By Chidera Nwokeke
On 5TH of December, 2019, the Legit.ng website published news about a man known as Biggy Nony, a Keke napep driver that was held up in a hospital over unpaid bills after the wife gave birth via CS which cost N170, 000. She was detained since Wednesday, November 6, 2019 after she gave birth to their child through caesarean section.
This creepy and disconcerting but common practice in Nigeria of the detention of patients for non-payment of hospital hills is almost a norm and this has led to flagrant abuse of the fundamental rights of patients. These bestialize and debauch practice is an infraction of their fundamental rights and the actions of these hospitals amounts to false imprisonment. This article is not a campaign or in support of non-payment of hospital bills (moreover a debtor is not a criminal) because patients have corresponding responsibility to pay their bills. However, this article will peruse on the legality of this baleful and ominous practice of hospitals for holding patients in detention for non-payment of their bills.
Sander E. Kenya stated that:
Hospital detention practice is refusing release of either living patients after medical discharge is clinically indicated or refusing release of bodies of deceased patients if families are unable to pay their hospital bills. He further stated that each additional day that patients are detained in hospital adds to their bills. This increasingly hinders family’s ability to obtain patients release.
This vile practice by hospitals creates traumatic separations since families often must leave the hospital to seek funds. Some patients are even detained for months in hospitals or mortuaries. Hospital detention for non-payment of bills is a barefaced reflection of a dysfunctional health care system structures, failed health-insurance coverage and mismanagement that exist in our Nigeria government.
Non-payment of hospital bills is not an offence in our instant Nigerian laws. It can only become an offence if a law provides or makes it an offence. It is a trite principle that offences and their punishment must be certain at all times. Hospital detention seems to be most common among the poor and vulnerable women and children who require emergency treatments notably for complications of childbirth. The negative effect of hospital detention over non-payment of hospital bill can push people deeper into poverty, aggravate hospital overcrowding, leads to school dropouts of children and deter others from seeking medical care.
In law, for a patient to be treated by a hospital, there is an agreement between the patient and the hospital. This agreement can be express or impliedly (especially in emergency situation). That means if either party breaches the agreement, the aggrieved party can seek legal redress in courts of law. So, when a patient fails to clear his medical bills, the hospital should not detain him since the hospital is not a gazette detention centre but can use legal means to recover the outstanding bill.
It is a trite principle of our law that a person cannot be a judge in his own case which is represented in the Latin maxim Nemo judex in causa sua. To this effect, the hospital cannot be the offended party, complainant, prosecutor and judge in their own case by detaining a patient in a non gazette detention centre. The act of hospitals locking up patient from exiting their premises on the guise that they must complete payment amounts to false imprisonment and infraction of the patient’s fundamental right.
A High Court of Anambra State presided over by Hon Justice Okuma has ruled that the act of corporate institutions especially hospitals locking up patients from exiting their premises on the guise that they must complete payment amounts to false imprisonment. This reasoning was given in the recent decided case of NGOZI OSEGBO & ANOR V THE REGISTERED TRUSTEES OF THE SYNOD OF THE DIOCESE ON THENIGER –SUIT NO: O/255/2017 – the plaintiffs had taken their 11 months old baby to Iyi Enu Mission Hospital for treatment but 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 plaintiff for more than 10 hours despite every plea to allow them put themselves together and sought for funds. The Court held that the acts of the defendants in detaining the plaintiff for ten hours in the circumstance of this case no doubt constitute acts of false imprisonment.
False imprisonment is denying a person freedom of movement or personal liberty without lawful justification. False imprisonment of a person is a breach of fundamental right to personal liberty. – OKEKE V IGBOERI (2010) LPELR-CA/B/304/2008, EBULUE & ORS V EZEBUO (2018) LPELR-CA/E/195/2014. Thus any unlawful bodily restraint or confinement of a person, however short the period of time is false imprisonment. – UDEAGHA V NWOGWUGWU (2013) LPELR-CA/K/44/2005. The act of false imprisonment must be direct, though it is immaterial whether it was done intentionally or negligently. False imprisonment is actionable in itself without the plaintiff having to prove harm or damage. Lord Edward Coke J said “Every restraint of the liberty of a free man is imprisonment although he be not within the walls of any common prison.”
The state of mind of the tortfeasor is irrelevant. Once there is an act of false imprisonment, the tortfeasor is liable in the absence of lawful excuse. The purpose of tort of false imprisonment cannot be overemphasized; it is to protect the fundamental right to personal liberty and freedom of movement from being taken away by government, person or corporations.
For a patient to enforce an action for false imprisonment, he must prove that he was totally and completely restrained. Where there is a reasonable route, exit or means of escape, there is no false imprisonment. The means of escape must be reasonable. Where a means of escape will endanger the life of the plaintiff, he can still maintain an action for false imprisonment. In committing false imprisonment, it is not necessary that force be used on the plaintiff by way of battery. A threat to use force on the plaintiff whereby the plaintiff is restrained by fear is sufficient.
The court in the case of AIZEBOJE V EFCC (2017) LPELR-CA/L/861/2007 held that the right to personal liberty guaranteed under section 35 of the 1999 constitution is not an absolute right. A person can be deprived of his liberty upon reasonable suspicion of having committed a crime. In another case of NDEM & Ors V EKPEYONG (2017) LPELR-CA/C/206/2011 held that by virtue of Section 35(1) of the 1999 Constitution of Nigeria, one of the exceptions to the right of a person to the protection of his personal liberty is when the deprivation of liberty is in execution of a sentence or order of a court in respect of a criminal offence of which he has been found guilty. It is obvious that indebtedness to hospital is not and cannot be a ground for reasonable suspicion or a crime at all and a person cannot be deprived of his right because of non-payment of hospital bills.
In the case of IGBOKWE V C.O.P. EDO STATE (2017) LPELR-CA/B/172/2011 the court held that section 35 of 1999 CFRN provides for personal liberty of the individual. By this section, the individual cannot be deprived of his personal liberty except in accordance with the law. The constitution itself set out in details the basic procedure and conditions for lawful deprivation. The personal liberty of a citizen having been so guaranteed will generally not be curtailed by another citizen or the government or corporation. The law is however equally settled beyond per adventure of doubt that, the said fundamental rights of liberty in certain special circumstances can be curtailed but only as permissible under the same constitution. Deducing from the provisions of Section 35 of 1999 CFRN, it is barefaced that indebtedness is not one of the exceptional grounds recognised by the section upon which a person may be deprived of personal liberty and detained by a hospital.
In the case of FORT ROYAL HOMES LTD & ANO V EFCC & ANOR (2017) LPELR-CA/A/211/2013 the Court held that every person is protected from arbitrary arrest and no man shall be arrested except for reasonable cause allowed or permitted by law. A man should enjoy liberty and freedom without unpermitted interference or inhibition. It is illegal for hospitals to arrest, detain patients for non-payment of bills because hospitals are not detention centres recognised by law. Detention centres are only to be kept by security agencies having powers to arrest and detain. Hospitals, whether private or government owned cannot own, establish or run detention centres in Nigeria.
It is apropos to restate the position of our law that it is wrong for a hospital to use police or other law enforcement agency to recover hospital bills from patients. Debt collection on behalf of hospitals is not the job of the police or other law enforcement agencies and has never been their duty.
It is germane to state that detention of patients for non-payment of hospital bills goes against all that human rights standard and norms are known for because it robs off the dignity of the affected patients and such cruel act is degrading and inhumane. The court in the case of ZAMAN V STATE (2015) LPELR-CA/J/8C/2013 held that the word dignity means “The state of being noble; the state of being dignified; a right to hold a title of nobility, which may be hereditary or for life. As deduced from this definition, can it be said that detaining a patient in hospital for non-payment of bill noble or dignifying? I answer in the negative submit that such act is not noble or dignifying and as such amounts to torture, inhumane degradation and that is cruel. In the case of BASSEY & ANOR V AKPAN & ORS (2018) LPELR-CA/C/256/2013 the court held that the right to dignity of human person under Section 34 of the 1999 CFRN is not a nebulous one. The constitution is clearly on what it entails. That section provides: Every individual is entitled to respect for the dignity of his person and accordingly- a. No person shall be subjected to torture or to inhuman or degrading treatment.
To boot, the exceptions provided for in section 34 of the 1999 CFRN, there is no express or implied terms to show that the right of dignity of a person can restricted because of non-payment of hospital bills but hospitals have continuously engaged in this ungodly act of depriving patients their right to dignity of person. Ponder on this; what will be the impression a reasonable person will hold of a patient who is detained in the hospital for non-payment of bills? Your answer is correct as mine. The estimation and respect the reasonable man holds of the man will certainly reduce.
A violation or breach of any of the provisions is actionable under section 46(1) of the 1999 CFRN and it reads as follows: “46(1) Any person who alleges that any of the provision of this chapter has been, is being or likely to be contravened in any state in relation to him may apply to a high court in that state for redress. By virtue of Fundamental Rights Enforcement Procedure Rule 2009, public interest litigation can be brought on behalf of these vulnerable ones that are detained illegally in hospitals for non-payment of bills. – OKONKWO V EZEONU & ORS (2017) LPELR-CA/E/55/2012.
A patient can maintain a civil action like tort of false imprisonment and enforcement of fundamental right of liberty and dignity of persons against a hospital for detaining him for non-payment of hospital bills without regards to the fact that there may be a patient-hospital contractual relationship. The defence of lawful justification cannot avail any hospital for detention of patient for non-payment of bill because there is no law that makes it an offence for a patient to owe a hospital and there is no justifiable reason whether morally, socially or religiously that can avail the hospital.
Conclusively, banning and criminalizing the detention of patients for non-payment of hospital bills will help preserve and advance the respect of the fundamental right of dignity of patients. Apart from a patient maintaining an action for infraction of his fundamental rights, he can maintain an action for false imprisonment. Aside the actions a patient can enforce in law through the court, it is pertinent that the government should have a mechanism to help reduce the abuse of the fundamental rights of patients through hospital detention. It is also my humble submission that the provision of free health services for citizens should be a top priority for government as this will help preserve the fundamental rights of citizens.
Chidera Nwokeke can be reached at Nwokekechidera@gmail.com