‘If the Patient Dies, Kill the Doctor’
THE VERDICT By Olusegun Adeniyi email@example.com
Monday’s statement by the Nigerian Medical Association (NMA) that one of its members, Uyi Iluobe, was murdered by relatives of his patient at a hospital in Oghara, Delta State is a serious allegation. Iluobe’s death, according to the NMA President, Uche Ojinma, as “response of the relatives to the loss of a patient from suspected gunshot injuries can never be justified and has taken violence against doctors and other healthcare workers from injuries to murder.” Ojinmah added that “It is unbelievable that in the face of a debilitating medical brain drain, the few doctors that patriotically decided to stay back and take care of our fellow citizens are being murdered by same Nigerians.”
I join in commiserating with the family of the deceased doctor but rushing to the conclusion drawn by the NMA on this matter is most unfortunate. Yesterday, the Delta State Police Public Relations Officer, DSP Bright Edafe debunked insinuations that the doctor was killed by relatives of a patient. “The rumour doing the rounds that he was murdered by the family of a patient who died in the hospital is false. There is no record of any patient’s death in the hospital,” according to Edafe who confirmed that the doctor was indeed killed within his hospital premises.
I started from the premise that the NMA’s conclusion is unhelpful, but I also understand the reason why they did so. Attacks on doctors by families of patients who die are becoming prevalent in Nigeria. Last week in Kwara State, following the death of a butcher by name Alhaji Saliu at the University of Ilorin Teaching Hospital (UITH), his relatives went berserk by attacking a medical doctor on duty. This prompted the hospital to seize the corpse while the Association of Resident Doctors (ARD) declared a five-day strike. The UITH corporate affairs manager, Mrs. Elizabeth Ajiboye, explained that the patient was brought to the hospital with severe complications and the doctors on duty did all they could to save him without success. “Three of the patient’s relations pounced on one of the doctors on duty, pinned him to the wall, and punched him severally but he managed to escape from them,” explained Ajiboye who justified the seizure of the corpse by the hospital. It took the intervention of senior citizens before the corpse was eventually released for burial, although the management insists on prosecuting the violent family members.
Last month, an angry man and his son attacked a medical doctor and a nurse at the Federal Medical Centre (FMC), Idi-Aba, Abeokuta. The tag team of father and son reportedly rained heavy blows on the doctor shortly after they were informed of the death of a 53-year-old woman at the emergency ward. Ogun State NMA chairman, Kunle Ashimi, who condemned the incident said the woman had a serious heart condition. “She was at the end stage of heart failure. This was explained to the relatives when she was brought to the facility but, notwithstanding, we also believe in miracles, and we feel that we should do our best to see what can happen.” Apparently because a miracle didn’t happen, “the husband and son of the deceased descended on the doctor that had been taking care of the patient when the news of her death was announced,” according to Ashimi.
That these assaults on doctors have gone on for so long with little attention paid by relevant authorities is disturbing. At the University College Hospital (UCH) Ibadan three years ago, family members of a septuagenarian attacked a doctor and nurses on duty over the death of their patient, before they were arrested by the police. “The relatives of one Usman Zubair, a 74-year-old man, who was receiving treatment in the hospital, went wild and attacked the medical personnel when they learnt of his death. The deceased had secondary Grade A diabetes, and his ankle was amputated to enable him to live a normal life, but he later gave up” explained the Police Public Relations Officer (PPRO), SP Olugbenga Fadeyi. “The family of the deceased came around, became unruly, mobilised other miscreants to assault Dr Adeleke Adedapo and some of the nurses on duty and also vandalised chairs and tables in the hospital ward.”
Meanwhile, attacks on doctors by families of deceased patients is a global challenge but it is more prevalent in some countries than others. In a story titled ‘The family will kill you if the patient dies: the doctors facing attack in Iraq’s hospitals’ published on 9th August this year by The Guardian of London, it was reported that “In Baghdad 87% of doctors say they have experienced violence at work, some involving guns, and most at the hands of patients’ relatives.” A May 2016 New York Times report, ‘A Danger for Doctors in China: Patients’ Angry Relatives’ highlights the same problem.
Interestingly, India, where most Nigerians seek medical solution, is renowned for attacks on doctors by relatives of patients who die. In an online petition initiated by Dr Sumit Periwal to Prime Minister Shri Narendra Modi already signed by 1455,298 persons when I last checked on Tuesday morning, he shared several accounts of how medical doctors have been assaulted by family members of patients in India. “We, Doctors, are responsible for this situation. When the media discredited us, we did not speak. When politicians and local goondas barged into hospitals and caught our collars, we did not speak. When mobs threatened us, we did not speak. When hospitals and ICUs were vandalised, we did not speak,” Periwal wrote. “But we must speak now. The list of assaults on doctors is endless. A chronicle of so many assaults on doctors across India is given below. And so many more go unreported.”
One of the dozens of cases listed by Periwal occurred on 10th June 2019, when a doctor was subjected to “brutal assault by a mob of 200 who were brought in two lorries on the death of a 90-year-old patient at NRS Medical College, Kolkata.” Another happened on 30th July 2020 when “a doctor of a superspeciality hospital was repeatedly stabbed and attacked by the son of a COVID patient who passed away in the hospital.” And on 23rd April 2021, “20 Policemen assaulted a doctor with rods for not getting bed in Allahabad Medical College, amid corona crisis when there is lack of beds, medicines, and oxygen.”
Dr Raghury Hedge, specialist in ophthalmic plastic surgery & ophthalmic oncology, shared the harrowing experience of his father, also a medical practitioner who was nearly killed for what was no more than an act of kindness, blaming the problem on the society. “The inability of the society to acknowledge altruism of the doctors will be the reason to discourage the next generation of brilliant students from taking up this unforgiving profession.” He then posed some questions: “What is the law of the land doing to prevent these Kangaroo courts from passing judgment on doctors? Who will take care of the damage to life, property, and reputation that a doctor must suffer? When will the media, politicians and the community wake up? Who will highlight this ugly barbaric side of healthcare in India?”
We should pose the same questions in our country. Besides, given unfounded insinuations that the killing of Dr Iluobe was because he rejected a gunshot victim, that has raised some pertinent issues. Going by provisions of the Compulsory Treatment and Care for Victims of Gunshot Act 2017, health workers are mandated to treat gunshot victims. But there are two problems. Section 3, subsection one of the Act specifies that “A hospital that receives or accepts any person with a gunshot wound shall report the fact to the nearest police station within two hours of commencement of treatment.” In cases where such victims are cult members, health workers are aware of the danger of reporting to the police as required by law. For that reason, many doctors and hospitals would rather err on the side of caution by rejecting a gunshot wound patient rather than admit and compromise their safety.
There is another problem associated with the Act. My friend and medical practitioner, Henry Ewunonu has always argued that the sections which criminalise refusal to treat victims do not factor in the reality that most clinics lack the capacity for handling these injuries and that any delay in the name of providing first aid before referral could worsen the case. This is an issue that would have to be looked at by critical stakeholders in the health sector, but we will come back to it another day. That is not the thrust of this intervention.
I have read the accounts of families of several patients suggesting they would not have lost their loved one if the healthcare professionals (or the hospital) who treated them had applied a duty of care. I don’t know what the regulations are concerning negligence by health professionals, but I subscribe to the idea that they should be stringent enough to deter the kind of laxity that we witness in an environment where innocent lives can be, and are often, cynically wasted due to carelessness. But I also know that there are cases where families of victims simply find it difficult to accept that people die.
One fascinating book I recommend on this is ‘Did He Save Lives? A Surgeon’s Story’ by David Sellu, a respected British surgeon whose distinguished career of over four decades was brutally terminated in 2010 when a patient died under his care in a private hospital. Prosecuted and convicted for the patient’s death, Sellu’s practice licence was suspended, and he served 15 months in prison for what was not his fault. He eventually won the appeal against his conviction, but the damage had already been done.
Notwithstanding my misgivings about the NMA statement, it is a fact that professionals in the health sector are becoming increasingly endangered in Nigeria. Anybody who has followed the social media must have read several unverified stories that are used as fodders by the ‘May-Nigeria-not-happen-to-you’ mob. Once someone relays an account of how a relative died (and the whole story is most often never told) in hospital, commentators jump to conclusions that it ‘the usual Nigerian malaise’. Almost as if people don’t die in foreign hospitals. Yes, there are cases of criminal negligence, and they must be dealt with. But it is not right to conclude that all cases of death in our hospitals are due to the negligence of health professionals.
At the root of this crisis is the propensity for jungle justice in Nigeria. I have written countless columns on the subject. But while jungle justice for all manner of offences, and even for no offence at all, may have been with us for a long time, we should do everything to prevent a descent to anarchy that the barbarism of attacking health professionals for the death of patients exemplifies. If there are issues of negligence, there are appropriate channels for reporting professional misconduct and seeking redress. That is the civilized way. We must deal with the impulse that drives Nigerians to take the law into their own hands when things don’t go their way.
The Bulletproof Saviour
Last September in Anambra State, five people lost their lives when gunmen ambushed the convoy of Senator Ifeanyi Ubah. “Two police officers were killed. The other three that died in the attack were one civilian and two aides of Ifeanyi Ubah,” according to Tochukwu Ikenga, police spokesperson in the state, who added that two other police officers were also injured. A month later in October, it was the convoy of a popular Christian cleric, Apostle Johnson Suleman, that was attacked by gunmen. Seven people, including three police officers, were also killed. And on Monday, the lives of four policemen were gruesomely terminated when the convoy of a former Imo Governor, Ikedi Ohakim was attacked by gunmen in the state.
In each of the three incidents, and many similar others that claimed police personnel, the target of the attacks and members of their families escaped because they were being driven in bulletproof vehicles. Ohakim was forthright in narrating his escape: “We were driving between Isiala Mbano and Ehime Mbano. These people blocked us at a place called Umualumaku. They attacked us from behind and were firing at our vehicles consistently. I thought I was a dead man, and I was with two of my children – my son and daughter,” said Ohakim. “What saved me was the bulletproof vehicle. That I am alive today is by the special grace of God and the bulletproof vehicle.” Kameh Ogbonna, media aide to Ubah, also made the same admission about what saved his boss. “If not for the bullet proof jeep the senator was riding in, he would have been dead by now,” Ogbonna told the media.
While money can buy you a lot of things, including security from the bullets of assassins, one of the supreme ironies of Nigeria is that the country is ‘under policed,’ Yet our prominent people are ‘overpoliced’. Following the recent assault on a policewoman at the residence of her principal, a ‘Professor’, the Police Service Commission (PSC) called for a review of the operations of the Special Protection Unit (SPU). “With the security problems ravaging the nation, there is an urgent need to free many police officers loitering in private houses and following big men around.” said the PSC spokesman, Ikechukwu Ani. As I argued in my intervention on the issue, maintaining public order and safety, enforcing the law, and preventing, detecting, and investigating criminal activities are the primary responsibilities of the Police. And they cannot play such roles effectively if most of their personnel are on guard duty for prominent citizens.
However, the problem at hand is that these VIPs ride in bullet proof vehicles while their police orderlies and other security details are cramped in no-roof Hilux vehicles. Now that these agents of state are susceptible to the attacks of sundry criminal gangs that may be after their principals, that should compel introspection on how to mitigate the risks they bear. Should these high-net-worth individuals not be made to provide insurance coverage for their police/security personnel? Should they not be compelled to ensure that the vehicles conveying their police personnel and security details be bulletproof?
These are some of the questions that need interrogation in view of the frequency of attacks on the convoys of these big men. We cannot continue to expose the personnel of our police and other security details to such danger without thinking about their welfare and what happens to their families in the event of fatal attacks.
I wish all my readers a prosperous 2023.
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