When Medical Negligence Becomes Criminal

The recent conviction of the Medical Director of Excel Medical Centre, Dr. Ejike Orji, by a Lagos High Court is a timely warning to healthcare professionals to maintain ethical
standards and avoid medical errors, writes Wale Igbintade

The importance of the medical profession to humanity cannot be over-emphasiSed. However, in the course of practice, legal issues often arise on ethical breaches, which if not arrested can undermine the integrity of the profession and erode people’s confidence in the practitioners.
In recent times, there have been complaints of serious ethical violations by medical doctors, such as unnecessary surgeries, and negligence, which directly harms patients.

A few weeks ago, Justice Adedayo Akintoye of the Lagos High Court sitting at Tafawa Balewa Square, (TBS) sentenced the Medical Director of Excel Medical Centre, Dr. Ejike Orji, to one-year imprisonment for causing grievous harm, negligence and endangering the life of a 16-year-old patient.
The court held that Dr. Orji acted below what is reasonably expected of a medical doctor, and was found guilty on four out of the six counts of charges brought against him by the Lagos State Government.

On Thursday, July 26, 2018, the victim, Master Somtochukwu Ezi-Ashi, sustained an injury on the basketball court at the University of Lagos (UNILAG) Sports Centre while playing basketball with his mates. He was taken to Excel Children Medical Centre, located at 45B Corporation Drive, Dolphin Estate, Ikoyi Lagos, at about 11:30 am by one Mr. Emmanuel, a security detail attached to the Ezi-Ashis and one Mr. David Joy Makinde, a student of UNILAG on the instruction of his mum, Mrs. Ngozi Ezi-Ashi. Somtochukwu’s mum arrived shortly after he was taken to Excel and saw Orji attending to him. At that point, there was no open wound or blood on his left foot where he sustained the injury. He only had a slightly swollen left knee.

On seeing her son’s injury, Mrs. Ezi-Ashi inquired from Orji what he intended to do to the swollen knee. He said he needed to get an X-ray done but would have to stabilize Somi’s knee before that. He asked Mrs. Ezi-Ashi to sit in the “waiting room”, while Somi was carried into an inner room in the hospital.
A few minutes later, Mrs. Ezi-Ashi was informed by Dr. Orji that Somi had been sedated and that she could go in and see him. The said Mrs. Ezi-Ashi found Somi deeply asleep with a synthetic and thermal plaster cast covering his entire left leg from his toes to his upper thigh. Dr. Orji did not obtain Mrs. Ezi-Ashi’s consent, since her son is still a minor, to sedate Somi. Neither did he tell her that “stabilizing” the leg meant a plaster cast.

Shocked, Mrs. Ezi-Ashi asked Dr. Orji if it was wise to put the cast before doing the X-ray and he said yes, insisting that it does not make any difference. A couple of hours later, Somi woke up and complained immediately that the cast was very tight. This was before he was taken to one Broad Places Radiology, located at 15 Babatunde Street, Off Ogunlana Drive, Surulere, Lagos (referred by Dr. Orji) to get an X-ray. Upon return to the hospital with the X-ray results, Somi kept on complaining that the cast was tight but Dr. Orji was not available at the hospital then. A doctor at the hospital gave Somi some antibiotics, pain relievers and castor oil capsules.

Despite the absence of Dr. Orji at the hospital when Somi was brought back from the radiology, Mrs. Ezi-Ashi called him to inform him that Somi was going through severe discomfort as a result of the tightness of the cast on his leg. But, Dr. Orji purportedly dismissed her concerns and informed her over the phone that he has seen the x-ray result and that Somi has sustained a fracture and a plaster cast was the exact treatment needed. Dr. Orji further informed Mrs. Ezi-Ashi that the tightness of the cast will reduce in two days.

Dissatisfied with Dr. Orji’s casual attitude to the extreme discomfort that her son was going through, Mrs. Ezi-Ashi called her brother-in-law who is a medical practitioner in the United States for a second opinion and she was informed by her said brother-in-law after consultation with his colleagues in orthopedic practice that plaster cast was not needed in the circumstance.

After the telephone conversation with Dr. Orji and her brother-in-law, Mrs. Ezi-Ashi called Dr. (Mrs.) Orji, who is actually Somi’s doctor and expressed her concerns about the plaster cast. Dr. (Mrs.) Orji asked Somi to do some toe movements which he was unable to do and agreed with Mrs. Ezi-Ashi that the plaster cast was actually very tight, but allegedly threw her hands in the air and said she was not the surgeon.

Subsequently, Excel discharged Somi, but he was unable to sleep that night as a result of the extreme discomfort he was going through occasioned by the tight plaster cast. His uncle, the medical practitioner in the US whom Mrs. Ezi-Ashi had called earlier in the day, got back to her for a second time and insisted that his colleagues who are orthopedic surgeons at the hospital where he works in the US said there was no need for plaster cast and that it should be removed immediately.

On the morning of Friday, July 27, Somi was taken back to see Dr. Orji who stubbornly refused to remove the cast but cut a square off the plaster cast at the back of Somi’s thigh to release some pressure according to him. On getting home, at about 5 p.m. Somi brought his mum’s attention to liquid oozing out from where Dr. Orji had cut off the plaster cast. Mrs. Ezi-Ashi called Dr. Orji immediately and told him about the fluid; he requested that Somi be brought back to the hospital.
It was while Mrs. Ezi-Ashi was waiting with Somi for the evening appointment with Dr. Orji that her husband, Mr. Isioma Ezi-Ashi, returned from Abuja. Upon getting to the hospital, Isioma asked Dr. Orji to remove the cast because it was too tight. It was a very reluctant Dr. Orji that agreed to remove the cast. Dr. Orji then suggested that Somi spend the night at his hospital, in order to keep his leg elevated. Somi and his mum slept at the hospital that Friday night and left on Saturday morning.

On Sunday morning, the family noticed there was liquid accumulating on Somi’s left hip. At this stage, the family decided to get a second opinion and got in touch with Dr. Kamoru Omotosho, an Orthopedic Surgeon, as the liquid above the bandage on Somi’s hip was getting bigger.
Upon getting to Dr. Omotosho’s Kamorass Specialist Clinic, it was discovered that Dr. Orji did not remove the entire plaster cast as the back of Somi’s leg was still covered with it. The implication was that Somi’s foot was wrapped for almost four days in a very tight plaster cast.

When the bandage was eventually removed by Dr. Omotosho, Somi’s leg was covered with big blisters and cuts from the surgical blade used by Dr. Orji in a futile and unprofessional attempt to remove the plaster cast. Dr. Omotosho carried out his own assessment of the leg and told Mr. and Mrs. Ezi-Ashi that Somi had lost feeling in his leg and could not move his ankle and toes.

On the morning of Monday, August 30, Isioma reached out to his childhood friend who is an Orthopaedic Surgeon based in the UK, Dr. Ike Nwachukwu, who happened to be in Nigeria at the time. Dr. Nwachukwu referred the family to one Dr. Jide Lawson, at the Reddington Hospital, located at Victoria Island, Lagos. Dr. Lawson examined Somi’s leg and admitted him immediately.

Between Thursday, August 2, and Friday, August 10, 2018, Somi had six surgeries on his left leg as preliminary stages of compartmentalization had already set in. He was later discharged by Reddington to enable his parents to take him to the United States for further treatment.
Miffed by what happened to their son, Mr. and Mrs. Ezi-Ashi wrote a petition to the Office of the Inspector General of Police against Dr. Orji. The matter was sent to the Police Special Fraud Unit (“SFU”), Milverton Road, Ikoyi, Lagos to investigate.

The SFU upon conclusion of their investigation arraigned Dr. Orji before an Igbosere Magistrate’s Court on a single charge, which the family felt does not reflect the seriousness of the offence. Dissatisfied, the family approached the Lagos State Directorate of Public Prosecutions, on November 26, 2018, to take over the matter. The DPP preferred information against the Orjis at the Lagos State High Court.

In the course of the trial, the DPP brought a motion for discontinuation of the case against Dr. (Mrs.) Orji. The application was granted and the State continued with the prosecution of Dr. Orji alone. The State called 10 witnesses in proving its case, while the Defendant (Dr. Orji) called two witnesses including himself. His other witness was an expert witness, a Professor of Orthopedics who was a one-time Minister of Health in Nigeria.

Among the witnesses of the State, four of them including its expert witness, a Professor at the Lagos State University Teaching Hospital (LASUTH) are Consultant Orthopedic Surgeons. The defendant’s expert witness is also a Consultant Orthopedic Surgeon. All five Doctors (including the defendant’s expert witness) agreed in the course of the trial that a very tight plaster cast if not removed within four to eight hours can result in Compartment Syndrome (CS). They also agreed that the CS can become irreversible if the tight plaster cast is in place for 24 hours. Somi was under the care of Dr. Orji who refused to remove the cast despite repeated requests from his parents to do so for about 72 hours.

Furthermore, all five surgeons who testified in the case gave evidence that the consequences of a tight plaster cast on any part of the body are taught in the fourth year in practically every medical college. Students are taught at that early level of medical training that once a patient complains of tightness of a plaster cast, the only remedy is to remove the entire cast immediately to save the patient’s limb and life in some cases.

Evidence adduced by witnesses in court revealed that Somi had thirteen major surgeries including a nerve transplant. Six of those surgeries were carried out in Reddington Hospital, Victoria Island, Lagos, Nigeria while the remaining seven including plastic surgery and nerve transplant were done at John Hopkins Hospital, Baltimore, Maryland, United States.

Somi is now recuperating in the USA…