Medical Negligence- The Doctor as a Scapegoat (I)

About fifteen years ago, as a young house officer on call in the labour room of a general hospital in Abuja. One night, I made a mistake that stayed with me.

The woman’s labour was long. To ease the baby’s passage into the world, an episiotomy was done. One of the experienced midwives supervised me and, confident enough, encouraged me to repair it myself. As I stitched, I inserted two sanitary towels into the woman’s private part to pack and stem the bleeding while I worked. I finished the repair, removed the pads, cleaned her up, wrote up her post-delivery medications, and discharged her.

I was exhausted. All I wanted was to collapse onto the dirty mattress in the call room. But first, prayer. I had missed Maghrib, so I dragged myself to perform ablution. And just as I raised my hands for Takbeer, a doubt crept in. You know how Shaytan suddenly reminds you of all the things you did or didn’t do during prayer? Ehen! My mind started whispering to me- Fatima, did you remove one pad or two?

Till date, I do not know how I finished that prayer. The speed and alacrity with which I did ‘salama’ and rushed to the patient, only to be told that she had just left. Tapdi! I looked up her number in the file and called her back immediately mumbling some silly story about correcting a prescription. Luckily the husband bought the story and agreed to bring her back

In the examining room, I told her that I needed to make sure her stitches were ‘tight enough’.  Sure enough, as I looked inside, I saw my nemesis. I had removed only the second pad. The first pad was still there.

I nearly wept from relief. After removing it, I cleaned her up again and made extra effort to look for free antibiotics for her. I even bought two cans of chilled Maltina and saw her off to her car, where her husband was waiting patiently.

That very day, I went back to the midwife on shift and begged her to teach me the method of tying the pads together so that with one pull, both pads came out.

One small mistake, and my medical career would have been over before it even started.

That day I learned something medical school never taught me: medical errors are rarely born out of wickedness or incompetence alone. More often, they emerge at the intersection of fatigue, system failure, inexperience, poor supervision, and overwhelming workload.

When I heard of Chimamanda’s son’s death, the first thing that I said to myself was ‘not again’. Not because I do not feel her grief, but because I instantly knew the chaos that would follow. Doctors in Nigeria had not finished reeling over the deaths of friends of Anthony Joshua, and now this. I knew it would be just a matter of time.

They did not prove me wrong. Their lawyers came swiftly, neatly and quietly, delivering an alleged 2.9 billion dollar lawsuit. Euracare has since launched an internal investigation following clinical governance standards, emphasising their commitment to patient safety and transparency. Furthermore, Nigeria’s Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, has intervened by establishing a National Task Force on Clinical Governance and Patient Safety.

Like the Gen Z’s say:  Aura for Aura.

The Diasporans have come to show us how it’s done.

Medical negligence is not unique to Nigeria. Wrong-site surgeries, retained surgical instruments, medication errors, and failures of monitoring occur in the world’s most advanced health systems. Entire patient-safety movements in the UK, the US, and Europe exist because medicine everywhere is practised by humans, not machines.

The difference is not that Nigerian doctors are more careless. It is that Nigerian doctors often work under conditions that make errors more likely and error more dangerous.

Yet, when tragedies occur, public discourse is quick to search for a villain. The Nigerian doctor becomes the face of negligence, the scapegoat for a broken system. This is neither fair nor useful.

When a junior doctor makes a mistake at the end of a 36-hour shift, the question should not only be “Why did the doctor err?” but also “Why was the system designed to allow this?”

Everytime, we hear of a medical error, the first thing the management does is to suspend the doctor in charge. Then we investigate, and depending on the outcome of the investigation, the Dr is either hanged or reinstated. Never have I heard of a case where the system was changed to prevent the error from happening again.

Let me give you a real-life example: Somewhere in a Nigerian government hospital, two doctors performed a Caesarean Section on a pregnant woman. The operation went well. While cleaning his instruments, the peri-op nurse suddenly discovers that one of his artery forceps is missing. He raises an alarm. The whole surgical team then proceeds to check the dirty sheets, under the table and in every nook and cranny of the theatre, but the forceps isn’t found. The Lead surgeon requested that the patient be taken for an emergency x-ray. Lo and behold! The forceps is found nestled cosily behind her uterus. The patient is immediately returned to the surgical table and opened again. Remember that the woman is awake the whole time.

After that incident, the woman can’t stop talking, and soon the gist reaches management who of course calls for an investigation. During the investigation, it is discovered that the peri-operative nurse is, in fact, not a qualified peri-op nurse. He is a ward nurse who was drafted to fill in the gap because the original peri-op nurse who was supposed to be on duty was on maternity leave. The management realises that they have only six qualified peri-op nurses for the entire 500 bed specialist hospital that has eight theatre suites.

As if that was not enough, management realised that the doctors did not follow protocol before closing the patient after the surgery. The senior doctor, after making sure the uterus was closed properly and there was no bleeding, asked the junior doctor to ‘finish up’ (close the abdomen). He then went out to the lounge to sip coffee and watch the news.

The junior doctor, excited to be working without supervision, closed up quickly and even bragged to the anaesthetist that it took him less than 10 minutes to ‘close’. The anaesthetist does his job of returning the patient to the recovery room, noting that her pulse is a bit high. He says nothing.

The management notes down all these points and comes up with a decision: The senior doctor is to be suspended. After all, heads must roll. Management must be seen to do the right thing. Damage control and all that PR bull shit.

Does the hospital board employ more peri-op nurses? No. Do they send currently employed nurses for peri- operative training? No. Do they create a surgical checklist to ensure that everyone plays their part before, during and after the surgery? No. Do they change the teaching standards to make sure that senior surgeons always stay and supervise until after the completion of the surgery? No, they do not.

Instead, the doctor is suspended, the patient is offered an apology, and many photos are snapped with management showing teeth and holding press briefings.

Until the next tragedy occurs.

When supervision fails, when protocols are unclear or unenforced, when reporting errors leads to punishment rather than learning, we create a culture where mistakes are hidden instead of prevented.

Blaming doctors alone does not make patients safer. In fact, it does the opposite.

It drives errors underground. It discourages openness. It fuels defensive medicine. It accelerates brain drain, as doctors flee systems where they feel unsupported, vilified, and unsafe. I know of a doctor who was sacked on account of medical negligence; he is now a successful psychiatrist abroad.

Countries that have improved patient safety did not do so by hunting for villains. They did so by building systems that assume human fallibility and design safeguards around it using checklists, supervision, rest periods, team accountability, and learning from error rather than denying it.

Doctors are not scapegoats.

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