Posted on: Fri 22-04-2016

WHO KILLED, OR IS KILLING THE NIGERIAN PUBLIC HOSPITALS AND OTHER  PUBLIC HEALTH INSTITUTIONS: A REJOINDER

The maples and ferns are still uncorrupt, yet, no doubt, when they come to consciousness, they, too, will curse and swear - Ralph Waldo Emerson, Nature, 1836.

The attention of Association of Medical Laboratory Scientists of Nigeria (AMLSN) has been drawn to the malicious, condemnable and highly fallacious article purportedly emanating from Nigerian Medical Association (NMA) captioned  PUBLIC HOSPITALS ARE DEAD, DOCTORS WARN  published on page 4 of the Guardian of March 10, 2016 and the Press Release captioned IMPENDING DISASTER AND COLLAPSE OF GOVERNMENT  HOSPITALS AND THE PUBLIC HEALTH SECTOR: A CALL FOR IMMEDIATE ACTION AGAINST EXISTING AND EMERGING ABSURDITIES IN THE NATION’S HEALTH SECTOR and  published  in The  Punch of Tuesday, March 15, 2016 pages 34 and 35, and a few other national dailies. 

Ordinarily, the Association of Medical Laboratory Scientists of Nigeria (AMLSN) would have ignored the hogwash; but for the magnitude of misinformation and failed attempts to portray Medical Laboratory Science profession as an appendage of pathologists (a group of medical doctors), AMLSN therefore feel duty bound to clear the air. This clarification is also necessary in order to save Nigerians who could be misled by the tears of the lamenting NMA statements which we advised, should be treated by the public, as ‘the ranting of a drowning man’. 

In her attempts to  maintain the posture of  ‘Mr know-it-all’ NMA blamed, derided, indicted and insulted the Judiciary and the learned and respectable judges in Nigeria by shamefully and wrongfully too, accusing  them of being bought by other health professionals to pervert justice! NMA must be made to prove their allegations against the eminent judges; else, it (NMA) stands the risk of libelous litigation(s) against her. NMA practically told the judiciary that they erred in passing the recent judgments because none went their way.  While NMA’s allegations may appear hard on the judiciary, their accusations in the said publications are to further buttress the overbearing nature of the NMA in deriding every other professionals.   We would not be surprised if NMA wakes up tomorrow to say her members can do the work of judges in the National Industrial Court of Nigeria (NICN) and Supreme Court judges more than the eminent judges/ justices. In Hospital environments, NMA members have penchants for headship of Accounts, Security, Maintenance, Pharmacy, Nursing, Medical Laboratories, Optometry, Physiotherapy and every other departments in the hospitals.

The fact is that, Medical Laboratory Scientists and other health professionals are distinct and separate from medical doctors whose profession is medicine/surgery. It has been clearly pronounced by various courts of competent jurisdictions and in different cases, that every health profession, especially Medical Laboratory Science is separate, distinct and autonomous, and that each practitioner should head his/her practice. These landmark judgments were given for examples, in AMLSN vs FMC Asaba Management & Others (Suit No: NICN/ABJ/128/ 2012-Judgement delivered in 2013); AMLSN vs Jos University Teaching Hospital (JUTH) Management & Others (Suit No: NICN/JOS/8/2014-Judgement delivered on the 5^th of October, 2015); AMLSN/NUAHP(formerly NUPMTPAM) vs Obafemi Awolowo University Teaching Hospital Management & Others (Suit No NICN/ABJ/284/2014-Judgement delivered on 27^th January, 2016)  These judicial pronouncements were all delivered in favour of Medical Laboratory Scientists. The era when medical doctors treat other health professionals as ‘errand boys’  and ‘girls’ or ‘slaves’ is gone and gone forever!

Sadly too, NMA criticized and brandished the legislative arm of government as ‘incompetent’ with false allegations that the legislature has been ‘hijacked’ and it is ‘colluding’ with other health professionals to hastily pass laws and  upgrading training courses of health professionals without due legislative processes. This obviously is insulting to the distinguished Senators and Honourable members of the House of Representatives. This is tantamount to accusing the legislatures of knowing nothing in legislative business.

NMA has refused to appreciates advances that have been made in Medical Laboratory Science profession, Pharmacy, Physiotherapy, Nursing, Imaging Science, Optiometry etc; they forgot too, that medicine/surgery itself, started as a diploma program before undergoing metamorphosis to what it is today, through legislative processes . Unfortunately, the ladder they used to climb to the top is what they want to destroy so that others will not find anything to climb up with. What a wicked disposition. NMA should live and let others live too!

It is laughable to read that NMA expected that other health professionals should not be elevated to the zenith of their profession for reason of cutting down on government high wage bill. While regulatory bodies and government establishments saw the need to upgrade courses for improved services, only NMA sees capacity development as quest for pay rise. No wonder they have been on the neck of government with all manners of demands for pay-rise and entry points while the health system rots due to mismanagement with billions of dollars wasted by Nigerians on medical tourism. Good administrators look at capacity development in terms of what it will bring to service delivery and productivity but NMA alone sees capacity development in terms of how much money comes into the pocket. This is laughable!

They also alleged that “frivolous courses and programs with no relevance to hospital and indeed the healthcare industry were quickly developed and accredited for other health professionals…” this is ludicrous, especially the jaundiced insinuation that “duration of training have been elongated as a way of measuring the medical training…” While NMA failed to point out such “useless” programs in the health sector that other health professionals engage in, their submission has clearly demonstrated their deep seated envy against other professionals and their desire to keep everyone down while they alone soar. One could keep on wondering on the rationales for extending or intent to extend, the years of MBBS training to ten or eleven years without any addition to scope of learning but  a desperate attempt to give a false impression that they spend more years in the university, and so,  should earn more than others in the health sector.

Signing of Laboratory Test Results by Pathologists: In their write-ups, NMA directed their colleagues not to use results of completed medical laboratory tests that are performed, reviewed and signed by licensed Medical Laboratory Scientists but not counter-signed by Pathologists who professionally, contributed nothing to the generation of the results.

The Scheme of Service for Medical Laboratory Scientists, approved by  Federal Government and released from the office of the Head of Civil Service of the Federation  in sections, 2.9, 2.9.1, and  2.9.2 of the said scheme of service, saddles the responsibilities of taking charge of general administration of the Medical laboratory Services Department, budgeting and ordering laboratory equipment and reagent, advising on the formulation, execution and review of Medical Laboratory Policies on the Director of Medical Laboratory Services who is a Medical Laboratory Scientist. Similarly, Section 22(2) of MLSCN Act 11 2003 states “A person who is not a member of the profession (medical laboratory Science)  shall not practice the profession or, in expectation of reward, take or use any name, title, addition or description implying that he is in practice as a member of the profession”……….

 Nigerians should ask NMA to display the law that empowers them to conduct laboratory tests, sign laboratory results or supervise medical laboratories? Nigerians should also ask them if they are registered and licensed by the Medical Laboratory Science Council of Nigeria (MLSCN) to do the work of medical laboratory scientists. As it stands today, only MLSCN is saddled with the task of inspection, monitoring, accrediting, and regulating the PRACTICE of Medical Laboratory Science in both public and private hospitals, clinics and other health institutions in Nigeria. Funny enough, the enabling law for Medical and Dental Council of Nigeria (MDCN) which is the regulatory body for all medical doctors in Nigeria) does not even give MDCN power to inspect, monitor or accredit clinics and hospitals wards for compliance with the standard requirements (which they should have requested to have , at least, to flush out substandard hospitals and clinics that are daily killing innocent Nigerians!) yet pathologists through NMA, erroneously deceived Nigerians that MDCN had power to regulate clinical laboratory practice whereas the MDCN law  only empowers them to regulate clinical laboratory  PRACTICALS for the purpose of teaching medical students in the field of pathology. While we are aware that NMA is attempting to alter the word ‘PRACTICALS’ in their enabling law  to ‘PRACTICE’, we anxiously await them to do that and use the wrath of the laws of the land to sweep them to prison for attempted forgery and twisting the law of the land to achieve illegal goal for their members. NMA and her cohorts must be told that there is always an end to impunity!

 

Duties of Medical Laboratory Scientists and the Pathologists in the Care/Management of Patients: The duties of the two autonomous professionals are quite distinct and separate from one another. It is likened to the duties of an Architect and a Builder-two distinct professionals in the built environment. It is quite obvious that NMA does not understand the duties of the pathologists in the care and management of patients and they were merely exhibiting solidarity for their colleagues-the pathologists.  If they did, they would not have claimed that “pathology and medical laboratory science professions were related” even when the Laws establishing these professions are different and separate and their schemes of service are separate and distinct. Medical Laboratory Scientists read Medical Laboratory Science in the university while Pathologist read Medicine and Surgery in the university just as Pharmacists read pharmacy in the university etc.

  Recent court judgments in favour of Medical Laboratory Scientists have pronounced medical laboratory science as a distinct and separate profession from medicine/surgery. It is laughable to say that pathology, a branch of medicine which should concern itself with practicals during the training of  medical students or  performing post mortems for dead bodies and  running special clinics based on the findings from the results of the patients’ tests performed, reviewed and signed  by medical laboratory scientists, or  conduct ward rounds with their doctor colleagues so as to advise them on how best physicians should interpret laboratory test results in the treatment or management of the patients. Rather than performing all these duties as medical doctor/pathologists, they abandoned their duties and instead, are now claiming authority over Medical Laboratory Scientists whose scheme of service and law empower them to legally perform routine and specialized analysis of patients’ samples in the laboratory, total management/administration of the laboratory to ensure high quality test results among other duties, for the purpose of making such results ready for  use by physicians in the treatment or management of patients and for several other purposes.

For proper records and the need to convey the truth to the enlightened public, AMLSN wishes to summarize as follows:

(1)    Insults to the Office of the Head of Civil Service of the Federation, the Judiciary and the Legislatures by NMA:  NMA in all her said publications insulted the psyche of the Office of Head of Civil Service of the Federation from where circulars and schemes of service for different professionals are released, the legislature where laws are made and the judiciary that interprets the laws of the land. Obviously, these were among the several attempts to enslave other health professionals by some NMA members. All other health professionals will continue to pay due respects to these esteem officers and will continue to treat the judiciary as the last hope of the common man and the oppressed.

  
(2) It is illegal and an open invitation to Contempt of Court for the Pathologist to attempt to sign or counter-sign the results of medical laboratory tests performed, reviewed and signed by licensed Medical Laboratory Scientists: The directive by NMA to her members that any medical laboratory test not signed by pathologist should not be used for the care of patients is insulting to the intelligence of all Nigerians. It is an affront on the various judgements of the National Industrial Courts of Nigeria as referenced earler. The claim by NMA had been roundly deflated by the various judgements delivered by eminent judges on cases all ruled in favour of Medical Laboratory Scientists. It is surprising that NMA, in an attempt to express unwarranted solidarity for their colleagues (the pathologists),  directed their members to ignore judicial pronouncements in the cases determined between Medical Laboratory Scientists and the pathologists and were all separately ruled in favour of Medical Laboratory Scientists. This is one of the several examples of lawlessness and impunity which some of the elements in NMA have been encouraging and promoting.

(3)  Privatization and Outsourcing of Hospital Services: One must commend President Muhammadu Buhari (GCFR) for his willingness not to Privatize or commercialize Health Services. This is because Privatization, Commercialization or Outsourcing of Health Services will make health services to be out of reach of the common man.  No doubt, Privatization, commercialization or outsourcing of Health Services would increase the out-of-pocket health expenses of Nigerians especially the poor masses, it would hinder Universal Health Coverage which must be affordable, available and accessible to the citizenry. The directive by NMA that laboratories, pharmacies, x-rays and other services rendered by other core health professional services except those rendered by medical doctors, should be privatized and outsourced by Chief Medical Directors CMDs and Medical Directors (MDs)-who are also NMA members in all government hospitals, is a further display of selfishness.

 

Sadly, NMA further directed in her publications under reference, that CMDs and MDs of Public Health Institutions in Nigeria should explore the patronage of private laboratories outside Public Hospitals rather than canvassing for developing the capacities and infrastructures in Public Hospitals and Primary Health Centres through-out the country to enable government at all levels achieve Universal Health Coverage. This directives by NMA, was clearly affirming the opinions of other health professionals such as Medical Laboratory Scientists, Radiographers, Pharmacists, Physiotherapists, Nurses etc that the CMDs and MDs are being used by NMA to destroy or kill other health professionals and their services in public hospitals through Public Private Partnership (PPP) which NMA members poorly misunderstood as implying privatization, commercialization or outsourcing. It is worthy of note that if PPP policy of government is to be adopted, then, it should be in line with the set guidelines of the Federal Government and must be for all the professional services in the health sector including the services rendered by the medical doctors and should not be selective against a particular profession or group of professions.

 

(4) Who then has killed or is killing the Public Hospitals in Nigeria?: As stated above, NMA poorly understood the  principles, practices, and guidelines for Public Private Partnership (PPP) and the roles of Infrastructure Concession Regulatory Commission (ICRC) to check the abuse of PPP by some NMA members. Nigerians should now clearly know, who has killed or is killing the Public Hospitals and making health services to be out of reach of the masses. Health services which are inalienable rights or social services to the masses by any caring governments at all levels, are now being recommended for privatization and commercialization by some members of NMA, out of selfish interest,  ego and disregard for professionalism in health sector. Privatization, Commercialization or out-sourcing of laboratory and pharmaceutical services perhaps, is to continue to make some of the NMA members richer through commissions, rebates and inducements which such private investors usually give them as a reward for sending patients (or patients’ samples) to private laboratories, X-ray centers, pharmacies etc. Some of them would not even refer patients to centres that would not give returns in form of rebates or commissions. This, usually, is at the expense of the expected services at the public health institutions and at the expense of the poor masses. That could be a major reason why the public hospitals are being killed by some members of NMA.  They are, to say the obvious, the ones killing the public hospitals/health institutions; yet they cry foul that the public hospitals are dead! Some of them even refer cases that could be managed in Nigeria to foreign hospitals due to likely commissions or rebates for patronage. Thus, encouraging and promoting unnecessary and avoidable medical tourism.

   
(5) Yayale Ahmed Committee Reports:  It is laughable to note that while NMA was quick to condemn judgements of courts of competent jurisdiction and  eminent judges for upholding the rule of law, vehement in rejecting Justice (rtd) Abdullahi Gusau’s Committee’s Report, oppose implementation of government circulars and scheme of service for medical laboratory scientists and other health professionals in health institutions, it was selfishly calling for a white paper on Yayale Ahmed’s Committee’s Report which has been roundly condemned by other health professionals. No doubt, the Yayale Ahmed Committee’s Report in its present form, grossly promotes enslavements of other health professionals in her recommendations. Yayale Ahmed Committee’s Report cannot replace judicial pronouncements by eminent judges of courts of competent jurisdiction in cases already determined and ruled in favour of medical laboratory scientists against the pathologists. Any white paper based on the recommendations of the Yayale Ahmed Committee that is at variance with judicial pronouncements and laws regulating the practice of other health professions would not and shall not be accepted by AMLSN and other health professionals!

 
(6) The various professionals in the health sector are no slaves: The various professionals in health sector will and shall always resist injustice, inequity, impunity and lawlessness which some NMA members are advocating in favour of their colleagues who are medical doctors. 

(7) Where court judgements as evident in the court judgements mentioned earlier in this write-up, were not obeyed and respected, schemes of service and circulars for the various health professionals released by the Office of the Head of Civil Service of the Federation were ignored, rights and privileges of other health professionals were denied by some NMA members (because majority of CEO of the health institutions are NMA members), then, that could be seen as ‘living in the jungle’ and an open invitation to anarchy in the health sector. 

 

(8) Manipulation of her members in Public offices by NMA: AMLSN has watched with disbelieve and unimaginable surprises the several attempt by NMA to use her members holding several public offices in Parastatals, Ministries, Departments and Agencies (MDAs) to intimidate and harass other health professions whenever they insist on obtaining their legitimate rights in their work places. It is now amazing to see the rate at which NMA members are issuing queries to any health professional that demonstrate boldness to insist on professional autonomy! As a professional Association, AMLSN shall continue to resist oppression and intimidation of her members. The era of Apartheid and Colonialism has long gone forever!

 

It is imperative to remind members of NMA who are CEOs of Health Institutions or similar public positions, that they are supposed be unbiased umpires or Administrators by virtue of the public positions they occupy.  Section 172 of the Nigerian constitution (1999-as amended) clearly states that “A Person in the Public Service of the Federation Shall Observe and Conform to the Code of Conduct”. The code of conduct as exemplified in the Constitution fifth schedule part 1, articles 1, 9 and 10 provides:

Article 1:  “A Public Officer shall not put himself in a Position where his personal interest conflicts with his duties and responsibilities”.

Article 9:  “A PUBLIC OFFICER shall not do or direct to be done in abuse of his office, any arbitrary acts prejudicial to the rights of any other person knowing that such acts is unlawful and contrary to the Code of Conduct.”   

Article 10:   A public officer shall not be a member of, belong to or take part in any society the membership of which is incompatible with the function or dignity of his office.  A situation where NMA call her members occupying public offices, to ignore court judgements or take laws into their hands in other to undermine the laws of the land by promoting their own personal interest, is against the fundamental principle of the practice of “TRUE MEDICINE” “THAT A PHYSICIAN MUST CAUSE NO HARM” Similarly, The action of NMA undermines the code of conduct for public officers, her actions are prejudicial to rights and responsibilities of other Healthcare Professionals. Above all, her public outcry has nothing to do with patient interest, rather they are self-serving!

(9)   The era of slavery and impunity in the health sector is gone and gone forever!

Conclusion: Nigerians should rise up against the overbearing attitude of the Nigerian Medical Association(NMA) and tell them the naked truth that they have mismanaged themselves, the medical team as well as  Public Hospitals and other Public Health Institutions in Nigeria. Nigerians should also tell them to adjust and respect the reality of today that abhors professional ego, they should supports professionalism and not ‘jacks of all trades’ They should abide by the  recent judicial pronouncements in favour of Medical Laboratory Scientists and or other professionals in health sector  or risk imprisonment for contempt of court.

NMA should live and let other health professionals live too, for the sake of quality health services in Nigeria. The sky is so large to accommodate everybody!

Alh. Toyosi Y. Raheem National President 

 

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