THE ILLEGALITY OF RESIDENCY TRAINING IN THE TEACHING HOSPITALS IN NIGERIA

THE ILLEGALITY OF RESIDENCY TRAINING IN THE TEACHING HOSPITALS  IN NIGERIA 

The argument is that the University Teaching Hospitals (Reconstitution of Boards, etc.) Act (shortened thereafter as Board Act), did not provide for residency training in the Teaching Hospitals in Nigeria. It is then contended by the advocates that residency training in Teaching Hospitals, given the clear provisions of the relevant Acts, is an illegal intrusion into the statutory mandate of those Acts.

In fact, the phrase "residency training" or its individual terms, were said to be patently absent in the whole length and breath of the Teaching Hospitals Management Board Act, and the University Teaching Hospital Act. The advocates of this proposition thus argue that Teaching Hospitals should not be allowed to sustain the residency training program as practised today, as the Teaching Hospitals Management Board Act and the University Teaching Hospital Act (both of which regulate Teaching Hospitals), have no place or provisions for such training.

The proponents of the illegality of residency training for medical practitioners in the Teaching Hospitals depend on the following provisions of the Acts.

FIRST, Section 19 of Board Act at the Interpretation section, states:

19. In this Act, unless the context otherwise requires—

“Associate University” means the University from which the hospital derived its name and whose medical students receive aspects of their training from the hospital;

“Medical student” means a student whose course of instruction is—
(a) designed (either alone or in conjunction with  other courses) to enable him to qualify as a medical practitioner;
(b) designed for the further training of medical practitioners;

“Students” means a person enrolled at an institution controlled by the Board for the purpose of pursuing a course of instruction at the institution.

SECOND, Section 7(2) of the same Board Act states: Functions of the Hospital Management Board:

7(2) The duty of operating the hospital imposed by the foregoing subsection shall include, without prejudice to the extent of that duty apart from this subsection, the duty of providing proper courses of instruction for the medical students of the associate University, and the Board may perform the last-mentioned duty by arranging with the approval of the Minister, for students of such associate University to attend courses at other institutions not controlled by the Board.

THIRD, Section 16 of Board Act states: Powers of the Board in relation to expansion, staff, etc., of the hospital:

16(1) The Board shall be responsible for laying down general policies and guidelines relating to major expansion programmes of the hospital and the provision of facilities for the training of medical students of the associate university and it shall be the duty of the Board to execute such policies and to keep within such guidelines.

FOURTH, Section 1 of the University Teaching Hospitals Act (shortened thereafter as University Act) states:

There shall be established in Lagos (for instance) a teaching hospital, to be known as the Lagos University Teaching Hospital, for the purpose of providing such facilities for the training of medical students as are usually provided by Teaching Hospitals of internationally high repute.

Note that the last-cited section did not expressly restrict the provision of facilities for training of medical students to those medical students of the associate University. Note however that section 7(2) of the Hospital Board Act did restrict the duty of providing course of instructions by the hospitals to medical students, to only medical students of the associate University.

The proponents therefore argue that since medical students created by both Acts above (ie the Board Act and the University Act, both cited above) must by implication have an Associate University, that resident doctors do not belong here, as they do not have an Associate University. The proponents also go further to argue that National Postgraduate Medical College and the West African College of the Surgeons are both not Universities as  contemplated by the two Acts.

The proponents, thereafter suggest that only those doctors undertaking their postgraduate training in the Universities are covered to embark on further medical training in the Teaching Hospitals. Finally, they argue that "medical students" and "students" as defined in the Board Act, only includes Associate University medical students (undergraduate or postgraduate), and in-hospital nursing and technician students. Any other categories of students not in the above stated categories of students were outside the Acts and thus illegal interlopers of introductions.

The pertinent questions as enunciated by the proponents of the illegality of residency training in the Teaching Hospitals are:

1. Have the above two relevant Acts provided that all the medical students in the Teaching Hospitals must have an Associate University
2. Is National Postgraduate Medical College a University, such that it is now the Associate University for the residents
3. If granted, but not conceded, that number 2 above is true, do the Teaching Hospitals derive their names from the National Postgraduate Medical College

The opponents of this strong assertion that residency training in the Teaching Hospitals is illegal, have come up with their own position. They state that medical students as used in the two relevant Acts included the residents. The opponents rely on the provisions in the National Medical College Act as well as the Board and Hospital Acts.

The long title of the National Medical College Act states -

An Act to establish a National Medical College to be charged with the responsibility of conducting examinations in the various specialised branches of medicine, surgery, obstetrics and gynaecology and dental surgery and other related matters.

Section 1 of the National Medical College Act: Establishment of National Medical College, states:

There is hereby established a National Medical College (in this Act referred to as "the College") which shall be a body corporate with perpetual succession and a common seal.

Section 2 of the Act: Functions of the College, states:-

The College shall have responsibility for the conduct of PROFESSIONAL post-graduate examination of candidates in the various specialised branches of medicine, surgery, obstetrics and gynaecology and dental surgery and making awards in relation thereto accordingly.

Section 10 of the National Medical College Act states: Candidates for examinations:

Where a candidate offers himself for examination under this Act he shall satisfy the appropriate Faculty Board-
(b) that he is in possession of and is therein named as the holder of a certificate from an institution recognised by the College showing that he has satisfactorily attended the prescribed course of training in the particular speciatised branch and for the prescribed period of the course.

Section 13 of the National Medical College Act states further: Publication of approved standards and institutions:

The College shall, from time to time, publish in the Federal Gazette and elsewhere as it may think fit - (b) the list of institutions recognised for the purposes of section 10 of this Act.

Finally, the National Medical College Act fails to define National Medical College with respect to its status as a University.

The pertinent questions to be gleaned from the position of the opponents of the asserted illegality of residency training in the Teaching Hospitals are as follows.

1. Did the Board or Hospital Act make any reference to National Medical College or its examination candidates
2. Did National Medical College Act mention or incorporate the terms residency or Teaching Hospitals so as to imply that its candidates for examinations shall be trained in the Teaching Hospitals as residents
3. Can National Medical College Act provide for a training program for Hospital and Board Acts, if the program is not properly envisaged in the provisions of the Hospital and Board Acts.

It must be appreciated that the arguments on both sides of the sphere have some merits and demerits. However, a common ground is readily discernible. What then is the legal basis of Residency Training Program in the Teaching Hospitals. Is residency training program a contrapted professional intrusion, or a calculated statutory design.

The academic or professional postgraduate status of the National Medical College is beyond the scope of this article, so also is the argument on the capacity of the National Medical College Act to dictate training program for the University Teaching Hospitals Act or the Hospital Management Board Act, especially in an area that is allegedly not contemplated by those two Acts.

The author of this article shall examine these in subsequent articles, as the bone of contention in this article can be resolved without a voyage into the murky waters that the above two controversies would degenerate.

Therefore, answer to the touchy subject of illegality of residency training in the Teaching Hospitals, can be readily got and found in the definition of medical students, and the definition of students, in the relevant Hospital and Board Acts.

The definitions are hereby laid down again for ease of reference.

1. “Medical student” means a STUDENT whose course of instruction is—
(a) designed (either alone or in conjunction with  other courses) to enable him to qualify as a medical practitioner;
(b) designed for the further training of medical practitioners;

2. “Students” means a person enrolled at an institution controlled by the Board for the purpose of pursuing a course of instruction at the institution.

The combined effects are that medical students are not included in the definition of students. While students are enrollees of the Board, medical students are enrollees of the Associate University.

The first limb, in the definition of medical students, stresses that the medical students must be aiming to qualify as medical practitioners. This obviously means that they must be University students from the Associate University. On the other hand, the second limb of the definition of medical students states it clearly that the other categories of medical students mean medical practitioners in further training. Further training of medical practitioners can either be academic or professional further trainings. If the Acts envisaged that both academic and professional medical students must come from an Associate University, then there is a problem there. The author of this article thinks so.

There is obviously no restriction as to the type of further training in the second limb of the definition of medical students in the cited Act. Therefore, the further training could be academic or professional postgraduate training. If they are in the academia, they have an associate University, but if they are in the professional category, then they are the candidates envisaged in the National Medical College Act, meant for Fellowships. They are the residents. They are a group not envisaged by the Hospital Acts.

Further still, the definition of "medical students" in the Board Act, pulverizes the assertions of the proponents of residency in illegality, and brings their arguments to the bare floor. A critical look at the definitions would reveal that at no time in the Act did the Act state that all the medical students (undergraduate and postgraduate medical students training in a Teaching Hospital) must have an Associate University. No place did the Acts say that all medical students training in a Teaching Hospital need not have an Associate University too. It is trite that where the law does not expressly or impliedly admit the existence of a thing, the law prohibits the existence of that thing.

©Awkadigwe Fredrick Ikenna 2017
MBBS, LLB, MWACOG, DSC

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