Peju’s Death as Catalyst for Healthcare Reform in Nigeria

Following the tragic death of Mrs. Peju Ugboma, from alleged medical negligence, her family, while seeking for justice, shares with Sunday Ehigiator, events preceding the unfortunate incident of her death on Sunday, April 25, 2021, and how they intend to drive a reform in the Nigeria health sector, to avert related cases in future

Until her death, 41-year-old mother of two beautiful girls, Peju Ugboma was the founder and CEO of ‘I Luv Desserts’. She was happily married to her long time friend, Ijeoma Ugboma, whom she met right at the beginning of her undergraduate years at the University of Lagos, and they were married for almost 14 years before she met her untimely death.

How It Started

Speaking with THISDAY, her husband, Mr. Ugboma narrated that bright and cheerful Peju had no underlying medical condition before deciding on her own to go for an “Elective Hysterectomy Surgery” at Premier Specialist Medical Centre, Victoria Island (VI), on April 22, 2021.

“The financial requirements by Premier were met pre-surgery. She had also done extensive tests and was given the all clear for surgery by Dr Akiseku the Gynecologist. Before she went, she said she wanted to eat a good meal because the surgery would require that she would not eat for three days post surgery.

“We had a good meal of pounded yam and vegetable with assorted meat at a restaurant and she walked into Premier Specialist by herself, little did we know that she would be wheeled out in a body bag two days later.”

First Concern Raised

Ugboma said he first began to raise concern when he saw “her blood pressure on the monitor immediately after surgery on Friday afternoon of April, 23. The doctors assured me that there was no cause for alarm as she was being transfused with blood, and her blood pressure would stabilise.

“Later, Peju was awake and coherent. We were having a chit-chat and even shared a few jokes. I therefore did not suspect that anything was wrong. By Saturday morning, April 24, Peju told me that the doctors said her kidneys were not functioning optimally and they will bring in a Nephrologist from outside to review her.

“I met the Nephrologist and she told me that she administered treatment and Peju was expected to recover. I therefore did not think anything was amiss as Peju and I were communicating, although she complained of pains in her abdomen. I did not see the gynecologist immediately after the surgery or later on for that matter neither was there any communication from him at any time on my wife’s condition.”

Shocking Demand for Blood

Ugboma revealed that on the evening of Saturday, Dr Renner called him and told him that they would need to move Peju to an Intensive Care Unit (ICU) for better management, but failed to reveal that his wife was in distress.

“To my shock, he told me that they would need to give her two to three pints of blood in addition to what had been given to her earlier. Premier did not have blood to give her. He suggested that we reach out to family and friends on a blood drive. We immediately swung into action and reached out to people far and wide for her blood match of type B+.”

He said despite the scarcity of Peju’s blood type, families and friends were still able to raise nine pints of blood for her treatment, which was much more than the four the hospital had requested.
“Friends and family responded and people came from as far as Magodo to donate blood for us, and we gave Premier Specialist Medical Center nine whole pints of blood,” he said.

Alleged Exploitation and Negligence

Ugboma said, before Peju was moved to ICU, Premier Specialist Medical Center asked him to make another payment as different from his initial payments before the surgery, “and I instantly did a transfer of N1 million to them. Peju was given blood from donors but she complained bitterly about discomfort and pain. Dr Renner was with her and kept trying to manage her. I asked him what the next steps were, and he said it was to take her to another hospital the next day to do a CT scan.

“Another shock was that Premier Specialist Medical Centre did not have a CT scanner. They would therefore have to move an ICU patient out for a CT scan, but all I wanted was for my wife to get better. I was with Peju until 1.30 am on Sunday morning, April, 25, when I went to sleep in her room in the hospital. By 6.30 am, I went to see her before heading home to freshen up.

“But the Peju I saw on Sunday morning looked sharply different from the one I left five hours earlier. All the vitality in her face was all gone, her eyes had been taped to cover her pupils, and Dr Renner told me that she did not do well through the night and had to be placed on a respirator.

“I called a family friend who is a Consultant Gynecologist in the UK and he told me that he thought Peju was having internal bleeding and the doctors needed to open her up immediately to stop the bleeding. He asked to speak to the doctors. I gave the phone to Dr Asemota, who spoke to him. He also spoke to Dr lwu and finally he spoke with Dr Osinowo who is the Medical Director of Premier Specialist Medical Centre.

“The UK consultant told all three doctors without mincing words, that Peju was bleeding internally, and the doctors needed to open her up immediately and take care of it, and his words were ‘time is of essence’. Unfortunately, and tragically, his wise counsel was not heeded as the doctors proceeded with arrangements to move Peju to Evercare Hospital, Lekki. It took them well over three hours before they moved Peju to Evercare, where she arrived at 1.43pm.

“To my shock, on getting to Evercare, I was asked to pay yet another NI million deposit. I was taken aback as I had just paid N1 million the evening before to Premier Specialist and I thought they would take care of the referral. I made the payment immediately and sent a confirmation email to the Evercare accounts department. Also to my shock, Peju was moved to the ICU on the 5th floor, instead of doing a CT scan as I was earlier told.”

Peju’s Last Moments

After much effort at concealing his tears, Ugboma narrated that upon arriving at the ICU, the real nightmare for him began. “I watched the Head of the ICU declare that Peju had no pulse even before she was taken off from the ambulance bed. Emergency CPR commenced. I watched the medical personnel run helter-skelter in a futile bid to save Peju’s life. I sat down and watched my wife take her last breath as life ebbed out of her.

Autopsy and Casenote Episode

Ugboma said, immediately after Peju was declared dead, Dr Asemota approached him and “offered that they would carry out an autopsy on her. We refused because we were completely dissatisfied with the care she received from Premier and wanted an independent autopsy carried out. This was done at the Lagos state University Teaching Hospital (LASUTH) on April 30, but not without more issues with Premier as the independent Pathologist requested for Peju’s medical notes.

“Premier came up with all sorts of stories about why the case notes had not been sent a whole three days after the request was made, and it took a physical visit from family and a shouting match before the medical notes were sent to the pathologists for the autopsy. In light of this, I am of the opinion that the medical notes that went to the pathologist were tampered with or altered.”

Ugboma also told THISDAY that the hospital never deemed it fit to reach out to him nor any member of the family “until the story went public when some print (including THISDAY) and electronic media published the news.

“It might also interest you to know that last week, we wrote letters to all five hospitals where Peju had medical records, which includes, George’s Memorial in Lekki, Citizens Medical Centre in Ikoyi, Medicin Specialist Women’s Hospital in Lekki, MeCure Lekki, EverCare Hospital in Lekki and Premier Specialist, VI.

“Every other hospital has sent in Peju’s records as we speak, except Premier. Why is Premier withholding my wife’s records? To me the answer is in the Evercare’s medical report that states that Peju’s case should be referred to a coroner.”

Cry for Justice

Ugboma therefore called on every appropriate instrument of the law to intervene in the case and ensure justice is served. He said he is not only calling for justice for Peju but also seeking “justice for the thousands of victims of a faulty healthcare system”.

He likewise called for a reform in the Nigerian healthcare system “where patients will have rights and know their rights, and where doctors will be held accountable for malpractices and negligence. We have retained Olisa Agbakoba Legal and Primera Africa Legal to help us with all legal issues and representation”.

He concluded that getting justice and ensuring Peju’s death leads to a total reform of the country’s healthcare system was more important to him “than getting any financial compensation from the hospital, except the compensation is to restore my wife back to life”.

Panacea for Healthcare Reform

Speaking with THISDAY, a Senior Advocate of Nigeria (SAN), and Founder, Olisa Agbakoba Legal (OAL), Olisa Agbakoba, said Peju’s case would be cited as illustration for a proposed ‘Patient’s Bill of Rights’ and ‘Healthcare Reform Legislation’.

“We all know what has happened to Peju, she had a surgery that was botched by her surgeons, and the reason it was botched is because the healthcare system in Nigeria is very fragile. So when we make a case to the relevant authorities or agencies, we can point to Peju’s case as an example, and using the case, we can then think of how we can avoid a recurrence.

“We are going to present in Lagos State, a Lagos State Healthcare Reform Legislation, which will correct a lot of the gaps. For instance, there are about eight classifications under the Health Facility Management Law of Lagos State. When I read it again, I was shocked that that type of law exists, because it does not require a hospital to have certain basic equipment. It just said, the hospitals shall have adequate equipment; that’s not good enough.

“It is important that you specify the nature of the hospital, because there is a difference between the general hospital, a specialist hospital and a teaching hospital, but the law does not make all these differences. So part of what we are hoping to do is to present a health policy document, attached with a proposed legislation that can resolve the gaps.

“So if you are opening a clinic, then let us know it’s a clinic. If you are opening a hospital, let us know it’s a hospital, and the equipment you will have in the hospital will be clear. How can a hospital of this nature, so called specialist hospital, not have a CT scan, and Ultra scan? If a patient’s tummy was operated and stitched back, there is a likelihood that something may go wrong, if I want to know what is wrong, how do I see that if I don’t have a scan? So this is part of what the reform will address.

“Also, there are two broad things in medicine, one is standard of care and the other is negligence. I have talked about how to eliminate medical negligence. On standard of care, the patient has the right to know. The hospital has to hang patient’s rights all over the hospital; a patient who had surgery is entitled to know that the doctor who performed the surgery must visit at a particular time.

“So the ‘Bill of Rights’ of a patient is totally absent from the law. It’s only the Federal Consumer Council that has developed a patient bill of rights. It’s absent entirely from the healthcare legislation of Lagos State. So when doctors begin to feel the pressure to behave properly, their services will improve. But that is currently absent with doctors. They just open a hospital, put a sign and call it hospital, whereas, it is nothing but a day clinic.

“So this healthcare reform package is aimed at making doctors understand that when they put a sign, which they tag hospital, it carries serious responsibilities, including closure of the hospital,” he noted.

Health Commissioner’s intervention

Following a call for thorough investigation into Peju’s death, the Lagos State Commissioner for Health, Prof. Akin Abayomi through a tweet on his handle, @ProfAkinAbayomi assured the family that, the state’s Health Facility Monitoring and Accreditation Agency (HEFAMAA) had commenced investigation into the case.

The tweet read; “I hereby assure the residents of Lagos State that the Health Facility Monitoring and Accreditation Agency @HEFAMAA_LASG immediately commenced a comprehensive investigation into the case of the late Mrs. Olapeju Ugboma after it received notice of the circumstances of her death at the Premier Specialist Medical Centre to determine the facts of the case.

“The ongoing investigation, among other things, has included an assessment of the hospital’s systems and investigative interviews of individuals affiliated with it. Additionally, a case summary of the care rendered to the patient, credentials of the health workers at the hospital and documents submitted to the agency by the hospital are being reviewed.

“@HEFAMAA_LASG also held a meeting with Mr. Ijoma Ugboma at its office to obtain information about the case from the family. Further investigation by @HEFAMAA_LASG will include the review of the medical records of the patient and additional documents, and also inquiries from those who attended to the deceased.

“At the conclusion of the investigation, the State Ministry of Health plans to issue a statement regarding any action that is warranted under HEFAMAA’s regulatory oversight powers.”

Reaction from Premier Hospital

In a statement made available to THISDAY and signed by Dr. C. Fadipe for management, Premier Specialists’ Medical Centre while expressing their condolence said they were saddened by the loss of Mrs Peju Ugboma.

The statement reads in part, “the hospital welcomes all statutory inquiries and is currently fully cooperating with the relevant regulatory bodies as is the protocol in cases of this nature. It intends to continue doing so until a conclusion is reached. However, with regards to the numerous enquiries made by the media, the ethics of the medical profession does not allow the hospital to breach client confidentiality even in the extreme case of death. Therefore, the hospital in its bid to enforce that, will regretfully not be in a position to respond to these enquiries.

“The hospital further appeals to the general public not to exacerbate the grief of the deceased’s family by speculating on unfounded rumours and unsubstantiated facts. We urge patience and restraint in order to allow the authorities conduct a thorough investigation and make their findings known. Once again, our sincere condolences to the family of the deceased. We pray that the Lord comforts them.”