THE FINAL ANSWER AND SOLUTION TO THE CONFLICT BETWEEN THE MEDICAL LABORATORY SCIENTISTS AND THE PATHOLOGISTS

The perennial conflict between the medical laboratory scientists and the pathologists in the Nigerian Teaching Hospitals will now be laid to rest with the solutions provided at the end of this article. But before we get to the solution, there is a need to fully understand the workings of a Nigerian Teaching Hospital according to the enabling laws creating the teaching hospitals viz a viz the performance of the primary functions of the Nigerian Teaching Hospitals which is the training of medical students, as well as to understand how the hospital clinical activities, distinct and intermixed with the medical and other training programs of a Teaching Hospital are organized in each hospital wards, clinics, laboratories or theatres.

A Nigerian Teaching Hospital is a creation of the relevant law. The principal purpose of creating the Teaching Hospitals is for the training of the medical students. Medical students according to the enabling laws creating Teaching Hospitals in Nigeria are only the undergraduate medical students and the postgraduate medical students. The postgraduate medical students are the academic postgraduate medical practitioners and the professional postgraduate medical practitioners called resident doctors.

Therefore, a Teaching Hospital in Nigeria, according to the enabling laws, is essentially a training institution for the medical profession. It simply means that the generation of revenue for government and patient care part of the functions and duties discharged in the Teaching Hospitals across Nigeria are mere incidental realities and functions.

A close look at the laws creating the different Teaching Hospitals in Nigeria will expose this reality to anybody who can read and understand written documents. Throughout the length and breath of the enabling Teaching Hospital laws are the clear and specific functions of training of medical students.

There are still two other functions performed by the Teaching Hospitals across Nigeria according to the enabling laws creating the Teaching Hospitals, namely the training of Nurses and Technicians. Apart from these categories of trainees, a Nigerian Teaching Hospital is not enabled or entitled to train any other type of professionals.

However, it is instructive to note here that these latter two categories of trainees, according to the relevant enabling laws, are a sort of in-house trainees, unlike the medical students category that have an Associate University and are also capable of training outside the Teaching Hospitals that employed or appointed them.

The training of the Nurses and Technicians in the Teaching Hospitals, according to the enabling laws,is also not among the principal purpose for the creation of the Teaching Hospitals. Rather, it is a mandate given to the hospital management boards to undertake if need be. In other words, no hospital in Nigeria can be a Teaching Hospital if not created for the training of medical students; but every Teaching Hospital in Nigeria can function and operate without training nurses and technicians.

The greatest blunderous presumptions of those that are poorly informed about the institution and operations of the Teaching Hospitals in Nigeria as presently constituted is that they do not actually know the purpose and functions of a Teaching Hospital. For the avoidance of doubts, and in full compliance to the enabling laws of all the Teaching Hospitals in Nigeria, a Teaching Hospital is an institution established for the training of medical students. Medical students comprise the undergraduate medical students and postgraduate medical students according the definition in all the Teaching Hospital laws in Nigeria.

The primary purpose of establishing of a Teaching Hospital in Nigeria according to the enabling laws is for the production of both graduate medical practitioners and specialist doctors. Any other function performed by the Teaching Hospitals is secondary; and a secondary function cannot displace a primary purpose.

The secondary functions of the Nigerian Teaching Hospitals include treatment of patients in the course of medical training, training of hospital nurses and technicians, and the generation of revenue for government. These secondary functions are dispensable when circumstances permit. For the above reasons, it is obvious that the Nigerian Teaching Hospitals are not a place created for unnecessary rivalries between medical teachers and the support staff of the Hospitals. Even the Federal Government has no powers to alter the architecture of a Teaching Hospital in Nigeria unless the laws creating the Teaching Hospitals are changed, in which case the Teaching Hospitals may be changed to perform another purpose.

A Teaching Hospital is for the medical practitioners, more or less, what the Nigerian Law School is for a graduate law student, and the Institute of Chartered Accounts of Nigeria is for the Accountant. The only difference is that duties are discharged to the public in the course of medical training, unlike what is obtainable in the mentioned kindred institutions.

Moreover, as a medical training institution, the Nigerian Teaching Hospitals are organized in such a way as to make possible the training of medical students. The training of medical students, which the enabling laws creating the Teaching Hospitals in Nigeria mandated the Teaching Hospitals to perform, is regulated by two laws namely the Medical and Dental Practitioners Act, and the Nigerian Medical College Act.

The Medical and Dental Practitioners Act regulate the training of the undergraduate medical students while the Nigerian Medical College Act regulates the training of the postgraduate medical students, who are the resident doctors.

The Teaching Hospitals in Nigeria therefore must train the medical students according to the stipulations of those two relevant laws, because the principal purpose of creating the Teaching Hospitals across Nigeria is to train medical students.

The main question, at this juncture, is whether the respective Teaching Hospital Management Boards have followed the provisions of the above two mentioned regulatory medical training Acts in the organization and management of the different Teaching Hospitals across Nigeria to train and produce worldclass medical students.

An undergraduate medical student is required as of necessity to pass through all the fields of medicine during his undergraduate medical training. The different fields of medicine are provided for in the Nigerian Medical College Act. One of such fields of Medicine, relevant to this article, is the Faculty of Pathology.

The different Faculties of Medicine were created long before the enactment of the Medical Laboratory Science Council of Nigeria Act, which law created the medical laboratory science and scientists. The conflict between the medical laboratory scientists and the pathologists is that the medical laboratory scientists have asked the National Industrial Court of Nigeria to grant them professional autonomy, as well as declare that their profession was created to repeal and replace Pathology.

There is no place in any of the Nigerian laws that it is stated that the medical laboratory scientists have repealed and replaced the Pathologists. The request of the medical laboratory scientists was not based on any written law in Nigeria.

On the other hand, the pathologists maintained that the medical laboratory technicians/scientists were only trained to assist the pathologists with sample analysis and other sundries in the Pathology Laboratories. That was the state of affairs even before the creation of the Medical Laboratory Science profession in 2003.

The National Industrial Court, in some Teaching Hospitals across Nigeria, granted the request of the medical laboratory scientists that they repealed and replaced the pathologists by implication of law. This, the Court did, citing the leges posteriores principle. That Court, in effect, repealed the extant provisions of the Medical and Dental Practitioners Act, and the Nigerian Medical College Act, both of which have been in operation after valid enactment by the National Assembly of Nigeria in 1988 and 1975 respectively, on the mere leges posteriores principle of law.

The nagging questions abound. How do the medical laboratory scientists and pathologists work together in the Nigerian Teaching Hospitals. How do we retire, remove and replace all the pathologists in the Nigerian Teaching Hospital now that the Court has repealed the profession. How do we stop forthwith the training of more pathologists, as the Court has declared that the pathologists have been repealed and replaced by the medical laboratory scientists. How do we disband the Faculty of Pathology in the different Teaching Hospitals, Universities, and the Postgraduate Medical College of Nigeria. How do we alter the Nigerian Constitution to accommodate the medical laboratory scientists in section 144 of the Constitution.

Whether the presiding judge of the National Industrial Court ever considered the myriad cataclysmic implications of his pronouncements when he repealed the operational legislative statute of the medical profession on mere leges posteriores  principle of law, is beyond the scope of this article.

This article is not a treatise on the proprietariness of the judgment of the National Industrial Court, nor is it a castigation of that judgment. There is currently a stay and an appeal against that judgment as well as a determined effort to ignore the judgment by reorganized medical practices. But the truth be told that while the pathologists are amenable to working with the medical laboratory scientists as a veritable support staff, the medical laboratory scientists want the pathologists to vacate the pathology laboratories for them in its entirety. To the medical laboratory scientists, the continuous existence of the pathologists is a perpetual impediment to their progression to the zenith of their profession.

Remove the pathologists, and the medical laboratory scientists would then be able to Head the hospital laboratories. The headship of the hospital laboratory is the zenith of their profession. It is instructive to note that a medical laboratory scientist can aspire unhindered by any living being in Nigeria and attain the highest professional and academic zenith of their profession. They can acquire unimpeded a Masters Degree in medical laboratory science, a PhD Degree and the highest Grade Level in the Nigerian Civil Service. These ascendency, to the medical laboratory scientists, are not considered the zenith of their profession. The only zenith of their profession is the heading of the hospital laboratories in the Nigerian Teaching Hospitals.

Thus, bearing this topsy turvy idea of ZENITH, how do we accommodate the desires of the medical laboratory scientists in the Nigerian Teaching Hospitals for peace to reign.

The way forward can be found in the organization of the various Hospital Nursing Services in the Nigerian Teaching Hospitals.

The integration of all the medical support services in the Teaching Hospitals, namely the medical laboratory scientists and others, need to follow the "successful" organization of the Department of Nursing Services in the Teaching Hospitals.

This organization, if followed with the modifications I shall make infra, and the hospital management board favourably disposed to apply it, will bring peace again to the hospital laboratories in Nigeria. It must be noted that this arrangement will not only be for the Nurses and Medical Laboratory Scientists; the arrangement will extend to the Hospital Orderlies, Radiographers, Physiotherapists, Opticians etc.

How will this new set-up work. Let us first have a look at the current state of the organization of the Nigerian Teaching Hospital.

The Nigerian Teaching Hospitals are made up of the Administrative staff, the Clinical staff and the Technical staff. The Administrative staff category towers above the Clinical and the Technical staff categories, and it has no direct bearing on the subject matter of this discussion.

The Clinical staff category includes the medical personnel and the support staff. The medical personnel include the clinicians, the radiologists, other physicians and the pathologists. The support staff include the nurses and the hospital technicians. The hospital technicians include the orderlies, the laboratories technicians etc.

The Teaching Hospitals across Nigeria are also organized into Departments for residency training and the training of medical students, and other training purposes, as well as for clinical and other administrative purposes.

The clinical duty points in the various clinical departments include the Wards, Clinics, Theatres and the Laboratories including, but not limited to, the pathology laboratories.

These duty points are manned by, not just one professional body or professional but instead, by different professional bodies or professionals with one common goal, ie the legitimate satisfaction of the user's legitimate clinical needs.

At one duty point, using the Labour Ward as an instance, there are doctors, nurses, orderlies and messengers working in that point.

Now, the Labour Ward is a creation of the Department of Obstetrics and Gynaecology. The Department of Obstetrics and Gynaecology is the Teaching Hospital training ground for both undergraduate medical students of the Associate University and the postgraduate medical practitioners training in the Faculty of Obstetrics and Gynaecology of the Nigerian Postgraduate Medical College. The Nigerian Postgraduate Medical College is a creation of the Nigerian Medical College Act.

The Department of Obstetrics and Gynaecology is composed of medical practitioners from Professors of Obstetrics and Gynaecology, the consultants, the complement of residents down to the house officers and the undergraduate medical students. The Department is headed by a Head of Department who is an Obstetrician and Gynaecologist. The approvals and disciplines of members of this Department gets to the hospital management authorities through the Head of the Department.

The department of Obstetrics and Gynaecology is also a training point for the Nurses and Midwives. The Nurses and Midwives are not under the control of the department; rather, they are posted, and are under the Head of Nursing Services. The approvals and disciplines of these nurses also get to the hospital management authorities through the Head of Nursing Services.

The department of Obstetrics and Gynaecology is also involved in patient care of obstetric and gynaecology problems. The patients with obstetric and gynaecology problems are cared for by doctors and nurses working in the Department of Obstetrics and Gynaecology; yet these doctors and nurses are under different controls. As a team, the two professionals do not work in discordance. No. There is a smooth flow of command. The nurse knows her role as a support staff. She also knows her limits. She works with the obstetricians and his panel of residents to bring about a quality care for both complicated and uncomplicated cases in obstetrics and gynaecology, with the nurses each time looking up to the obstetricians for guidance and support. There is therefore a protocol that guides the relationship between these two professionals, with the obstetricians always providing the required clinical leadership and responsibilities.

The Head of the Nursing Services, posts the nurses to the different clinical Departments of the Teaching Hospitals. The Hospital Nursing Services Department is saddled with a lot of responsibilities as the number of nurses in the Nigerian Teaching Hospitals could be more than the number of doctors in all the Departments of the Teaching Hospitals put together. The Head of the Hospital Nursing Services coordinates the approvals, rotations and disciplines of the members of the nursing profession, as well as controls the other nursing professional prerogatives. The nurses therefore rise to the zenith of their clinical profession by heading the Department of Nursing Services, in addition to other snippets of Zeniths of that profession.

The above arrangement, with my proposed modifications, is what the medical laboratory scientists need in our Teaching Hospitals.

Each hospital management board should establish a Medical Laboratory Supplies Unit. The Unit shall be headed by a medical laboratory scientist. The functions of this Unit should be to post and control medical laboratory technicians and scientists to the different pathology laboratories and side laboratories of the Teaching Hospitals, just the same way that the Department of Nursing Services post and control nurses in all the clinical service points of the hospital. These medical laboratory scientists and technicians shall work under the Pathologists who would always provide the needed leadership in clinical laboratory diagnosis of diseases. The approvals and disciplines of the members of this new Unit should get to the hospital management authorities through the Head of that Unit through a proposed Department of Support Services. The medical laboratory professionals can now reach the peak of their profession and everybody would rest. All the paramedical professional groups can aspire to head this new Department of Support Services.

It must be noted that this proposed medical laboratory Unit and any other Units created for the support staff shall have no parent Faculty, as they have no Associate University. They shall only have a parent Department of Clinical Support Services that is directly under the CMAC. They also do not have any clinical job protocols of their own. The proposed Units are only for the posting of members of their staff to the relevant Medical Faculties as support staff. What their staff members do in the Faculties are to be determined by the Faculty Board of the recipient Faculty, just as it is obtained with the nurses posted to the different Faculties; and not by any specific assignment by the posting paramedical Units. The design of the Faculty Board Protocols for all the staff members working in a Medical Faculty of the Nigerian Teaching Hospitals shall take into consideration the representation of the different professional bodies working in the Faculty, the relevant laws or regulations establishing the Teaching Hospital and the professional bodies, and the scheme of service of all the constituting professional bodies working in the Medical Faculties.

This is the method and arrangement that successfully applies to the nurses and it would be good for, not only the medical laboratory professionals, but also to any other paramedical professionals that demand for hospital professional autonomy in our Teaching Hospitals across Nigeria.

The modifications here is that Department of Nursing Services will have to be abolished and replaced with Nursing Supplies Unit, which shall also be under the Department of Clinical Support Services. The Nursing Supplies Unit, just like all other Support Staff Supplies Units, shall be responsible for the posting of members of their professional group to the newly created Medical Faculties. The nurses will also compete with all other members of the support staff for the headship of the to-be-created Clinical Support Staff Department.

However, a new Department to be called the Department of Nursing Training, shall be created under the office of the CMAC. This department shall be specifically created for the management of the Nursing School under the CMAC. It should not be mixed with Nursing Supplies Unit which is for the posting of nurses to the Medical Faculties.

It has not ended here though. The members of the medical profession who are consultants in their different fields might feel shortchanged that a more junior staff of a paraprofessional body is allotted an air-conditioning apartment as Head of Department, while he still has no office to work from.

The solution to this, though it may appear costly, and thus not be appealing to those with disposal action, is to convert all the medical departments in the Nigerian Teaching Hospitals to Faculties, taking a cue from the provisions of the Nigerian Medical College Act. These Faculties would feed directly the Faculties of the Postgraduate Medical College of Nigeria.

These Faculties will thereafter be split into Departments. This new order and arrangement will not only afford more consultants more opportunities to head departments and reach the Zenith of their profession, it will also spur competition, as well as expand specialization in the different Faculties of the Nigerian Teaching Hospitals, and improve medical training and patient care. To, cut costs, these new Departments may exist in the minds of the consultants rather than in physical structural departmental edifices.

Every member of staff can actually be cleared to the CMD through their Medical Faculty thus: The CMD, Thro The CMAC, Thro The Dean of the Medical Faculty, Thro The Head of Department, Thro The Unit Head. While Consultants shall head the Faculty departments, the Senior Registrars shall head the Medical Units.

Awkadigwe Fredrick Ikenna
(MBBS, LLB, MWACS, DSC)

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