MDCN and the Practice of Medicine Limitations and Way Forward
By
Dr. T. A. B. Sanusi,
BDS, M.Bioethics, LL.M
Registrar,
Medical & Dental Council of Nigeria
Introduction/Historical Perspectives
Regulation of Physicians and Dental Surgeons in Nigeria preceded the statutory provisions
Portuguese were the first set of allopathic doctors recorded in Nigeria, came in 1472
In the year 1504, the Roman Catholic Mission opened a hospital at St. Thomas Island off the Bight of Benin
About same period the Trans Atlantic slave traders came with ship doctors and surgeons that attended to the healthcare needs of the slavers and slaves
During the year 1865, the Roman Catholic Mission established another hospital, the Sacred Heart Hospital at Abeokuta whilst St. Margaret’s Hospital Calabar also came into being in 1898
Before the establishment of these hospitals, a medical examining board in 1789 recorded doctors’ names mainly Dutch, followed by Danish and British names on its register
Notably most of the explorers that came to Nigeria were medical men such as Mungo Park, David Livingstone, Schnister, John Kirk
Some of the doctors of Dutch West Indies Company went to Benin and treated the local people
West African Medical Service originated from the West African Frontier Force with the Medical Departments of the various British Colonies( Nigeria, Ghana(Gold Coast), Sierra Leone and the Gambia) established in1902
It was in that era that the regulation of the conduct of medical and dental practitioners started in Nigeria
Thus establishing the Medical Practitioners Disciplinary Board in the Colonial Dept of Health for the doctors whose names were in the register of GMC in England with the Director of Medical Services being the Chairman
This position of statutory regulation of the professions of Medicine and Dentistry was maintained till independence in 1960
The indigenous statutory regulation came into being through the effort of the then and first Nigerian Inspector of Medical Services, Sir(Dr) Samuel Manuwa
This effort culminated into promulgation by the Federal Parliament of the Medical and Dental Practitioners Act that became operational from 18th December 1963
This law created Nigeria Medical Council, the first regulatory body for the professions of Medicine and Dentistry in Nigeria
Had its Inaugural Meeting on Saturday 24 October 1964 at the Boardroom of the Federal Ministry of Health
Dr.S.O.Awoliyi was the first President with memberships drawn from;
University of Ibadan
University of Lagos
Ministry of Health,Kaduna
Ministry of Health,Ibadan
Ministry of Health,Enugu
Ministry of Health,Port Harcourt
Royal Orthopaedic Hospital,Igbobi,Lagos
Vom Hospital,Vom,Northern Nigeria
Private Practice
Dr.M.S.Graham-Douglas was the first Registrar of Council
Mandates of Council
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
Securing in accordance with the provisions of this Act the establishment and maintenance of registers of persons entitled to practise as members of the medical or dental profession and the publication from time to time of lists of those persons
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
Performing the other functions conferred on the Council by the Act
Following the amendment by Decree 78 of 1992, the functions of MDCN were expanded to include;
Supervising and Controlling the practice of Homeopathy and other forms of Alternative Medicine i.e. Naturopathy, Acupuncture and Osteopathy
Making regulations for the operation of Clinical Laboratory Practice in the fields of Pathology, which include Histopathology, Forensic Pathology, Autopsy and Cytology, Clinical Cytogenetics, Haematology, Medical Microbiology and Medical Parasitology, Chemical Pathology, Clinical Chemistry, Immunology and Medical Virology.
Registration
Provisional: This is granted on graduation from accredited medical school or passing the Assessment Exam i.e. foreign trained graduates as this will enable newly qualified to the mandatory one year housemanship
Full: Granted immediately on successful completion of housejob
Limited/Temporary: Granted to foreigners wishing to practise in Nigeria. Here there are two types, those with recognised additional qualification(s) may not need to sit for assessment exam while those without recognised additional qualification will sit and pass assessment exam before registration.
Challenges of Registration
Foreign trained graduates now come with unverifiable certificates
Some foreign trained graduates don’t have our minimum entry requirements into local medical schools
Non payment of practising fees as at when due
Universities not releasing the degree certificates on time especially for those seeking for full registration
Internship training centres releasing these doctors and signing them off before completion of housemanship
Teaching Hospitals reluctance in engaging the house officers to fill up the quota granted by MDCN
Impersonation/Falsification/ “Quackery”
Non Payment of Practising Fees
Section 14(5) MDP Act states “Any medical practitioner or dental surgeon who in respect of any year and without paying the prescribed practising fees practices as such shall be guilty of an offence and shall be liable on conviction:
In the case of a first offender, to a fine of twice the prescribed practising fee; and
In the case of a second or subsequent offence, to a fine of not less than ten times the prescribed fee, and if the medical practitioner or dental surgeon is in the employment of any person, that person shall also be guilty of an offence and punished in like
manner as the medical practitioner or dental surgeon unless he proves that
the failure to pay the practising fee was without his knowledge, consent or
connivance”.
Inspectorate
Due to various challenges in the practice, Council at its December 2007 meeting at Ado Ekiti created this department with the following functions;
-Inspection of Accredited Medical/Dental Schools
-Inspection of Internship Training Institutions
-Licensure
Education
Prior to Decree 67 of 1979 MDCN had jurisdiction over both undergraduate and postgraduate trainings.
The only postgraduate training under MDCN now is the housemanship
Essentially MDCN prepares the Minimum Guidelines for Medical and Dental Education at the undergraduate level
Section 9 of MDPA is instructive with subsection 3 conferring the legitimacy of instituting the Assessment Exam on the holders of foreign medical or dental qualifications recognised by the government of the countries from where such qualifications are obtained.
Professional Discipline
Section 15 of MDP Act Subsection 1 established Disciplinary Tribunal which is our domestic court that technically has a status of the High Court
Subsection 2 is about the composition of the DT, stipulates that the Chairman of Council is the Chairman of the DT with other ten members that shall include not less than two persons who are fully registered dental surgeons.
Subsection 3 established the Investigating Panel whose function includes
Conducting a preliminary investigation into an alleged professional misconduct
Compelling any person by subpoena to give evidence before it
Make order for interim suspension of registered practitioners for the protection of the members of the public
Subsection 4 provides that Council shall appoint fifteen members of the Panel with not less than three dental surgeons as members
Please note the difference between memberships of both Disciplinary Organs of Council.
Penalties For Professional Misconducts
Striking off the name from the relevant register
Suspension from practice for a period not more than six months
Admonishing the registered practitioners
Limitations of MDCN
Lack of funding despite adequate budgetary proposal
Frequent dissolution of Council
Disciplinary organs of Council can not function anytime it is in abeyance
Council can not prosecute quacks caught.
Ways Forward
Allowing the perpetuity of Council via constitutional amendment so that when boards of parastatals are dissolved regulatory bodies are exempted
Another constitutional amendment that will not tie the membership of the disciplinary organs to members of Council alone esp. DT
Good Funding
Allowing the doctors to take its statutory positions on the boards of other professions allied to Medicine and Dentistry esp. on their Education Committees
How much is payment for additional qualification and how can I pay.
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