THE UNTH EXPERIENCE: DENTISTS ARE STATUTORILY EXCLUDED FROM CMD POSITION IN NIGERIAN TEACHING HOSPITALS

This article reveals that the laws in Nigeria today as presently enacted do not allow or permit a Dentist to be appointed a Chief Medical Director of the University Teaching Hospitals in Nigeria by the President of Nigeria. This position is based on provisions of all the extant laws as enacted by the National Assembly of Nigeria.

The appointment into the post of a Chief Medical Director in the Federal University Teaching Hospitals in Nigeria is strictly regulated by law. Section 5 of the University Teaching Hospitals (Reconstitution of Boards, etc.) Act stipulated the entire requirements thus:

5 (1) There shall be for each hospital a Chief Medical Director who shall be appointed by the President on such terms and conditions as may be specified in his letter of appointment or as may be determined from time to time by the Federal Government.

(2)      The Chief Medical Director shall (a) be a person who is medically qualified and registered as such for a period of not less than twelve years, and has had considerable administrative experience in matters of health and holds a postgraduate medical qualification obtained not less than five years prior to the appointment as Chief Medical Director; and (b) be charged with the responsibility for the execution of the policies and matters affecting the day-to-day management of the affairs of the Hospital.

The qualification for the post of the Chief Medical Director is thus a combination of factors that include that the person must be medically qualified, registered as a medically qualified person for a period not less than twelve years, and has postgraduate medical qualification for a period not less than five years. There is also the administrative competence requirement.

The high point here, however, are the words "medical" and "medically". The statutory meanings of these parts of speech derived from the practice of medicine, and when elucidated by the provisions of the relevant laws, shall lay to rest the legislative intendments that only medical practitioners can be appointed Chief Medical Directors.

The discussion is therefore essentially centred on "who is medically qualified"? Medical qualification is covered by the Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended). This Act provides for the regulation of two professions as well as for the regulation of the practices of Pathology and Alternative Medicine in Nigeria.

The name of the Act derived from the two major Professions that it regulates namely Medicine and Dentistry. The Act is not a Medical Act. It is not a Dental Act. It is a Medical and Dental Act regulating the two different Professions as well as practice  of Pathology and of Alternative Medicine. To throw more light on this, the relevant portions of the Act need to be reproduced.

Section 1(2) Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended) states:

1 (2). The Council shall have responsibility for:

(a) determining the standards of knowledge and skill to be attained by persons seeking to become members of the medical or dental profession and reviewing those standards from time to time as circumstances may permit;

(b) Securing in accordance with the provisions of this Act, the establishment and maintenance of registers of persons entitled to practice as members of the medical or dental profession and the publication from time to time of lists of those persons;

(c) Reviewing and preparing from time to time, a statement as to the code of conduct which the Council considers desirable for the practice of the professions in Nigeria

(d) supervising and controlling the practice of homeopathy and other forms of alternative medicine .........

From the foregoing, it is clear that a professional practitioner under this Act is either a medical practitioner or a dental surgeon. The non-professional practitioners include the practitioners of the Alternative Medicine.

The meaning of "or" in the phrase "medical or dental profession" as used in Section 1(2) above has been laid to rest by the Nigerian Courts. In the case of Nwaogwugwu v. President F.R.N. (2007) WRN (Vol. 12) 24 at 53 Lines 30 - 35 (CA), Court of Appeal Per Adekeye, JCA, on the interpretation of the word "or" and what "or" connotes in a statute, stated:

 "The use of this word 'or' in a statute, connotes disjunctive participle used to express an alternative or to give a choice of one among two or more things. The word always bears a disjunctive meaning in an enactment. It separates the provision proceeding it from the provision coming after it. Its role is to show that the provisions in which it is appearing are distinct and separates one from the other. Abia State University v. Anyaibe (1996) 3 NWLR (Pt. 439) page 646."

Therefore, Legislature separated the two professions of Medicine and Dentistry. To buttress this separation, Section 17(1)(2) of Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended) thereafter goes on to state:

17(1) Subject to subsections (6) and (7) of this section, if any person who is not a registered medical practitioner –(a) for or in expectation of reward, practices or holds himself out to practice as a medical practitioner; or(b) takes or uses the title of physician, surgeon, doctor or licentiate of medicine, medical practitioner or apothecary; or(d) without reasonable excuse takes or uses any name, title addition or description implying that he is authorized by law to practice as a medical practitioner, he shall be guilty of an offence.

(2) Subject to subsections (6) and (7) of this section, if any person who is not a registered dental surgeon---(a) for or in expectation of reward, practices or holds himself out to practice as a dental surgeon; or(b) takes or uses the title of dental surgeon, dentist or dental practitioner, or(c) without reasonable excuse takes or uses any name, title, addition or description implying that he is authorized by law to practice as a dentist, he shall be guilty of an offence under this section.

The clear import of the above provisions is that Legislature did not just create two indistinct professions with one regulator. No. The Legislature in fact created two distinct and different professions with their differences so wide that it is a criminal offence for members of one profession to practice the profession of the other profession. The professions are so different that it is a punishable offence for a medical practitioner to practice or hold himself out as a dental surgeon; or a dental surgeon to practice or hold himself out as a medical practitioner.

The question still remains whether "medically qualified" persons must be medical practitioners alone or both medical practitioners and dental practitioners. Are medical doctors, by extant Nigerian laws, the only medically qualified persons in Nigeria, or do medical doctors share this medical qualification with other practitioners including the dental surgeons. It is submitted that medical qualification is specifically and exclusively allocated to medical practitioners, while dental qualification is specifically and exclusively allocated to dental surgeons according to the Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended). Medical and Dental qualifications and registration are completely covered by the Act. Section 9 of the Act stated:

9 (1) Subject to subsection (2) of this section, the Council may approve for the purposes of the Act - (a) any course of training which is intended for person who are seeking to become, or are already members of the medical or dental profession and which the Council considers is designed to confer on person completing it sufficient knowledge and skill for the practice of that profession or for practice as members of a specialized branch of that profession; (b) any institution in Nigeria which the Council considers is properly organized and equipped for conducting the whole or any part of a course of training approved by the Council under this section; (c) any qualification which, as a result of an examination taken in conjunction with a course of training approved by the Council under this section is granted to candidates reaching a standard at the examination indicating, in the opinion of the Council that they have sufficient knowledge and skill to practice the profession in question or to practice as members of a specialized branch of that profession.

(2) The Council shall not, in pursuance of subsection (1) of this section, approve a qualification granted by an institution in Nigeria unless the qualification bears one of the following designations (with or without the addition of words indicating specialization in a particular field), that is to say –(a) Bachelor of medicine and surgery; or (b) Bachelor of dental surgery.

The Act went ahead to define "approved" and "Approved medical or dental qualification" as used in the above Section 9(1) at its Section 21(1) thus:

“Approved” means for the time being approved under section 9 of this Act.

“Approved medical or dental qualification” means a qualification which is approved in respect of the medical or dental profession".

The clear import of the above stated approved qualifications as defined by the Act is that a medical practitioner shall have a medical qualification while a dental practitioner shall have a dental qualification. The Act, went further to cap it all, by defining Certificate of Experience of Medical and Dental professions at its Section 11 (1) thus:

11 (1) A person who, after obtaining an approved medical or dental qualification, satisfies the conditions specified in subsection (2) of this section shall be entitled to receive free of charge a certificate of experience in the prescribed form.

This means that a practitioner can only obtain either medical qualification or dental qualification. Those that shall obtain medical qualifications have already been identified as medical doctors while those that shall obtain dental qualifications have been identified as dental surgeons.

On the issue of registration as medical practitioner or dental surgeon, Section 6 of the Act stated:

6 (2) It shall be the duty of the Registrar to prepare and maintain, in accordance with rules made by the Council under this section, registers of the names, addresses and approved qualifications, and of such other particulars as may be specified, of all persons who are entitled in accordance with the provisions of this Act to be registered as medical practitioners or dental surgeons and who apply in the specified manner to be so registered.(3) Separate register shall be maintained for medical practitioners and dental surgeons respectively, each of which shall be divided into the following parts:-i. one part for fully registered persons;ii. one part for provisionally registered persons, in the case of medical practitioners; andiii. one part for persons who have been granted limited registration under section 13 of this Act.

However, it could still be argued by some naysayers that even though there is a provision for medical qualification for medical doctors and dental qualification for dentists, the phrase "medically qualified" could still be extended to dental surgeons as they are regulated by the same Medical and Dental Council of Nigeria. It is submitted with bended mirth and bated chuckles that this argument could also be extended to the practitioners of Alternative Medicine to the extent that practitioners of Alternative Medicine could aspire to the office of the Chief Medical Director after they have been registered as such for twelve years. This argument is however blown to pieces by Section 18 (2) of the Interpretation Act of Nigeria which states:

18(2) Where by subsection (1) of this section or any other enactment a meaning is assigned to a word, parts of speech related to the word have corresponding meanings.

The import of this section of the Interpretation Act is that "medically qualified" can only be ascribed to those that have medical qualification according to the Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended). Dental Surgeons are therefore dentally qualified. To integrate the Dental Surgeons into the scheme of things in the aspiration for the post of a Chief Medical Director, it is put across that the phrase "medically qualified" has to be altered to read "medically and dentally qualified" through legislative amendment of the Act.

On a lighter mood, it must be stressed that the phrase "postgraduate medical qualification" as a requirement for qualification to be appointed a Chief Medical Director is not an exclusive preserve of the Medical Consultants as it is presently made to look. Any postgraduate medical qualification, including Primary and Membership qualifications, as well as Master Degrees and PhD, are all valid, provided that the Applicant for that office has expended  the requisite minimum periods. A resident doctor can therefore be legally made a Chief Medical Director according to the Medical and Dental Practitioners Act Cap. M8 LFN 2004 (as amended).

Awkadigwe Fredrick Ikenna (MBBS, LLB, MWACS, DSC).
awkadigweikenna@gmail.com
08039555380