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Why doctors’ private practice can’t be banned

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Dear minister of health, Do not arrogate to yourself, the powers you do not have. Neither the Federal Executive Council nor the Federal Ministry of Health, represented by the Honourable Minister of Health, has such power as to ban private practice by doctors in public service. Such power is vested in the National Assembly according to S4(1) of the Constitution of the Federal Republic of Nigeria (CFRN) as amended, and there is an existing law regulating private practice by medical doctors in public service. Why is it that our leaders always take actions that will be subject of litigation and the end of such litigation will ridicule their offices? Why can’t our leaders learn from the past? One of the reasons Governor Wike won his opponent(s) at the Supreme Court was that his opponent based their arguments on the electoral guideline (which is a mere executive pronouncement) whereas Wike and his lawyers based their arguments on the electoral law (which is an Act of the parliament). The Executive has no right to either ban or modify an existing law without passing through the Legislative arm of the government as earlier cited.

Dear minister, let me start by drawing your attention to an already existing law regulating private practice by doctors in full time government employment. The said law was enacted by the National Assembly, which has the statutory power to make laws for the federation.
Rule 49 of the Code of Medical Ethics in Nigeria 2008 edition states that:
49(1):  Medical and Dental practitioners who are in full time employment in the public service in Nigeria are free to employ their spare time and unofficial hours to engage in medical or dental practice for remuneration as follows:

a. A registered practitioner in full time employment in the public service shall not engage himself in extra-mural private practice during official duty time under any circumstances.

b. A registered practitioner who holds the appointment of Consultant status or a medical or dental officer of more than Ten years
Post-registration experience may run one private consulting clinic which will open for business only during periods when he is not on official duty.

c. A Consultant or registered practitioner of similar status in (b) above shall offer in-hospital care to his private patients only within the public hospital he is in full employment. It is unethical for a registered practitioner in full employment in the public service to give in-hospital care, that is investigatory, admission and institutional care to patients outside the hospital in which he is in full time employment.

d.  A registered practitioner of more than ten years post-registration who is in full time employment in the public service but is not engaged in clinical responsibilities in the public hospital may engage, outside the official duty hours, in clinical practice in an institution owned and run by full time private practitioners or hold consultations only in his own consulting clinic.

e. It is unethical for a registered practitioner engaged in a public health institution to demand and/or receive money from hospital patients under any guise whatsoever, either before or in the course of attending such patients.”

In view of this, it is clear that neither you nor the Federal Executive Council has the right to dictate to medical doctors in public service what they will do with their spare/unofficial time as they are citizens with inalienable rights to Personal Dignity; Liberty; Freedom of Conscience; and Freedom of Movement as contained in sections 34, 35, 38 and 41 of the CFRN respectively. I am aware that each Federal Ministry has a legal unit that is only consulted when there is a pending litigation and you leaders cannot consult your legal units before making ambiguous statements like this current ban on private practice by doctors in public service.

Also, for the non-consultants fully employed by the government, I will refer you to Rule 49(2) of the same Code of Medical Ethics in Nigeria.
49(2): Private practice by non-consultant registered practitioners who are in full time employment in the public service:

A medical or dental practitioner who does not have the status of a consultant may engage in private practice outside his official hours in an institution owned and managed by a full time private practitioner. It is unethical for a registered practitioner who is not a consultant or less than ten years post-registration and who is in the public service to own and run any private medical or dental facility.

The Medical and Dental Council of Nigeria hereby directs registered practitioners who are Chief Medical Directors, Medical Directors or Medical Superintendent in charge of public health institutions to provide facilities, programmes and systems in hospitals they administer, to enable practitioners engage in intra-mural private practice.

It is hoped that this measure will significantly curb the penchant for extra-mural private practice by practitioners during official hours.

Dear Minister, let us assume that the figment of your imagination or that of the Federal Executive Council to control what medical doctors in public service do with their unofficial/spare time is real, why did you not convince the Federal Executive Council to ban pharmacists, medical laboratory scientists, physiotherapists, nurses and other members of JOHESU in public service from private practice? Are they sacred cows and untouchable? When National Association of Resident Doctors (NARD) went on nationwide strike, we all witnessed the roles your ministry played but when JOHESU went on a similar strike, almost all, if not all their demands were approved. Are you aware that many consultants do not have private offices in our public hospitals? Are you also aware there are no rooms for many consultants in our public hospitals to rest while at work, and that negates the caveat attached to Rule 49 of the Codes of Medical Ethics cited supra, which states that: The Medical and Dental Council of Nigeria hereby directs registered practitioners who are Chief Medical Directors, Medical Directors or Medical Superintendent in charge of public health institutions to provide facilities, programmes and systems in hospitals they administer, to enable practitioners engage in intra-mural private practice.

Are you aware that many so-called tertiary hospitals cannot boast of eight hours power supply in a day? It may interest you to know that many of these doctors are still being paid peanuts as salaries and to worsen the whole situation, many of them are owed for several months? I hope your ministry will convince the Federal Executive Council to ban governors and hospitals that owe medical doctors their monthly salaries and arrears? Do I need to reiterate the poor and dilapidated states of our facilities in the so-called public health institutions? I thank God that wife of the president has started that by telling us that there is no single syringe in Aso Rock clinic and that the X-ray machine there is not functioning, if such could happen to a hospital closest to, and at the doorstep of Mr. President, with such mind-boggling annual budget, then one can only imagine the states of our public hospitals very far from Mr president.

I hope your ministry is aware of the false health information being disseminated to Nigerian public by the herbal practitioners? Is there any ban that is imminent for such practice? Which directorate in your ministry supervises the information herbal practitioners disseminate to unsuspecting members of the Nigerian public? These herbal practitioners are there to tell Nigerians that every ailment is caused by Staph (Staphylococcus) and when staph stays longer in the body it turns to virus. This is where your ban is needed, dear minister, at least to save Nigerians from noise pollution and false health information and not issuing a ban that contravenes an existing law.

I want to state in an unequivocal term that neither your Federal Ministry of Health nor the Federal Executive Council has the statutory right to dictate to medical practitioners in public service what they will do with their spare/unofficial hours and any attempt to undermine the existing law will lead to litigation.


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