When Doctors Err: Medical Negligence & Patient Rights in Nigeria

Introduction

What happens when the very people entrusted to preserve life cause harm instead? Medical negligence in Nigeria sits at the heart of this question. Rooted in the tort principle of negligence as laid down by Lord Atkin in the landmark 1932 case of Donoghue v. Stevenson, medical negligence arises when a doctor’s act or omission falls below the expected standard of care, leading to injury or death.

In law, proving negligence requires three essentials:

1. A duty of care must exist.

2. A breach of that duty must be shown.

3. Damage or injury must directly flow from that breach.

In healthcare, this duty of care is inherent the moment a patient seeks treatment. But the Nigerian legal and medical frameworks reveal complex layers of responsibility that extend far beyond the consulting room. This review explores not only negligence but also medical errors, malpractices, contractual breaches, fiduciary duties, and human rights violations. It also dives into vicarious liability, causation, discharge against medical advice (DAMA), criminal negligence, and the delicate balance between protecting patients and shielding practitioners.

Current Knowledge and Key Issues

Medical Negligence in Nigeria vs. Medical Error

Medical errors occur when a doctor chooses an inappropriate treatment method or improperly executes an appropriate one. But not every error equals negligence. An error without resulting harm may attract disciplinary sanctions from professional bodies rather than legal liability. Negligence arises only where the breach of duty causes actual injury.

Beyond Negligence: Other Legal Remedies

Patients who cannot prove negligence may still seek redress under:

• Contract law: Every doctor-patient relationship implies a contractual promise of reasonable skill and care. A breach may justify damages.

• Fiduciary duty: Doctors hold a position of trust and must prioritise patients’ best interests, as upheld in Norberg v. Wynrib.

• Human rights law: Patients’ autonomy, right to health, and right to privacy are constitutionally and internationally protected. The Nigerian National Health Act 2014 explicitly requires doctors to provide full disclosure on treatment options, risks, and costs.

Standard of Care and Breach of Duty

The benchmark isn’t perfection but what a “reasonable doctor” of similar standing would do. Yet courts recognise that specialists are held to higher expectations than junior doctors. Cases like Bolam v. Friern and Bolitho v. City and Hackney highlight the role of professional consensus but also the court’s duty to question outdated or unsafe practices.

Causation: Linking Harm to Negligence

Proving causation is often the hardest part. Patients must show that the injury directly resulted from a doctor’s actions, not merely coincidental. In Barnett v. Chelsea & Kensington, the patient’s death was deemed unavoidable despite the doctor’s neglect, thus no liability.

Res Ipsa Loquitur: When the Facts Speak for Themselves

While this doctrine can shift the burden of proof to the doctor, courts rarely apply it in medical cases due to the complexity of the human body. Still, in glaring physical errors (e.g., leaving instruments inside a patient), it may hold.

Hospital and Vicarious Liability

Hospitals are increasingly viewed as “providers of treatment” rather than mere venues. They may be directly liable for poor facilities or vicariously liable for staff negligence. Lord Denning’s ruling in Cassidy v. Minister of Health remains instructive.

Discharge Against Medical Advice (DAMA)

Patients have the right to refuse treatment. However, improper handling of DAMA, such as failing to inform the patient of risks or incomplete documentation, can expose doctors and hospitals to liability. Well-executed DAMA forms protect both parties.

Criminal Negligence

Negligence may also attract criminal liability when it amounts to reckless disregard for life. Under Nigerian law:

• Section 303 of the Nigerian Criminal Code demands reasonable skill and care in medical treatment.

• Section 343 criminalises rash or negligent treatment that endangers life, even if no death occurs.

Cases like R v. Akerele and R v. Ozegbe underscore the judiciary’s strict stance. Unlike New Zealand’s “substantial departure” standard, Nigeria makes no distinction between recklessness and incompetence.

Key Findings

• Not all medical negligence in Nigeria meets the high threshold of negligence.

• Nigerian law leans toward protecting practitioners, particularly through the “reasonable man” test.

• DAMA mishandling can itself constitute negligence.

• Human rights, contract, and equity provide alternative routes for patients denied relief under negligence.

• Nigerian criminal law treats ignorance and recklessness alike, imposing severe consequences.

Conclusion 

Medicine, by its nature, carries risk. But when harm arises, justice demands balance. Patients shouldn’t be left helpless simply because negligence is hard to prove. Nigeria can learn from global models:

• No-fault compensation schemes (as in New Zealand) could relieve patients of litigation burdens.

• Redress schemes (like the UK NHS Redress Act 2006) offer alternatives in less severe cases.

• Criminal laws should differentiate between recklessness and incompetence, ensuring fairer outcomes.

At its core, this is about trust. Patients entrust their lives to medical practitioners as we try to reduce medical negligence in Nigeria. The law must protect that trust without stifling the practice of medicine itself.

Ignorantia Juris Non Excusat
(Ignorance of the law is not an excuse)