Addressing Medical Malpractice in Rwanda: Challenges and Legal Implications.

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Medical malpractice occurs when a healthcare professional neglects to provide appropriate treatment, take appropriate action, or gives substandard treatment that causes harm, injury, or death to a person.[1]

The Rwanda Medical and Dental Council, defines medical malpractice as a professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient with most cases involving medical error.[2]

Medical malpractice allegations in Rwanda primarily originate from the Ministry of Health (MoH).[3] However, a significant challenge arises because not all cases occurring across the country are registered by the Rwanda Medical and Dental Council (RMDC). This discrepancy results in many cases going unreported or unaddressed. A large proportion of allegations—approximately one-third—relate to Obstetrics and Gynecology. These cases often stem from inadequate follow-up after medical procedures such as induction, leading to complications that could have been prevented with closer monitoring.

Several issues Contributes to Medical Malpractice in Rwanda, among them;

Incompetent Medical and Paramedical Staff; Some healthcare professionals lack the necessary skills and training to provide adequate medical care, increasing the risk of errors and malpractice.

Poor Documentation of Patients’ Files; Inadequate record-keeping leads to difficulties in tracking patient history, making it challenging to provide consistent and informed medical treatment.

Lack of Standardized Procedures; The absence of clear and uniform medical guidelines contributes to inconsistencies in patient care, leaving room for errors and negligence.

Lack of Administrative and Disciplinary Measures by Employers; Some healthcare institutions fail to enforce accountability among their staff, allowing medical errors to persist without proper corrective actions.

Frequent Appeals Against Council Decisions; Many medical practitioners challenge the RMDC’s rulings, which delays justice and weakens the effectiveness of disciplinary actions.

Legal and Institutional Dilemmas; The RMDC faces accusations in both administrative and civil courts, highlighting the legal challenges in regulating medical professionals. A significant dilemma arises from conflicting perceptions of the Council’s role.

Medical Practitioners (MPs) often feel that the RMDC exists primarily to punish them rather than to protect and support the medical profession.

 

Article 27 of the LAW Nº44/2012 OF 14/01/2013 ON THE ORGANISATION, FUNCTIONING AND COMPETENCE OF THE MEDICAL AND DENTAL COUNCIL, stipulates that; disciplinary measures on medical doctors and dentists which can be taken by the organs of the Council are; warning; reprimand; temporary suspension of practice for a period not exceeding six (6) months; and removal from the register of members of the Council. The disciplinary measures for medical doctors and dentists are carefully structured to reflect the seriousness of their faults. For minor offenses that do not threaten patient life or tarnish the dignity of the medical profession, the Bureau of the National Council Board is authorized to issue a warning or a reprimand. In instances where the fault may pose a risk to the patient’s life or the integrity of the profession, the Board has the power to impose a temporary suspension of practice for up to six months, with the understanding that such cases must also be reported to the Minister of Health. In more severe situations, where a practitioner’s conduct is considered fundamentally incompatible with the responsibilities of their profession, the Board may decide to remove the individual from the register, and this action is communicated publicly. To ensure fairness, serious offenses and their corresponding disciplinary measures are clearly outlined in the internal rules and regulations of the Council, and before any action is taken, the medical doctor or dentist in question is given the opportunity to be heard by the appropriate disciplinary organ.[4] Sadly, this article is not much in use due to existing cases already brought to court. One of them is NYIRABATESI Laurence v. KING FAISAL HOSPITAL.

NYIRABATESI Laurence sued King Faisal Hospital for medical negligence after a delayed C-[5]section in 2003, which caused severe complications, including a fistula and permanent disability. The Gasabo Intermediate Court initially ruled in her favor, awarding 20,000,000 Rwandan Francs in compensation. The hospital appealed, arguing lack of jurisdiction and insufficient evidence, and the High Court overturned the decision, claiming the case should have been filed in the Administrative Court since the hospital became a government institution in 2011. NYIRABATESI appealed to the Supreme Court, and the case moved to the Court of Appeal in 2018. Medical experts confirmed that the delay and surgical errors caused her permanent injury. The Court of Appeal ruled in her favor, ordering the hospital to pay 28,000,000 Frw for damages, 1,500,000 Frw for legal fees, and 500,000 Frw for court costs, with the decision delivered on July 19, 2019.

 

Conclusion

While the legal framework for addressing medical malpractice exists in Rwanda, challenges like underreporting and inefficiencies in enforcement persist. The RMDC’s role is crucial, but further reforms are needed to strengthen accountability. The NYIRABATESI case exemplifies these systemic challenges.


[1] Medical News Today, ‘’ What is medical malpractice?’’- https://www.medicalnewstoday.com/articles/248175#what_does_a_malpractice_case_involve on 23 February 2025

[2] Prof. Justin WANE, ‘’Medical Litigation.’’ https://www.rmdc.rw/IMG/pdf/Medical_Litigation_Presentation_KMA.pdf on 23 February 2025

[3] IDEM

[4] Official Gazette nº 02 of 14/01/2013, LAW Nº44/2012 OF 14/01/2013 ON THE ORGANISATION, FUNCTIONING AND COMPETENCE OF THE MEDICAL AND DENTAL COUNCIL, Article 27.

[5] URUBANZA No RCAA 00073/2018/CA, URUKIKO RW’UBUJURIRE RURI I KIGALI, RUHABURANISHIRIZA IMANZA Z’IMBONEZAMUBANO, RUHAKIRIJE MU RUHAME URUBANZA No RCAA 00073/2018/CA NONE KU WA 19/07/2019

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