Sola Ogundipe & Chioma Obinna
18 July 2008
In 2007, the Lagos State Government promulgated The Coroner's System Law that established a new system of investigation of death in the State. The Coroner's Law which imposes specific civic responsibilities on individuals in both private and official capacities, is intended to strengthen the security of human life by investigating suspicious or questionable deaths, and enabling the state take action necessary to forestall the repetition or continuance of circumstances capable of bringing about avoidable loss of human life.
It is a specially designed law aimed at curtailing deaths caused by extrajudicial killings in all ramifications as well as deaths from medical negligence. But even though the Coroner's System Law was enacted to provide a regulatory framework for the investigation of deaths occurring in certain questionable or suspicious circumstances provided for under the law, doctors under the aegis of the Nigeria Medical Association (NMA) Lagos Sate branch are crying foul over the new law and have threatened to stop the issuance of death certificates should the State government go ahead with plans to effect the law.
Saturday Vanguard is on top of the development and reports that doctors have been at loggerheads with the Lagos State Government over the issue.
Different reactions from doctors have been trailing the passage of the law. Many claim that the process that led to the law was fraudulent. But the State government says the Coroner's System Law is here to stay. The law has been enacted but the controversy lingers ......
Issuing the threat at a press conference in Lagos, State chairman of NMA, Dr. Babafemi Thomas called for urgent suspension and withdrawal of the law establishing the corner system of Lagos state for purposes of holistic review.Thomas who alleged that the whole exercise was a travesty of due process said the law lack advocacy abinitio.
According to him, "We are inferring that the system and the law contravenes federal and international status and constitute an affront to moral justice in that certain pertinent key stakeholders in the health system development were neither consulted nor co-opted in the deliberations."
Continuing, he alleged that "the enactment exercise relied squarely and solely on the office of the forensic pathologist of the Lagos State for its bank of information. No impact was sourced from the medical and dental council of Nigeria which is the primary regulatory body for ethical practices within the medical profession in Nigeria.By this convert or avert omission, are further emphasising that the process that generated the document was not due.
As it stands and if the law is enforced to the letter, the average medical practitioner incurs the risk of being put in jail for issues as basic as issuing a death certificate." He further state that the law exposes the practicing medical professional, particularly those in private practice, to persons who may want to exploit its loopholes for the purpose of extortion.
Drawing attentions to some sections of the law, Thomas cited a sub-heading under sections 7 (1,23) 8,9 (1(a), b, 2) stating that 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.He further argued that the legislation empowering his office to do so, is in the same vein grossly defective adding that the act is an affront to the medical community in Lagos.
The doctors also disagree on the issue of one man acting as the only forensic pathologist in the state. According to them, a forensic pathologist cannot play God as the final and sole determinant of the cause of death but can only be a contributor. They also demanded that 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.
What the Coroner's Systems Law is all about
The law establishes a Coroner's System for Lagos State under the control and administration of a Chief Coroner of the State - section 1(2). A Judge of the High Court of Lagos State appointed by the Chief Judge of Lagos State shall be the Chief Coroner of the State - section 2. The overall administration of the Law is vested in the Chief Coroner - section 3.
The Law also provides for the designation of a Magistrate to be a Coroner in each District in the State - sections 4 and 5. A Subsidiary Legislation attached to the Coroners Systems Law designates four Districts as follows: Lagos Coroners District; Ikeja Coroners District; Yaba Coroners District; and Apapa Coroners District. The Magistrate in charge of each Coroners Court should however not be below Magistrate Grade 1- section 4(1).
The Law makes provision for the appointment of Chief Medical Examiner and District Examiner sections 7 and 11. The responsibility of the Chief Medical Examiner and District Examiner is to generally conduct medical investigation into the cause of death of any person referred to them amongst others. The implication of designation of four Districts is that only four District Medical Examiners can be appointed. In the event that there is the need for more Districts the Chief Judge may by a Subsidiary Legislation create more Districts pursuant to section 5.
The availability of a well equipped forensic laboratory is a sine qua non for the smooth functioning of a Coroners' System. Consequently, the Lagos State Government is committed to establish a first class forensic institute pursuant to the provision of section 8 that will be able to conduct all kinds of investigations that are required to enable the Medical Examiners and the Coroners to effectively discharge their responsibilities under the Law.
Reportable Deaths under the Law
The Law imposes a legal duty on any person to make a report of death to the Police, Local Government Authority, or Office of the Medical Examiner or the office of the Coroner and such deaths shall be subject to post-mortem examination where there is reasonable cause to believe that the cause of death was:
Unknown; sudden or unexpected and unnatural; violent, unnatural and suspicious; accidental or misadventured; due to self neglect or negligence of others; an industrial disease accident at work or industrial poisoning; due to negligent medical intervention, misconduct or malpractice; due to neglect during surgery or before recovery from anesthesia or diagnostic or therapeutic procedure; as a result of non-conventional medical procedure or medication; suicide, suspected suicide or assisted suicide; a known or unknown cause while in custody or shortly afterwards; due to ailment within twenty four hours of hospital admission; a maternal death occurring during or following pregnancy or that might be reasonably related to the pregnancy; as a child in care; an infant death as in Sudden Infant Death Syndrome (SID) and non- accidental injury; unnatural still birth and intrauterine death; and an ailment in a nursing home or hospital - section 14.
When information has been given to any of the agencies in respect of reportable deaths, such agency or a person authorised in that behalf by the agency shall proceed to the place where the body of the deceased person is lying and shall take full responsibility and carry out investigations in accordance with the functions of such agency - section 25(1). The agency shall without delay cause notice of the death to be sent to a Coroner in whose district the body was found. The agency shall arrange for the removal of the dead body to the office of the District Medical Examiner - section 25(3).
Investigation of Cause of Death
The basic duty of Coroners under the Law is the investigation of death occurring in questionable circumstances. Section 15 provides for circumstances when it is mandatory for the Coroner to hold an inquest. The circumstances with minor differences are similar to circumstances when a report of death should be made. It appears that in circumstances listed in section 15 (1) - (8) an inquest is mandatory while in other circumstances listed in section 14 it is mandatory to make a report of death.
It is only mandatory to hold an inquest under the circumstances listed in section 15. The only thing that is mandatory with respect to the circumstances listed in section 14 is that deaths in section 14 must be subject to post-mortem examination, but may not be subjected to an inquest except for cases falling also within section 15 unless the Coroner so decides under section 15(9). In addition it also mandatory for a Coroner of a district where a death occurs in custody to hold an inquest- section 18. Section 19 empowers a Coroner within whose jurisdiction a body is found to hold an inquest on it, notwithstanding that the cause of death arose elsewhere.
The Coroner in the course of investigation of death may obtain a medical report on the cause and manner of death and may require the Office of the Chief Medical Examiner to perform a post-mortem examination on the body and to make a report - section 26. The Medical Examiner is expected to perform the post-mortem examination and report his findings in writing to the Coroner.
Sections 31 to 41 govern proceedings during the conduct of inquest by a Coroner. The provisions empower the Coroner to find the cause of death without subjecting it to such strict legal rules of evidence that apply in normal judicial proceedings. Section 38 enables the Director of Public Prosecutions to inform the Coroner that sufficient ground exists for instituting criminal proceedings against any person already in custody or arrested in connection with the death under inquest. The Coroner upon receiving such information is empowered to stay the inquest until it is determined in accordance with Law.
The Coroner may however resume the inquest if the Coroner is of the opinion that public benefit may result from so doing.
Section 39 empowers the Coroner to order the arrest of any person after the close of inquest if it is of the opinion that sufficient grounds are disclosed for making a charge against any person in connection with the death subject matter of inquest. The authorities designated to receive the verdict of the Coroner are the Attorney-General of Lagos State, the Chief Coroner, the Chief Medical Examiner and the Divisional Police Officer in the District - section 41.
The Law provides for a review procedure where the Chief Coroner is not satisfied with the correctness of the verdict in any inquest. The Chief Coroner after hearing the Attorney-General or his representatives may quash the verdict by substituting some other verdict which appears lawful and in accordance with the evidence recorded or quash any inquest with or without ordering a new inquest to be held - sections 44 and 45.
Section 45 makes provision empowering the Attorney-General of Lagos State to intervene with respect to an inquest. The section provides that the Chief Coroner upon an application made by the Attorney-General may do any of the following: order an inquest to be held touching the death of any person; direct any inquest to be re-opened for the taking of further evidence; quash the verdict in any inquest by substituting some other verdict which appears to be lawful and in accordance with the evidence recorded; and quash any inquest with or without ordering a new inquest to be held.
Offences Created Under the Law
A number of offences were created to give legal teeth and force to the provisions of the Law. It is an offence for any person to carry out chemical preservation, dismemberment or disposal of the body of a person who died in circumstances requiring the holding of an inquest under the law without the approval of a Coroner. The punishment for the offence is 15 years imprisonment without option of fine.
It is an offence for any person who finds the body of a dead person in circumstances where report ought to be made and fails to make a report. The punishment for the offence is 3 months imprisonment or fine not exceeding N20,000. It is also an offence for any person in charge of place of custody to fail to notify the Coroner where death occurs in any custody. Punishment is 7 years imprisonment with no option of fine. The provisions of section 48 set out other penalties for non-compliance with the provisions of the law.
It is expected that members of the public, the media, law enforcement agencies, religious bodies and all other stakeholders will perform obligations imposed on them under the Law to report deaths occurring in circumstances required by the Law. We must all ensure that questionable deaths are properly investigated and persons implicated in such deaths are brought to justice.
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.
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