A Lagos coroner has ruled that the 12-year-old student of Dowen College, Lekki, Lagos, Master Sylvester Oromoni, who died in November 2021 under controversial circumstances suffered “avoidable excruciating pain” due to parental and medical negligence.

The coroner, Mikhail Kadiri, revealed this while delivering his findings which lasted for seven hours, 20 minutes on Monday.

The News Agency of Nigeria (NAN) reports that 32 witnesses testified in the coroner’s inquest which started sitting in January 2022.

Among the evidence the coroner relied on included the findings of two autopsies conducted on the deceased at the Central Hospital, Warri, Delta State, with only the family present and the Lagos State University Teaching Hospital, where about 10 pathologists representing various parties including the family, the Lagos State Government and Dowen College took part in.

Kadiri said that they all agreed that his death was caused by “Septicaemia (a life-threatening health condition caused by a patient’s body’s response to an infection), following infections of the lungs and kidneys arising from the ankle wound.

“No evidence of blunt force trauma in this body.

“The findings in the oesophagus and stomach are not compatible with chemical intoxication. Death, in this case, is natural,” he said.

Dr Sunday Soyemi, who led the Lagos procedure, had stated in the autopsy report that sepsis, which led to the death of the boy, could have been treated with “massive doses of intravenous antibiotic, intravenous fluid and blood transfusion.”

This, he said, was never done.

The coroner said that Sylvester was said to have sustained an injury on his ankle between November 20 and 21 and following first aid treatment, the school contacted his parents to come and pick him up for further treatment.

He added that a guardian was sent to the school who took him for an x-ray but no fracture was detected.

According to him, Sylvester was not taken to hospital for care in Lagos until days later when he was moved to his base in Warri, and treated at home by the family doctor, Henry Aghogho.

The family doctor, Aghogho, was also slammed for not providing the required duty of care for the patient whose home care treatment was “trivialised”.

Despite early diagnosis, the doctor was found to have abandoned the deceased for more than 32 hours and didn’t carry out an x-ray and scan early enough which would have revealed his deteriorating condition.

The coroner who broke down in tears several times while reading his findings and even rose at a point to comport himself, said the case was touching but needed objectivity.

He exonerated the school of negligence and the five senior students accused of bullying the deceased and administering a poisonous substance on him.

“The alleged suspects played no part in Sylvester’s death, but were victims of their past misdeeds.

“They were falsely accused, no staff of Dowen College played any role in the death.

“The school has improved on their facilities since the incident. The claims of chemical intoxication was never proven, and the faces of those allegedly bullying the deceased weren’t seen.

“The alleged confession of Sylvester was denied by several witnesses. Even if he was beaten, It didn’t lead to his death,” he said.

The coroner noted that parents should not take their children’s health with levity.

He also called for better synergy between police and medical team in such matters.

He also recommended proper psychological evaluation for the five students suspected to have bullied the deceased as a result of what they might be going through because of the allegations.