Femi Akintunde-Johnson
There is something profoundly disturbing about watching a human being fight for life while the people and institutions expected to help appear more interested in paperwork, payment, police reports, bed availability or some other administrative inconvenience. It is even more disturbing when the difference between survival and death is a few minutes, and those minutes are wasted negotiating the terms of admission.
The recent, widely publicised desperate attempt to save the life of a young gospel singer, reportedly rushed from one hospital to another – as many as eight, according to accounts – with little or no meaningful assistance before he eventually died, has once again brought this troubling reality into sharp focus. We have heard similar stories: victims of armed robbery, bleeding from gunshot wounds, reportedly asked to produce police reports before receiving treatment; pregnant women in labour turned away for lack of bed space; accident victims shuttled between hospitals while precious minutes disappear. These are not merely stories of administrative inefficiency. They are reminders of how precariously human life is sometimes valued in our healthcare system.
So, when the Senate began considering an amendment to the National Health Act, 2014, prescribing a six-month jail term or a fine of up to N300,000 for hospitals and healthcare providers who violate specified emergency treatment standards, I found myself broadly sympathetic to its underlying intention.
Sponsored by Senator Abdulaziz Yar’Adua, the proposed amendment seeks to establish enforceable timelines for emergency assessment, stabilisation and referral. Hospitals would be required to commence triage within 15 minutes of arrival, initiate basic stabilisation within 30 minutes and undertake immediate life-saving interventions where necessary. Where admission is required, a bed should be assigned within two hours, subject to availability. Facilities unable to accommodate patients must stabilise them and arrange appropriate referrals.
These are not unreasonable expectations. Indeed, one might wonder why some of them should require fresh legislation before becoming operational standards in a modern healthcare environment.
But then came the backlash. The Nigerian Medical Association (NMA), through its President, Professor Afekhide Ernest Omoti, strongly criticised the proposal, arguing that criminalising healthcare workers without first addressing systemic deficiencies was fundamentally unfair.
The objections are not without merit. Nigerian hospitals struggle with inadequate infrastructure, insufficient personnel, poor remuneration, shortages of essential medicines, oxygen, blood products, resuscitation equipment and functional ambulances. The continuing migration of doctors and nurses has further weakened an already overstretched workforce.
The association also drew attention to the inadequate implementation of the Basic Health Care Provision Fund, which is expected to support essential healthcare interventions, including emergency medical treatment. Hospitals that provide emergency services without receiving appropriate reimbursement are understandably concerned about the sustainability of such obligations.
These are legitimate concerns, and they deserve more than the familiar official response of setting up another committee. However, there is a distinction between a hospital being unable to provide a specialised intervention and its refusal to undertake basic measures that could preserve a patient’s life. There is also a difference between a doctor who cannot perform a procedure because the necessary equipment is unavailable and one who refuses to examine a patient because there is no deposit, police report or assurance of immediate payment.
We must not confuse professional helplessness with institutional indifference. Neither should we pretend they are always easily distinguishable. This is where the proposed legislation requires careful refinement.
First, the law must distinguish between wilful refusal, professional negligence, institutional incapacity and genuine clinical limitations. Criminal liability should not automatically attach to every failure to meet a prescribed timeline. It must be established that there was an identifiable breach of duty, that the person or institution had the capacity and opportunity to act, and that the failure was not reasonably attributable to circumstances beyond their control.
Second, initial emergency intervention must take precedence over financial and administrative formalities. A patient who is unconscious, bleeding or struggling to breathe should not first be required to demonstrate purchasing power. Nor should a gunshot victim have to negotiate with the police before receiving treatment. Documentation can follow; preserving life cannot.
Third, the prescribed timelines should be operational benchmarks, not rigid substitutes for clinical judgement. Triage must prioritise the severity of a patient’s condition, not simply the order of arrival. Equally, no doctor should be compelled to undertake an inappropriate procedure merely to satisfy a statutory deadline.
Fourth, responsibility must extend beyond individual practitioners. Where hospital management has failed to provide essential equipment, maintain adequate staffing or establish functional emergency protocols, institutional accountability must apply. Repeated or deliberate violations should attract appropriate sanctions, while genuine failures arising from circumstances beyond professional control should be treated differently.
Other countries offer useful lessons. South Africa’s National Health Act prohibits healthcare providers and establishments from refusing emergency medical treatment. Its framework also recognises the importance of stabilisation and appropriate referral where a facility lacks the capacity to provide further treatment.
Kenya’s Health Act, 2017, similarly defines emergency treatment to include pre-hospital care, stabilisation and arranging referral where the first healthcare provider lacks the necessary facilities or capacity. The distinction between inability and unwillingness is particularly relevant to Nigeria.
In the United States, the Emergency Medical Treatment and Labour Act (EMTALA) requires participating hospitals with emergency departments to conduct appropriate medical screening and provide stabilising treatment regardless of a patient’s ability to pay. Where necessary facilities are unavailable, appropriate transfer arrangements must be made.
The United Kingdom’s NHS also operates structured emergency triage, prioritising patients according to clinical urgency rather than financial status or administrative convenience.
Nigeria need not reproduce these systems wholesale. But we can adopt their central principles: compulsory initial assessment, immediate stabilisation, clear referral pathways, institutional accountability and protection for professionals acting within genuine resource limitations.
There is, however, an uncomfortable question lawmakers must confront. Section 20 of the National Health Act, 2014, already prohibits healthcare providers and establishments from refusing emergency medical treatment. Why, more than a decade after its enactment, are we still discussing the same abuses?
Perhaps the more fundamental problem is not the absence of legislation but the absence of consistent enforcement, adequate funding and institutional discipline. A new law cannot automatically produce oxygen cylinders, functional ambulances, intensive care beds or additional doctors. Neither can it manufacture empathy.
And empathy, in this conversation, is not a sentimental luxury. It is inseparable from the professional obligation to recognise the value of human life.
The NMA must be heard, particularly on the danger of punishing professionals for failures beyond their control. But the public must also be heard. Citizens cannot be expected to understand every operational difficulty while their relatives are being turned away at the very moment they need help most.
The National Assembly should use the committee and public hearing stages to produce legislation that protects both sides without compromising its central objective. Government must demonstrate commitment through transparent funding of emergency care, effective implementation of the Basic Health Care Provision Fund, improved staffing, essential equipment and functional ambulance and referral systems.
The proposed amendment must not become an instrument for prosecuting struggling doctors while the institutions that employ them remain inadequately equipped. Equally, professional associations must not allow legitimate concerns about working conditions to become an unintended defence of practices that endanger patients.
A doctor cannot be expected to perform miracles without the necessary tools. But neither should a hospital be permitted to turn away a dying person simply because its administrative machinery has not been properly lubricated.
When somebody arrives at a hospital in a life-threatening condition, the first question should not be who is paying, who authorised the admission or who has brought the police report. It should be what can be done, immediately, to keep this person alive.
We can argue about funding, manpower, infrastructure, professional protection and legislative wording. We should. But while those arguments continue, the patient must not become the casualty of a system in which everybody has an excuse and nobody accepts responsibility.
The first duty in an emergency is to save the life that can still be saved. Everything else must find its proper place afterwards.