Declaring Medical Negligence in Nigeria: Insights from Dr GODIT MILAM’s Case

Declaring Medical Negligence in Nigeria: Insights from Dr GODIT MILAM’s Case

Introduction

In Nigeria, there has been a concerning increase in medical negligence cases, largely due to a lack of manpower and inadequate healthcare infrastructure. Many Nigerians have faced substandard care, leading to injuries or deaths caused by healthcare providers’ failures. Despite the rise in victims, formal complaints or lawsuits remain low, often due to ignorance, financial barriers, and reluctance to take legal action against medical professionals.

Understanding who can declare medical negligence is crucial for upholding standards and protecting patient rights. This article explores this issue through the landmark case of Dr. Milam v. Medical and Dental Practitioners Investigation Panel & Anor. (2018) LPELR-45539, which sheds light on legal frameworks and the implications of labelling professional conduct as 'infamous' in Nigeria's medical field.

Summary of the Case

Dr Godit Milam, a medical practitioner, was brought before the Medical and Dental Practitioners Investigation Panel following allegations of professional misconduct. The case revolved around the unfortunate death of Mrs Florence Abatan, who died after undergoing a caesarean section and bilateral tubal ligation at Maitama General Hospital. The allegations against Dr. Milam included negligence in handling the patient's post-operative complications, which led to her demise.

The Medical and Dental Practitioners Disciplinary Tribunal, after a thorough investigation and hearings, found Dr Milam guilty of infamous conduct in professional respect and suspended him from medical practice for six months¹. This decision was subsequently appealed, leading to a significant legal discourse on the power and process of declaring medical misconduct.

The Court of Appeal upheld the tribunal's conclusion that the Appellant is liable for his actions. According to the court, Exhibit 7, a confidential case note by various doctors, details the care provided to the deceased patient in the Appellant's hospital. The Appellant significantly contributed to this exhibit, giving him a credible basis for evidence regarding the charges he faced.

The evidence clearly shows that the Bilateral Tubal Ligation (BTL) procedure performed by the Appellant was unjustified. Although both the Complainant and the deceased consented to the operation, this does not absolve the Appellant, who failed to establish a justifiable basis for recommending the procedure. Simply claiming consent is insufficient, given the evidence against it.

Who Has the Power to Declare a Medical Misconduct?

In Nigeria, the Medical and Dental Practitioners Act serves as the main regulatory framework for dealing with medical misconduct. The Disciplinary Tribunal and the Medical and Dental Practitioners Investigation Panel are empowered by this law to look into claims of professional misconduct. According to the Act, any behaviour that deviates from the anticipated standards of medical practice and damages the profession's reputation is considered "infamous conduct."

In determining cases of misconduct, the standard of proof employed is based on the balance of probabilities, which is a more lenient threshold than the criminal standard beyond reasonable doubt. This lower standard is significant as it facilitates the imposition of disciplinary measures even in the absence of absolute certainty.

Under the Act, if a practitioner engages in conduct that would be regarded as disgraceful or dishonourable by their peers of sound judgment, the General Medical Council has the authority to classify such conduct as ‘infamous conduct in a professional respect.’ It is essential to note that the evaluation hinges not on whether the act is deemed infamous for the general population, but rather whether it constitutes infamous conduct specifically for a medical professional, as established in Allison v. General Council of Medical Education and Registration (1894) 1 QB 750 CA.

In Nigeria, the Medical and Dental Practitioners Disciplinary Tribunal is charged with the responsibility of adjudicating cases referred by the Panel, as well as any other relevant matters as defined under section 15(1) of the Medical and Dental Practitioners Act. Upon finding a practitioner guilty of infamous conduct via the established process, the Tribunal, guided by Rule 25 of the Code, is empowered to impose various statutory penalties commensurate with the severity of the offence and the practitioner’s conduct throughout the investigation and trial.

Therefore, the case of Dr Godit Milam properly articulates the policy motives underlying professional disciplinary actions. Justice Tijjani Abubakar of the Court of Appeal, Lagos Division emphasised two fundamental policy considerations in this case: first, the internal regulation of the profession, and second, the idea that disciplinary actions are meant to offer protection rather than punishment. This interpretation is consistent with the High Court of Australia's position in NEW SOUTH WALES BAR ASSOCIATION v. EVATT (1968) HCA 20; 117 CLR 177, which emphasised that the tribunal's authority is essentially protective even though its use may cause the disciplined person to suffer severe deprivation because it is not punishment.

Insights from Dr Godit Milam’sCase

The case of Dr Godit Milam clarifies some important facets of Nigeria's approach to dealing with and deciding cases of medical misconduct, offering both the medical community and regulatory agencies important insights. 

At the forefront of this case is the vital concept of due process in disciplinary proceedings. This principle emphasizes the necessity for the accused, Dr Milam, to be granted a fair opportunity to present their defence. Such an approach is fundamental not only to uphold the integrity of the judicial process but also to ensure that all parties involved feel that justice is being served. Adequate representation, the right to respond to accusations, and the opportunity to gather and present evidence are all essential elements that contribute to a just outcome in any legal or disciplinary situation.

Protecting the public's health and upholding the highest standards of professional conduct should be the major goals of disciplinary procedures in the medical industry rather than merely punishing the practitioner. Instead of choosing a harsher punishment in this instance, the Tribunal's choice to suspend shows a well-rounded strategy that puts public safety first while yet giving the chance for professional rehabilitation. The idea that disciplinary measures should be used to correct behaviour and make sure the practitioner realises the significance of adhering to established medical rules is supported by this principle.

Additionally, the case also highlights the significance of an evidence-based approach in the adjudication of disciplinary actions. The application of the balance of probabilities standard requires a rigorous and thorough examination of all available evidence to arrive at a fair conclusion. During the proceedings, the Tribunal meticulously reviewed the relevant evidence and testimonies, ensuring that their decision was not only equitable but also justified based on the facts presented. This insistence on credible and cogent evidence underscores the necessity of transparency and accountability in the disciplinary process.

Ultimately, the long-term effects on a practitioner's professional reputation and career path are among the most significant ramifications of a declaration of infamous conduct in a medical setting. In the case of Dr. Milam, the results against him presented long-term threats to his reputation in the medical community in addition to immediate disciplinary repercussions. Such disclosure can have extremely negative consequences, including a reduction of trust from coworkers and patients alike and possible obstacles to career advancement. As a result, this case serves as a powerful reminder to all medical practitioners of how crucial it is to uphold the highest standards of ethics and practice to safeguard both their patients' welfare and their professional integrity.

Conclusion

The power to declare medical misconduct in Nigeria is a crucial instrument for ensuring accountability and preserving the integrity of the medical profession. The case of Dr Godit Milam underscores the significance of adhering to due process, balancing the protection of patients with fairness, and grounding decisions in credible evidence. By doing so, disciplinary bodies can maintain high professional standards and uphold patient rights effectively. This case serves as a potent reminder to medical practitioners of their ethical responsibilities and the serious repercussions of neglecting them. Additionally, it highlights the indispensable role of regulatory bodies in defending the public interest and sustaining the professionalism of medical practice in Nigeria.

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