accuses the University College Hospital (UCH), Ibadan where she delivered the baby, of medical negligence.

From its halcyon days and glorious height of being the best, in fact the premier, Teaching Hospital in Nigeria, the West African sub-region and beyond (it was once rated 4th in the Common Wealth) upon inception in 1952, the hospital, like other Teaching Hospitals in Nigeria, gradually went into decline as funding dried up. Qualitative healthcare delivery was simply not, and is still not, a priority of successive governments.

The question is:  were they negligent?

When is medical negligence? Asks FUNKE ABOYADE who was at Ibadan on July 15 to speak with Juwura’s family…

UCH declined to speak with THISDAY LAWYER (see overleaf)

The End and the Beginning…

It’s Friday evening, just before dusk, at the Adedeji residence at the Agodi area of Ibadan. In the corner of the sitting room, the crying of a waking baby in an otherwise tranquil environment startles this writer who has just arrived. She’d noticed the cot on arrival but hadn’t realised a baby was in it, so engrossed was she in the depressing task ahead. Immediately, three young ladies rush out from different directions - but oddly, as one - to attend to Titobioluwa Oluwadamisi and fuss over him. At once a house of sorrow and a house of joy, one of the many painful ironies of life…

At five weeks, Titobioluwa is growing well and clearly does not lack care, love and attention. His biological mother’s love is what he will never experience though. 29 year old Olajuwura Ohiseneme Amoo-Onidundu passed on the day after she gave birth to him. Olajuwura… loving wife of Banji, doting mother of Titoluwani, expectant mother of Titobioluwa, devoted daughter of Bunmi and Olohigbe Adedeji, adored sister of eight siblings – three of whom the writer had just met in a dramatic fashion earlier.

Titobioluwa, well fed and attended to, lies cooing in his cot then gradually drifts into sleep, blissfully unaware of the tragedy that had befallen his family just weeks earlier.

Their Story…

Juwura’s sisters – twins, 27 year old Jesutomiwo and Jesutomipe, both Medical Doctors and 26 year old Olugbemi, a lawyer – together with their brother-in-law, Juwura’s husband, 34 year old Banji, a Chartered Accountant, settle down for the interview. Their aged parents sit in another corner of the sitting room, quietly chatting with a visitor who has come to check their wellbeing.

Juwura, the fourth of nine children born to Arc. Bunmi and Dr. Olohigbe Adedeji, was a daughter any parent would be proud of. Graduating in Architecture as the best graduating student from the Obafemi Awolowo University in 2007 with grades only once before achieved in her Faculty, she cleared four prizes. She settled down the same year, on December 1, 2007, to marry her heartthrob, Banji, whom she’d met at the University and who had studied Accounting.

‘Our marriage was very pleasant all through’ he says, savouring the memories, ‘we never quarrelled, and if we did we settled it the next day’.

Born on Christmas Eve, 1981 at University College Hospital (UCH), Ibadan Juwura ironically passed away at the same hospital on June 8, 2011 after giving birth to her second child, Titobioluwa. Her first, Toluwani, a girl was also born at UCH.

Even the Fates Conspired…

Though she lived in Lagos with her husband, various factors conspired to ensure they took the decision to have her deliver at UCH. For one, Juwura was born at UCH. For another, her older sister, Oludunni, had earlier this year had a still birth. Her family blamed the private hospital in Lagos where she’d received her ante-natal care, for their nonchalant, even cavalier, attitude. It was an avoidable loss and she’d had to be rushed down to UCH to have the dead baby evacuated. There, accompanied by some of her Medical Doctor siblings, she’d received good care. Juwura who was also pregnant and had similarly registered for her ante-natal care at a private hospital in Lagos got worried – more so as she’d had her first baby, Toluwani, at UCH. It had been a long and hazardous labour, with the baby going into foetal distress, but she was safely delivered of her by Caesarean section in October, 2008.

‘The consultants made meaningful contributions and she received good care generally.’ recalls Tomiwo, ‘That’s why we were comfortable with her coming back to UCH’.

 And so it was easy to come to the decision to come down to Ibadan where her parents lived to have her second baby, as she’d done the first.

Promises, Promises…

Because of the difficulties which accompanied her first delivery Juwura desired an elective Caesarean but was discouraged by the doctors at UCH.

‘They advised a VBAC (Vaginal Birth After Caesarean Section)’ says Tomiwo. ‘The West African College of Surgeons wanted her to come as a kind of examination guinea pig and promised to supervise the birth. They also promised her an epidural if she had the VBAC’.

She came for their examination but, according to Tomiwo, the West African College of Surgeons did not fulfil their side of the bargain. She barely saw the consultant assigned to her throughout her pregnancy, they allege.

Tomiwo and Tomipe give detailed medical insight into Juwura’s medical history. The doctors, having subsequently diagnosed ‘unstable lie at term’, agreed it was an indication for a Caesarean Section. She was admitted into the hospital on June 6 and went in for the CS on June 7.

‘We’re not sure if the CS was supervised but she mentioned the doctor’s name after the operation. Because we’d been in the system for a year we knew he was a Registrar. If so, he should have been supervised by a Senior Registrar. She told us the Senior Registrar only ran in when complications arose’.

Before the surgery, her family was told to buy surgical supplies, an attestation to the poor state of the nation’s health care delivery system. For instance, according to Banji, he was asked ‘to buy a spina and connector, which they should ordinarily have. It’s for injecting anaesthesia’.

The Waiting Game…

Juwura was wheeled into surgery about 9.00 am, with Olugbemi, their mother, Olohigbe and Juwura’s husband, Banji, arriving the hospital at 6.30 am. It was a long and anxious wait for they did not hear anything for a very long time. She did not emerge till 3.00pm. In the interim, another pregnant patient had been wheeled in for surgery and delivered of her baby in short order. The family began to worry. A normal CS takes an average of only 45 minutes.

Luckily, Olugbemi who had studied law, also at Obafemi Awolowo University, saw a friend who had studied Medicine there at about the same period and was now a Houseman at UCH. She it was who went in to check the reason for the interminable wait and came back to advise the family to buy pentastarch, a blood supplement, as Juwura had lost a lot of blood. They were also told she needed to do a histology and given a tissue sample to take to the lab.

‘Then a slim woman came in, saying she needed to scrub because a patient was in trouble. I knew it was my sister since she had gone in first for surgery that day. The baby was delivered two and a half hours after she was wheeled in’, recalls Olugbemi.

Banji, worried about the sudden activity, asked one of the doctors what was happening but was assured there was no problem. ‘I was becoming very nervous because I saw them going in and out’.

He was asked to buy three pints of blood. ‘The doctor went with me to the blood bank; I could see he was very nervous’.

A card was attached to the tissue sample Banji was asked to take to the lab. He noted the medical jargon and told Olugbemi who in turn called Tomiwo. The doctors, it appeared, had erroneously cut Juwura’s fallopian tube.

A Wife’s Dying Words…

Juwura who had been conscious for the CS, having been given an epidural, was eventually put fully under - if a crisis can upset the patient they will put her under. When she came to she requested that her husband kiss her. He obliged. She then asked him to come closer, she had something to say. Her left fallopian tube had been removed, she told him. She had also, it seemed, left her body when she was put under, when the crisis began. Juwura had had an out of body experience.

Banji approached one of the Doctors to ask why they had taken out his wife’s fallopian tube without consulting any family member.

‘He admitted the tube had been injured and if they sewed it, it could result in an ectopic pregnancy.

‘At that time I lost faith in the system. If they could cut off her fallopian tube without telling me, it meant they could do anything. We would never have known if she hadn’t been conscious’.

By evening his wife was in great pain and her blood pressure dangerously low.

‘I was there throughout the night’ recalls Banji, ‘I took it upon myself to give her her pain reliever every four hours, because I’d lost faith in the system.’

The following day his wife asked for her phone and, rather unusually, began to call everyone – her mother, her colleagues, her sisters, et cetera. Tellingly, she also left names for the baby – Titobioluwa Oluwadamisi.

The Downward Spiral…

The twins continue the narration, ‘Before surgery her PCV was 37, after surgery the same day it was 22. By the next day it was 20. We were wondering: if the PCV was dropping, could she still be bleeding?’

She was also looking pale. Deathly pale.

Banji was asked to take her PCV sample to the lab but PHCN had struck. The sample went bad so he had to take another sample hours later.

Deadly Games…

He was also told to pay for another two pints of blood. The blood bank was within the hospital.

‘When they brought out the blood the first thing that struck me was the expiry date of the blood – it was about to expire’ he says. However, he kept his peace. He’d already had some run-ins with the staff at the blood bank and, according to him, ‘I didn’t want them to think I was becoming ‘too know’ so I didn’t say anything’.

By now his wife’s PCV had dropped to 17. The doctor accompanied Banji to the blood bank.

‘He was becoming restless and wanted the process to be fast so he went with me’ he recalls.

However, the blood bank staff had other things in mind.

‘They signalled to me to wait behind and talk to them when the doctor left but I pretended I didn’t see them. But one of them ran after me, claiming they wanted to help me and that they could ensure I paid less.

‘At that point money meant nothing to me; I just wanted my wife to be well. So I looked him in the eye and told him that the only way he could help me was to give me the correct bill.

‘They were trying to delay the process to make me pay less’ recalls Banji, clearly incredulous.

He refused to play ball. He paid dearly.

Frazzled…

Run off his feet all day, his wife persuaded him to take a break and go and eat. He’d hardly settled down to his food when he received a frantic call he will never forget. It was a call that sent chills down his spine. It was Juwura. ‘Banji! Ma bo! Mabo nisiyin!’ (Banji! Come! Come quickly!). He ran straight up four flights of stairs without pausing once.

He arrived in time to see the doctors remove the anti-shock vest which she’d been wrapped in after surgery. Frantic, he began to cry.

The weeping husband was told she was reacting to the blood. Transfusion was also stopped immediately.

Her Last Moments…

Tomiwo takes over the narration, ‘Usually, the protocol for removing anti-shock takes at least 75 minutes, but they took it off anyhow’.

Juwura was by now gasping and had to be rushed back to theatre to stabilise her. Tomiwo was allowed in by a colleague. Her sister’s vital signs were unstable, she was breathing fast and was on oxygen from the previous day. It wasn’t looking good. She could only speak with her and pray for her, to keep her sister calm.

It took the haematology team an hour to arrive, she alleges.

‘From theatre she went to ICU (Intensive Care Unit). Clinically, she was what we call “paper white”.

The Doctor in Red…

Despite this desperate state of affairs, they allege, the Senior Registrar (name withheld) sat, unmoved, at the Nurses Bay refusing to scrub or even remove her red high heeled shoes.

‘She insisted on the protocol of cross-matching even though the Obstetrician Registrar (name withheld) told her the patient was too clinically unstable to delay any further and the blood had been cross-matched for an hour, though not the full two’ recall the twins.

By then, the frantic husband had forced his way into ICU, entreating his wife to wait and not leave him. She was still breathing, but it was laboured.

‘They didn’t have bed sheets in ICU, they asked Tomiwo to bring a wrapper to cover her!’

The Red Herring…

At that point they were all ordered out and for the next one hour were told nothing. At a point they were asked to go and buy surgical gloves and other such things, one after the other, but they later discovered they’d been sent on a wild goose chase. By 9.00 pm Juwura had died and the doctors were in a quandary about how to inform them. It took another Medical Doctor colleague who was acquainted with the twins to go in and compel the doctors to tell the family what had happened.

Her primary cause of death was listed as haemoperitorium, whilst the secondary cause was said to be hypovolemic shock. She had lost half her blood.

‘They cut an artery during the CS and should have called in a Vascular Surgeon, instead the gynaecologist repaired it’ they allege.

A Slap in the Face

Tomipe’s words ring out, ‘It’s just like a slap that our profession did this! Our older sister (who’d had the still birth) got the best of care because we were there. If we had been on ground – but we were not as we would have risked extension of our NYSC year – they wouldn’t have done this! I feel dehumanised!

‘What hope is there for an average Nigerian who does not know anyone?

‘What we were trying to avoid is what happened! In supposedly the best place in Nigeria! I still cry and cry!’

For Tomiwo, ‘Our dad knows a lot of people in UCH and is also on the board of UCh Chapel. Because they came like every other person and trusted she was in good hands?’

‘Now we are asking questions and the hospital is saying we are rushing things?’ wonders Tomipe.

It is one of the cruel ironies of fate that four of Juwura’s siblings are Medical Doctors, but none could save her when it mattered most. Clearly, the irony is not lost on them.

Sadness and Joy…

Titoluwani, a boisterous two year old, comes bounding in, her slippers lost in transit somewhere. She’s still too young to understand that mummy is never coming back. Titotbioluwa gurgles contentedly in his sleep. He will never know his mother.

His naming ceremony took place on June 14 exactly one week after his birth and he was given the names left behind by his mother - a concession to the unusual circumstances, as traditionally in Yorubaland fathers name their children. On June 16, two days after his naming ceremony, his mother was committed to mother earth.

There’s hardly a dry eye in the room...

Tomorrow, August 10 Banji turns 35. It will be his first birthday without his beloved wife and mother of his children. It will also be yet another test of his stoic-ness in the face of this immeasurable tragedy…

The Question Again…

So, when is medical negligence?