In Defence of Citizen Rebecca

The Advocate

By Onikepo Braithwaite

Onikepo.braithwaite@thisdaylive.com

Condolences to the Sekidika Family

The death of young, beautiful, intelligent first class honours Microbiology graduate of Benson Idahosa University, Edo State,  Rebecca Sekidika, is so sad, painful, unfortunate and absolutely needless. May Rebecca’s soul rest peacefully in the bosom of the Lord. Amen. I seize this opportunity to express my heartfelt condolences to Rebecca’s Parents, siblings and family, and pray that they will experience God’s comfort during this extremely difficult time. 

Questioning Paragon Clinic and Imaging Centre About Rebecca’s Hysteroscopy 

Even though there is a popular Nigerian saying that we cannot question God, possibly because the Holy Bible tells us that God is perfect (Matthew 5:48), we can certainly question Paragon Clinic and Imaging Centre, Port Harcourt where Rebecca went for a simple Hysteroscopy, that is, “a procedure that allows a surgeon to look inside a uterus in order to diagnose and treat the causes of abnormal bleeding”. Rebecca’s symptoms were that she had not had her period for three months, and all the tests carried out on her, including a pregnancy test, were all negative. 

Though I’m not a medical doctor, to the best of my knowledge, a hysteroscopy to diagnose the reason for abnormal bleeding is done by inserting a Hysteroscope, which is a thin lighted tube, into the vagina, to check the cervix and uterus, and an anaesthetic is not required for this. At most, an injection to numb the cervix may be given. Anaesthesia/Spinal Anaesthesia is only required for an Operative Hysteroscopy, which is used to remove growths like polyps and fibroids, or procedures like Caesarean Section. One of the news reports I read, stated that Rebecca was given spinal anaesthesia. In a videoclip that I watched, Rebecca’s Father, Mr Sampson Sekidika, stated that her Mother heard the Doctors inside the operating theatre, shouting that Rebecca should wake up (a spinal anaesthetic (like an epidural) is a local anaesthetic that does not cause a patient to fall asleep). These pieces of evidence, therefore point to the fact that Rebecca was given some form of anaesthetic, which subsequently rendered her unconscious. Loss of consciousness, is one of the most dreaded complications of spinal anaesthesia. 

So, my first few questions would be, what has happened to the Hippocratic Oath taken by Doctors here? Why was Rebecca given spinal anaesthesia, for a procedure that shouldn’t have required anaesthetic? Was she instructed not to eat six hours before the procedure, as she would be given an anaesthetic? Were Rebecca and her Parents even told that she would/may be given an anaesthetic? It would have been gross negligence on the part of the Doctors not to tell a patient that an anaesthetic would be administered on them, and to observe the normal fasting protocol. Did Rebecca eat less than six hours before the procedure (no food or drink should be consumed by a patient, six hours before a spinal anaesthetic is administered)? What tests were carried out on her, before she was given the anaesthetic – her weight, ECG, blood tests etc to determine the type and dosage of anaesthetic to be administered (this would have been done a few days before the procedure)? Why did Rebecca throw up and throw up blood? Why was Rebecca found dead in a pool of blood? 

Mr Sekidika stated that they were not told that Rebecca would given an anaesthetic, which means that the fasting protocol to be observed before an anaesthetic is administered on a patient would not have been relevant, or observed by Rebecca as she would have been unaware of any plan to give her an anaesthetic. See the case of Ojo v Gharoro (2006) LPELR-2383 (SC) per Niki Tobi, JSC who cited Lord Denning’s book ‘The Discipline of Law’ and a sub-chapter therein, ‘Doctors at Law’ where his Lordship stated inter alia that “A medical man for instance, should not be found guilty of negligence unless he has done something of which his colleagues would say: “He really did make a mistake there. He ought not to have done it…”. It appears that the Doctors made a mistake, as Rebecca ought not to have been given a spinal anaesthetic for a simple investigative hysteroscopy, nor was she, or her Parents informed that she would be given one, and the issue of being asked to observe the required fasting protocol in advance by the Hospital, in order to undergo the hysteroscopy could therefore, not even have arisen. There is a risk of vomiting and bringing up food, choking and blocking the airways during a procedure, if an anaesthetic is administered on a stomach that isn’t empty, and there is also a high risk of death, and so it would be gross negligence on the part of the Doctor not to inform a patient beforehand to observe the fasting protocol. 

Rebecca’s Father stated that the Doctor told him and his colleague after Rebecca’s death, that 30 minutes after the spinal anaesthetic was administered on Rebecca, she stated that she felt like throwing up and started vomiting blood. Could it also be that Rebecca may have had an allergic reaction, to an anaesthetic that she shouldn’t have been given in the first place?

Negligence & Lack of Accountability 

I have always harped on the issue of lack of accountability in governance; it is also prevalent when it comes to inadequate medical treatment resulting in the death or maiming of patients. Medical professionals in Nigeria do not particularly face any consequences for their negligence, acts or omissions, even when it results in death. Nigerians also seem to resign themselves to being philosophical in such unfortunate circumstances – “Amuwa Òlòrun ni” (It is the will of God). No, it is not the Will of God, for a medical practitioner to be careless, reckless and negligent – that is medical malpractice. 

Cover Up

The attempt to cover up the cause of Rebecca’s death by citing Pulmonary Embolism/Vascular Rupture as her cause of death in the Death Certificate issued to her family, shows an attempt to escape culpability for Rebecca’s death, and it is good that her Father has decided to seek for justice for his daughter, instead of letting the matter go. The authorities need to investigate the cause of Rebecca’s death, thoroughly. 

In any event, the fishy death certificate issued for Rebecca may go to no issue. In Ozo v The State (1971) LPELR-2891 (SC) per George Baptist Ayodola Coker, JSC, the Supreme Court held that though medical evidence is desirable for the proof of the cause of death, it is not essential. Liability of a Defendant could be proved from the fact that the death of an individual, was as a direct result of the negligence of the Defendant. The facts available so far, appear to draw a nexus between negligence on the part of the Hospital and the Doctors that attended to Rebecca, and her death. Pulmonary Embolism doesn’t happen magically. It is a condition in which one artery or more may be blocked by a blood clot; it has symptoms like, shortness of breath, coughing and chest pain. Not only does it require diagnosis, Rebecca had no such symptoms. In Jimoh Dina v The State 1984 15 N.S.C.C.596 at 599 per Kazeem, JSC, the Supreme Court held that where there is no medical evidence as to the cause of death, it is proper for the Court to infer the cause of death from the surrounding circumstances; or from circumstantial evidence adduced before it. See the case of Essien v State 1984 3 S.C. 14 at 18 per Bello, JSC. Even if Paragon Clinic tries to cover up the cause of Rebecca’s death, the surrounding circumstances of her death definitely raise questions about the spinal anaesthetic that was given to her, and it must be ascertained whether this was the cause of her death. 

Punishments: Negligence & Manslaughter 

The Medical and Dental Professions are governed by the Code of Medical Ethics 2008 (CME). The punishments provided for malpractice in the CME, are lenient. Section 30 of the CME provides that where a practitioner’s negligence results in the permanent disability or death of a patient, the practitioner is guilty of gross negligence and is liable to six months suspension or having his/her name struck off the Medical or Dental Register. This is almost a slap on the wrist, for killing somebody. 

In Rebecca’s case, the surrounding circumstances appear to point to gross negligence leading to manslaughter. See the case of Adeyemi v State (1991) LPELR-172(SC) per Uche Omo, JSC.

Section 317 of the Criminal Code Act (CCA) which is applicable in the Southern parts of Nigeria including Rivers State, defines Manslaughter as unlawfully killing another in circumstances that do not constitute murder. The difference between murder and manslaughter, is the lack of men rea, that is, the intention to kill. See the case of Popoola v State (2018) LPELR-43853(SC) per Olabode Rhodes-Vivour, JSC where the Apex Court defined the offence of Manslaughter thus: “….the unintentional killing of a human being. Such a killing is not premeditated but accidental, in the sense that it was not intentional”. In Rebecca’s case, even if the men’s rea was lacking, it appears that the Doctors may have been reckless. In Omini v State (1999) LPELR-2638 (SC) per Adolphus Godwin Karibi-Whyte, JSC, the Supreme Court held that Sections 302-306 of the CCA ”….recognises the difference between doing an unlawful act and doing a lawful act with a degree of carelessness which the Legislature makes criminal”. I submit that this latter part of Karibi-Whyte, JSC’s judgement, that is, doing a lawful act with a degree of carelessness, appears to be applicable in the matter of Rebecca’s unfortunate demise, and Section 325 of the CCA provides for the punishment of life imprisonment upon conviction for the offence of manslaughter. Oftentimes, I wonder about if the definitions of some offences are adequate. Even if a Doctor doesn’t go to the hospital armed with the mens rea to kill a patient thereby constituting the offence of murder, the fact that he/she is trained to know that if they do something or fail or neglect to do it, it will most likely result in death of the patient, doing that thing or omitting to do it is not just reckless and shows a wanton (intentional) disregard for the patient’s life, but to me, it resembles an implied form of an intention to kill.

Apart from filing a Complaint against the Hospital and the actual Dr(s) involved, to the Medical & Dental Council for onward transmission to their Investigating Panel (see Section 25 of the CME), Rebecca’s Parents can also make a report to the Health Facility Monitoring and Accreditation Agency at the Federal Ministry of Health (HFMAA). A criminal investigation can also be conducted by the Police, and a finding of culpability for gross negligence or recklessness or wanton disregard for the life of Rebecca, could necessitate the matter being forwarded to the Rivers State Attorney-General’s Office for the DPP’s Advice and Prosecution. 

Conclusion 

Some of the reasons responsible for medical malpractice and negligence in Nigeria, are the greed of Doctors prescribing procedures that are not required, in order to make money. This lack of empathy and compassion which has become commonplace amongst our people because of corruption, poverty and harsh living conditions, is dangerous for the health sector; it also results in the taking up of cases that a Doctor or Hospital is not equipped to handle. Lack of experience on the part of some Doctors; carelessness; lack of adequate equipment in hospitals; misdiagnosis; mistake in treatment; administering the wrong meditation, fake medication and not treating a patient promptly. Also, lack of adequate monitoring of medical facilities by the HFMAA, so that there are so many Quacks in the health sector; the ease in which cover ups of uncountable unfortunate incidents like Rebecca’s happen, as opposed to the initiation of credible investigations, thereby fostering a lack of accountability on the part of medical professionals and the “Nothing go happen” culture. The Doctors defend themselves in the face of wrongdoing, a sort of ‘esprit de corps’, rather than testify against their erring colleagues. 

My dear colleagues and readers, kindly, share your views on what can be done to hold Doctors accountable for medical malpractice. For one, I think the CME should be reviewed and stiffer penalties inserted. The HFMAA, should also be more up and doing. Hopefully, the culture of corruption will not get the better of HFMAA Inspectors, leading them to give Medical Facilities that ordinarily should not even be in existence, a clean bill of health to continue their practice of hurting, killing and causing permanent disability to patients.