The Nigerian Medical Association has watched with utmost indignation and shock the concerted efforts of some employees of government working hand-in-gloves with some legal practitioners and judicial officers especially of the National Industrial Court of Nigeria (NICN) in a seemingly orchestrated manner to bring down the medical profession and by extension irredeemably hurt the Nigerian people. We had expected that common sense and sound reasoning, decorum, good conscience and morality will impact on the conduct and pronouncements of these individuals. Rather, the situation is getting out of hand on daily basis.
Every profession in the world has its history, tradition, developmental milestones, regulatory framework and indeed uniqueness. However, the unfortunate observation in our clime is that a group of people can wake up approach the legislative bodies and facilitate the enactment of a law in their favour without recourse to the overall impact on stability and smooth functioning of the sector. It is also our observation that these individuals have also approached law courts and through judicial pronouncements legitimized illegality that suggests that the tail can wag the dog. We are worried that in Nigeria as demonstrated by the NICN, a judicial officer will purport to know about medical training and practice, even at the specialist levels, than the world medical community, the medical training institutions, hospital management committees and Boards as well as the various Federal and State Ministries of Health. Some judicial officers have made pronouncements intended to rewrite hierarchical relationships of medicine and the professions allied to them, even likening the order of command and authority to slavery- an utter display of bias and ignorance of sectoral organisational peculiarities.
We would have continued to ignore this seeming display of ignorance for lack of other words, , but for the damaging consequences it is inflicting on the nation’s health care system, particularly in the areas of quality and safe health care and medical training. We are particularly incensed at the high level of impunity, indiscipline and rascality that are taking place in public hospital by medical laboratory scientists/technologists in desperate but futile efforts to supplant the Pathologists. This situation, seemingly aided and abetted by the some judicial officers of the NICN has lingered for too long that something needs to be done now by men and women of good conscience entrusted with the responsibilities of superintending health care services in Nigeria. This ugly display of insurgent professional rascality is also observed with radiologists and radiographers; ophthalmologists and optometrists/opticians; Public health physicians and public/ environmental health officers among others. The level of harm, damage and deaths resulting from this strange development in Nigeria cannot be allowed to continue.
One of the cardinal responsibilities of the doctor is to “defend and protect the interest and health of the patient at all times” and by extension the interest and health of the society in general. Medicine has an international pattern of practice based on well determined, defined and documented international best practices which accommodates the medical specialties and the paramedical or professions allied to medicine. There is no Nigerian brand of orthodox medicine. Nigerian doctors practice in line with international best practices within the limits of available resources and enabling environment.
In the face of this ever worsening provocations and continued silence by the statutory agencies of government, we unequivocally state as follows:
1. The standard and pattern of practice of medicine in Nigeria cannot be determined or dictated by persons or agencies outside the medical profession. Law making should be about promoting law and order, good governance and peaceful society, and not the enthronement of anarchy. Likewise, judicial interventions should check arbitrariness, lustful appetites and insatiable aspirations of those who want to practice medicine through the back door, and not to aid them.
2. The usurpation of the powers of the Federal Ministry of Health, National Council on Health and the Honorable Minister of Health on leadership and governance issues as it pertains development, management and oversight of the health system, establishment of standards, and management of human resources for health has denigrated and adversely affected the health system, and has continued to make Nigeria a laughing stock before the international community.
3. Similarly the determination of the framework and organisation of health care services in hospitals lie absolutely with the Management and Boards of the hospitals based on their mandates, resources and strategies for carrying out their assignments. Infact, the National Health Act mandates only the federal /state ministryof health on the responsibility of creating new cadres and other establishment rites based on need. These are not subject to any form of judicial encumbrances.
4. The curricula content, mode and organisation of training of doctors at both the undergraduate and postgraduate levels lie absolutely with the training institutions and the regulatory agencies vis-à-vis Universities, National Universities Commission (NUC), and the Medical and Dental Council of Nigeria (MDCN) for undergraduate training; and Accredited Hospitals Specialty Departments, National Postgraduate Medical College of Nigeria (NPMCN), West African College of Physicians (WACP), and West African College of Surgeons (WACS) for postgraduate medical training. For the medical field of Pathology (Laboratory Medicine) the clinical (pathology) laboratories belonging to each of its major specialties namely Chemical Pathology, Histopathology, Haematology& Blood Transfusion, and Medical Microbiology, and are all accredited for training pathologists. The same applies to the medical fields of Radiology and Oncology and their various appurtenances. It is mandatory that curricula are fulfilled in the course of training; no one can stop that.
5. Pathology is a major and critical field of Medicine concerned mainly with using body tissues, blood, urine, sputum and other body fluids and cells to make disease diagnosis in the clinical laboratories of the Pathology Departments/Specialties as enumerated above. There is no Medical Laboratory Science Department in any hospital anywhere in the world, including Nigeria; a mention of it in Nigeria is evidential of the inordinate ambition and insatiable self-aggrandizing desires of the overtly over ambitious Nigerian medical laboratory scientists. Medical Laboratory Science (formerly medical laboratory technology) is a course designed to train people to be able to support with work in clinical (pathology) laboratories in the same manner that midwifery was designed to train people to support in looking after pregnant women and child birth. Medical Laboratory Science is thus a profession allied to Pathology, and can never take the place of Pathology or attempt to supplant it. Same can also be said about radiography and radiology.
6. The training and practice of Pathology take place in the integral clinical laboratories of the pathology departments in hospitals. Without these clinical laboratories, Pathologists cannot function. It is incomprehensible therefore, that anyone will contemplate, how much less order, that Pathologists should exit the clinical laboratories for an allied profession whose total training content is less than 20% of that of Pathology and essentially deals with the basic aspect of sample processing, delegated right from establishment by the Pathologists. Everything taught in medical laboratory science is extensively covered at the lower levels of pathology training. It is therefore condescending, insulting and mischievous to allude that pathologists working in the clinical laboratories are practicing medical laboratory science. As a matter of fact, it is the medical laboratory scientist who practices an aspect of Pathology, as delegated to it by the Pathologist.
7. Worldwide both Pathologists and medical laboratory scientists (or equivalents), as well as other laboratory professionals work in a cohesive manner in the same hospital clinical (pathology) laboratories to deliver accurate laboratory results that will assist in the management of patients’ diseases. It is a great illusion for the medical laboratory scientists to claim sole ownership (we assume they mean sole workers) of the clinical laboratories and any such pronouncement by anybody will forever remain in the realm of illusion. In other climes with excellent health indices and virile healthcare delivery system, this harmonious coexistence with adherence to hierarchical chain of command and order in clinical laboratories is sacrosanct. This perhaps explains why Nigeria’s is greatly malfunctioning.
8. All hospitals (either in whole or in part) under the supervision of the Federal and State governments remain public properties. No individual or group of persons under whatever guise can legitimately claim ownership of any one or part thereof. The Management Committees and Boards of these hospitals have been lawfully assigned and empowered to draw up policies and manage the hospitals in public interest. This responsibility is absolutely that of the executive and does not make provision for the judicial encumbrances or dictations. We state unequivocally that he, who hires, assigns responsibilities and also fires when the need arises, provided due processes have been followed.
9. The Pathologists take ultimate responsibility for the output of all clinical laboratory work. They must therefore, supervise all delegated responsibilities to ensure they are carried out efficiently and correctly. Moreover, certain responsibilities of pathologists cannot be delegated and this assertion can be verified from all over the world. That the technician does the actual day to day repair jobs in the workshop does not make him independent of the mechanical engineer; neither does the presence of other professionals in a building site remove the architect from being the head of the team. The roads and bridges we drive on daily basis were built by the workmen; but there the architects and engineers take ultimate responsibility for the successes and failures of such projects. Why is Nigeria’s health sector different?
10. All sections or components of a hospital or clinic under the administration of the management of the Hospital or clinic are integral parts of the hospital or clinic and the Medical Director takes ultimate responsibility of any activity in any section of the hospital, and is accountable to the federal or state ministry of health through the appropriate agencies and on professional liability to the Medical and Dental Council of Nigeria (MDCN), the regulator of medical and dental practice, including but are not limited to, Clinical laboratory practice and radiology. Consequently, any other regulatory body usurping the functions of the MDCN in regulating medical activities where medical doctors and dentists operate under the guise of inspection is crossing the red lines. MDCN has repeatedly warned her registered professionals never to give in to such pretenses. That same order, we publicly reiterate to our members through this communication. No other professional regulatory will be granted access into the premises of any clinic or hospital.
11. We remind the Federal government that the past administration, in a genuine effort to resolve this unnecessary confusion, set up a committee of ten eminent administrators and professionals drawn from all the professions in health care, and chaired by no less a person than a former Head of the civil service of the Federation, former Secretary to the Government of the Federation and former Minister of Defence Alhaji Mahmud Yayale Ahmed which among other modalities undertook an onsite observational enquiry to some countries in Africa, Europe and the USA to understudy the operations of health care services and make evidence-based recommendations to government that will enable it establish international best practices here in Nigeria. The report with its beautiful recommendations is still gathering dust in government offices.The National Health Act with its unequivocal prescriptions for development, administration, funding and oversight of the health sector is yet to be evidentially implemented.
Having stated as above we resolve as follows:
1. Never again shall we fold our hands and watch as members of professions allied to Medicine put the lives of our patients in danger due to pursuit of inordinate ambitions or other nefarious reasons. As recently supported by the evidence of the no 1 citizen of Nigeria, doctors reserve the right of ultimate responsibility for patientcare including management modalities, patient testing and general decision making. This is also supported by the mandate to defend the medical professions from pretenders and bastardisation as enshrined in the 6th clause of the Physicians’ Oath which states “I will maintain by all the means in my power, the honour and the noble traditions of the medical profession”, consequently we shall use all lawful means to resist any action from all quarters that will so do.
2. That we shall strictly practice medicine in line with international best practices and in accordance with the Codes of Medical Ethics as espoused by the Medical and Dental Council of Nigeria and the global medical community. Medicine is not balkanized as there is no relinquishment or sectoral acceptance treaty; but carefully subdivided into subspecialties which are strategically supported with professions allied to medicine.
3. Pathology is a critical medical specialty. It is preposterous for any judicial officer to outlaw it or determine how and where it should be practiced. In that light, all clinical laboratories in public hospitals remain integral and inseparable components of their respective Pathology departments.
4. Having observed the negative consequences of the territorial conquest and annexation aspirations of laboratory scientists on the training of resident doctors, we wish to state that never again shall we tolerate any form of hindrance from access, interference or interruption of the work of pathologists and the training of doctors of any category in the hospitals’ clinical laboratories. Resident doctors are employed to render services while undergoing training to become specialists. All doctors including consultants are hereby directed to take measures to ensure that all these provocations are brought to a halt, and never again to be overlooked.
5. All doctors shall henceforth reject all laboratory results from any laboratory where the pathologists or the resident doctors are being challenged by anybody whosoever and shall no longer send patients, samples or specimens to such laboratories until normalcy is restored. Doctors are hereby directed to mobilize and restore normalcy in affected clinical laboratories in the shortest possible time for the benefit of patients.
6. Similarly we call on the Medical and Dental Council of Nigeria, the National Postgraduate Medical College of Nigeria, the West African College of Physicians and the West African College of Surgeons to as quickly as it becomes known to them to withdraw all accreditations from any training institution in which any of its training programmes is being interrupted or interfered with.
7. We call on the judicial officers and members of the National Industrial Court of Nigeria to exude caution on matters concerning the health care industry before it causes irredeemable damage and anarchy in the system. Our members have been and continued to be threatened with imprisonment for just doing their job. We consider this highly incredible and shall do everything within our powers to protect our members from this incessant threat to their freedom and existence. We see a dire need for the National Judicial Council to examine the activities of some judicial officers of the NICN in this regard and rein them in.
8. We commend the Chief Medical Director of the Lagos University Teaching Hospital (LUTH), Lagos and his management for the recent actions taken to restore normalcy in the Pathology Departments of LUTH. We call on other Chief Medical Directors to take the same course.
9. We also call on the Managements and Boards of hospitals to take necessary measures to instill discipline in the system. A situation in which associations and unions appear more powerful than authorities does not augur well for our health care system. People have under the guise of unionism fragrantly crossed the red lines without consequences. Misconducts must be seen and treated as such.
10. We make a passionate appeal to members of the Nigeria Bar Association (NBA), the highly revered Body of Benchers and the National Judicial Council to x-ray the destructive and self-serving activities of some of their members that may truncate the age-long cordial relationship between the two remaining noble professions in Nigeria.
11. Government should as a matter of absolute necessity commence full implementation of the Alhaji Yayale Ahmed report without further delay. The much touted industrial disharmony in the Nigerian health space is a local creation never witnessed in any other part of the world despite the advancement of the professions allied to medicine. The prescribed remedies should be applied to prevent further destruction of the system. Expensive equipment have been vandalized, chemical and reagents contaminated, documents mutilated and removed from archives all in a bid to hurt the doctors. Patients have essentially been the victims.
12. We call on the Federal Ministry of Health to commence without delay the implementation of the relevant sections of the National Health Act 2014 with specific reference to governance and management of human resources for health in the health sector of Nigeria to prevent the looming anarchy with very likely disruption of services in the health care system of Nigeria. A stitch in time now will save many lives.
13. In the same vein, the Federal Ministry of Health should begin the implementation of targeted public private partnership options which will mitigate the frequent breakdown of medical equipment and other facilities, and promote greater efficiency and responsibility while curbing truancy and other forms of infractions of the civil service rules.
14. We warn those agencies who could not differentiate between the words “part” and “adjoin” to steer clear of all facilities that are parts of hospitals and/or clinics. It is not another error often committed between “dowry” and “bride price”. For the avoidance of doubts, the Oxford Advanced Learner’s Dictionary of Current English by AS Hornby, 7th edition defines the word “adjoin” as ‘To be next to or joined to’ and “part” as ‘some but not all of a thing; section, piece or feature of something; member of something, a person or thing’. Facilities adjoined to clinics or hospitals are not part of the clinics or hospitals, and therefore not under the administration or responsibility or the management or medical director. Once the doctor in charge claims oversight responsibility over such facility it has become part of the clinic or hospital, and not adjoined to it. This clarification became necessary following provocative disturbances of clinics and hospitals in operation by some professional regulatory bodies under the guise of regulating their members. This will no longer be tolerated or overlooked. Only doctors and dentists operating under the auspices of the MDCN and or the State Ministries of Health and the FCT can lawfully and competently regulate, inspect or evaluate the practices or responsibilities of doctors and dentists. This position is sacrosanct.
15. We hereby call on all doctors and dentists operating private health care facilities, including but are not limited to hospitals, clinics, pathology services (clinical laboratories), radiology services and ophthalmology services to ensure they have up to date registration and licensing with the relevant state Ministries of Health and FCT and that their practicing licences are valid. The NMA will henceforth intensify its support to the State Ministries of Health and FCT as well as the MDCN to ensure that quackery and sub-standard practices are minimized or completely eradicated. It is now mandatory to seal all official documents completed by registered practitioners with the recently launched doctor’s seal available from NMA offices across Nigeria.
16. We seize this opportunity to call on President Muhammadu Buhari to take steps to as a matter of national emergency reconstitute the Medical and Dental Council of Nigeria. It is sad that Nigeria is the only country in the world today that has no existing medical regulatory Council in place to guide against malpractices and other infractions in medical and dental practices. For 22 years now the Council has only been in place cumulatively for only nine and a half years. This explains why erring doctors are not being sanctioned when cases are reported to the Council as there is no court (Medical and Dental Practitioners Tribunal) for trial after investigations. The Council constitutes the Tribunal for trial of cases. Therefore if there is no Council there will be no trial of cases. The last Council was dissolved about two years ago by the present administration. By law the Council has a perpetual succession, and about 98% of members are statutorily specified.
Finally, we restate that we remain committed to assisting the nation to achieve efficient, accessible, prompt and courteous healthcare at all times as the most formidable professional body in Nigeria. It is in the realisation of this that NMA in response to the recently released MICS/NICS report 2016 is utilising all her resources and potentials to improve immunisation coverage in the country as our corporate social responsibility.
God bless Nigerian Medical Association (NMA)
God bless the Health Sector
God bless Nigeria.