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DILEMMA OF CITIZEN AKPAN

By NBF News
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The glowing accolades that accompany medicine's great advances co-exist with an increasing restive and suspicious image of physicians as cold, greedy, compassionless and distracted in their treatment of patients. Though there are still many old school physicians, old school in the sense of deeper commitments, distinguished in their dignified long white coats and cutting the image of a wise and sympathetic healer, there are unfortunately some active and dangerous practitioners out there with less scrapples to their Hippocratic Oath, ethics or legal concern in their dealings with patients as my recent experience with one of the teaching hospitals in the country recently tend to portray.

This seemingly cold and exploitative image of some physicians is largely traceable to the failure of our health care regulators and the legislature to beam the right lights on the sector and enact lasting policies, besides the need to award contracts to paint hospitals, supply beds and ambulances.

We have failed to invest in the retaining and regulation of physicians who managed these hospitals, on the erroneous assumptions that as professional, they can regulate themselves. Medicare in any country is a serious item on the development index, as medical practice plays a crucial role in a nation's development. It is the veritable measurement of its human development and growth. For this reason, many progressive governments have refused to abdicate the regulation of medical practice to professional bodies alone, even when some of these bodies tend to assuage societal concerns of malpractice in some form of sanctions and reprimands.

This is insufficient. The idea that the medical profession is self regulatory is exploded by the fact that in many of these countries, there are laws, which regulate and decide who may practice as physicians within its borders and also define conditions under which the physicians shall practice, even extending to the provision of licences and rules for conducts in matters of discipline of physicians in terms of procedures, notices, fair hearing, questioning of witnesses.

Even after the licences have been granted it does not become a permanent property right. The impermanence of a licence is emphasized by the fact that some of the countries have provisions which require periodic or annual renewal of these licences and where a physician fails to meet the registration requirements, his licences can be suspended and not restored until he or she has met certain requirements including re-examination in some instances.

The rigorous regulation processes aside, many of these physicians are tied to vigorous ethical principles, which are the springboard of all their interactions with patients, colleagues and other members of the society. The second line of the third stanza of the Hippocratic Oath enjoins physicians to protect the sick from 'harm and injustice'. The significant feature of this ancient oath and which has been retained all through history is that the practice of the physician is an art, a calling, having a quasi-religious overtone.

This fundamental moral principles of preventing injustice to patients is the core of the laudatory American Medical Association's Principles of Medical Ethics, which is almost impari materia, with ourNMA's code of ethics and which provide that physicians shall be dedicated to providing competent medical services with compassion and respect for human dignity and shall deal honestly with patients and colleagues and strive to expose those physicians deficient in character or competence or who engage in fraud or deception.

On Friday 15th April, 2011 at about 8.45am, one Mrs. Grace Akpan, was rushed to the hospital with advanced labour contractions. She was kept in the emergency room in the hospital, unattended to for over five hours. Her labour contractions were occurring at the rate of one every five minutes and her water was already breaking out in consistent small amounts. Alarmed at her conditions, the husband, Mr. Augustine Akpan, a commercial bike rider enquired from the attending nurses around, but he got a sharp rebuke. He was pointedly told that he might have to take his wife away from the hospital, because she did not register with the hospital for ante-natal service.

However following intense pleas, Mr. Akpan was instructed to make a deposit payment in the hospital account No. 02710050000029, with the United Bank for Africa, UBA located in the hospital premises. Mr. Akpan promptly complied and was issued a teller with No.0659865 evidencing payment, upon which the hospital commenced treatment. Unfortunately however, the delay and shenanigans of the hospital over non-registration and attendance of ante-natal sessions, worsened Mrs. Grace Akpan's conditions, such that when she was finally wheeled into the theatre at about 3.50pm, for caesarean operation, she was in dire condition, battling for her own life. After the operation, the twin babies, both boys were in intense struggle to survive the distress of their delivery. Within hours one of them died and the other was promptly taken to the intensive care unit of the hospital.

Giving accounts of the twins' death in a recent press statement, the Chief Medical Director of the hospital, Prof. Mike Ibadin said the babies were exhausted on delivery 'so when the baby came out, the baby was not responding. Because, when normally you deliver a baby you slap the baby and baby will start crying. Even when they did all that (the slapping) for ten minutes the baby did not respond'.

With minimal hope of survival, the second baby was placed on life support, at the rate of N20,000 daily, while the distressed Mrs. Akpan was taken into intensive care. After five days, the second baby died. In a carefully worded Death Certificate issued by the hospital, on the cause of death, and signed by one Dr. T. Thieum of the Department of Child Birth, on behalf of the hospital, baby Akpan II, died of 'severe birth Asphyxia', which is the proximate consequence of loss of consciousness as a result of low oxygen and too much carbon dioxide in blood. Infact, suffocation causes asphyxia, which led to Baby Akpan II's , renal failure as stated by the authorities of UBTH.

These deaths would have been avoided if the hospital doctors had promptly responded to the distress cries of the Akpans, instead they endlessly harangued the couple over fees and ante-natal sessions. Stung by criticisms over the babies careless death, Prof. Ibadin, in a recent press statement, falsely claimed that Mrs. Akpan may have patronized traditional birth attendants. There are scrappy unsubstantial allegations which do not exculpate the hospital of a negligent conduct. Mrs. Grace Akpan was brought straight from home to the hospital and not from any private hospital or the operating table of a road side quack!

Having accepted to treat Mrs. Akpan a valid contract to ensure safe delivery of the twins was entered between the hospital and the Akpans. Professional liability of physicians is usually founded upon the breach of a duty which arises from a contractual relation between doctors and patients. In the absence of a contract between the doctor and the patient, the law imposes not duty on the doctor to act fairly and treat a patient.

The physician - patient relationship may be established by an express or implied contract. A patient who has stepped on pieces of broken bottles might go to a doctor's office. By doing so, the patient is making an offer to enter into a contract and when the physician begins to examine the injured foot, the offer has been accepted and contract has been created.

In this case of the Akpans, the management of UBTH's attempts to declaim responsibility and liability for the deaths baby Akpan I and Akpan II, on the basis of an alleged prior visit to traditional births attendants is shameful and ludicrous. You have to admit negligence, before you can negative it with contributory negligence as a defence, which will certainly not suffice in the circumstances of this case, in the absence of evidence of this spurious claim.

On the 26th of April, 2011, Mrs. Akpan was declared fit and well to go home and was subsequently discharged. This is where second nightmare began. The management of UBTH, slammed additional bill of N80,000 as charges for accommodation - bed space and feeding. Mr. Augustine Akpan already exhausted financially and disappointed at the death of his babies after almost 12 years of search was unable to immediately raise the money and pleaded for time to bring the money. But the hospital refused his taking his now discharged wife home.

Consequently, restrictions were placed on Mrs. Akpan's movement in Ward M2. On the 27th of April, 2011, she was pointedly told by nurses, that owing to the inability of her husband to pay and having been formally discharged, she was no more to set her feet outside the glass doors of Ward M2. Round the clock surveillances were placed on her, including telling other patients to watch her moves. It was a hellish treatment for a woman who had just lost a set of twins. But to UBTH, this was just business, no time for emotions, which is a sad reflexion of our harsh and inadequate health services.

Uwoghiren writes from Benin City