Society and ReligionThe Stethoscope

A Dangerous Precedent: Be Informed

Case
This was reported in the news:

A High Court in Anambra State presided over by Hon. Justice Okuma, has ruled that the act of corporate institutions, especially, hospitals, locking up their customers/clients/patients from exiting their premises on the guise that they must complete payment, amounts to false imprisonment.

This reasoning was given in the recently decided case of Mr. Chinonso Osegbo, Mrs. Ngozi Osegbo and The Registered Trustees of the Synod of the Diocese on the Niger with Suit No: 0/255/2017.

The Plaintiffs had taken their 11-month old baby to Iyi Enu Mission Hospital for treatment, but the child died while undergoing treatment. The hospital was said to have locked up the Plaintiffs and insisted that they would not be allowed to leave the hospital until all payments had been made. The hospital thus detained the Plaintiffs for more than 10 hours despite pleas to allow them to go and seek funds.

Judgement
Delivering the judgment on 12 June, 2018, after considering the arguments on the parties’ written addresses, the Court held that the Plaintiffs had proved their case.

“The act of the Defendants in detaining the 1st Plaintiff for ten hours in the circumstance of this case no doubt constitutes acts of false imprisonment. I must deprecate the uncivil and indecent way and manner the Defendants recovered the said hospital bill.

“It is not expected that the first Defendant particularly will engage itself in such uncivil and illegal means of debt recovery. Much as this Court recognizes the fear in disappearance of patients when it comes to payment of hospital bills or debts generally, I do not find it sufficient to justify illegality that two wrongs do not make a right,” the Court said.

The Court awarded the sum of N500, 000 (Five Hundred Thousand Naira) against the Registered Trustees of the Synod of the Diocese on the Niger that owns Iyi Enu Mission Hospital together with 35% interest on the judgment sum until final liquidation of same.

Interpretation
The court therefore decided that it was unlawful for the hospital to detain the parents and force them to pay for the care of the baby. That the hospital had no right and erred, in putting pressure on the family to pay for services rendered.

In Nigeria, hospitals are damned if they fail to treat before payment. The government specifically mandates hospitals to treat victims of gunshot injuries without asking for payment first. Now, it seems the courts may punish hospitals asking for payment after treatment.

My thoughts
There are two issues at stake here.

One is that a baby died under circumstances that are not clear in the report. However, the lawsuit was not about medical negligence or failure of treatment. The hospital treated the baby who unfortunately, did not make it. The hospital therefore rendered the service and reasonably expected to be paid.

The second point relates to the manner of collecting the debt. The hospital had no confidence in the family and did not feel that it would be paid. Otherwise, given the circumstances, they would not have insisted on immediate recompence of the debt.

So, what should hospitals do?

Personally, I will work with the relatives to come to terms with the loss and hopefully turn them into hospital advocates. It’s all about being sensitive to the situation and displaying emotional intelligence in a difficult situation. Provide them with the opportunity to return at their convenience to repay the money owed. Once in a while, one would be surprised that they do actually return to repay the debt!

In conclusion
The court ruling is a dangerous precedent. Doctors, health practitioners, hospital owners and health associations such as the Nigerian Medical Association and the Guild of Medical Directors should appeal the ruling.

It is a dangerous precedent and does not bode well for private hospitals.

Meanwhile:

1. Build in a risk premium into your pricing system accounting for the percentage of such patients in your practice so that there’s a planned financial provision that allows for this management risk.
2. Have a risk assessment system for patients unable to make a reasonable deposit beforehand and decide on best management strategy which may include referral to another centre.
3. Have standard legal documents that a patient signs beforehand agreeing to the “credit facility” you are offering them and payment for same shortly.
4. Have standard legal documents of undertaking with provision of a guarantor for patients unable to pay before discharge and plan a realistic payment plan for them.
5. Private Hospital Associations in non-credit societies should keep a register of black-listed ‘dishonorable’ patients who renege on the above agreements/responsibilities. This limits the exposure of other hospitals in the local area.
6. The hospitals should also consider taking the defaulter to court.

Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc, a Contributor to Newspackng, is a neurosurgeon with Brain and Surgery Consortium at 8 Buchanan Crescent, Off Aminu Kano Street, Wuse 2, Abuja.

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