Right of Reply: The column for Readers who feel strongly about issues expressed by the Advocate, and have a view point. 

Justice Beyond the Body: Correcting Statements in Onikepo Braithwaite’s Article; ‘Baby Nkanu: Negligence or Meningitis?’

This article by Thaddeus Idenyi is a Rejoinder to Onikepo Braithwaite’s Article of 20/1/2026, “Baby Nkanu: Negligence or Meningitis?”. He accuses Onikepo Braithwaite’s article of being inaccurate, insisting that it is possible to determine the cause of Nkanu’s death with medical records and no autopsy. He also appears to conclude without adequate proof, and without input from Euracare, that Baby Nkanu died from Propofol Infusion Syndrome, elaborately educating Readers on the effects of an overdose of Propofol

Introduction

The death of Master Nkanu Adichie-Esege, is a tragedy that pierces the conscience of our nation. Yet, tragedy must not be compounded by inaccuracy. In her article published in Thisday Lawyer on Tuesday, 20th January, 2026, Onikepo Braithwaite suggested that determining if Nkanu died from a Propofol overdose, requires proof from an autopsy and without a postmortem examination, the cause of death cannot be proved. This rejoinder is written to correct those misstatements of law and medicine.

As will be clearly demonstrated, the law does not abandon truth because an autopsy or postmortem report is absent.

The Law Beyond the Body

The position of the law has always remained settled to the effect that, in the interpretation of statutes the entire provisions must be read holistically and not in isolated fragments. See the cases of Council of Legal Education v AMU (2025) LPELR-81723(CA), Onyejegbu & Anor v Ezeude & Ors (2022) LPELR-59150(CA) and Minister of Education & Ors v Mafara (2024) LPELR-62557(CA). If the provisions of the Coroners System Law of Lagos State, 2007 have been read as a whole, the submissions of Braithwaite would have been different. Why do we say so?

Whilst it is clearly evident as cited by Braithwaite that by the provisions of Section 48(1) of the Coroners Systems Law of Lagos State, 2007, requires the approval of a Coroner before chemical preservation of the body of a person who died in circumstances requiring an inquest can be undertaken, that provision neither suggests nor prescribes that an inquest cannot be undertaken where the body has been either or completely destroyed or cremated as in the instant case.

In fact, the Coroners Systems Law of Lagos State envisages this situation perfectly, as it is understood that there may be cases where the body will no longer be present as at the time of an inquest thus, it is provided in Section  21 of the law as follows;“Where a Coroner has reason to believe that a death has occurred within his District and in such circumstances that an inquest should be held, he may hold an inquest regarding the death if he considers it necessary, notwithstanding the:

(a) total destruction or partial destruction of the body by fire or any other cause, an inquest cannot be held except by virtue of the provisions of this Section;

(b) fact that the body is lying in a place from which it cannot be recovered.

Provided that the law relating to inquest shall apply with such modifications as may be necessary on or after a medical examination of the body found within the Coroner’s District”.

This provision anticipates precisely the situation at hand: where grief, cultural choice, or circumstance results in burial or cremation, the law still insists that inquiry can still proceed. To suggest otherwise and allege

crime in the burial of the deceased child, is to mislead the public and weaponise grief against mourning parents.

At any rate, the Nigerian courts have consistently affirmed that cause of death can be established without autopsy. For example, in Ado v State (2019) LPELR-50964(CA), it was held by the Appellate Court that: “With regard to the submission that the lower Court could only have established the cause of death through the autopsy report of a medical doctor, it is now fully established that where there are other evidence upon which the cause of death can be inferred, it is not vital to resort to a medical report. A Court can in the absence of a medical report, properly infer the cause of death from the evidence and the circumstances of the case.” See similarly the decision of the Supreme Court in Muhammad v State (2017) LPELR-42098(SC), where it was observed that: “…where the cause of death is obvious, medical evidence ceases to be of any practical or legal necessity in homicide cases. Such a situation arises where death is instantaneous or nearly so”.

Those decisions were in fact, in cases of culpable homicide where proof beyond reasonable doubt is required, and not even in an inquisitorial proceeding or a matter relating to medical negligence which may or may lead to criminal proceedings but bolster a civil claim for damages.The jurisprudence is thus, clear: law does not insist on ritual where reason suffices.

Clinical Records as Evidence

What is more? Autopsy, though a valuable tool, is not the sole path to truth. In paediatric care, clinical protocols and contemporaneous records often provide more reliable evidence than postmortem tissue, depending on the particular case. In this case where a propofol overdose is alleged to have accelerated death, there is available literature which clearly indicate that one of the adverse effects of use of propofol is Propofol-Infusion Syndrome (PRIS).

PRIS is characterised by myocardial failure, severe metabolic acidosis, bradyarrhythmias, rhabdomyolysis, acute renal failure, hypotension, dyslipidemias, and cardiac arrest and is associated with a mortality rate of more than 80% of deaths arising from propofol. Risk factors for PRIS were identified to include younger age, presence of airway infection, severe head trauma, high dose propofol infusion (> 5 mg/kg/hr) for > 48 hours. In a clinical article titled Sudden Death Associated with Propofol Infusion Syndrome by Ng M.J, et al. published in the International Journal of Forensic Sciences 2024, (available online at https://medwinpublisher.org/index.php/IJFSC/article/download/1386/1237/3205) it was opined that; “The risk of developing PRIS increases, when the maximum permissible duration of propofol administration (48 hours), and its single dose of more than 4 mg/kg/hour are exceeded”.

An examination of the medical records, will most certainly reveal the dosage administered. If it exceeds 4mg, then the probable cause of death will be associated with the administered dosage. It is material in this regard to note that, although Baby Nkanu was critically ill, he was brought into the health facility where he was last managed in a stable condition before certain procedures were performed. He was sedated, but he never regained full consciousness thereafter, and subsequently, suffered respiratory failure; a known symptom of PRIS. This sequence of events is crucial. If meningitis were the sole cause of death, why did collapse occur only after sedation? This is a crucial question, to which available medical records can provide an answer.

Furthermore, international best practice underscores this point. The South African Journal of Anaesthesia and Analgesia (2016), in its Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children, mandates that before sedation:

• A health evaluation, including a focused airway examination, must be performed by a trained sedation practitioner.

• Communication with the child is essential, and children unsuitable for sedation must be identified.

• Pre-sedation assessment should be recorded on a medical history questionnaire and sedation monitoring chart.

• Evaluation must include age (with caution for children under 5),weight, birth and neonatal history, prematurity, fasting status, and full medical history.

An examination of these records vis-à-vis the dosage administered becomes vital. It can provide strong circumstantial evidence, of what triggered respiratory failure.

Propofol is well-documented in medical literature as a sedative that, when overdosed, can cause respiratory depression and failure. This is why paediatric protocols insist on weight-based dosing and continuous monitoring. If dosage records reveal administration above safe thresholds, or if monitoring was inadequate, the inference of negligence becomes compelling.

It must also be reiterated that an inquest to the cause of death suspected to have been caused by medical negligence, is not necessarily to establish guilt or for criminal prosecution, but to unravel the truth regarding the medical care offered, and for preventive steps in the future. When properly viewed, the temptation to insist that an inquest

must proceed on the basis of a postmortem for some proof beyond reasonable doubt, becomes less fanciful.

Res Ipsa Loquitur and Clinical Negligence

This leads us to the established doctrine of res ipsa loquitur “the thing speaks for itself”, which has long been applied in medical negligence cases. In Cassidy v Ministry of Health [1951] 2 KB 343, Denning LJ remarked:

“I went into hospital to be cured of two stiff fingers. I have come out with four stiff fingers, and my hand is useless. That should not happen, if due care had been used. Explain it if you can.” Thus, the burden to prove absence of negligence shifted to the health care facility to explain.

In Thomas v Curley [2013] EWCA Civ 117, the Court of Appeal held that, injury caused in an area other than the operative site “called for an explanation as to how that might have occurred in the absence of negligence”. Applied here, if a child, brought into a health facility in a stable condition, suddenly suffers respiratory collapse under sedation inconsistent with proper dosage and monitoring, the hospital must explain how this occurred absent negligence. The records themselves demand accountability.

Meningitis and Accountability

The possibility of meningitis has been raised. Yet, the existence of an underlying condition, does not absolve medical professionals of responsibility. The child was stable before sedation, but never regained consciousness afterwards, and only then suffered respiratory collapse. This temporal link points to sedation management, not meningitis alone. If meningitis was indeed, present, a proper pre-sedation assessment should have flagged it as a risk factor. The failure to identify or act upon such a risk, compounds the negligence. Medicine does not operate in absolutes; neither does law. The task is not to choose between illness or negligence, but to examine how care was rendered within the context of illness.

Conclusion: Guidance and Equal Publication

This rejoinder is not an indictment. It is a call for accuracy. The law allows inquiry, even without a body. Clinical records can establish negligence, without autopsy. To insist otherwise, is to misinform the public and distort the legal state of affairs. We urge Onikepo Braithwaite, to give this rejoinder the same widespread publication as her original article. Justice demands no less. 

Thaddeus Idenyi, Partner, Pinheiro LP