Introduction
Mrs. Okafor, a 52-year-old diabetic patient, was admitted to a private hospital in Lagos for a routine laparoscopic gallbladder removal (a minimal surgical procedure). Her consulting surgeon performed the operation successfully, but shortly afterwards, she developed a severe infection that led to septic shock. Upon investigation, it was discovered that the surgical instruments used had not been properly sterilised due to a malfunctioning autoclave machine. The biomedical technician had flagged the fault a week before, but hospital management delayed repairs due to budget constraints. Additionally, the nurse in charge failed to verify the instrument sterilisation log, as required by protocol. To worsen matters, the early signs of infection were miscommunicated between the night-shift nurse and the attending physician, leading to a 12-hour delay in intervention.
In this scenario, Mrs. Okafor's harm did not stem from the surgeon's skill, but from multiple failures involving defective equipment, protocol breaches, communication lapses, and poor institutional oversight, each raising potential legal liability beyond the doctor's conduct.
This case of Mrs Okafor reveals a fundamental truth about medical negligence in Nigeria: responsibility rarely stops with the individual practitioner. When disaster strikes in a complex system, the first instinct is to hunt for a villain, someone to pin the whole mess on. While media narratives often single out doctors, many failures stem from systemic issues involving hospitals, nurses, equipment manufacturers, labs, and others.
This article explores the full chain of legal responsibility when multiple parties are liable in a case of medical negligence.
Understanding Medical Negligence in Nigerian Jurisprudence
Medical negligence constitutes an act or omission by a medical practitioner which falls below the accepted standard of care, resulting in injury or death of the patient.1 The Supreme Court defined negligence in U.T.B. (Nig.) v. Ozoemena2 as "a lack of proper care and attention; careless behaviour or conduct; a state of mind, which is opposed to intention; the breach of a duty of care imposed by common law and statute resulting in damage to the complainant."
We see a lot of hospitals engraving a sign that reads 'We Care, God Heals" yet we see a lot of medical personnel and hospitals guilty of medical negligence, ignoring the first part of such inscription. Medical professionals are legally bound to uphold a duty of care, and breaching this duty, resulting in harm, can lead to compensation claims. Perfection is not required, but a reasonable standard of care must be maintained.3 It is important to note that the law does not require medical professionals to be perfect every time they carry out their job, as this is not humanly possible.4
It is important also to note that negligence is complete and actionable where the Defendant owes a duty of care to the Plaintiff; the duty was breached and damages were suffered arising from the breach. From the scenario painted in the introduction, one can see that the hospital owes a duty to the patient for a successful surgery, and that duty was breached due to the action of the hospital's failure to repair the autoclave machine because of budget constraints. The negligence from that scenario did not emanate from the surgeon, which eventually involved multiple parties, but started from the time the hospital failed to repair the autoclave machine.
Crucially, Nigerian jurisprudence recognises that negligence encompasses acts and omissions by all healthcare providers and not just doctors. This includes nurses, pharmacists, laboratory attendants and any other healthcare provider. This is contrary to the general belief that only doctors can be liable for medical negligence.5 Medical negligence in Nigeria extends beyond simple mistakes to encompass systemic failures across healthcare delivery.
Who can sue and be sued for medical negligence?
Individuals directly affected by medical errors generally have the right to sue for malpractice. Exceptions exist for deceased patients or minors, allowing close relatives or guardians to pursue legal action.6
Who Can Be Liable For Medical Negligence?
When it comes to medical negligence in Nigeria, liability can be attributed to multiple parties depending on the circumstances. The increasing complexity of healthcare means that a single patient encounter can involve: Surgeons, anaesthetists, pharmacists, nurses, lab technologists, diagnostic labs and administrative staff.
Generally, anyone involved in providing medical care to the patient can be guilty of medical negligence. Identifying all liable parties is crucial for a comprehensive medical negligence claim, ensuring that all responsible entities are held accountable for their actions.7
This may include one or more of the following parties:
1. Physicians and Surgeons:
It is established law that doctors owe a sacrosanct medical duty of care to their patients, which requires a high degree of skill and competence; otherwise, liability for medical negligence may arise.8 Doctors hold primary responsibility for diagnosis, treatment decisions, and surgical procedures. They are liable for procedural errors, misdiagnoses, and failure to obtain consent. If a doctor fails to provide the standard of care and causes harm, the doctor may be held liable for damages incurred by the patient.
2. Nurses:
They are responsible for the execution of care plans, medication administration, and post-operative monitoring. Negligence occurs through improper monitoring or administrative errors. 9 If a nurse fails to provide proper care and injures a patient, the nurse may be at fault for medical malpractice.10 Also, if a nurse administered the wrong medication, the nurse may be liable for injuries.11
3. Medical Institutions:
Liability of medical institutions with respect to medical negligence can be direct liability or vicarious liability. Direct liability refers to the deficiency of the hospital itself in providing a safe and suitable environment for treatment as promised.12 For example, this will arise where equipment which are expected to be available is not available or is not functional, leading to harm, injury or death of patients. Examples include: a non-functional ambulance, non-maintenance of medical records, and transmission of infections, among others.13
4. Pharmacists:
The case of Horton v Evans14 affirmed the principle that Pharmacists are under a duty to take at least some steps to ensure that prescriptions are not inappropriate.15 In this case, the court ruled that Pharmacists have an obligation to question the correctness of a prescription with the prescribing physician or patient, especially if the patient has had previous prescriptions for the same medication.
5. Pharmaceutical Companies/Device Manufacturers:
Liable under product liability principles for defective drugs or medical devices that cause patient harm.16 Pharmaceutical companies are responsible for producing safe and properly labelled medications. When drugs cause unexpected harm, manufacturers may be held liable.17
Joint and Several Liability in Medical Negligence
Joint and several liability is a legal concept that applies to medical malpractice cases involving multiple parties. Joint liability refers to a situation where two or more parties are responsible for a single act of negligence. Several liability, on the other hand, refers to a situation where each party is responsible for their own individual act of negligence. Joint and several liability enables a patient to obtain full compensation from any one or more of the negligent parties involved, without the need to pursue each party individually. This principle simplifies litigation and ensures that the plaintiff can still receive compensation even if some of the defendants are unable to pay their portion.
By suing multiple defendants in a medical malpractice case, the plaintiff improves their chances of a favourable outcome, potentially increases the amount of compensation, and benefits from a more efficient legal process by combining claims in one action. This approach ensures that all liable parties are appropriately held accountable.18
A victim of medical negligence has several avenues for seeking redress. They may initiate a civil lawsuit against the physician or other healthcare providers for alleged tortious conduct. Additionally, the victim can lodge a complaint with the appropriate regulatory authority, such as the Medical and Dental Council of Nigeria. In cases involving serious misconduct, the matter can also be reported to the police. If the investigation uncovers evidence of gross negligence, recklessness, or a blatant disregard for the victim's life, the police may prosecute the offender directly or refer the case to the State Attorney General's office for possible criminal prosecution in appropriate cases.19
Conclusion
In Nigeria, addressing medical negligence effectively requires looking beyond the doctor. Modern healthcare involves a network of professionals, institutions, devices, and third-party services, each carrying legal duties. For practitioners and patients alike, understanding this chain of responsibility is critical to ensuring accountability, fair compensation, and systemic improvements. True patient safety is a shared responsibility, demanding accountability at every level, from individual practitioners to hospitals.
Footnotes
2. (2007) 3 NWLR (Pt. 1022) 448, (Pp. 464-465, paras. H- A; 487, paras. F-G)
3. https://lawpavilion.com/blog/an-insight-into-medical-negligence-under-nigerian-jurisprudence/#_ftn21
4. https://lawpadi.com/sue-medical-negligence-nigeria/ Ojo V. Gharoro & Ors (2006) 10 NWLR (Pt. 987) 173
6. https://www.scirp.org/journal/paperinformation?paperid=126067#return77
7. https://gohonlaw.com/can-multiple-parties-be-liable-for-your-medical-malpractice-case/
8. Otti v. Excel-C Medical Centre Ltd (2019) 16 NWLR (Pt. 1698) 274 (P. 316, paras. E-F)
10. Dickson Igbokwe v. University College Hospital Board of Management (1961) WNLR 173
11. https://gohonlaw.com/can-multiple-parties-be-liable-for-your-medical-malpractice-case/
12. Agarwal & Agarwal : Medical negligence & hospital's reponsibility. Journal of Indian Academy of Forensic MedicineVolume 31, Issue 2 June 2009 https://journals.sagepub.com/doi/epdf/10.1177/0971097320090221
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC7245980/#cit0031
14. [06] EWHC 2808 (Q.B), [220007] P.N.L.R. 17
15. Clerk & Lindsell on Torts, Second supplement to the Nineteenth Edition 10-82 Page 66
16. https://gohonlaw.com/can-multiple-parties-be-liable-for-your-medical-malpractice-case/
17. https://www.kytrialfirm.com/blog/can-multiple-parties-be-liable-for-medical-errors/
18. https://gohonlaw.com/can-multiple-parties-be-liable-for-your-medical-malpractice-case/
19. https://punchng.com/legal-remedies-available-to-victims-of-medical-negligence/
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