Rt. Hon. Adebo Ogundoyin
Chairman,
Conference of Speakers of State Legislatures of Nigeria
Dear Rt. Hon. Speaker,
RE: URGENT CALL FOR COMPREHENSIVE LEGISLATIVE REFORM TO ADDRESS MEDICAL NEGLIGENCE CRISIS
I write to draw the attention of the Conference of Speakers to the escalating crisis of medical negligence and to urgently advocate for immediate legislative intervention to overhaul our healthcare regulatory framework at the state level.
The recent tragic loss of Nkanu Nnamdi, one of the twin sons of renowned author Chimamanda Ngozi Adichie and her husband Dr Ivara Esege, following what should have been a routine medical procedure at Euracare Hospital in Lagos, has once again exposed the dangerous inadequacies in our healthcare regulatory system. This devastating incident involving the improper administration of Propofol, a high-risk anaesthetic requiring exceptional care, is unfortunately not an isolated occurrence within Nigeria’s healthcare facilities.
As a specialist in medical malpractice law with over two decades of experience handling more than 50 cases across Nigeria, I can attest that our states face a systemic healthcare crisis characterised by:
1. Preventable deaths from routine procedures due to inadequate pre-operative assessment, monitoring failures, and improper medication administration;
2. Absence of independent oversight mechanisms to inspect facilities and enforce standards;
3. Potential tampering with medical records to avoid culpability, undermining investigation integrity;
4. Complete failure of accountability systems allowing negligent practitioners and facilities to operate with impunity;
5. Conflation of policy-making with regulatory enforcement within State Ministries of Health, creating fundamental governance failures;
6. Chronic underfunding of healthcare systems contrary to international standards and Nigeria’s own commitments under the 2001 Abuja Declaration to allocate at least 15% of annual government budgets to healthcare.
Our healthcare sectors once functioned under robust supervisory structures with Chief Medical Officers and Health Inspectors responsible for oversight, compliance monitoring, and accountability enforcement. Today, under various State Health Laws, this essential regulatory infrastructure no longer exists or is not as effective as it used to be. The sector has become over-centralised under State Commissioners for Health who have assumed roles that improperly conflate policy development with regulatory enforcement.
There is currently:
a. No systematic inspection regime for healthcare facilities operating within our states;
b. No effective enforcement of professional standards in private and public health institutions;
c. No independent investigation mechanism with powers to preserve medical records;
d. No transparent public reporting on facility performance and patient safety incidents.
I urge the State Houses of Assembly to:
i. Legal Foundation and Structure:
• Enact a unified State Clinical Negligence and Patient Safety Law consolidating fragmented provisions across multiple statutes;
• Codify clear standards of care incorporating the Bolam-Bolitho test and Montgomery principles on informed consent and material risk disclosure;
• Establish clear demarcation between civil liability (compensation), criminal liability (gross negligence), and professional disciplinary proceedings to prevent jurisdictional confusion.
ii. Independent Regulatory Architecture:
• Establish a State Healthcare Quality and Safety Commission as an independent statutory body separate from the Ministry of Health with powers to license, inspect, investigate, and sanction healthcare facilities;
• Separate policy-making functions (Ministry) from regulatory enforcement functions (Commission) to eliminate conflicts of interest;
• Reintroduce and strengthen the offices of Chief Medical Officers and Health Inspectors with statutory mandates, adequate staffing, and enforcement powers to conduct facility inspections, investigate complaints, and ensure compliance with healthcare standards;
• Create a Healthcare Facility Inspection Division with statutory powers to conduct unannounced inspections and enforce compliance;
iii. Clinical Negligence Resolution Mechanism:
• Establish a State Clinical Negligence Resolution Scheme to provide accessible, timely compensation without requiring full litigation;
• Create mandatory pre-litigation mediation for all medical negligence claims with statutory 90-day resolution timelines;
• Institute an administrative redress scheme for lower-value claims (under ₦5 million) to reduce litigation costs and delays.
iv. Professional Accountability Framework:
• Mandate professional indemnity insurance for all healthcare practitioners and facilities with minimum coverage levels based on specialty risk profiles;
• Establish a Medical Expert Witness Register to address the critical shortage of experts willing to testify in negligence cases;
• Create legal immunity for expert witnesses acting in good faith and prohibit professional retaliation.
v. Patient Rights and Protection:
• Enact comprehensive Patient Rights and Responsibilities provisions guaranteeing informed consent, access to medical records within 7 days, right to second opinions, and effective complaints mechanisms;
• Require all healthcare facilities to maintain independent patient advocates and establish internal complaints resolution procedures;
• Mandate contemporaneous medical records meeting minimum standards with severe penalties for falsification or destruction.
vi. Healthcare Quality Infrastructure:
• Establish a mandatory adverse event reporting system (confidential and non-punitive) to enable systemic learning;
• Create a public healthcare facility performance database providing transparency on safety indicators, complaint volumes, and disciplinary actions;
• Implement systematic pre-operative risk assessment protocols and high-risk medication administration standards.
vii. Access to Justice Reforms:
• Designate specialised Medical Negligence Divisions within State High Courts with trained judges and strict case management timelines;
• Expand Legal Aid Council coverage to medical negligence claims involving catastrophic injury or death;
• Explicitly permit conditional fee arrangements (no-win-no-fee) with capped success fees to reduce financial barriers.
viii. Healthcare Financing and Budgetary Reforms:
• Legislate mandatory minimum healthcare budget allocations meeting the Abuja Declaration commitment of 15% of state government expenditure annually, with statutory protections against budget cuts except in documented national emergencies;
• Establish progressive budget implementation targets: minimum 10% allocation within one year, 12.5% within two years, and full 15% compliance within three years of enactment;
• Create statutory mechanisms ensuring full release and utilisation of appropriated health funds, with quarterly reporting requirements to the State House of Assembly and penalties for non-compliance;
• Mandate health budget transparency through public disclosure of allocations, releases, and expenditures across all health institutions, programmes, and interventions;
• Establish dedicated healthcare trust funds with ring-fenced revenue from state-generated sources including taxation on alcohol, tobacco, and other luxury goods to supplement budgetary allocations;
• Institute performance-based budgeting linking healthcare funding to measurable outcomes including reduced preventable deaths, improved patient safety indicators, and facility compliance rates.
ix. Federal-State Healthcare Regulation Coordination:
• Collaborate with the National Assembly to establish clear federal-state coordination for healthcare regulation, drawing upon the UK’s integrated model where the General Medical Council handles professional standards, NHS Resolution manages clinical negligence claims, and the Care Quality Commission oversees facility quality;
• Advocate for amendments to the Medical and Dental Practitioners Act 2004 establishing concurrent jurisdiction with formal Memoranda of Understanding between state Healthcare Quality and Safety Commissions and federal regulators (MDCN, NMCN, PCN)—federal authorities regulating professional conduct while states oversee facility licensing, inspection, and patient safety;
• Support creation of a National Clinical Negligence Resolution Scheme modelled on NHS Resolution with state-level implementation and federal-state cost-sharing;
• Push for statutory timelines binding MDCN to complete investigations within 120 days and tribunal proceedings within 180 days, with mandatory publication of all disciplinary decisions;
• Advocate for mandatory professional indemnity insurance nationwide, establishment of a National Medical Expert Witness Register accessible to state courts, joint investigation protocols for cases involving both individual misconduct and institutional failures, and integrated databases enabling real-time sharing of disciplinary actions between jurisdictions;
• Support adoption of the UK’s “duty of candour” requiring healthcare providers to inform patients when things go wrong;
• Advocate at the federal level for compliance with international healthcare financing standards, including the Abuja Declaration’s 15% budgetary allocation and WHO’s 5% of GDP benchmark for public health expenditure.
This coordination is essential because Nigeria’s current fragmentation, where MDCN handles professional discipline federally while states regulate facilities, creates gaps that negligent practitioners exploit. State leadership in establishing robust mechanisms combined with strengthened federal structures would create the comprehensive framework Nigeria desperately needs.
The Adichie-Esege family tragedy starkly demonstrates how our healthcare regulatory system fails to protect patients and hold negligent practitioners accountable. Legislative inaction costs lives daily that proper oversight, professional accountability, adequate financing, and accessible justice could save. States have both the moral obligation and constitutional capacity to lead transformative healthcare reform. The proposed framework would establish comprehensive patient protection, effective accountability systems, sustainable financing aligned with international standards, and accessible justice pathways: transforming our healthcare sector from one marked by impunity and preventable tragedies to one anchored in safety, transparency, and the sanctity of human life. We urge the House to act urgently.
Please accept, Honourable Speaker, the assurances of our highest esteem and professional regards.
Yours faithfully,
For Olisa Agbakoba Legal
Dr. Olisa Agbakoba SAN