Medical ethics and jurisprudence by CBt5G1

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									    Medical ethics, Medical
jurisprudence and the Nigerian
            doctor
                 By
  Dr Olanrewaju T. Adedoyin,FWACP
   Associate Professor/Consultant
            Paediatrician
  SAVANNAH JOURNAL OF MEDICAL
  RESEARCH AND PRACTICE (SJMRP)
• SJMRCP is a scientific journal of the Kwara
  State chapter of NMA.
• It aims to meet world standard and adhere to
  international best practices in Journal
  production.
• It would be produced at least twice a year and
  distributed to all members of Kwara State
  NMA, other branches and interested people
  who subscribe.
  SAVANNAH JOURNAL OF MEDICAL
  RESEARCH AND PRACTICE (SJMRP)
• We therefore welcome and invite all our members to
  submit papers for publication in the maiden edition
  which would be launched in the first week of
  December 2011.
• To meet this target set by the Executive council of our
  Association, you are specially invited to send papers
  on original research, case reports, review articles,
  letter to the editor and short communication to the
  Editor-in chief on or before 19th September 2011.
• Manuscripts received after this date may not be
  included in the maiden edition but would be
  considered for subsequent editions.
  SAVANNAH JOURNAL OF MEDICAL
  RESEARCH AND PRACTICE (SJMRP)
• Manuscript should be presented in the
  following order and all pages numbered
  consecutively (Title page, Abstracts,
  Introduction, Materials and methods, Results,
  Discussion, Acknowledgement, References,
  Tables and Figure legends). Abstracts should
  not be more than 250 words.
  SAVANNAH JOURNAL OF MEDICAL
  RESEARCH AND PRACTICE (SJMRP)
• Manuscript should be typewritten on A4 size
  paper in clear and concise English. It should be
  typed on one side of paper only, with double
  spacing and ample margins. Page number should
  be done in a consecutive manner.
• Manuscripts, figures and tables should be
  submitted in three copies (one original and two
  clear photocopies) plus an electronic copy in
  word format in a CD disc. Another electronic
  copy should be also be sent to the e-mail:
  ooadedoyin@yahoo.com
  SAVANNAH JOURNAL OF MEDICAL
  RESEARCH AND PRACTICE (SJMRP)
• The hard copies and CD disc should be enclosed
  in a large envelope addressed to Dr O.T.
  Adedoyin, The Editor-in-Chief, Savannah Journal
  of Medical Research and Practice, Department
  of Paediatrics, University of Ilorin Teaching
  Hospital, Ilorin.
• It could also be dropped at the Doctor’s House,
  13 Peter Tokula Road, GRA, Ilorin.
• NB: Please you are free to forward this mail to
  your friends and colleagues outside Ilorin and
  Nigeria.
                    CONTENTS
• Medical ethics
• Ethical problems encountered in clinical decision
  making
• Duty of care
• Ethical principles for medical and dental practitioners
• Medical and Dental council of Nigeria
• Medical and Dental Practitioners Disciplinary Tribunal
• Medical Jurisprudence
• Medical malpractice
• Cases, Judgments and questions raised
               Medical ethics
• Ethics is the study of what is right or wrong. It
  deals with ideal human conduct.
• Medical ethics is an applied ethics that studies
  moral values and judgment as they apply to
  medicine
• It is that aspect of medical practice that governs
  the doctors behaviour and decisions in the
  course of caring for patients and interacting with
  his colleagues and other members of the health
  team.
        Values in medical ethics
• Autonomy-right to refuse or choose treatment
• Beneficence –act in the best interest of the
  patient
• Non-maleficience- First ,do no harm
• Justice-Scarce resource should be fairly and
  equally distributed
• Dignity –Patient and the person treating him have
  the right to dignity
• Truthfulness and honesty-informed consent must
  be given
 Sources of medical law in Nigeria
• Decree No. 24, Constitution of the Federal
  Republic of Nigeria (promulgated 1999)
• Medical and Dental Practitioner Act cap 221,
  laws of the Federation of Nigeria 1990
• Other laws regulating other allied professions
  relevant to medical practice in Nigeria
• African Charter of Human and Peoples Rights
• United Nations Charter on Human Rights
  (1948)
           The Physician oath
• The physician Oath is a code of ethics of the
  medical profession and is a behavioural
  guideline between the doctor and
a) His patient
b) His fellow practitioner
c) His colleagues
d) The public
e) The government
     Ethical problems encountered in
          clinical decision making
• Problem involving technology; When should a patient be
  started on life saving machine?
• Problem involving resources: Should a patient with serious
  disease be given priority in the face of scarce resources?
• Problem involving research: Should research deceive the
  patient to obtain data.
• Problem involving risk of disease: Should people be
  stopped from leading their life style for the purpose of
  reducing health problems (legislation against alcoholism,
  smoking e.t.c.)?
• Problem involving professionalism in medicine: How much
  duty of care should the doctor exercise?
                    Duty of care
• This is an undertaken towards the patient
• The doctor assumes responsibility for the care of the
  patient
• The doctor owes a duty to warn patient of risk in a
  proposed treatment
• A doctor owes it a duty to the patient to use his knowledge
  and skill in the care of his patient
• A doctor owes it a duty to write prescription clearly. Where
  a prescription is not of sufficient clarity and the pharmacist
  fails to spot the error, there is a breach of duty of vigilance
• Even if the patient can prove a breach in the duty of care,
  he has to show that he suffered physical/mental damage
  for a legal action to succeed
 General ethical principles for medical
  and dental practitioners in Nigeria
• Promoting the health of the patient while respecting
  his dignity as human being
• Providing the general health of the community
• Upholding the honour and dignity of the profession
• Participating in governance and ensuring that laws and
  actions not favourable to the profession are looked into
• Safeguarding the public by exposing incompetent and
  unethical members of the profession
• Not divulging confidential information about the
  patient unless compelled to do so by law through the
  patient’s consent
 General ethical principles for medical
  and dental practitioners in Nigeria
• Performing his duties without interference from
  non-medical organ
• Consulting more experienced practitioners or
  colleagues when in doubt of medical needs of the
  patient
• Must not certify what he has personally not
  verified or collaborate with agents to confirm
  sickness in absence of illness
• Conforming to generally accepted principle when
  performing biomedical research
 General ethical principles for medical
  and dental practitioners in Nigeria
• Charging fees only for professional service
  rendered
• Not receiving fees for referring patient and desist
  from fee splitting
• Safeguarding against publicity in the media which
  may expose his patient or portray him as having
  special skill
• Avoiding unethical advertisement of himself in
  order to solicit for patients
• Carrying out treatment or regime for which he
  has no competence, knowledge or resources
ETHICAL CONSIDERATION WHEN
  A DOCTOR DEALS WITH HIS
        COLLEAGUES
1) He should respect his colleagues especially senior
   members and if he is a senior member, he should show
   good examples to the junior ones
2) He should avoid giving advice on litigation or lawsuit
   against his colleagues except if he is directly involved
3) He should avoid treating his family except in minor
   illness and if he looks after a colleague, it is a
   professional norm not to charge professional fees.
4) As a matter of courtesy, he should communicate his
   opinion on cases referred to him to his colleague
   referring the cases
ETHICAL CONSIDERATION WHEN
      A DOCTOR DEALS WITH HIS
                     COLLEAGUES for consultation
5) He should not take over cases referred to him only
6) He should not entice his colleagues’ patient directly or indirectly to
   his own practice
7) Should his advice be sought by a patient wanting to sue another
   doctor for professional misconduct, his frank opinion should be
   conveyed to the doctor in question
8) If he hands over his case to another doctor, he must do so with
   adequate and detailed information of the patient
9) If he takes over a case, he must make sure that all fees accruable to
   the doctor from whom the case is taken over is paid.
10) If he has a practice in a locality he should intimate colleagues in the
   area of his presence, however it is advisable for him to clear with
   MDCN
ETHICAL CONSIDERATION WHEN
      A DOCTOR DEALS WITH HIS
                           PATIENTS taking care of patients in
1)He is to act as a responsible medical officer,
   a private institution or consulting principal medical officer in public
   institution
2) Ethics of professional secrecy and confidentiality must be
   maintained
3) Should a competent relative wishes to terminate a doctor’s service
   and the patient is not competent to do so, a formal undertaking
   should be given for the termination of the service
4) The doctor if more than 10 years post registration but not involved
   with clinical responsibility in public hospital can run his own
   consultation in his clinic.
5) The doctor must not demand or receive money from hospital patient
   if he is employed by the hospital
       Medical and Dental Council of
             Nigeria(MDCN)
• It was established by the medical and Dental
  Practitioners Act, Cap 221 laws of the federal Republic
  of Nigeria 1990. The council can sue and be sued.
Functions include:
• Regulations of professional conduct and national policy
• Approval of institutions at which medical courses of
  training are to be given as well as course of instructions
  prescribed and qualifications granted by such
  institutions
• Supervising the nature of the instruction and the
  examination leading to the qualifications to be granted
  by the institutions
     Medical and Dental Council of
           Nigeria(MDCN)
• Regulation of medical practitioners
• Regulation of the standards of medical
  profession
• Preparations and maintenance of medical
  register
• Granting limited registration in respect of
  employment for specific period
      Composition of the MDCN
• Chairman
• 1 representative from each of the States,2
  nominees of the Honourable Minister of Health, 1
  rep of NPMCN, 3 reps of Colleges /Faculty of
  Medicine, 1 Pathologist from NPMCN, 2 reps of
  FMOH, Commandant of Armed forces Medical
  Corp & School, 2 reps of Nigeria Dental
  Association, 9 reps of NMA, 1 rep of Alternative
  Medicine Practitioners, The Registrar/ Secretary
  of Council
    Medical and Dental Practitioners
         Disciplinary tribunal
• It has similar status of a High Court of the Federal
  Republic of Nigeria.
• The tribunal is responsible for the investigation of
  medical misconduct
• Provide peer control by establishing mechanism for
  finding out the standards of professional performance
  of its members. It can also suspend a doctor’s
  registration so as to remedy his deficiencies. Such
  doctor will have to undergo a retraining exercise
• The council can only act on complaint received and
  cannot institute disciplinary proceeding s by itself
    Medical and Dental Practitioners
         Disciplinary tribunal
• If found guilty by the professional conduct committee
   of MDCN of serious professional misconduct whether
   while he is registered with the MDCN or not, the
   MDCN may direct that a doctor’s
1. Name be erased from the registered
2. Registration be suspended for a period not exceeding
   12 months
3. Registration be conditioned and subject to his
   compliance with the directive of the committee for a
   specified period
4. Behaviour may result into warning
     Shortcomings of the disciplinary
               tribunal
• Members are not lawyers and lack legal training
• Members do not always follow due process in their
  deliberation
• Where government is involved in litigation, tribunal may
  favour government because they are appointed by
  government
• Sometimes proper legal procedures are not followed before
  they come to conclusions
• If doctors are involved in malpractice, the tendency is to
  favour their colleagues
• The reasons for their final judgment are not often clear
• Accused are not sometimes giving fair hearing and good
  opportunity to defend themselves.
           NMA and discipline
• Any medical or dental practitioner registered
  under the Medical and Dental Practitioners
  decree 23 of 1998(Act Cap 221 laws of the
  Federation Of Nigeria 1990) shall have the right
  to be a member
• Any member adjudged to have put the profession
  into disrepute will be subjected to disciplinary
  action and after due process may be subjected to
  the National disciplinary committee who will
  report to the National Executive Committee
• The following decision may be recommended:
            NMA and Discipline
•   Reprimand
•   Removal from office (if he is the executive)
•   Denial of right to vote
•   Referred to the MDCN for disciplinary action
          Medical Jurisprudence
• Juris –Law; Prudentia-Knowledge
• It deals with the interaction between medical science
  and the law. It is also called legal medicine.
• It is concerned with;
• The responsibility of the medical doctor to his patient
  should there be an adverse result from operation, drug
  prescription and diagnosis
• Responsibility of members of the medical profession
  for their actions
• Court decisions and legislation enacted by the
  parliament on how rightly thing s should be done when
  faced with medical circumstances
        Medical jurisprudence
• Laws governing the interactions between
  doctors and patients and the organization of
  health care
• Legal consequences of doctor-patient
  relationship, doctor –doctor relationship and
  doctor –state relationship
Issues under criminal law falling under
                 MJ
• Assault
• Rape
• Indecent assault of females
• Acceleration of death
• Causing death by threat or intimidation or
  deceit
• Medical treatment
                    Criminal law
• In criminal law, there is a blame in which a person’s moral
  behaviour is called to question e.g. rape. There is also a
  corresponding harm
• The offence may be felony or misdemeanor. A
  misdemeanor is a less serious crime punishable by
  imprisonment for not more than 3years. A felony is a very
  serious crime e.g. murder, arson punishable by death or
  with imprisonment for 3 or more years
• The injured person must first go to court for justice by
  public law before he can institute civil claim
• A doctor is not criminally responsible for a patients death
  unless his negligence or incompetence demonstrates
  disregard for the life and safety of the patient
                     Case
• Mr. and Mrs. Ade sued Dr Kunle for damage in
  respect of sexual offence committed by Dr
  Kunle on Mrs. Ade during post natal
  examination. Dr Kunle’s lawyer applied for the
  action to be stayed because it was felony for
  which Dr Kunle has not been prosecuted.
             Law of contract
• Areas of Medical jurisprudence where
  contract is applied
• Blood donation, organ donation, biomedical
  research, adoption, surrogacy, in-vitro
  fertilization, artificial insemination,
  manufacture and distribution of drugs and
  medical equipment e.t.c.
                     Case
• The ‘My pikin’ saga in 2008 in which some
  Nigerian children died of kidney failure after
  ingesting a pharmaceutical product –’My
  pikin’
                Questions
• Is there any contract between the
  pharmaceutical company and the consumers?
• Has it been shown by post mortem that ‘my
  pikin’ caused the renal failure?
• Has the provision of NAFDAC and NSO been
  breached by the company?
• Can Nigerian Government take action against
  the company for compensation for the
  children?
               Company Law
• When the hospital is incorporated, individual
  owners are not directly liable for their actions,
  but the hospital.
• A doctor who registers his hospital without
  incorporation is directly responsible for any
  liability.
• The current practicing license of the doctor is
  necessary before CAC will grant a license
             INSURANCE LAW
• The hospital or medical institution can insure
  against cases of medical malpractice brought
  by patient against hospital employees
• The NHIS should be able to take care of that
• If a hospital is found liable in a case brought
  by patient against medical malpractice of its
  doctors, to recover the money it paid as
  compensation, it must be registered as a
  limited liability company.
               Labour Law
• The Nigerian Law as it is in the Nigerian
  constitution said that:
• All citizens without discrimination on any
  ground have opportunity for securing
  adequate means of livelihood
• All persons on employment are safeguarded
  from abuse
                Labour Law
• The doctor owes it a duty to keep his patient
  secret information in cases of;
• Venereal disease e.g. HIV/AIDS, STI
• Environmental diseases e.g. Tuberculosis
• Hereditary disease e.g. sickle cell disease
• Doctors should not give employers medical
  information unless the patient gives his
  consent for disclosure
     INTELLECTUAL PROPERTY LAW
•   The following cannot be patented;
•   Mathematical model
•   Scientific theory
•   Method of treatment for humans
•   Surgery, therapy and diagnostic methods
           Constitutional Law
• The medical and Dental Council is expected to
  give doctors accused before it fair hearing
  and follow due process according to the
  Nigerian constitution
       Case 1-Alakija vs MDPDT
• The disciplinary committee had passed
  judgment to remove Dr Alakija from Medical
  register for 2 years following an enquiry on his
  medical malpractice. At the appeal, MDCN lost
  its case because Dr Alakija was not giving fair
  hearing and the Registrar of MDCN was also a
  member of the disciplinary committee and
  was seen as judge of his own case (Alakija v
  MDPDT(1959)4F SC 38
      Case 2-Denloye vs MDPDT
• The disciplinary tribunal ruled that Dr
  Denloye’s name be removed from medical
  register. He was not told his offence until he
  and his counsel came to the tribunal. At the
  appeal, the case was dismissed because it was
  a denial of justice. The unilateral questioning
  of witnesses and the appellant without
  appellate counsel opportunity to cross
  examine was seen as unfair (Denloye v
  MDPDT(1968)I ALL NLR 306
        Case 3-Olaye v MDPDT
• Dr Olaye and 3 others were accused of failure
  to attend to patients contrary to medical
  ethics. The tribunal ordered that their name
  be struck off the register. The court of appeal
  found that the rule of natural justice were not
  followed and the accused were not given fair
  opportunity to defend themselves (Olaye v
  MDPDT(1977 NWLR PT 506 CA
   Legal rights of the unborn child
• The unborn child has no legal rights until it
  enters the society i.e. until it is born (Paton v
  British pregnancy advisory trustee (1979)
  QB276
 How should a doctor behave in court
• He should dress properly to show his
  professional status and his seriousness
• His evidence must be given in clear loud voice
• He should not say more than necessary. He
  should speak in monosyllable.
• If he talks too much, he may give loophole for the
  lawyer to capitalize on.
• The doctor who is a witness should not be hostile
  , angry, rude, sarcastic during questioning
  otherwise the lawyer would take advantage to
  disorganize him
 How should a doctor behave in court
• If the doctor feels that the lawyer is asking an unfair
  question , he can appeal to the magistrate or judge.
• The doctor should resist answering ‘Yes’ or ‘No’ which
  the lawyer may like, but it is not adequate to explain
  yourself.
• Do not claim to be an expert in areas you are not
  familiar with
• It is better to say ‘Not to my knowledge’ or ‘I cannot
  remember’ when you are not sure
• You may appeal to the magistrate or judge to let you
  read your report or note to refresh your memory
 How should a doctor behave in court
• Should the lawyer become intimidating , you
  should seek the protection of the court
• Get to court early so as to find out from the court
  clerks the kind of magistrate/judge (strict, radical,
  amiable e.t.c.) to enable you adjust yourself.
• Magistrate should be addressed as “ Your
  worship”. The High court judge as “My Lord”. If it
  is medical tribunal, the chairman is addressed as
  “Sir”
  Disciplinary cases and Judgment
• Dr James Umezuruike of the Pathmost holistic
  Health center was accused of self advertisement
  and professional misconduct in a Nigerian
  newspaper(The Guardian)of May 8, 2003. In the
  publication, it said
• He was accused of advertising natural health
  care delivery system
• He claimed that humanity needed such system
• He said clients have opportunity to benefit from
  both methods of health care delivery
  Judgment by the MDCN Tribunal
• The tribunal examined the publication and did
  not find element of self advertisement in it. As
  for professional misconduct he was found
  guilty
• Dr Umezurike was advised to be careful of
  what he allowed the press to write about him
• Dr Vital Eseihem Uhumoibu of Otibiuor Okhere
  Teaching Hospital, Irrua, Edo State was accused of
• Indecently examining Mrs. Maria Okburebor and
  other patients while attending to them in the
  consulting room
• Conducting vaginal examination without wearing
  gloves.
• He admitted all the accusations and The
  investigating panel set up by the hospital found
  him guilty
                 Judgment
• The MDCN panel found him guilty of infamous
  conduct and struck his name off the register of
  medical practitioners in Nigeria
          Medical Malpractice
• This is a defect in the way the doctor behaves
  professionally
• If the standard of medical care offered to his
  patient is inadequate, it is called MEDICAL
  NEGLIGENCE
• If his behaviour to his patient is unbecoming
  of his profession, it is called PROFESSIONAL
  MISCONDUCT
     Specific medical malpractice
• Negligence e.g. a swab is left behind after
  operation
• Assault and battery e.g. failure to obtain
  appropriate consent may make a doctor liable to
  intentional assault and battery.
• Fee splitting: when a doctor shares fee with
  another doctor to whom he has referred a
  patient, the patient should be informed and
  separate bill made for this payment. The doctor
  who refers the patient is permitted to get an
  amount commensurate to his services
     Specific medical malpractice
• Itinerant surgery: When a hospital doctor
  operates on a patient away from the hospital at a
  place where he may not provide necessary care
  and may not be available when he is needed. if
  the patient dies or is harmed consequently, the
  doctor may be accused of ‘itinerant surgery’
• Advertising: A doctor must not advertise himself
  in such a way as to be prejudicial to other doctors
• Invasion of Privacy: A doctor should not release
  information to the media unless he has got
  specific written permission to do so
       Specific medical malpractice
• Abuse of death certificate; Issuing of false death certificate is a
  serious offence which if proved may result in the doctors name
  been struck off from the register. The following points are
  important;
• The occurrence of death should be verified before death certificate
  is issued
• The doctor must have attended to the deceased during his last
  illness. If the doctor has not seen the deceased within 14 days ,the
  coroner must be informed
• All sudden deaths or deaths associated with suspicious
  circumstances must be reported to the police or coroner
• In case of cremation, another senior doctor must sign the certificate
  after studying the declaration made by the first doctor. A medical
  referee must also be involved
Informed consent, battery, assault
• Informed consent: information is given to patient
  about his or her medical condition, how she is to
  be treated, the risk and consequences of the
  treatment and the alternatives to the treatment
  so that he can decide on his choices of treatment
• Battery is a criminal offence. It is unacceptable
  physical contact if there is absence of consent or
  the consent is not for the medical procedure
  which subsequently took place
• Non consensual medical treatment entitles the a
  patient to sue for battery
 Informed consent, battery, assault
• Negligence is different from battery because in battery
  the patient must establish that the doctor touched him
  without his consent. Fro negligence it must be proved
  that the doctor touched the patient with his consent
  and an injury has arisen for which the patient is
  claiming damages
• Any treatment of the adult person of a sound mind
  when the person has refused treatment is an assault.
  In case of a child, the court or the parents have the
  right to consent on behalf of the child
• A minor cannot be assaulted by the doctor since he
  has no right to refuse treatment.
         WHO recommendation on
             confidentiality
• All information must be kept secret even after
  death
• Information can only be disclosed if the patient
  gives explicit consent or if the law provides for it.
• Consent may be presumed where the disclosure
  is to other health care providers involved in the
  patient’s treatment
• All identifiable patient’s data must be protected
• Patients have the right of access to their medical
  records and to those that contain their diagnosis
  and treatment
          WHO recommendation on
              confidentiality
• Patients have the right to require the correction,
  completion, deletion, clarification and or updating personal
  and medical data
• Patient’s private and family history cannot be intruded on
  unless with patients consent or where it is necessary for
  patient’s diagnosis and treatment.
• Patients admitted to health establishments have the right
  to privacy when they are being examined or treated
• Proper respect must be shown for the patient’s privacy
  when any medical intervention is carried out. Only those
  who are necessary to be present are allowed, unless the
  patient consent or request otherwise
      Exception to the obligation of
               confidence
• Disclosure may be justified in the public interest
  where failure to disclose appropriate information
  would expose the patient or someone else to a
  risk of death or serious harm.
• A doctor is entitled to deny patient access to his
  medical records on the basis that disclosure could
  cause serious harm to the physical and mental
  health of the patient or to any other individual
                    Case
• Dr Amanga has been the family doctor for Mr.
  and Mrs. Togo. Mrs. Togo has been married for
  5years without any issue and has consulted Dr
  Amanga. During the medical interview with
  Mrs Togo, she said she had total removal of
  her uterus(Total Hysterectomy) some few
  years before marriage. Dr Amanga revealed
  this information to Mr. Togo who then sued
  his wife for divorce.
                  Question
• Is Dr Amanga disclosure of public interest?
• Would Mrs. Togo or any other person be at
  risk of any serious harm by the disclosure?
  (Furniss v Fitchett (1985) NZLR 396
                       Cases
• Miss Felicia Ojo went to UBTH complaining of painful
  menstruation and infertility . She saw Dr Gharoro, A
  consultant O&G who diagnosed secondary infertility
  from uterine fibroid.
• An operation to remove the fibroid was suggested to
  which she consented.
• The operation was performed in December 1993 by Dr
  Ejide at the same hospital.
• Post operative abdominal pain was persistent and Dr
  Ejide asked for an X-ray which then showed an object
  consistent with a broken needle in her abdominal
  wall.
                    Cases
• A secondary operation to remove the broken
  needle was suggested to which Miss Ojo
  consented. Unfortunately the operation was
  not completely successful because part of the
  needle was still left inside
• Miss Ojo sued Dr Ejide for N2million as special
  damages for negligence and lost the case at
  the court of appeal. She appealed to the
  supreme court
                  Judgment
• Miss Ojo never called any witness on her behalf
• The respondent called expert witnesses including
  2 medical doctors and a radiologist
• There was no doctor on behalf of Miss Ojo to
  demonstrate to the court the pieces of needle
  left inside her
• Dr Gharoro told the court that the surgical needle
  was not strong and could break or snap easily,
  should the surgeon be using this type of needle
• The appeal court failed to convict the doctors of
  negligence.
                         Cases
• A woman was delivered of a baby and was admitted to
  Kenayo specialist hospital because of severe pain in her
  pubic area. The doctor at Kenayo decided she needed
  blood transfusion but the patient and her husband refused
  the treatment because they were members Jehovah
  Witness.
• The woman signed for release from Kenayo Specialist
  Hospital. Her husband then took her to another hospital
  where the doctor there was shown the release letter. She
  signed against blood transfusion. The doctor admitted her
  and continued to treat her without blood transfusion. She
  died after 5 days.
• Dr Nicholas Okonkwo, the respondent was charged before
  the MDCN tribunal for
                   Cases
• Attending to patient in a negligent manner
  and conducting himself infamously contrary to
  section 16 of the Medical and Dental Act
• Carrying on an action contrary to his oath as
  medical practitioner and hereby conducting
  himself infamously in a professional way
  contrary to section 16 of the Medical and
  Dental Act
                     Judgment
• Dr Okonkwo pleaded not guilty but the tribunal found
   him guilty
• He took the case to the appeal court. He won the case
   but the tribunal appealed to the supreme court
• The decisions of the Supreme court were:
1. The tribunal had no jurisdiction to try criminal offences
2. The function of the MDCN panel was to conduct
   preliminary investigation only
3. Infamous conduct cannot be established unless it is
   covered by the criminal code
                Judgment
• The tribunal should have passed the case to
  criminal court established for trial of such
  offence
• The doctor has considered 2 choices and has
  done his best to ameliorate the consequences
  on the patient
                     Cases
• A complaint of professional misconduct was
  made against Dr Denloye. The MDCN panel called
  witnesses but never called Dr Denloye nor his
  lawyer to appear before it.
• Later, Dr Denloye was called to give evidence but
  the chairman of the panel refuse to produce the
  evidence taken before Dr Denloye was
  summoned.
• The panel found Dr Denloye guilty of professional
  misconduct. Dr Denloye appealed to the Supreme
  court
                Judgment
• He won at the Supreme court because he was
  not giving fair hearing by the panel
• The conduct of Dr Denloye prove to be of
  criminal nature and it is the regular court
  that should try him
                          Case
• Dr Samuel Olutunde Aliu appeared before the MDCN
   investigating panel charged with
1. Processing ,sanctioning and acquiescing in the
   advertisement of the services rendered by his hospital
2. Distributing a 1993 desk calendar which contained
   several offending notes including one that says Dr
   Aliu’s Hospital will get his patient to Health for all by
   the year 2000 or even before that year
3. Conducting himself in an unprofessional manner
   contrary to the code of ethics
                 Judgment
• Dr Aliu pleaded not guilty and claimed he did
  not know anything about it. When he now
  knew about it , did he issue a rebuttal?
• He was found guilty as charged but based on
  the plea of his counsel, he was strongly
  reprimanded
                            Case
• Dr Babajide Femi-Pearse, a registered medical practitioner
   and Chief Consultant Surgeon in a public hospital also ran
   his private clinic. His case came up with with MDCN . The
   allegation against him were
1. He started to operate a clinic in a bid to earn money
2.He instituted a course of treatment in his clinic (suprapubic
   cystostomy ) not indicated in for patient’s treatment for
   profit
3.In spite of request by the patient’s daughter for her father to
   be discharged to government hospital after the operation
   because of the deteriorating condition, he refused to
   discharge him
4. His management of the patient led to the patient’s death
                    Judgment
• The tribunal condemned the patient’s motivation for
  monetary gain which led him to unwanted treatment
• Found that he, Dr Pearse failed to do certain
  laboratory tests which could have justified his course
  of action
• Found that Dr Pearse did not keep any clinic case note
• Directed that Dr Pearse name be erased from the
  register for a period of 12 calendar months because
  he had changed his plea to guilty and had shown
  remorse.
                         Case
• Dr Afam E. Ezendiugwu, a registered medical
   practitioner of Sophi clinic, Ifako, Agege, Lagos was
   accused of Negligence. The case against him was
1. He did a Caesarian section on Mrs. Faith Ashiye in April
   1996 without the necessary consent form. The patient
   died 4 days post-surgery
2. He relied on resident surgeons to carry out the
   operation without using the appropriate specialist in
   O&G
3. He did not ensure that necessary qualified nurses
   looked after the patient after her recovery
                     Case
• He was accused of professional malpractice
  because
• He caused surgery to be done without any
  clinical condition
• He failed to refer the patient in good time to a
  center with better post operative
  management when the patient developed
  complication
                  Judgment
• Dr Ezeadiugwu’s lawyer raised an objection to
  MDCN tribunal trying the case because it was a
  criminal case. But it was resolved because the
  case should be decided as it is framed and not as
  it could be or should have been framed
• As for negligence, the surgery (C/S) did not
  require the level of specialist O&G
• Payment of surgical fee and the knowledge of
  operation are not enough evidence for consent
• C/S was not indicated and no effort was made to
  deliver the patient normally
                   Judgment
• The doctor failed to refer to a better facility
• He was suspended from practice for six
  months
                    Case
• Dr Henry Awani ran a private clinic at
  Amukoko in Lagos. He was accused of
  attempted sexual assault on a patient, Mrs.
  Ogades, who presented with vaginal bleeding.
  The offence was in 1976, but tribunal did not
  begin sitting till 1980
                 Judgment
• The tribunal found Dr Awani not guilty of
  malpractice because she did not prove her
  case beyond reasonable doubt.
• Dr Awani was advised to always have a
  female nurse around when examining a
  female patient.
                      Case
• This case was brought by the family of the late
  Miss Nkoh Meka to the MDCN. Miss Nkoh saw Dr
  Iroha for treatment of infertility. She had then
  been married for 9months. Dr Iroha did not wait
  for semen analysis before investigating for
  blocked fallopian tubes.
• Without obtaining consent for anaesthesia, Dr
  Iroha administered anaesthesia to Miss Meka.
  She died during the recovery phase of anesthesia
               Questions raised
• Was Dr Iroha right to start investigation for infertility
  after 9 months of pregnancy?
• Should Dr Iroha not wait for the semen analysis(Which
  in this case showed oligospermia)?
• Was there a demonstrable blocked fallopian tube?
• Did Dr Iroha obtain written consent from the couple to
  carry out investigation under anaesthesia
• Was Dr Iroha competent to administer anaesthesia
                   Judgment
• He was found not guilty of treating infertility after
  9months.
• Guilty of not waiting for the result of semen
  analysis
• Guilty of assault and battery for not obtaining
  written consent from the couple
• Negligent for not taking care of the patient during
  the recovery phase of the anaesthesia
• He was suspended for 3 months from practice
                    Case
• Dr Olumide is a Consultant Obstetrician and
  Gynaecologist. He was accused of leaving a
  cloth material in the abdomen of his patient
  Mrs Onigbayo in April 1997 and of enticing
  Mrs Onigbayo from a General Hospital to his
  private clinic
• In his defence, Dr Olumide said the duty of
  counting instrument and swab was that of
  the nurses
                  Judgment
• The tribunal insisted that the responsibility of
  ensuring that nothing was left behind is the
  duty of the surgeon.
• The tribunal in their judgment said Dr
  Olumide’s action is tantamount to infamous
  conduct with respect to the charge brought
  against him and suspended him from
  practicing for 6 months
                         Case
• Kehinde and her twin were born at a Maternity and
  child health center in Ibadan in 2004. Her sister died 2
  days after.
• Kehinde had diarrhoea after 2 weeks that necessitated
  her been admitted to UCH Ibadan.
• She was put on an infusion and the person who set up
  the drip forgot the tourniquet in her right hand
  overnight.
• In the morning the arm was noticed to be swollen
  and black(gangrenous) because blood flow to the
  hand had been obstructed. The baby’s arm had to be
  amputated
                Questions
• Who is negligent in this case?
• Should the hospital compensate the baby’s
  parent?
• Should the hospital be responsible for
  providing prosthesis for the child?
                          Case
• Mr and Mrs Eniola’s first baby developed jaundice after
  delivery. Baby Eniola was taken to LUTH where it was
  decided to offer her EBT. Her father was asked to donate
  blood for this procedure.
• Baby Eniola’s case worsened and series of test done on her
  showed that she was HIV positive. The Baby’s parent were
  recalled for HIV test and this was negative.
• How could Baby Eniola be then HIV positive? The original
  blood used to transfuse Baby Eniola was screened before
  transfusion and was HIV negative. The donor of this blood
  was subsequently recalled and he tested positive.
• Comment on the following action taken by the then
  Minister of Health
                    Questions
• CMD was sent on terminal leave
• CMAC, Chief Medical laboratory Scientist, ,Desk officer
  and HOD Haematology were relieved of their posts
• Assistant Director , Laboratory services was demoted
• A consultant Haematologist was warned
• Nothing was said about financial compensation to
  Mr&Mrs Eniola
• What will be the role of the NMDC if this case was
  reported to the council?
                  Recommendations
1.   Medical doctors should from time to time go through continuous medical
     education programme on medical ethics and medical jurisprudence.
2.   The general public should be informed through the mass media of their
     rights regarding doctor / Patient relationship
3.   Medical curriculum should lay more emphasis on medical ethics and
     medical jurisprudence and the course should be made compulsory in the
     Medical Curriculum
4.   Hospital administration should make sure that doctors they employ have
     insurance policy against malpractice litigation from patients.
5.   Doctors in private practice should insure not only their hospital but also
     themselves against malpractice suite that may be brought against them by
     patients
6.   Doctors who are summoned to answer charges by MDCN disciplinary
     committee should engage the services of a medical jurisprudence lawyer
                Gratitude
• Profound gratitude to Prof Wole Alakija who
  provided the enlightenment at a recent
  workshop in Abuja (June 2011).
• References made to his book titled ‘Handbook
  on medical ethics and Medical Jurisprudence
  (4th Edition)’

								
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