Nigeria: Observance Of The Patient Safety Measures In The National Health Act: The Panacea For Medical Negligence In Nigeria

INTRODUCTION

Patient safety is a fundamental principle of health care. Globally, patient safety has been recognized as a public health challenge. Relevant institutions, recognizing this challenge, have established mechanisms to drive improved patient care and safety. Every year from 2019, on the 17th day of September, the world marks 'World Patient Safety Day. This day was set aside by the World Health Organization (WHO) to draw the attention of all stakeholders¹ in the healthcare ecosystem to the critical importance of patient safety and to advocate for its improvement.

In some climes, the instrumentality of the law has been deployed to facilitate patient safety. In Nigeria, going by its provisions, one of the key essences of the National Health Act of 2014² is the optimal achievement of patient safety by healthcare institutions in the country. Thus, even though the Act does not specifically provide for patient safety in the strict sense of the word, proper adherence to the principles enunciated in the legislation will result in reduced medical errors and improved patient welfare. The legislation guarantees many patient's rights. These are the rights that if protected and respected by healthcare professionals will pave the way for the actualization of patient safety.

This article will show that to reduce the incidences of medical negligence in Nigeria, there must be strict adherence to the key principles of the National Health Act of 2014.

WHAT IS PATIENT SAFETY?

In Nigeria, patient safety remains an emergent issue. That explains the dearth of judicial pronouncement on what constitutes patient safety. This is a fallout of the almost nonexistent case laws on healthcare issues, and the lack of specific legislation that speaks solely to patient safety in the country. Thus, we will rely on definitions drawn from the medical sphere.

Patient safety is defined by the WHO as "the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. ³It is a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce its impact when it does occur.⁴ Further, patient safety involves identifying, assessing, and managing patient-related risks and occurrences to improve patient care and reduce patient harm.⁵ Operationally, patient safety refers to the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare.⁶

WHAT IS MEDICAL NEGLIGENCE?

The tort of medical negligence arises out of the fiduciary relationship between the healthcare provider and the patient.⁷ That relationship presupposes that the healthcare professional has shown himself to possess certain skillsets and knowledge, and thus to act contrary to that representation would be to breach the confidence reposed in his possession of the skillset. In Nigeria, for a doctor (as an example) to be held liable for medical negligence the action must be such that falls short of the standard of a reasonably skillful medical professional.⁸

THE NATIONAL HEALTH ACT AND PATIENT SAFETY MEASURES

With the above definitions in mind, we will now turn to consider why the observance of the patient safety measures as enshrined in the National Health Act, 2014 could assist in stemming the scourge of medical negligence in Nigeria.

A perusal of various law literature and regulatory codes⁹ reveal the common incidents that amount to medical negligence in Nigeria. They ranged from unreasonable delays in attending to patients to incompetent patient assessment. Others include incorrect diagnosis despite glaring clinical features, mistakes in drug administration, failure to inform the patient as to the risk associated with a treatment option, and failure to obtain informed consent before treatment, among others. Furthermore, it has been shown that the common barriers to patient safety are communication and feedback errors. Thus, it's been argued that communication within and across professionals involved in patient care is essential in minimizing patient safety incidents and accidents.¹⁰

The question now arises: having regard to the above-mentioned incidents that could constitute medical negligence, what is the role of the National Health Act in the reduction of these incidents?

Granted that the National Health Act might not be the poster child for the full achievement of patient safety in Nigeria, it nonetheless provides principles by which healthcare professionals must abide if the incidences of medical negligence are to be reduced. There are salient provisions in the legislation that address some of the incidents that result in negligent acts. Unreasonable delay in attending to a patient has been cited as one of the resultant acts of negligence. What does the National Health Act have to say in that regard? The Act is very explicit on the obligation of the healthcare provider to attend to emergency cases without delay.¹¹ The Act goes a step further to make it an offence for the healthcare provider to refuse to attend to an emergency case. It goes without saying that if healthcare providers abide faithfully by this provision of the law, incidences of fatalities arising out of negligence will be reduced.

Further, the National Health Act is very clear on the extraction of informed consent from a patient before a course of treatment or surgery.¹² Failure to do so amounts to negligence. The issue of informed consent is a patient safety measure and ought to be adhered to strictly. This is because a patient has the legal right to refuse a particular treatment option having taken into consideration its associated risks.

Communication and feedback systems among healthcare professionals have both been identified as common factors that create the environment for negligence. The National Health Act has established certain measures to curtail these factors. First, is the mandatory requirement of health establishments to keep medical records.¹³ Another is the penalization of certain acts such as the falsification of medical records by deletion or addition¹⁴; failure to create or change a record when properly required to do so¹⁵ and the creation, change or destruction of a record without the authority to do so.¹⁶ If these measures are adequately followed, the communication and feedback challenge will be solved.

CONCLUSION

Patient safety remains a public health challenge in Nigeria. Undoubtedly, the present legal framework is limited in addressing the challenge. However, the situation is not completely hopeless. Our healthcare professionals are enjoined to adhere to the provisions that cater for the patients under the National Health Act, for that is a starting point while we await a more robust framework.

Footnotes

1. Such stakeholders include healthcare professionals (doctors, nurses, pharmacies, radiographers, medical laboratory scientists etc.), policy makers, patients and their families.

2. This is the key legislation in the health law space in Nigeria. This Act and other health related legislations regulate the health care system in Nigeria.

3. https://www.who.int/news-room/fact-sheets/detail/patient-safety Accessed March 2024.

4. https://www.who.int/health-topics/patient-safety#tab=tab_1 accessed March 2024.

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951849/#:~:text=Background%3A%20Patient%20safety%20involves%20identifying,northern%20part%20of%20the%20country. Accessed March 2024.

6. https://journals.lww.com/npmj/fulltext/2020/27030/patient_safety_in_a_resource_constrained_context_.9.aspx accessed March 2024.

7. Abatan v. Awudu (2003) 10 NWLR (Pt. 829) 451 CA.

8. OTTI v. EXCEL-C MEDICAL CENTRE LTD & ANOR (2019) LPELR-47699(CA) (Pp 52 - 53 Paras F - B).

9. For instance, the Rules of Professional Conduct for Medical and Dental Practitioners which was revised in 2014 and currently referred to as the Code on Medical Ethics in Nigeria.

10. Iloh GU, Chukwuonye ME. Drug promotion in a resource-constrained Nigerian environment: A cross-sectional study of the influence of pharmaceutical sales representatives on the prescribing behaviours of Medical Practitioners in Abia State Arch Med Health Sci. 2017;5:215–22

11. Section 20, National Health Act, 2014.

12. Section 23, National Health Act.

13. Section 25.

14. Section(29)(2)

15. Section 29(2)(d)

16. Section 29(2)(c)

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