Residents in Iyanyan Community in the FCT, Abuja were given a rude awakening when a legal practitioner Steve Eke (esq) was gunned down along Abacha Road by unknown gunmen.
According to available information, Mr Eke was shot by assassins at about 9:00 pm but was swiftly taken to the nearest hospital in the hopes that the medical officers there would arrest his critical health crisis and provide adequate and sufficient treatment to the now deceased but in a completely absurd yet unusual twist of events, Steve was rejected by all the hospitals he was rushed to until he finally succumbed to his wounds in the hands of his loved ones.
The story of Mr Eke is one of many unfortunate incidences where gunshot victims are refused treatment or not promptly treated for their often life-threatening wounds. A similar fate befell David Ntelam-Rex, a System Engineer who was shot on his way home from work at Jibowu, Yaba, Lagos, Nigeria and allegedly refused by Lagos State Teaching Hospital [LASUTH] but referred to Military Hospital Yaba, Lagos. The military hospital also refused but referred him to the Lagos State Teaching Hospital (LUTH) where he was accepted only to be confirmed dead.
The reason for the persistence of this tragic tale is often due to the harassment that the medical practitioners face at the hands of security agencies for treating gunshot wounds without prior clearance from a Police station.
It is in part a result of the rise in gunshot mortality due to the refusal by healthcare providers to give primary emergency care to victims that informed the enactment of the Compulsory Treatment and Care for VICTIMS OF GUNSHOTS [CTCVGS Act] 2017 which has now been domesticated in Lagos State and River State.
Reasons ranging from arbitrary Hospital policies; lack of proper background information on the gunshot victim; poor or inept health facilities; harassment from members of the Police force; poor information about patient rights; improper medical training; all contribute to the persistence of this blight on the health care sector in Nigeria.
Again, as is with many other issues plaguing the Nation, the problem is not the inadequacies of applicable Law rather, it is the un-enforcement and non-implementation of statutory provisions or their penalties.
The CTCVGS Act is an 18 Section Act which imposes a duty on public and private hospitals to accept, receive and treat all Gunshot Victims without the prior need for a police clearance. It also imposes a duty on security agencies, such as members of the Police and Military forces to render all possible aid to anybody suffering from gunshot wounds.
The law in fact expressly forbids the refusal of immediate and adequate treatment by any hospital in Nigeria regardless of payment for services. The law also attempts to create a medical code of practice to be followed by all hospitals in the country when faced with a gunshot victim.
The following contains a highlight of the procedural expectations of a hospital fixed with a situation under the CTCVGS Act:
(a) Under no circumstance is a hospital or medical facility to reject a gunshot victim
(b) Upon receipt of such a victim commence immediate treatment and care enough to ensure adequate treatment is being provided to such a victim.
(c) Report the admission of such a victim to the police station nearest to the hospital for proper documentation and the possible investigation into the circumstances of his injury.
(d) Notify family members or relatives within 24 hours of identifying such a victim.
The law also provides an array of sanctions for erring hospitals, senior administrative staff and security personnel who run foul of its Laws. Depending on the degree of misfeasance or nonfeasance, sanctions ranging from fines to imprisonment, to restitution for loss suffered are available to the victim or members of his family.
It is however observed that in spite of the operation of the law which has been in force for more than 5 years, several incidences of gunshot mortalities still persist. Might it be due to the incohesive procedures and practices within the medical community or maybe the non-compliance of hospitals?
What is however settled is that Sections (1) and (3) of the Act mandate any hospital within the location of a Gunshot Victim to provide immediate and adequate treatment with or without an initial deposit.
The problem does not stem totally from the medical community, it is this writer’s opinion that in enacting the law, the Legislators took for granted the quality of and the uniformity of healthcare standards expected across all healthcare providers. There is no gain in saying that “immediate” and “adequate” are terms that are subjective and dependent on corollary factors including availability of staff, equipment and funding. This in turn creates a situation where the term “immediate” or “adequate” is not uniform across the board.
The National Assembly also took for granted the level of private and public investments in the healthcare sector. With no minimum financial threshold requirements for the setting up a private hospital or health care facility in so far as health services are run by licensed medical practitioners, the “nearest hospital” to a gunshot victim might, in reality not be equipped or be ill-equipped to provide “immediate” or “adequate” treatment as required by the statute. This is arguably the most causating factor of what has now been dubbed in colloquial terms in the health sector as the “referral syndrome”. A term which means that a critical or emergency patient is referred from hospital to hospital without actually receiving any treatment until he dies.
Misinterpretation and conflict of laws
The history of denying stab wounds or gunshot victims is traced to the robbery and firearms (special provisions)law now an act due to the high crime rate of the post-civil war. Section 4(2) mandates medical practitioners or hospitals to inform the police of any gunshot victims.
Sadly the Nigerian Police misinterpreted this section by issuing a directive banning emergency medical attention for gunshot victims without prior police permission. Section 20 maintains that a health care provider or health worker or health establishment shall not refuse a person emergency treatment.
In concluding this piece, it is important for the National Assembly to take a harder look at the foundational legal architecture providing for health care in the Country and make laws mirroring international best practices in the Health care sector such as group funding of the health care sector, compulsory health taxation, regulation of operational License of health care facilities etcetera. If the legal fabric of the health and medical space is not wholistically reviewed, Laws such as the CTCGV Act, 2017 will merely create a case of applying balm to a tumour.
Author: Ishola Agboola, LL.M