- Our fears, by doctors
The cruel fate of involving in an accident or being shot by robbers could happen to anybody. Given the sanctity of human life, and the fact that the law makes provisions for obligatory treatment and care for such persons, it becomes puzzling to see some Nigerian hospitals still reject gunshot victims. ISIOMA MADIKE, in this report, looks at this vexatious issue
Doctors, by their professional calling, have a duty to save lives. But the issue of harassment when victims are treated without police report appears to be a veritable ground for hospitals to turn back accident or gunshot victims even when such are innocent persons in need of help.
A recent incident in which an Ogun State-based senior Engineer with Erickson, Adebayo Akinwunmi, died has again brought the issue to the front burner. Akinwunmi, 41, was said to have been shot by dare-devil armed robbers in his house at Ofada-Mokoloki, Ogun State. Reports, quoting his family, claimed that he was rushed to Reddington Hospital in a pool of his blood but that the hospital’s doctors refused to attend to him.
The hospital, reports further alleged, insisted on a police report, which the family could not immediately produce. Akinwunmi regrettably died shortly afterwards.
His elder brother, Babatunde, a chief scientific officer with Lagos State government was quoted to have said that the family was shocked to see a report by the hospital twisting the whole story.
“I demand that the hospital should accept responsibility for my brother’s death by writing a letter of apology to the family and issuing a press statement correcting all the lies they are feeding the world.
“Failure to do this, our family will issue a statement detailing what happened and seek redress. If they apologise with an official letter and issue an official statement, we will allow sleeping dogs lie, after all, nothing will bring my brother back to life again. But we would not like hospitals to continue doing this to Nigerians,” he added. He, nonetheless, gave details of how his brother died.
Babatunde said: “His wife called me around 1.30 am that day that my brother was shot by armed robbers. I raced to the scene to see him in a pool of his blood. We quickly rushed him to Reddington Hospital in Lagos where his office maintains a retainer ship.
When we got to the hospital, we were ushered into their reception. While we were appealing for urgent treatment, the nurses were just lazily walking around without treating him.
“Our pleas for urgent treatment were rebuffed as they loudly demanded that we should present a police report before they will treat my brother, who was losing a lot of blood through the gaping bullet wound on his shoulder pad. When we continued to plead, reminding them that my brother ’s company has a retainership with the hospital, one of the nurses simply told us that there was no doctor on duty even if they change their mind and they referred us to Lagos State University Teaching Hospital (LASUTH), Ikeja.
“At that stage, we decided to rush him to LASUTH but when we got there, he was pronounced dead by doctors. Sadly, while we were on our way to the hospital, my brother who was losing blood kept on urging us to rush him to his hospital, Reddington, assuring us that they save him but the same hospital ignored him because we could not show a police report immediately.
That was how my brother, who won an award last year as the best staff in Ericsson, the communication company where he worked and was sent on an all-expense paid trip with his wife to the USA, gave up the ghost.”
The robbers, numbering four were said to have scaled the fence into the engineer’s house. The robbers did not wear any mask, according to one report, which quoted an anonymous source.
T h e source said: “The man’s wife was sleeping when they shouted through the window that the family should open the door. They showed their guns and threatened to shoot.
The man asked the wife to stay in the bedroom and assured the robbers that he would open the door. He was about to open the door when the men, who had become impatient, broke the door with their legs.
“As they were querying the man for being sluggish, the wife came out and started begging them. They asked the wife what they had and she gave them their ATM cards, phones and laptops.
But as they made to leave, one of them shot the engineer in the rib region. Not in support of the action, the three others reprimanded the shooter, led the wife out and asked her to open the gate to get someone to take her husband to a hospital.
They asked her not to shout.” As depressing as the Akinwunmi’s case appears, his, was just an addition to the growing statistics of such preventable deaths.
The past is replete with needless deaths after hospitals rejected injured people. Funmi Odusina, a postgraduate student of the University of Lagos, who was in the company with her friends at a Lagos beach, was rescued from drowning, but was rejected by some private hospitals. She died on the way to the Lagos Island General Hospital.
There is also the case of Ogunbayo Ohu, the then Assistant News Editor of The Guardian, on September 20, 2009. Ohu, who was attacked by assassins in his house in Egbeda, Lagos, by unknown killers, did not die instantly. Reports had it that he would have survived the gunshots if the neighbouring hospital he was taken to had promptly attended to him.
He was said to have been rejected at the hospital and could not make it to the nearest public hospital. Similar incidents included the 2008 case of Saka Saula, the then chairman of the Lagos State chapter of the National Union of Road Transport Workers, who was reportedly shot in his house. He, like many others before him, died on the way to a public hospital after a nearby private hospital refused to treat him. The case of two brothers – Raphael and Felix Omorukhe, who died after an armed robbery attack in Lagos, easily comes to mind. While Felix died instantly, Raphael initially survived, but died later after he was turned back by private and public hospitals because there was no police report.
A female undergraduate in one of the respected universities in the South-West also suffered the same fate after she was rejected by the institution’s teaching hospital for lack of proper identification. Another student equally died in one of Nigeria’s oldest polytechnics in a related circumstance.
In most cases, family members and other sympathisers of gunshot victims are often too shocked and confused to really have the stability of mind to think rationally. Just imagine what the frame of mind of a woman who virtually watched as her husband was being brutally murdered would be at that particular moment, one commentator noted.
This is exactly why it is crucial for health workers to always consider the sanctity of the human life in such decisive circumstances. However, Reddington Hospital, which has been on the spotlight since the unfortunate death of Akinwunmi, who was said to have been rejected by the hospital, made headline news across the country, has reacted.
It said in a statement that it does not demand police report or any other report before attending to gunshot victims in any of its hospitals capable of handling such cases. In the statement signed by the Group Medical Director, Dr. Olatunde Lalude, the hospital said it was untrue that it rejected the gunshot victim.
Lalude said: “We want to maintain that our hospital was established primarily to save lives and provide health care to those in needs. It would be against the objectives of the founders to reject any patient except where the hospital feels that such a case would be better handled elsewhere and would be appropriately referred.”
He said that the investigations carried out by the hospital in the case of Akinwunmi, showed that he could not be attended to because the branch does not have the capacity in terms of personnel, and equipment to attend to such a case.
Lalude said: “The doctor directed the driver to take them to LASUTH, which has both an intensive care and a cardiothoracic unit. Critically, at that time of the day (after 2 am) LASUTH is approximately five minutes’ drive from the Reddington Hospital. It would have endangered his life further if an attempt had been made to delay things by taking him into the Reddington Hospital for stabilisation.”
But, health experts, in other climes, have said that gunshot victims are prone to anaerobic infections, especially tetanus and gas gangrene. Emergencies, they added, need a quick response, not a denial of treatment. Not in Nigeria, however, where many of such victims still bleed to death.
Several directives by the police high command have changed nothing. The Inspector-General of Police (IGP), Ibrahim Idris, had in March 2017, ordered hospitals to treat gunshot wounds with or without police report.
Fatai Owoseni, then Lagos State Commissioner of Police, who spoke on behalf of the IGP, said the police boss only previously advised hospitals to ensure that they make proper report at the nearest police station. He said: “Any medical practitioner who insists on the production of a police report is doing that on his own. All the hospital needs to do is to report at the nearest police station for accountability and record purpose.
This is important for the protection of the hospital because when the police are aware, they can protect the hospital from further invasion by the victim’s gangs to rescue him. Our personnel have been warned not to hoodwink any medical practitioner.” Owoseni said the command was aware of the public observations on acts of indiscipline by some policemen, saying that the area commanders and Divisional Police Officers (DPOs) had been cautioned.
“We have passed on your observations and we hope they pass it on to their subordinates too,” he added. Lagos State Commissioner of Police, Imohime Edgal, also threatened after Akinwunmi’s death, that the police would “arrest and diligently prosecute” any hospital, either private or public, that fails to treat a patient with gunshot injury on the premise of no police report.”
A statement by Chike Oti, Public Relations Officer of the police in Lagos, described the action of Reddington and LASUTH as “cruel”. He reminded the hospital managements of the “Compulsory Treatment and Care of Victims of Gunshot Act, 2017”. Oti said: “In the light of this development, the command wishes to inform all medical practitioners in Lagos State that the Act demands that, every hospital in Nigeria whether public or private shall accept or receive for immediate and adequate treatment with or without police clearance any person with gunshot wounds.
The Act, however, requires the hospital treating such a patient to report the fact to the nearest police station within two hours of commencement of treatment.” Governor Nasir el-Rufai, had, in 2016, also directed all hospitals in Kaduna State, to start treating persons with gunshot wounds and accident victims before demanding police report.
Samuel Aruwan, the governor’s spokesman, who disclosed this, said the directive was part of the agreement reached during the 15th session of the state Security Council meeting. He said that saving lives was more critical than waiting for a formal police report, and warned that any hospital that failed to abide by the decision would be held for criminal neglect.
He said: “Lives must be saved first, before the formalities of demanding police reports from victims. After saving lives, hospitals and other agencies can start making inquiries regarding how the gunshot wounds and other injuries were sustained.
We consider it a gross abdication of responsibility if any hospital leaves injured patients unattended to because of the absence of police report. What is important is saving lives.
“There is no reason for an innocent citizen who has survived armed robbery and needs treatment for gunshot wound to be denied the medical attention he requires. The hospitals can comply with reporting requirements to the police after providing the care the patient needs.
This is the unanimous resolution of the Kaduna State Security Council. “As governor, I have communicated this decision to the Kaduna State Ministry of Health and Human Services and other concerned agencies operating in the state. All our healthcare agencies have been advised that it will amount to criminal neglect to deny or delay critical care to such patients.”
The Minister of Health, Isaac Adewole, had equally issued a similar directive to medical doctors to treat the injured when six medical doctors from Ekiti State died in a road accident in Kaduna State after a hospital denied them first aid treatment.
Retired IGP, Solomon Arase, was also forced to reissue the directive in September 2015, stopping police from molesting doctors who treat injured persons.
The Federal Road Safety Commission (FRSC) has not been left out of this. It had, at a time, also announced that it would, henceforth, prosecute hospitals that reject accident victims brought by its patrol teams.
The frustration of the FRSC stemmed from the difficulty of getting help for traumatised accident victims who need urgent medical attention. Whatever consideration that may have informed the practice of rejecting patients with gunshot wounds, it said, is a pathetic admission that in Nigeria, the dignity due human life is often denied.
Whereas the law mandates the FRSC to rescue accident victims, administer First Aid and take such to the nearest hospital or medical facility for proper medical attention, the law is silent on who foots the bill, especially, if the victim dies. Members of the public face the same predicament as a traumatised victim can’t negotiate his or her own treatment at a most critical moment.
But, apart from being implicated by the police, most hospitals refuse accident victims purely on the basis of payment of cost incurred. All hospitals in the country, including the General Hospitals, operate on cash payment basis. While a proverbial Good Samaritan might be altruistic to pay the hospital bills of a vehicle accident victim or any other traumatised person, the FRSC, which has the statutory duty to rescue such persons, is often in a dilemma over payment once it manages to get a hospital for the patient.
And the hospitals, especially, private ones would ever hardly administer treatment free of charge. It is on this strength, perhaps, that the Nigeria Medical Association (NMA), is putting up a strong argument regarding the issue.
The National Secretary of the medical body, Dr Olumuyiwa Odusote, believes that the law was deficient and was not fair to the health facilities. He was quoted to have said that the NMA had in the past voiced its reservations on the Gunshot Wounds 2017 Act.
“NMA believes that even though the law seeks to protect patients with gunshot injury, it is deficient. This is because sometimes, to intervene and save the lives of patients with gunshot wounds, it takes far more than four hours to achieve but that law restricts the period within which you are to report to the police to two hours.
“If for example, the patient was shot on the chest and you have to take him to the theatre immediately in order to stabilise him and stop him from bleeding, that procedure takes more than two hours to carry out. It means that I am liable. By the time I come out to say I want to make a report to the police, they can arrest me for concealing a gunshot wound patient.
“If a law penalises my intention to save a life, what should I do naturally? To avoid anything that will put me in that circumstance, the easiest way is to refer such patients to centres where they have enough, while the doctors are working, some administrative officers somewhere are contacting the police. But most of the private hospitals we have in the country are usually run by the doctor himself who also administers treatment.
By the time he tries to save that life, he will not have time to make that report. “Again, the police we have in the country will take advantage of that and God help that doctor if he doesn’t have money to give, he is going to be thrown behind bars for doing his legitimate duties. It is difficult for me to say that any doctor who does not take such a patient should be blamed,” Odusote said. He did not stop at that but said:
“The second problem is that the law does not make provision as for who pays. The law says you must treat, yes, even if you treat, who pays? One of the major problems we have in this country is that we don’t have a good healthcare financing system. Most patients pay out of pocket. And most of these patients cannot afford out of pocket payment for healthcare.
If you say you want to force a facility to treat patients and by the time he finishes and the patient cannot pay, who pays? It will take a few months for such facility to shutdown naturally, and then deny care for thousands of others.” Odusote also argued that a doctor can only accept a condition that he or she is competent and equipped to manage.
“If you say I must treat a gunshot wound and I don’t have the facilities to do so, the moment I take that patient and he or she dies, I become liable. The law allows us to refer a patient that we cannot manage. Once I know I cannot manage a patient, it is better for me to refer than to keep a patient for hours and now say sorry we cannot do anything for you and go to another place.
It is better to let the patient know abi ni tio that I cannot manage your condition and refer to a better centre.” However, armed robbery was said to have become rife, shortly after the Nigerian Civil War in 1970. The military government, which noticed that robbers, who escaped with gunshot wounds were being treated at hospitals, reacted by promulgating the Robbery and Firearms (Special Provisions) Decree No. 47 of 1970. A 1986 amendment to the decree stated that hospitals must notify the police if they treated any gunshot victim.
Acting on this, the police banned emergency medical treatment for gunshot victims. Incidentally, President Muhammadu Buhari signed the Compulsory Treatment and Care for Victims of Gunshot Act, 2017, not too long ago.
This, ordinarily, should have put to rest the contentious issue once and for all. The import of the President’s assent to the law, is that victims of gunshot and car accidents should receive immediate treatment in the hospital without qualms.
The law makes provisions for obligatory treatment and care for victims of gunshot as it stipulates that a person with a gunshot wound shall be received for immediate and adequate treatment by any hospital in Nigeria with or without initial monetary deposit.
The Act also stipulates that a person with a gunshot wound shall not be subjected to inhuman and degrading treatment or torture by any person or authority, including the police and other security agencies.
The law is primarily concerned about access to medical care, irrespective of circumstances leading to the gunshot. In that instance, suitable treatment from medical workers, and essential assistance from security agencies should follow treatment of gunshot victims irrespective of the cause of the shooting. This becomes rather very essential in view of the fact that it is not every gunshot wound victim that is a criminal. The medical Oath, according to the Act, is binding on medical doctors all over the world.
It stipulates that the desire to save life should be central in all their concerns. It also stated that health workers have the fundamental task of first and foremost caring for the injured and the sick on the basis of the ethics of their profession. Aside the humanitarian and professional perspectives, some have said that it is legally wrong for medical workers to insist on the production of police before attending to victims of gunshots.
Unfortunately, with the incessant harassment of the medics by the police, no one seems to be speaking of comprehensive protection of the health workers in case the unexpected happens.
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