December 2, 2023

What Does the Law say About Patients’ Rights by Sofiyyullah Oladipo Akinyemi

Patients being generally people in need of Medical attention and health care and treatment, do have some peculiar rights, these rights are however not new because some of them are rights that have been embedded in the fundamental rights provisions in the Constitution.

The right to life enshrined in section 33 of the 1999 constitution as amended would be inchoate without an attending access to quality healthcare,
• Section 20 of the National Health Act 2014 prohibits a health worker or health establishment from refusing emergency health treatment to a person for whatever reason. Section 20(3) allows the health care provider to refuse treatment to a person who is physically or verbally abusive, or sexually harasses the health worker, except such person is a psychotic patient.
• Section 23 and 24 of the NHA safeguards the right of patients to access to full details of all relevant information pertaining to their health.
• Section 26 OF the NHA declares all information relating to a patients health Status, or stay in a health care facility as confidential.
• The disclosure will be lawful where
• a) the user consents to that disclosure in writing;
• (b) a court orders or any law requires that disclosure ;
• (c) in the case of a minor, with the request of a parent or guardian ;
• (d) in the case of a person who is otherwise unable to grant consent upon the request of a guardian or representative ; or
• (e) non-disclosure of the information represents a serious threat to public health.
• Other rights of the patient are stated in Patients Bill of Rights which is collection of patients’ rights that exist in other instruments including, the Constitution, the Consumer Protection Act, the Child Rights Act, the Freedom of Information Act, the National Health Act, the code of medical ethics and the Hippocratic Oath.
• Section 46 also guarantees the right of patient to seek medical check up, investigation or treatment any where within and outside Nigeria the condition that no public officer of the Government of the Federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation or referral shall be dully approved by the Minister or the Commissioner as the case may be.
• Interestingly in Medical and Dental Practitioners Disciplinary Tribunal v. John Nicholas Okonkwo. [2001] FWLR (pt. 44) 542., the Supreme Court per Ayoola JSC upheld the right of a competent adult patient to reject life saving treatment. The court held among other things that, ‘if a competent adult patient exercising his right to reject lifesaving treatment on a religious grounds, thereby chooses a patch that may ultimately lead to his death, in the absence of judicial intervention overriding the patient’s decision, what meaningful option is the practitioner left with, other, perhaps than to give the patient the comfort?
• The supreme court in Okonkwo, upheld the right of a patient to freedom of thought, conscience and religion. When it held there was nothing a medical practitioner could do save state intervention when a patient refuses life saving treatment based on his faith.

The Patients’ bill of rights guarantees the following rights:
• 1. Right to relevant information,
• 2. Right to timely access to medical records,
• 3. Right to transparent billing
• 4. Right to privacy
• 5. Right to clean healthcare environment
• 6. Right to be treated with respect.
• 7. Right to receive urgent care
• 8. Right to reasonable visitation
• 9. Right to decline care
• 10. Right to decline or accept to participate in medical research
• 11. Right to quality care
• 12. Right to complain and express dissatisfaction regarding services received.
• The Patient Bill of Right is remains a policy document.
• patients who suffer harm or injury as result of breach of any of the rights in the PBoR may seek to enforce them through the mechanisms provided by the CPC pursuant to the Consumer Protection Act, or by instituting an action in court pursuant to the provisions of the Constitution, the National Health Act and under common law tort for medical negligence or breach of Doctor/Patience Contractual duty of care. In addition, disciplinary proceedings may be instituted under the Medical and Dental Practitioners Act against the medical practitioner or healthcare provider in breach of the patient’s rights.
• This is making an incorrect diagnosis particularly when the clinical features are so glaring that no reasonable skillful practitioner could have failed to notice them.
• WHO is a reasonable doctor
• A reasonable doctor is one who acts in accordance with a practice accepted as a proper and reasonable by a body of skilled medical men or opinion, and such doctor will not negligent merely because there is a body of opinion which would take a contrary view. This is as stated Bolam v Friern Hospital Committee [1957] 1 WLR 582, where it was held that a doctor would have a defence “if he has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular art.
• The Bolam test remains the starting point in ascertaining who is a reasonable doctor, Medical Negigence /malpractices cases have called into question the idea that an acceptable standard of care can be left alone to Doctors to judge without any significant role performed by the court.
• In Abi v Central Bank of Nigeria, 4 [2012] 3 NWLR 1. the patient, an employee of the first defendant, took ill and was admitted in the defendant’s clinic where he was examined by the third defendant. The plaintiff claimed that the third defendant had negligently diagnosed, prescribed and administered on him drugs, including gentamycin, that made him permanently deaf. The Court of Appeal, Abuja Judicial Division made reference to Bolam and found that the third defendant had conformed with an acceptable standard practice. It was held that “The courts have long recognized that there is no negligence if a doctor exercises the ordinary skill of an ordinary competent man professing to have that special skill.
• But the court eventually adopted the test used in Bolitho v. City and Hackney Health Authority, [1996] 4 All ER 771, where a child required Intubation but was not intubated by a Doctor and subsequently suffered brain injury, and the Court held that a medical decision that is not capable of withstanding logical analysis is unreasonable and the treatment therefore negligent.
• Hence the test of who of the proper practice upheld by a body of skilled professionals would also be evaluated by the Judge to determine if a doctor was reasonable by all material standards.
• The judge in Bolitho had reasoned that:
• ‘It is not enough for a defendant to call a number of doctors to say that what he had done or not done was in accord with accepted clinical practice. It is necessary for the judge to consider that evidence and [to] decide whether that clinical practice puts that patient unnecessarily at risk.
• This has been followed in Ojo v Gharoro (2015) 2 NWLR (Pt. 1447) 421; (2013) LPELR- 21375(CA) And Unilorin Teaching Hospital v. Abegunde (2006) 10 NWLR (Pt. 987)173 S.C.
• Generally, the limitation period for damages for negligence is three years.

To be continued…

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