Treatment of Emergency Medical Cases: Why Garki Hospital is Different

Christiana Osuji

Bayo Ohu, a journalist with The Guardian Newspapers, died from gunshot wounds inflicted by assailants who invaded his Lagos residence in September 2009. He was quickly rushed to the hospital, but medical staff on duty refused to admit him for treatment. Their reason? The relatives did not come with a police report. While his relatives were making efforts to take him to another hospital, he died on the way. 

Despite the widespread condemnation that followed the action of the hospital, the practice of rejecting gunshot victims without a police report has become a vexed issue in the country.

Similar incidents include the 2008 case of Saka Saula, the then chairman of the Lagos State chapter of the National Union of Road Transport Workers, who was shot in his house. A nearby private hospital refused to treat him. He died while he was being transported to a public hospital.

In September 2023, Miss Greatness Olorunfemi, a victim of ‘One Chance’ commercial vehicle criminals in Abuja, lost her life due to the same non-availability of a police report.  The victim was pushed out of a moving vehicle and allegedly rejected by staff at Maitama Hospital, Abuja when she was rushed there by good Samaritans.

There have been a series of reports over the years of gunshot injury victims being denied treatment at medical facilities following the demand for a police report.

Health experts state that depending upon the severity and extent of the injury, gunshot victims can die from hemorrhage, shock or damage to vital organs. Moreover, they may be at risk of infection, especially tetanus and gas gangrene. Therefore, such emergencies need a quick response, not a denial of treatment.

In Nigeria, many of the gunshot victims bleed to death due to delays in treatment. Hospitals, which are meant to be places where lives are saved and where those in need of emergency help are attended to, often appear to be unresponsive to the demands of time.

It is bewildering that many Nigerian hospitals are still rejecting accident, rape, robbery and gunshot victims. 

Experts have noted that it is unethical for a doctor to reject a patient who has come to seek healthcare services, stressing that if a doctor or hospital cannot treat a patient, such a doctor or hospital should refer the patient to a higher hospital, rather than reject the patient.

Rejection of patients from medical facilities contributes to avoidable deaths of patients as emergency cases are also turned down.

This occurrence in our hospitals is a clear contravention of the human rights of patients, and yet this practice is still widespread, occurring in medical facilities across the country. 

It is a global phenomenon, typically occurring in countries where emergency healthcare isn’t free or insured. 

What does the law say?

The stance of the law is clearly stated in The Compulsory Treatment and Care for Victims of Gunshot Act, 2017, which came into effect on the eve of 2018. The Act mandates all medical facilities to receive and accept victims of a gunshot for immediate treatment without a police report.

The Act makes provision for various rights and obligations as well as penalties. The rights are in two categories: The rights of a gunshot victim and the rights of a volunteer or helper of a gunshot victim. The obligations are also in two categories: obligations of hospitals and it states that:

The Victim

Any hospital in Nigeria whether public or private shall receive and accept for immediate treatment of anyone with a gunshot wound, a person with a gunshot wound should be given adequate treatment without an initial monetary deposit; and that a person with a gunshot wound shall not be subjected to inhuman and degrading treatment or torture by any person or authority including the police or other security agencies.

The Hospital

Any hospital that receives a person with gunshot wounds must report to the nearest police station within 2 hours of commencement of treatment; notify the family members or relations within 24 hours of becoming aware of the victim’s identity; keep an adequate record of treatment given to the injured person; and ensure the victim is fit and no longer in need of dire Medicare before the Chief Medical Director certifies him fit to be invited by the police for investigation.

 The Police

The Act listed the responsibilities of the police as render every possible assistance to any person with gunshot wounds and ensure that the person is taken to the nearest hospital for immediate treatment; commence an investigation to ascertain the circumstances under which the person was shot; and furnish the hospital with background information on the victim.

In December 2014, Nigeria passed the National Health Bill into law, which described denying patients medical attention as an offence.

Section 20 (1) and (2) of the National Health Act states that “a health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason. A person who contravenes this section commits an offence and is liable on conviction to a fine of N100,000.00 or imprisonment for a period not exceeding six months or to both.”

The Federal Government has pleaded severally with medical facilities in the country to stop rejecting patients, especially in emergency cases but these pleas have seemingly fallen on deaf ears.

A doctor must see the patient first and if he does not have the facility to handle the patient, he should refer the patient to a higher hospital.

The code of ethics of the Medical and Dental Council of Nigeria MDCN, expects    a doctor to do all that is reasonably expected of him or her for any patient’s well-being. The definition of “reasonably expected” therefore depends on the doctor’s experience and skill and the availability of resources, especially   equipment.

Recent orders from the IGP on police report

Recently, the Inspector General of Police, Dr Olukayode Egbetokun ordered all hospitals and all medical personnel across the country to treat gunshot victims without asking for a Police report.

The directive, based on the Compulsory Treatment and Care for Victims of Gunshot Act, 2017, was contained in a Police internal memo dated October 25, 2023, and signed by the erstwhile Force Principal Staff Officer, COMPOL Olatunji Disu.

The memo was addressed to all Deputy Inspectors-General of Police, Assistant Inspectors-General of Police, Commissioners of Police and the Commandants of Police Colleges in Ikeja, Kaduna, Oji-River, Maiduguri and Enugu.

The memo reads: “I forward herewith a copy of letter HMSH&SW/IG/CTCV/ 10/2023 dated 3rd October 2023, received from Federal Ministry of Health & Social Welfare on the above-underlined subject, and write to convey the directive of the Inspector-General of Police that you comply with and enforce the provisions of the Compulsory Treatment and Care for Victims of Gunshot Act 2017 without any hesitation.

“The Inspector-General of Police further directs that you make this a subject of lecture and circulate widely for the members of the public to be aware of our compliance with the National Law.”

Medical experts have asked aggrieved patients with strong cases of rejection by doctors or hospitals to write to the Medical and Dental Council of Nigeria and the Nigerian Medical Association for investigation and disciplinary action where necessary. 

The Medical Director at Garki Hospital, Abuja, Dr Adamu Onu said it is a grievous offence for a doctor or a medical facility to reject a patient. A doctor will first see the patient and if he does not have the facility to handle the patient, he should refer the patient to a higher hospital, he said.

“Every medical practitioner must show empathy and not reject a patient. Some hospitals may have reasons for rejecting a patient. If the capacity is not there, they should refer and not reject. But there may be extraneous issues, for instance, if the doctor is attending to a patient and there is friction between the doctor and that patient and the doctor considers his life not safe with the patient.

“At Garki Hospital, we don’t reject patients either for inability to pay or any other reasons. When for instance, available bed spaces are all occupied by patients receiving care, and this often happens, we will attempt to administer some first aid and then refer. We have no reason to reject any patient,” he said.

Indeed, two recent episodes corroborate Dr Onu’s assertion. On August 24, a two-storey collapsed at Garki 2, Abuja. The victims were rushed to Garki Hospital where they received prompt treatment before some were referred to other hospitals.

On September 8, two gunshot victims due to an unfortunate incident at the Garki International Market were rushed to Garki Hospital emergency department at about 2.30pm where treatment was immediately commenced. One of the victims, Mubarak Nana Usman is still undergoing treatment at the same hospital.

It is instructive that in both instances, Garki Hospital did not ask for police reports before attending to the injured. 

 Example of Garki Hospital, Abuja 

Garki Hospital, which in 2008 got accreditation to operate the health insurance scheme, currently has one of the largest numbers of enrollees in the FCT and accepts secondary referrals from other facilities. The hospital is also the only facility that carries out highly specialized surgery under the National Health Insurance Scheme, NHIS.  For example, several NHIS enrollees have had hip and knee replacement surgeries done in Garki Hospital.

Dr. Onu said the hospital operates an open and transparent billing system and tries to ensure that no patient waits for more than 30 minutes before seeing a doctor, thanks to its fully integrated electronic medical record application that handles all facets of healthcare.

It also has several thousand private health insurance enrollees.

The hospital has over 235,000 registered patients which include 33,906 NHIS enrollees spread across 55 Health Maintenance Organizations, HMO. Under the FCT Health Service Scheme (the FCT’s version of social health insurance), the hospital attends to 8,139 enrollees from three HMOs. There are about 1,831 private health insurance enrollees spread across 35 organizations and it offers corporate services to 10,502 persons from 16 registered organizations. 

Dr. Onu said the national health insurance scheme is working smoothly because the hospital implemented standardized operating procedures and leveraged on economies of scale from medical digitalization. This has led to achieving operational efficiency such that patients can receive pre-authorization codes within 30 minutes of request from the HMOs. That is why it has been recognized as a model health insurance hospital meeting the objectives of the scheme in pursuing universal health coverage for Nigerians.

With the success posted by the Nisa Premier-Garki Hospital partnership, the Infrastructure Concession Regulatory Commission in 2017 indicated the possibility of replicating the initiative to revive more fledgling healthcare centres in Abuja. 

The success of the public-private partnership agreement between the FCT Administration and the Nisa Medical Group is a signpost on how the government can make public hospitals work smarter, deliver quality healthcare services to Nigerians and curb medical tourism. It is indeed an indication of the Renewed Hope Agenda of the current administration.

…Osuji wrote from proedgecomng@gmail.com