DOCTORS AT WAR OVER CORONER'S SYSTEM LAW

SQUIB FEATURE
Full text of the position of the Lagos State NMA on enactment of the Corona’s Systems Law

THAT (i) The State Coroner’s System commenced or came into force on the 18th of May 2007 on Assent to at Ikeja by the Governor of Lagos Chief Bola Ahmed Tinubu. (ii) That the Coroner’s Law Cap C16 of 2003 is repealed. (iii) That under sub-heading “General Provisions”, there are 25 sections (“1 -25”). (iv) That under sub-heading “Post-Mortem Examination”, there are 5 section(“26 - 30”). (v) That under sub-heading “Procedure at Inquest” there are 16 sections (“31- 46”). (vi) That under sub-heading “Miscellaneous”, there are 7 sections (“47-53”). (vii) That there 3 schedules, one for section “8” one for section “17”, and one for section “49”.

(viii) That under the second (2nd) schedule, there are 10 (ten) forms (“A - J”). (ix) That under the third (3rd) schedule, there are 6 (six) forms (“A - F”). (x) That there is appended a subsidiary legislation, described as directions given by the Chief Judge under section 5 of the Coroner’s System Law, “a declaration of Coroner’s Districts” as well as “a ‘Citation”. However, without being exhaustive, we would like to draw your attention to certain vexatious sections of the enactment and the arguments, we are making as the basis of our inferences. (I) Under Sub-heading General Provisions Sections 7 (subsections) (1,2,3) 8,9 (1(a), (b), 2) we wish to make the following arguments: It is a gross abuse of discretion for an Attorney-General of a city, state or federation to be seen as appointing the Chief Medical Examiner within his jurisdiction. The legislation empowering his office to do so, is in the same veingrossly defective. We consider this an affront to the medical community in Lagos. The requirements for the post of Chief Medical Examiner of the state as herein spelt out are self-conceited, self-serving and spurious. Again, they constitute an affront to the medical community in Lagos, particularly the body of pathologists.
“Forensic Pathology” is only a sub-specialty of the whole body of pathology. It is not the supreme branch of pathology in itself. Also any two opinions in Forensic pathology may not be the same. The enactment under section 10(e) is grossly defective in that it seeks to make synonymous the office of the Chief Medical Examiner and the Forensic Institute of Lagos State.

This attempt to put this structure on ground is totally misplaced and is considered a “BACKDOOR ACTIVITY”. All in all, it is our sincere belief that the language of “Forensic” as used so profusely, in this enactment, in all matters of death in Lagos State is the sole diabolical, handiwork of the “self-acclaimed sole forensic pathologist” of the state. We consider this again a gross abuse of language because not all deaths are “criminal investigable”, which this enactment is forcing us and every one else to so believe. Lagos State must remain “AN EQUAL OPPORTUNITY EMPLOYER” at all times. A “Forensic Institute” or “Forensic Pathologist” cannot “play God” as the final and sole determinant of the “cause of death”. It or he can only be contributory, as a part, to a whole. Again a “Forensic Institute” must defer to the Medical and Dental Council of Nigeria for purposes of accreditation, otherwise all its activities shall be deemed irregular and unlawful (II). Sub-heading “General Provisions” Sections 14 (b,d,h,q) 15 (4,8), 17 “A Report of death” shall be made to any of the agencies for the report of death (vis-a-vis Police, Local Government Authority, Office of the Medical Examiner) or the office of the Coroner.

Herein it is not spelt out in what form is a Report of Death to be. Phone call? Personal (verbal) visitation? Piece of writing from anybody? It must be noted that this legislation precludes or does away with, entirely, the old practice of issuing a “physician endorsed Death Certificate” wherein the latter’s impression as to be cause of death to the best of his knowledge is solicited for, which by and large should constitute a portion of the originations of the Reasoning of the Coroner as to have cause to subject the death to post-Mortem examination in the office of the medical examiner.

We would also like to bring to the fore that the listing under “reasonable causes” to subject the death to post-mortem examination is not only exhaustive but speculative, vindictive, grievous and burdensome. By this listing “all deaths” are not only Reportable but subject to post-mortem examination.

A review of section 14 subsections 1 and 2 reveals that on one hand a registered medical practitioner is precluded from issuing a medical certificate of the cause of death and on the other hand a funeral director is being requested to procure same from him. This is a great contradiction. Section 15 further affirms that all reportable deaths are subject to the “holding of an inquest” in addition to a post-mortem examination because again the listing is exhaustive, speculative, vindictive, grievous and burdensome. Section 17 reveals that also in compelling compliance of the citizenry, the Coroner is further empowered to issue warrants for exhumation of bodies, notwithstanding any law or custom to the contrary— i.e religious or otherwise.The medical community herein stands to be re-informed as to the followings: What death is Natural? Old age or prolonged illness? What or who determines negligent medical interventions under this enactment? The state or the Medical Dental Council of Nigeria (MDCN) a federal body? What constitutes: (i) Unnatural still birth? (ii) Intra-uterine death?

Why should an inquest be held because a Coroner is informed that a death within his district has occurred “as a result of” medical intervention? This by itself is an action initiated with prejudice because it is a conclusion before a conviction. It could be better re-phrased as “whilst on” or “during” medical therapy (“intervention”) which in these instances may not warrant an inquest because a “status of innocence” is presumed until proof of incompetence or negligence is made by the appropriate practice regulating authority, the MDCN.

What constitutes any maternal death desirous of an inquest? Permit us to draw a picture between a client, who is accusing his lawyer of negligence (non-diligent) practice of law and is referred to the Judicial Council for redress, and another client who is accusing his doctor of negligence (non-diligent) in the practice of medicine and is referred to court of law for redress as being prescribed by this enactment, instead of the Medical Council.

(III) Sub-heading “General Provisions” Section 25 Subsections 1,2,3. Herein again the rights of the practising physician are not protected. The relatives of the patient-client can take advantage of this defect in enactment by facilitating the removal of their deceased by merely reporting to any of the agencies without attempting to first settle the Bills of CARE. The fears of the practitioner-physician are herein founded on experience. (IV) Sub-heading “Procedure at Inquest”, Section 32 Subsection 1: A Coroner is empowered to exercise his power in and compelling the attendance of witnesses, etc.Here again we see the rights of the practicing physician as not being protected.

We are therefore advising, that with regards to the instance of the physician-surgeon, deference should be made to the MDCN with regards to summoning and compelling of witness. (V) Sub-heading “Miscellaneous” Section 48 lays emphasis on offences and penalties and itself is an expatiation of the General Provisions. Particularly worrisome to the medical community is the word “custody” as applicable to hospital, clinics, and hospices. The scenario is (a) “any death occurs in any “custody” (any place of confinement including Prison, Police State, hospital premises, asylum, rehabilitation centre etc). Here again the rights of the practitioner physician are grossly violated in that all deaths in hospitals are subject to the holding of an inquest.

It is herein advised that Section 18 and 48 of the law should exclude/exempt hospital premises and hospices which by convention, care for the sick and dying. Again in this instance deference should be made to the MDCN which has always had jurisdiction over such practice. Section 48 subsection 6 gives hint of power of accreditation of mortuaries, private or public, solely to the office of the Chief Medical Examiner, therein precluding the oversight of the Health Facilities Monitoring and Accreditation Agency HEFAMAA of the State Ministry of Health which hitherto had jurisdiction. Herein, with regards to the issuing of death certificates, the medical practitioner is wholly precluded because he stands liable on all the grounds of this enactment.

This is very demoralizing and very emasculating. (VI) Under whatever schedule or System Law, there is no provision for any forms in which a practitioner-physician can safely and in writing, notify the appropriate authorities of a death without being culpable. This is very emasculating.