Barrister Laolu Osanyin is a lawyer with expertise in Medical Law and has gained international renown in the field. Currently the first and only African on the Board of Governors of the World Association for Medical Law (WAML); he is a member of the World Association for Medical Law, the American College of Legal Medicine (ACLM) and also a member of the Nigerian Bar Association (NBA).
With 15 years of legal practice, Osanyin provides legal consultancies for corporations and government agencies on business regulatory frameworks and corporate governance. In this interview, he talks about the state of medical law practice in Nigeria.
What made you choose Medical Law as a career?
I know I was very privileged to have what is very rare in Nigerian universities, which is that I had mentorship. I met a lawyer by name Chinua Asuzu. He was doing postgraduate programme while I was in year one. So all through my university days, I was an intern in his office. So I had learnt a lot and I had envisioned what I wanted as a practitioner. He had his masters in Medical Law in the 80’s. I believed I needed to explore that angle so I got a very good soft landing by virtue of the fact that I had a mentor. So even before leaving the university, I had known what I wanted to do; I had known my area of specialty. It was pretty easy because I had a mentor which was very rare. I had personal experiences but as a matter of fact, it was not the experience that took me to medical law. It has not been easy being virtually a lone wolf because people kept asking me what I was trying to achieve. Nobody does this thing in Nigeria, they’ve not heard about it. But I knew it was workable and I am happy that people have seen the value that we are adding both in the health and legal sector.
Give us an insight into your educational background.
I had a unique one. I am the son of two professors. I grew up in a university environment and I believe that also gave me the courage to do what a lot of people dared not do. My father was a Professor of Theatre Arts. He is late and my mother is a Professor of Education. She is still in service. I had my nursery and some of my primary education abroad but completed here in Nigeria. My secondary school was here – I went to Yaba College of Technology, where I read Business Administration, then went to read Law at the University of Lagos, where I got both Bachelor’s and Master’s degrees. Then I got my international certifications as well.
When patients are victims of medical malpractice what advice do you have for such people?
First, doctors and patients need to be enlightened on this. Patients have rights which are protected by law. If these rights are infringed upon, the patient has a right of recourse against such health worker by taking legal action. In addition to this, the health worker must recognize that he has legal responsibilities and I believe that is where we have problems. Health workers, especially those in the public healthcare system appear to be quite flippant, nonchalant and at times, grossly negligent. You have to beg them to attend to you. Failure of health workers to attend to patients promptly is often the reason the patient’s family run helter-skelter, looking for lab results or for x-ray because somebody who has been paid to do it is sitting somewhere and does not care. If those health workers understood the fact that those patients can as a matter of fact sue them and get their licenses suspended or withdrawn and they still have to pay compensation, then they would sit up. But we try not to whip up sentiments by trying not to encourage patients to sue. Instead, we try to educate health workers on the need to respect the patient’s rights because if they do respect the patient’s right, there would be less complaints, and there would be reduction in litigation. We have to be very careful because it is a thin line. Nigeria can easily be a litigious country where people will go to court and if they bombard the health system with litigation, the health system might not function at all. So, that is why we are educating health workers. Lagos State has been leading the way in this regard. I commend them for this and encourage other states to emulate them.
What is the position of the law regarding hospitals and doctors who harvest the body parts of patients without their consent during surgery or sexually violate female patients receiving treatments?
I think that the first thing that should happen, particularly in Lagos State, which is the most populated in terms of health demands, is that a medical law summit needs to be held where advice such as this will be given to participants. Health workers need to be trained, even at the grass roots on issues of medical law, medical malpractice and misconduct. These things you have mentioned occur every day. Selling of organs, tissues, blood products and medical information are all malpractices. They are happening because many of the health workers don’t even know they are breaching the law. So we need to bring it down because the more you talk about health insurance in Lagos, the more you are investing in Lagos, you have more traffic and eventually you’re going to have more cases of malpractices. Now if you have a work force that is unprepared for the whirlwind that will come, then you’re going to have serious problems. People are trooping into Lagos State, coming to use the facilities, wanting to get transplantation and if the health force here is not properly educated on medical law issues, the National Health Act 2014 and on patients’ rights, you will find out that Lagos State might have to set aside funds for paying compensation for malpractice or settling claims.
About 20 years ago, a man who had diabetes was taken to a state hospital. He was not tested before he was given glucose to boost his energy level. He never got out of the hospital alive. Would you advise the family to sue the state or just let it go?
You see, there has to be a sense of accountability. If somebody is negligent, there has to be sanctions. I am not saying there should not be sanctions. So if someone is culpable for having done something badly, there must be sense of accountability. In this example you’ve given now, that person should have been sanctioned. However, there is what we call ‘statute of limitations’ which prevents a patient after a long period of time to sue. If you try to see the doctor who committed this error now, he will have a defence called statute of limitations which is effective after eight to 10 years. The human mind cannot recollect several things that happened 10 years ago. Who are your witnesses? Where will the doctor be? What evidences can you give? Except the patient is still suffering from that injury or unconscious for 20 years, or the patient has been infertile for 20 years by virtue of the treatment given by the doctor. But not a situation where a fellow’s father died 20 years ago, then you speak to someone like me and say you want to sue, the law will state that you have slept on your right. Despite this, health practitioners should still be accountable. Two, can we sanction all of them or should we allow all of them be sanctioned? So how do we prevent it? By training them. You cannot invest in health, in equipment and you do not invest in capacity building. If you don’t develop the capacity of the workers, you are fooling yourself. So build big theatres, install state-of-the-art equipment and your workers are negligent, you’re fooling yourself. So it is important to invest in building the capacity of your workers not only for the benefit of the health workers but for the state as well. Same thing with the federal government and the local governments in order to prevent two things: patients/citizens dying unwittingly at a cheap rate and instance of malpractice claims. By the time your hospital is bogged down with malpractice claims, how effective can they run their practice? By the time your doctors are compelled to appear at the tribunal every other month, how effective can they be? No health worker wins a malpractice case.
You must try to avoid a malpractice case from getting to court. Essentially, what the person is looking for is settlement. It can be an apology or financial compensation. It’s a badly managed malpractice case that will get to court. Nobody wins it. The victim doesn’t win, the doctor doesn’t win. And I will explain why. If somebody’s wife has died and he has to be appearing in court for the next six years, he will not even have a sense of closure. He will continually relive the experience he’s had. In the end, has he moved on with life, has he won? Secondly, the doctor will have to keep appearing in court every day. It is bad for his practice and his reputation. At the end when he is exonerated, the social media has taken it viral that a patient died in his hospital, he was negligent, and police arrested him and all sorts. It is bad for his practice. At the end of the day, who wins? It is a no-win situation. So what we try to do is educate the doctors from even making errors that are so flimsy that can lead to lawsuits and all. Secondly, what is more important is that if patients are properly treated, there would not be unnecessary loss of lives. So it is supposed to be a win-win situation: train the doctors well. Let them understand the patient’s right so they won’t have cases or waste time and resources in court. Patients too will be better treated and there would be less mortality and less malpractice claims.
Do you believe it is necessary for health management organisations to serve as intermediaries between companies and hospitals?
It is extremely important that health insurance is in place. You can’t afford to do out-of-pocket payment for health services. Health insurance is the future. That is what can make treatments of patients sustainable here. We’re still grappling with that in Nigeria but it is important. However, it has to be properly monitored so there are no malpractices. At times, they practice what I call defensive medicine where patients do not need certain examinations but because of financial considerations, they require that certain tests that ought not to be done on patients be done in order for them to have proper regulation of everyone in the health sector. Not only the doctors but the managers, the insurance, everybody must be properly supervised.
The Senate at the moment is urging the government to declare a state of emergency in the health sector. What is your view on this?
The health sector in Nigeria is shabbily and poorly funded and we are still fooling ourselves. A population as big as Nigeria should not have a meager and abysmal budgetary allocation for health. As a matter of fact, the budget for health is a death sentence to Nigerians. Health is not child’s play. It is not the Olympics. It is continuous that is why in order to safeguard lives, it has to be properly funded. So far, it has not been. We can only appeal to them to make it right.
What challenges do you face in the cause of practicing in Nigeria?
Really, my challenge is here in Nigeria. At times, knowing the international statute one has and knowing that opportunities abound outside the country, one is at times torn between living here and going where you will be more appreciated, where everything works in your favour than being a lone wolf here and it is painful that you have to convince people that you want to teach them how to avoid problems. Meanwhile, in other climes, you are already recognized internationally, you just go there and you’re a red peg in a red hole. But here, you have to virtually beg and lobby to teach them on how to avoid having problems. It is ironical but it is the Nigerian situation where merit and intellectualism are not appreciated. They would rather give artists money to sing, sponsor reality programmes, which add no value to the system. The system does not encourage meritocracy and knowledge based practice. At times, one is torn between staying in such a situation against all odds to help them succeed and yet, you’re being called internationally to come. It is worse when my Nigerian colleagues abroad see me and ask “What are you doing in that country Olaolu?” A lot of my colleagues have utterly lost hope. So I am asking myself, “What am I still doing here?”
What was it like growing up?
I grew up in a secure environment and had the best upbringing anybody could ever ask for. I lived in a university environment and had the privilege of travelling with my parents during their sabbaticals, in parts of the world, schooling abroad, learning different languages, and even visiting non-English speaking countries. My father was a playwright and an artist, so I had the privilege of seeing him on stage, acting on stage with my father. He wrote a lot of books in the Pacesetter series in those days. Some of which we have started adapting to screenplay now. Maybe in another one year, you’ll see one of Bode Osanyin’s films. I watched my dad act in the theatre, saw him do Eyo. It was a very robust environment and very academic and that gave me the confidence to do a lot of things that nobody dare do. Coming out of law school and setting up my own practice, I was not driven by money but what value I could add. I grew up in that environment where I saw everything. I had parents who were achievers. Having good grades was not a big deal because it was what I met at home.
QUOTE: Here, you have to virtually beg and lobby to teach health workers how to avoid having problems. It is ironical but it is the Nigerian situation where merit and intellectualism are not appreciated. Companies would rather give artists money to sing, sponsor reality shows that add no value to the system. The system does not encourage meritocracy and knowledge based practice.