What Healthcare Providers Need to Know About Refusing Emergency Treatment in Nigeria: Legal Duties, Liability and Who Pays for Care?
By Prof. Cheluchi Onyemelukwe and Yusuf Balogun
Introduction
Emergency treatment is one area where the legal duties of healthcare providers intersect with the protection of life, patient rights, and access to healthcare.[1] The World Health Organisation (WHO) recognises emergency care as an essential, time-sensitive component of universal health coverage and as a primary point of contact with the health system for many people worldwide, particularly where access to routine healthcare is limited.[2]
In Nigeria, however, persons in need of emergency medical treatment continue to face refusal or delay in receiving such care by healthcare providers and health facilities in some cases.[3] These barriers may include demands for upfront payment, police reports, identification documents, or other administrative requirements.[4] While healthcare providers may have legitimate concerns about reimbursement and financial exposure, the legal framework establishes clear obligations concerning the provision of emergency treatment.[5]
The key question is therefore not simply whether emergency treatment may lawfully be refused. It is also how emergency care is financed where the patient is insured, uninsured or unable to pay at the point of presentation. This article examines the legal framework governing emergency treatment in Nigeria, the potential consequences of unlawful refusal and the financing mechanisms available to support emergency care.
Legal Framework for Emergency Medical Care in Nigeria
The National Health Act (NHA) 2014 is the primary legislation regulating Nigeria’s healthcare system and contains a specific provision on emergency medical treatment.[6] Section 20 of the Act[7] provides that a healthcare provider, health worker or health establishment must not refuse a person emergency medical treatment for any reason, and that a contravention constitutes an offence.[8] This provision establishes a clear legal obligation on healthcare providers to provide emergency medical treatment to persons requiring such treatment irrespective of their circumstances.
The Compulsory Treatment and Care for Victims of Gunshot Act 2017 imposes a specific obligation in respect of gunshot victims. It requires every hospital, whether public or private, to receive persons with gunshot wounds for immediate and adequate treatment, with or without police clearance[9]. Road traffic accident victims are also covered. The Federal Road Safety Commission (Establishment) Act 2007 empowers members of the Federal Road Safety Corps, in exercising their statutory functions, to arrest and prosecute persons suspected of traffic offences, including the rejection of accident victims by hospitals or medical personnel.[10]
In addition, the Patients’ Bill of Rights (PBoR), developed in collaboration with healthcare stakeholders and adopted in 2018, reinforces patients’ rights to urgent, immediate and sufficient intervention in emergencies.[11] It also identifies provider responsibilities, including evaluating and prioritising medical emergencies and maintaining responsive emergency services.[12]
Professional accountability also arises from duties imposed on healthcare providers. For instance, under the Code of Medical Ethics, a practitioner’s failure to attend promptly to a patient requiring urgent care, where the practitioner is in a position to do so, constitutes professional negligence[13] and exposes the clinician to disciplinary sanctions. Accordingly, emergency medical treatment cannot be denied on grounds such as inability to make an upfront payment or the absence of other administrative requirements.[14]
Who Pays for Emergency Treatment?
The legal obligation to provide emergency treatment raises an important question: who pays for the care? The statutory duty to provide emergency treatment does not itself establish a single payer for every emergency encounter. Rather, Nigeria’s health-financing framework provides different mechanisms through which emergency services may be funded or reimbursed.[15] The obligation to provide emergency treatment and the question of who bears the financial cost are related but distinct issues.
For healthcare providers, this distinction is important. Payment or verification of financial responsibility should not be used as a basis for refusing or delaying emergency treatment where the law requires treatment to be provided.[16] At the same time, facilities should have clear mechanisms for identifying the appropriate payer and recovering eligible costs after emergency care has commenced.
The Role of Health Insurance and the NHIA
The National Health Insurance Authority Act 2022 replaced the former National Health Insurance Scheme Act[17] and established the National Health Insurance Authority (NHIA) as the regulator of health insurance in Nigeria.[18] The Act provides for mandatory health insurance participation for persons resident in Nigeria[19] and gives the Authority responsibility for promoting, integrating and regulating health insurance schemes, as well as supporting the achievement of Universal Health Coverage.
Health insurance therefore plays an important role in financing emergency treatment. Depending on the scheme and benefit package, emergency services may be financed through federal health insurance programmes, State Social Health Insurance Schemes, or private health insurance arrangements. For healthcare establishments, this means that the absence of cash at the point of admission should not be equated with the absence of a payer. Where a patient is insured, the facility should verify the patient’s insurance status and follow the applicable authorisation and claims procedures without compromising the immediate provision of emergency care.
What Happens Where There Is No Health Insurance or Evidence of Payment?
Where a person is brought to a healthcare facility for emergency care without evidence of health insurance or an immediate payment mechanism, the absence of an identifiable payer should not be a basis for refusing or delaying emergency treatment. The facility should provide the necessary emergency care while establishing the patient’s insurance status and determining whether the case falls within an applicable emergency medical treatment financing mechanism.[20]
For eligible uninsured patients, or where the patient’s insurance status is unknown, the BHCPF’s Emergency Medical Treatment Gateway provides a source of reimbursement, subject to the conditions under the BHCPF 2.0 Guideline and treatment at an accredited facility.[21] The Guideline provides for reimbursement of eligible emergency treatment and ambulance services, including care provided during the first forty-eight hours. Where the financing mechanism does not cover the facility, it should continue to provide the necessary emergency care and, after stabilising the patient, take reasonable steps to establish a lawful payment arrangement with the patient, family, relatives, employer or another appropriate payer.[22]
The Basic Health Care Provision Fund and Emergency Medical Treatment
The Basic Health Care Provision Fund (BHCPF) provides an important public financing mechanism for emergency treatment.[23] The Fund was established under the NHA[24] and is financed from the federal government’s annual grant of not less than 1% of the Consolidated Revenue Fund, together with other sources of funding. 5% of the Fund is allocated to emergency medical treatment[25] and administered through the National Emergency Medical Treatment Committee (NEMTC).[26]
The BHCPF 2.0 Guideline provides that emergency medical treatment reimbursement funds may be used for ambulance transport and emergency treatment for the first forty-eight hours in an accredited treatment centre, subject to the eligibility conditions under the Guideline. These include vulnerable beneficiaries requiring treatment for obstetric emergencies and complications during labour and puerperium, emergencies in children under five years of age, road traffic accidents, gunshot injuries, snake bite emergencies, and other emergency conditions determined by the NEMTC from time to time.[27] This mechanism is intended to reduce the risk that eligible vulnerable patients are denied or delayed in accessing emergency care because of inability to pay.[28]
The Role of NEMTC and National Emergency Medical Service and Ambulance System (NEMSAS)
Under the BHCPF 2.0 Guideline, the Emergency Medical Treatment (EMT) Gateway is operationalised through the National Emergency Medical Service and Ambulance System (NEMSAS), which serves as the national coordination entity for emergency medical service and ambulance programmes across the States and the FCT. The NEMTC is responsible for governing and administering the emergency medical treatment funds under the gateway. The NEMTC also oversees the accreditation, claims verification and reimbursement processes applicable to participating emergency service providers.[29]
NEMSAS therefore has an operational role, including emergency transportation, ambulance coordination, communication and dispatch, referral and coordination of emergency service providers. NEMTC, on the other hand, provides the governance and financing oversight for the EMT Gateway. For healthcare providers, understanding this distinction is important because access to emergency treatment, ambulance services and reimbursement operates through related but distinct components of the emergency-care framework.[30]
What Are the Potential Legal Consequences of Refusing Emergency Treatment?
Depending on the circumstances, refusing or failing to provide emergency treatment may expose a healthcare establishment or individual healthcare professional to criminal, civil, professional, or regulatory consequences.
- Criminal Liability: Section 20 of the NHA imposes a binding legal obligation on healthcare providers, health workers and health establishments in relation to emergency treatment. Section 20(2) further creates an offence where emergency medical treatment is refused in contravention of the Act. The statutory penalty is a fine of ₦100,000, imprisonment for up to six months, or both, upon conviction. Where a gunshot victim is involved, additional statutory consequences may arise under the Compulsory Treatment and Care for Victims of Gunshot Act 2017. The Act creates an offence where a person or authority, including a hospital, stands by and fails to perform a duty imposed by the Act, resulting in the unnecessary death of a person with a gunshot wound. In such circumstances, such an individual may be liable upon conviction to a fine of ₦500,000, imprisonment for a term of five years, or both.[31]
- Civil Liability: Where a refusal or failure to provide appropriate care results in injury or death, the circumstances may give rise to a civil claim founded on negligence or another cause of action by the affected patient or the patient’s family. The central issues will include the duty owed by the healthcare provider, the standard of care, whether that duty was breached, and whether the breach caused the injury, loss or death complained of. Where liability is established, the healthcare provider may be exposed to claims for compensation or damages, including special and general damages and other forms of relief depending on the circumstances of the case.
- Professional Disciplinary Consequences: The conduct of individual healthcare professionals, including medical practitioners, nurses and medical laboratory professionals, may also raise issues under professional standards and disciplinary frameworks administered by their respective regulatory bodies. For medical practitioners, professional misconduct may result in disciplinary measures under the legal and regulatory framework.[32] Depending on the circumstances and the outcome of disciplinary proceedings, sanctions may include reprimand, suspension from practice or removal of the practitioner’s name from the relevant professional register.[33]
- Consumer Protection: A healthcare establishment providing services for consideration may also face a complaint before the Federal Competition and Consumer Protection Commission (FCCPC) where the circumstances raise consumer-protection concerns. This was recently illustrated in Life Bridge Medical Diagnostic Centre Ltd v FCCPC, decided by the Federal High Court, Abuja, on 15 April 2026. The Court upheld the FCCPC’s jurisdiction in relation to healthcare service providers and recognised the Commission’s authority to investigate complaints concerning healthcare services provided for consideration under the Federal Competition and Consumer Protection Act. The decision underscores the fact that healthcare service-delivery failures may have consumer-protection implications in addition to professional or clinical regulatory consequences.
How Healthcare Providers Can Reduce Legal and Financial Exposure
Healthcare providers should consider implementing a formal emergency-care compliance framework rather than leaving decisions concerning emergency patients solely to individual members of staff. At minimum, healthcare establishments should consider the following measures:
- Emergency Care Policy: Every healthcare establishment should have a written emergency-care policy that expressly prohibits refusal of emergency treatment on grounds such as inability to make an upfront payment or failure to produce a police report. The policy should also establish clear triage and escalation procedures, including who is responsible for assessing, stabilising, escalating and referring emergency cases.
- Referral Protocols: Healthcare establishments should maintain clear referral protocols identifying appropriate receiving facilities and setting out procedures for communication, documentation and safe transfer. Where a facility does not have the capacity to provide definitive treatment for a particular emergency, staff should understand the process for stabilising the patient, arranging referral and communicating relevant clinical information to the receiving facility.
- Proper Documentation: Healthcare establishments should maintain accurate and contemporaneous records of emergency cases. Such records should, where applicable, capture the time of arrival, triage findings, relevant vital signs, clinical assessment, treatment provided, decisions taken, communications with relatives or other healthcare providers, referral arrangements and the time of transfer or discharge. Proper documentation will demonstrate that the facility responded appropriately and in accordance with its legal and professional obligations.
- Payer Identification and Claims: Health facilities should establish a payer-identification and claims protocol. Staff should know how to identify whether an emergency patient is enrolled with an NHIA programme, State Social Health Insurance Scheme, HMO, or other recognised insurance arrangement. Verification should proceed alongside clinical management and should not delay essential emergency intervention. Likewise, facilities participating in relevant emergency medical treatment programmes should understand the BHCPF/NEMTC/NEMSAS claims and reimbursement framework.
- Staff Capacity Building: Continuous training and capacity-building programmes for healthcare workers, particularly in private and rural facilities, are essential to ensuring compliance with the legal and ethical requirements governing emergency care. Training should extend beyond doctors and nurses. Receptionists, security personnel, billing staff, administrators and other frontline personnel should understand that their initial response to an emergency patient may have significant legal consequences for the healthcare establishment.
- Timely Legal Advice: Healthcare establishments should consider maintaining access to qualified healthcare legal advisers or external counsel who can provide timely advice on regulatory and liability issues. Serious emergency incidents, unexpected deterioration or death, allegations of refusal of treatment, or complaints from patients or their relatives should trigger an appropriate internal review and, where necessary, prompt legal advice. Early legal intervention may assist the facility in preserving evidence, managing regulatory engagement and reducing unnecessary legal exposure.
Conclusion
Nigeria’s legal framework establishes a clear obligation on healthcare providers not to refuse emergency medical treatment. However, the existence of this duty does not mean establishments must absorb every financial cost. Funding pathways are available through the NHIA, State Social Health Insurance Schemes and the BHCPF’s Emergency Medical Treatment Gateway, operationalised through NEMSAS. The effectiveness of these mechanisms depends, in part, on appropriate accreditation, claims administration, referral coordination and timely reimbursement.
Healthcare providers must, therefore, ensure that financial, administrative, or operational considerations do not result in unlawful delays in emergency care. For hospital owners and medical directors, compliance should be treated as a board-level risk issue rather than an isolated clinical matter. Implementing proper compliance measures will help healthcare establishments reduce regulatory and legal exposure while strengthening their ability to meet their statutory, professional, and patient-care obligations.
This content is intended only to provide general information on the subject matter. It should not be construed as legal advice. You should seek specialist legal advice about your specific circumstances. For legal and regulatory support, please reach out to: [email protected] or [email protected]
ENDNOTES
[1] Toluwalase Oliver-Jude ‘Denying Emergency Care in Nigeria: Legal Implication and Redress Under the Nigerian National Health Act,’ JEE Africa, (2025) https://jee.africa/insights/denying-emergency-care-in-nigeria-legal- implications-and-redress-under-the-nigerian-national-health-act#_ftn2;
[2] WHO, ‘Emergency Care as an Essential Component of Universal Health Coverage in Eastern Mediterranean
Region,’https://www.emro.who.int/images/stories/about-who/ecs_in_emr_pre-
rc_paper_18_september_2016.pdf; WHO, ‘Emergency and Critical Care,’ < https://www.who.int/health-
topics/emergency-care#tab=tab_1>
[3] U.C. Kalu and Chidimma Anuli Ewelukwa, ‘An Appraisal of the Legal Framework for the Compulsory Treatment
and Care for Gunshot Victims in Nigeria,’ Multidisciplinary Journal of Law, Education and Humanities, Vol. 2, No. 2 (2025)
[4] Emeka, Ngozi Eunice. (2024) The Legal Framework for Emergency Medical Care in Nigeria: Messiah or Mirage? 4. 83-88
[5] Olusegun, Olaitan, ‘Emergency Medical Care and the Law in Nigeria: Towards Protection of Patients’ Rights,’ Journal of Health & Biomedical Law, Vol. 19, (2023): 251-286.
[6] The National Health Act 2014, Section 20(1)
[7] National Health Act 2014
[8] Section 20, National Health Act 2014
[9] Section 1 Compulsory Treatment and Care for Victims of Gunshot Act 2017
[10] Section 10(4)(z), Federal Road Safety Commission (Establishment) Act 2007
[11] Patients’ Bill of Rights (PBOR)
[12] Olusegun, Olaitan O, and Babafemi Odunsi. “Advancing the Rights of Patients in Nigeria: Analysing the Patients’ Bill of Rights.” Journal of Law and Medicine Vol. 30,1 (2023): 235-249.
[13] Rule 28, Code of Medical Ethics in Nigeria
[14] Olaitan Olusegun, Emergency Medical Care and the Law in Nigeria: Towards Protection of Patients’ Rights. https://www.researchgate.net/publication/377530482
[15] Onyemelukwe, Cheluchi, and Queen Ukpo. Improving Emergency Care Access in Nigeria: A Policy Brief. Health Ethics & Law Consulting, Aug. 2025, https://healthlaw.com.ng/wp-content/uploads/2025/08/Improving-Emergency-Care-Access-in-Nigeria-3.pdf
[16] Ibid
[17] Section 58, National Health Insurance Authority Act 2022
[18] Section 1, National Health Insurance Authority Act 2022
[19] Section 14, National Health Insurance Authority Act 2022
[20] Basic Health Care Provision Fund 2.0 Guideline https://bhcpf.gov.ng/_sh_files_2024_x9/BHCPF%202.0%20Guideline_Final.pdf
[21] Ibid
[22] Ibid
[23] Adamu, A.A., Ibrahim, K.A., Adamu, H. et al. Institutionalizing implementation research in Nigeria’s Basic Health Care Provision Fund. Discov Public Health 23, 1046 (2026). https://doi.org/10.1186/s12982-026-02419-7
[24] Section 11
[25] Section 11(3)(e)
[26] Basic Health Care Provision Fund 2.0 Guideline, https://bhcpf.gov.ng/_sh_files_2024_x9/BHCPF%202.0%20Guideline_Final.pdf
[27] Basic Health Care Provision Fund 2.0 Guideline, see page 161
[28] Adamu, A.A., Ibrahim, K.A., Adamu, H. et al. Institutionalizing implementation research in Nigeria’s Basic Health Care Provision Fund. Discov Public Health 23, 1046 (2026). https://doi.org/10.1186/s12982-026-02419-7
[29] Ibid
[30] Ibid
[31] Section 7, Compulsory Treatment and Care for Victims of Gunshot Act 2017
[32] Rule 28, Code of Medical Ethics in Nigeria
[33] Section 16, Medical and Dental Practitioners Act
ABOUT THE AUTHORS
Prof. Cheluchi Onyemelukwe
Professor Cheluchi Onyemelukwe is Managing Partner of Health Ethics and Law Consulting (HELC) and Professor of Law at Babcock University, where she teaches Health Law and Policy. She is Founder of the Centre for Health Ethics, Law and Development (CHELD) and chairs the National Task Force on the Decriminalisation of Attempted Suicide. Her legislative drafting work includes the National Health Insurance Authority Act, the Electronic Pharmacy Regulations, and several state health laws. She consults regularly for WHO, the World Bank, and ECOWAS and holds a PhD in law from Dalhousie University. A leading scholar in health law and policy in Africa, she is the author of Health Research Governance in Africa: Law, Ethics, and Regulation (Routledge), which examines how law, ethics, and regulation shape the oversight of health research on the continent. Her scholarship and advocacy also cover gender and violence against women and children.
Yusuf Balogun
Yusuf Balogun is a legal practitioner specialising in health technology, global health law, and public policy. His work sits at the convergence of innovation, regulation, and governance, with core focus areas including digital health, artificial intelligence, food and drugs law, data protection, and equitable access to healthcare. He provides advisory support on corporate and commercial matters, legislative drafting, dispute resolution, technology and intellectual property law, regulatory compliance, and public policy development, with additional interests in migration law, ADR, genomics, and biotechnology. He graduated with Second-Class Honours from Usmanu Danfodiyo University, Sokoto, and the Nigerian Law School, Lagos. He is a member of the Nigerian Bar Association and the International Law Association (Nigeria Branch), an Associate of both the Institute of Medical and Health Law and the Institute of Chartered Mediators and Conciliators, and an Accredited Mediator with the Mediation Training Institute.
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