ONLY NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA (NPMCN) CAN DECIDE HOW NIGERIAN TEACHING HOSPITALS SHOULD OPERATE: A CALL ON THE NPMCN TO DO THE NEEDFUL AND ORGANIZE OUR TEACHING HOSPITALS

This article aims to clearly dispel the misconception that Teaching Hospital Boards and Government have the responsibility and obligations to decide how Nigerian government-owned Teaching Hospitals should be operated.

The article is a legal pilgrimage on the legal basis of organizing the operability of a Teaching Hospital in Nigeria, to show that NPMCN is the only body empowered by law to decide how a Nigerian Teaching Hospital should be organized to operate.

This responsibility to design and organize how a Teaching Hospital should function in Nigeria wholy lies with the NPMCN. Any Teaching Hospital in Nigeria established by law is of legal necessity to comply with the regulations of NPMCN.

Having laid this important foundation, I now urge you to sit down and follow me as we embark on this legal pilgrimage.

The process of qualifying an individual as a member of any profession involves interactions of different events and processes created or recognized by law. Medical profession is no exception. To produce a medical doctor in Nigeria involves the following:

1. The creation of the medical profession by law
2. The creation of the training process by law
3. Creation of institutions where the training should be carried out by law
4. Regulations of the training and certification of the profession by law.

The laws applicable to the above events and processes in the medical profession are mainly:

a. The Medical and Dental Practitioners Act
b. The Nigerian Medical College Act
c.  The Universities Act
d.  The Teaching Hospitals Act
e.  The Teaching Hospital Laws
f.  The Board Reconstitution Act
g.  The Residency Training Act and
h.  National Universities Commission

There are still many other laws involved including the Constitution of the Federal Republic of Nigeria. These additional laws may not be significantly implicated in this article, and thus would not be mentioned.

The medical professional training is in two levels: the undergraduate and postgraduate levels of training. Both levels are regulated by the Medical and Dental Practitioners Act, while the Nigerian Medical College Act and the Residency Training Act regulate the postgraduate professional training level. These are without prejudice to any other regulatory laws.

It is noted that while the Universities Act, the Teaching Hospitals Acts and Laws, as well as Board Reconstitution Acts provide for the venues of the training for both the undergraduate and postgraduate medical training, the Nigerian Medical College Act, the Teaching Hospitals Acts and Laws, the Teaching Hospital Board Reconstitution Act and the Residency Training Act all provide for the venue for the postgraduate medical training. With this full complements of law in situ, Legislature has effectively insulated the medical training from executive interferences. In fact, the president of the Federal Republic of Nigeria or his agents cannot regulate medical training anymore. The time of executive fiat on the medical training has gone for good. There are now statutory bodies empowered to do a thing or another in medical training (undergraduate or professional postgraduate), regulations and certification.

Let us now look at what the law said about the venue for the training of medical professionals. We shall be citing the Ibadan University College Act. This is the Act:

"1. Short title.
This Act may be cited as the University College Hospital Act.

2. Establishment of the Hospital.
There shall be established at Ibadan a teaching hospital to be known as the University College Hospital, which shall be capable of providing such facilities as are usually provided in medical schools forming part of a University for the instruction of medical students in such subjects as are usually taught in such schools.

3. Establishment of the Board.
There shall be established for the management of the Hospital a Board of Management to be known as the University College Hospital Board of Management, which shall be a body corporate with perpetual succession and a common seal, and may in its corporate name sue and be sued and, for and in connection with the purposes of this Act, may acquire, hold and dispose of movable and immovable property.

4. Composition, functions, etc, of the Board.
The composition, functions and powers of the Board established under section 3 of this Act shall be as provided for in the University Teaching Hospitals (Reconstitution of Board, etc.) Act".

The complete Ibadan University College Act has just been laid above. That Act shows clearly that the Ibadan University College Hospital was established solely for the training of medical students. Medical students here is defined as both undergraduate and postgraduate (professional and academic) medical trainees. Medical students therefore comprises undergraduate medical students, house officers and resident doctors.

Secondly, the hospital management of the Ibadan College Hospital was stated to be the prerogative of a Board of Management to be known as University College Hospital Board of Management. This is the crux of this article.

This article seeks to explain that the management functions of the University College Hospital Board of Management and the Boards of any other Teaching Hospital Management Board for that matter, has now been strictly restricted to administrative functions only. The clinical and technical management regulations have been dispatched to the NPMCN.

This means that the processes of training of medical students, and by extension, the clinical endeavors of all the Teaching Hospitals across Nigeria, which are in fact all about medical training, are now regulated by the NPMCN. This simply means that the Board of Management, as it pertains to clinical and technical functions and management of all the Nigerian Teaching Hospitals that are not of purely administrative nature, has been placed under the regulations and control of the NPMCN, in so far as such Hospitals are Teaching Hospitals properly created.

Prior to 2018, the NPMCN was only empowered to do the following:

"13. 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:

(a)    particulars of the standards which are to be treated as sufficient for the purposes of examinations conducted by the College pursuant to this Act; and

(b)    the list of institutions recognised for the purposes of section 10 of this Act".

This empowerment restricted the regulations by the College to the conduct of professional exams into the different Faculties of medicine. These Faculties were only found within the College, and not in the Teaching Hospitals which were the training institutions.

The College became the Examination institution while the Teaching Hospitals became the Training institutions. The offshoot of these limitations of the functions of the College (and the Medical and Dental Council of Nigeria) on the conduct of the training of medical students was the production of Residency Training Manuals by the Teaching Hospitals for the regulation of the Residency Training, which was not regulated by law prior to 2018.

The Federal government issued its Residency Training Regulations to the Federal Teaching Hospitals while the Executive fiat of state governments sufficed for the state Teaching Hospitals. The only thing done by the NPMCN was to conduct examinations for candidates certified to have been trained by the Teaching Hospitals once those candidates provided evidence of training by the Teaching Hospitals to the College. It was immaterial that the students were trained with a full complement of support staff with defined duties and Organograms. It was immaterial that the medical trainee actually understood the limits of the different professional support staff and how the medical trainee should relate with other health professionals. The College had no hands in the training of candidates for the examination other than in accreditation of the training institutions. See section 10 of the Nigerian Medical College Act below:

"10.    Candidates for examinations

Where a candidate offers himself for examination under this Act he shall satisfy the appropriate Faculty Board-

(a)    that he is a registered medical practitioner or dental surgeon, as the case may be, so however that if the candidate is on the temporary register he may be examined only by leave of the Senate given either generally or as a special case; and

(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".

These whole methods and processes changed in 2018 with the presidential assent to the Residency Training Act of 2018. The College was made the sole regulatory body of both Residency Training and Residency Examinations and certifications.

The Faculties of the NPMCN consequently became saddled with a whole lot of new responsibilities. These responsibilities could extend to the institution of branch Faculties in the Teaching Hospitals. The different departments of the Teaching Hospitals can now have direct associations with the corresponding Faculties of the College.

Moreover, the Faculties of the College can now be linked directly to the Teaching Hospital Faculties that will be offshoots of the College Faculties for direct regulations of training.

The subsidiary laws of the College shall be applicable to all the Teaching Hospitals with immediate effect. The NPMCN can now legally decide how all the fields of medicine in the Teaching Hospitals can be organized for comprehensive training of medical students. Any such subsidiary law of the NPMCN made pursuant to section 13 of the Nigerian Medical College Act is a law as defined by the Interpretation Act of Nigeria. The Teaching Hospitals are therefore bound by the subsidiary laws made by the NPMCN.

It is instructive to note that the current subsidiary laws of the NPMCN for the different Faculties of the College included the position and  services of the clinical support staff as regards medical training. These curricula were made when the NPMCN was only an Examination body. With the extra responsibility of regulating Residency Training in all Teaching Hospitals in Nigeria awarded to the NPMCN, it is now ripe to overhaul the clinical activities of Teaching Hospitals for the best standard of training of medical students as provided in the Teaching Hospital Acts and Teaching Hospital Board Reconstitution Acts.

The Faculty Protocols and Organograms call. The relationships between the medical trainees and the support staff have to be clearly defined in the Associate Hospital Faculties of the Training Institutions. The proper training of medical students includes the proper training on interprofessional relationships especially when the support staff are inevitable. This responsibility of producing relevant subsidiary laws embodying the Organograms of medical outfits, now lies squarely on the laps of the NPMCN, the NPMCN being the sole legal regulatory body of all the clinical activities of the medical trainers and trainees of all the Teaching Hospitals in Nigeria.

All the Teaching Hospital shall be organized and equipped to apply the subsidiary laws made by the NPMCN to retain and sustain Teaching Hospital status.

Awkadigwe Fredrick Ikenna (MBBS, LLB, MWACS, DSC)
OBGYN ESUTTHP
awkadigweikenna@gmail.com