A Tale of Medical Negligence
Chiemelie Ezeobi reports that the death of Lagos-based pastry chef, Mrs. Peju Ugboma, has once again brought to the fore the menace of medical negligence in treatment of patients
Medical negligence, according to the Free Dictonary, is the improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist or other health care professional. In Nigeria, the Rules of Professional Conduct for Medical and Dental Practitioners, also known as the Code of Medical Ethics clearly stipulated what amounts to medical negligence and they include:
failure to attend promptly to a patient requiring urgent attention when the practitioner was in a position to do so; manifestation of incompetence in the assessment of a patient; making an incorrect diagnosis particularly when the clinical features were so glaring that no reasonable skillful practitioner could have failed to notice them; and failure to advise, or proffering wrong advice to, a patient on the risk involved in a particular operation or course of treatment, especially if such an operation or course of treatment is likely to result-in serious side effects like deformity or loss of organ.
Others include failure to obtain the consent of the patient (informed or otherwise) before proceeding on any surgical procedure or course of treatment, when such a consent was necessary; making a mistake in treatment e.g. amputation of the wrong limb, inadvertent termination of a pregnancy, prescribing the wrong drug in error for a correctly diagnosed ailment, etc; failure to refer or transfer a patient in good time when such a referral or transfer was necessary; failure to do anything that ought reasonably to have been done under any circumstance for the good of the patient; and failure to see a patient as often as his medical condition warrants or to make proper notes of the practitioner’s observations and prescribed treatment during such visits or to communicate with the patient or his relation as may be necessary with regards to any developments, progress or prognosis in the patient’s condition.
Essentially, there are various laws governing medical practice and one of such is the Medical and Dental Practitioners Act (CAP M8) which is designed to regulate and govern medical ethics in Nigeria and rules of professional conduct for Medical and Dental Practitioners. Another one is the Rules of Professional Conduct for Medical and Dental Practitioners.
Also, medical practitioners are governed by International Code of Medical Ethics (Declaration of Venice 1983), as well as The
Hippocratic Oath, an ethical guideline/pledge taken by physicians to serve humanity to the best of their ability and without discrimination of any sort and without breaching patients confidentiality.
But despite all these ethics and laws, Nigeria has been plagued by malfeasance of medical negligence, often leading to death.
Death of Pastry Chef
Recently, the issue of medical negligence came to the fore again following the death of Lagos-based Founder and CEO of I Luv Desserts, a pastry confectionary, Mrs. Peju Ugboma. After her death, the bereaved family accused Premier Specialist Medical Centre, Victoria Island, Lagos, of alleged medical negligence in handling her surgery.
According to the family, the award-winning pastry chef died due to alleged gross negligence on the part of the hospital, which led to her untimely death.
In a statement issued by Mr. Nwabeze Ugboma for the family, he said “an independent autopsy carried out by pathologists at LASUTH with credible observers and Premier Hospital in attendance revealed that Peju suffered internal
bleeding. It was discovered that she had about two litres of blood in her abdomen and
pelvic area.”
Giving a run down of the events that led to her admission in the hospital, the subsequent surgery and death, he said the deceased went for elective surgery for a fibroid issue on Thursday, April 22, 2021.
He said: “She walked into the hospital by herself unaided as it was by no means an emergency surgical procedure. She had concluded all the necessary tests required before the surgery, including ECG, PCV, and COVID -19 tests.
“Her vitals were okay and she had no preexisting conditions prior to surgery. All payments were made for the preliminary tests. The hospital demanded their account be funded to the tune of N1.5 million and the family deposited N1 million immediately.
“The surgery was carried out on the morning of Friday, April 23, 2021, by Drs. Akinsiku, Iwuh, Asemota, Renner, and some other medical personnel in Premier Specialist Hospital, Victoria Island. Peju’s husband saw her after the surgery on Friday, and she complained about severe abdominal pain and discomfort, which he felt was not unusual for someone who had just come out of surgery. However, her blood pressure had dropped to as low as the range of 50/30.
“The doctors then gave her blood transfusion because she had lost a lot of blood during the surgery. Early on Saturday morning, she told her husband that the veins on her hands had collapsed and the hospital wanted to give her fluids on a vein close to her neck and collarbone.
“She also mentioned that the doctors said her kidneys were not functioning optimally, and a Consultant Nephrologist had been called in to come in that Saturday morning. This was a shock to them both as all tests prior to surgery were fine. The consultant eventually came in as scheduled but dismissed both their concerns.
“By Saturday evening, she had been given three pints of blood. It’s worthy to note that none of the gynecologists who performed the surgery attended to her throughout that Saturday despite all her pain and concerns expressed by her husband. That same Saturday evening, her blood pressure dipped further. Dr. Renner told her husband that they would need to move her to the ICU. He was asked to pay an additional N1.5 million before she could be moved to the ICU and he paid the money without delay.
“Peju was admitted into the ICU immediately after payment. Dr. Renner then told her husband that he needed an additional three pints of freshly donated B+ blood, as Premier Specialist Hospital did not have any in the hospital’s blood banks. This left him with no choice but to go on a blood donation drive from friends and family. Several donors were screened and they donated a total of nine pints of blood that night. this was going on, Peju kept complaining of severe pains, and her eyes had turned yellowish. At about midnight that Saturday, she was sedated intravenously. By 6.30 am on Sunday, her husband was surprised to find out that his wife had been placed on a respirator. Dr Renner told him that her condition had deteriorated through the night.
“Her husband saw that she looked pale, and her eyes had been taped as if to keep them closed, but she was still breathing and the monitors were still reading. Peju’s husband had been in touch with a family friend who is a UK based consultant
gynecologist. The consultant raised alarm and insisted on speaking with the doctors at Premier hospital. He spoke with Drs. Asemota, Iwuh and the medical director Dr Oshinowo.
\“He stated expressly that he was of the opinion that she had severe internal bleeding and needed to be moved back to the operating theatre for the bleeding to be arrested immediately. Premier team however ignored his advice. Premier decided to move Peju to a hospital where she could have a CT Scan and possible dialysis. By 10 am on Sunday, her husband was informed that his wife would be moved to Evercare Hospital, Lekki Phase 1.
“However, it took three hours before she was moved to Evercare.
Immediately she arrived there she was met by their medical team and taken to the
ICU. Her husband was asked to pay another N1 million at Evercare, and he made the payment immediately. The head of the ICU detected that Peju did not have a pulse and emergency CPR commenced immediately. This failed and she was pronounced dead by 2.20pm on Sunday.”
Autopsy
After her death, he said Premier Specialist Hospital offered to do an autopsy, however, the family insisted on an independent autopsy. On this he noted that “the independent pathologist requested Peju’s full medical report prior to the autopsy as is normal practice but Premier Specialist Hospital management were playing games to stall releasing it.
“It took a visit by family to Premier Hospital who engaged the doctors and management in a shouting match and nearly resulted in a physical
confrontation before the medical reports were released.”
He further alleged that the medical reports sent to the independent pathologist may have been tampered with or altered, adding that it was “clear that Peju bled internally from Friday after the surgery till Sunday when she died, and it is shocking to note that Premier hospital was negligent enough not to pick this up and save her life. Peju’s tragic and unfortunate death has left behind two heartbroken little girls, a grieving husband and an aged mother and loved ones”.
Speaking to THISDAY afterwards, Mr. Nwabeze Ugboma said the hospital reached out to them last Saturday that they wanted to come pay condolence call at the house but they turned it down. He said: “We reminded them that they have sent a condolence letter already, so they didn’t need to come to the house again.” Silence from Premier Hospital
When contacted for their reaction, the operator at Premier Hospital dispatched the call to the hospital and a staff simply identified as Deborah promised to reach out with answers. After taking down the reporter’s phone number, she said the management will provide answers to the questions, which they did not even five days after.
Also dialling Evercare Hospital, the customer service agent, who answered the call said the management was not available to speak, but said she was instructed to send an email address to communicate the message, which she did not.
Demands for Justice
Her demise prompted the #JusticeForPeju Ugboma hashtag on Twitter with many Nigerians demanding justice in the case.
Investigation by Lagos
On their part, given the public outcry that greeted the incident, the Lagos State Commissioner for Health, Akin Abayomi, directed the state’s Health Facility Monitoring and Accreditation Agency (HEFMAA) to investigate the allegations of unprofessional conduct leveled against Premier Specialist Medical Centre.
FCCPC Intervention
Intervening in the matter, the Federalist Competition & Consumer Protection Commission (FCCPC) issued notices of commencement of investigation. They also summoned two hospitals accused of medical negligence leading to the deaths of the patients in their care- Premier Medical Specialist Centre over Ugboma’s case and Beachland Hospital, Ogun State, over one Omolara Omoyajowo, a staff of Lagos State Emergency Management Agency (LASEMA).
According to FCCPC Chief Executive Officer, Babatunde Irukera, the initial information the commission gathered was sufficient for them to open an investigation into the cases.
“As such, the Commission has today issued Notices of Commencement of Investigation & Summons to Produce (NCISP) to relevant persons/entities. The Commission is also communicating with the Medical & Dental Council of Nigeria (MDCN), to expand engagement to the extent that any pertinent conduct may be otherwise unprofessional and, or may be subject of any disciplinary process (if applicable).
Quoting Section 17(a), (e), (s) and (y) of the Federal Competition & Consumer Protection Act (FCCPA), he said it “mandates the commission to enforce any enactment with respect to the protection of consumers, conduct investigations into matters related to consumer protection; ensure consumer interests receive due consideration, and provide redress to obnoxious practices; ensure service providers comply with local and international standards of safe service delivery”.