Last week, Governor Nasir el-Rufai of Kaduna State returned to what he is best known for: creating ripples in silent waters. The fiery fervour with which doctors in public hospitals ripped off helpless patients has portrayed them as Mammon worshipers rather than professionals committed to saving lives. Many healthcare seekers have plunged to their graves due to the inability of victims/relations to cough out whopping sums to secure treatment. Even at the federal level, the deteriorating state of health has been attributed to poor commitment by health practitioners, especially doctors. As far back as 2017, the federal government had announced a plan to bar doctors in public service from private practice in the hope that increased commitment by doctors was capable of ensuring better days ahead for the crawling sector. The move by el-Rufai to prevent government doctors from private practice resonates with the earlier threat by the former minister of health, Professor Isaac Adewole. Sounding upbeat on his government’s determination to emancipate the state’s health sector from ruination, el-Rufai disclosed a plan to pass a law that will constitute an act of illegality for doctors working in public hospitals to engage in private practice.
On a simple level, this approach could turn out as a prologue for the common good of rejuvenating the state collapsing public health system. This plan to bar doctors from private practice runs contrary to Section 4(1) of the Constitution of the Federal Republic of Nigeria (CFRN), as amended, which regulates private practice by medical doctors in public service. The plan to bar doctors from private practice is in clear violation of relevant laws enacted by the National Assembly. It is an incontrovertible fact that the role of most doctors in these public hospitals is in clear breach of what they were employed for. While some of them may be engaged in private practice to complement meagre salaries , the absence of regulatory measures makes a chaos of the entire system. Relevant laws in Nigeria, including Code of Medical Ethics, recognise the right of doctors in government hospitals to engage in private practice. Rule 49 of the code states: “(1): Medical and Dental practitioners who are in full time employment in the public service in Nigeria are free to employ their spare time and unofficial hours to engage in medical or dental practice for remuneration as follows: a) A registered practitioner in full time employment in the public service shall not engage himself in extra-mural private practice during official duty time under any circumstances. b) A registered practitioner who holds the appointment of Consultant status or a medical or dental officer of more than ten years post-registration experience may run one private consulting clinic which will open for business only during periods when he is not on official duty.”
Giving green light to doctors to participate in private practice, section d notes: “A registered practitioner of more than ten years post-registration who is in full time employment in the public service but is not engaged in clinical responsibilities in the public hospital may engage, outside the official duty hours, in clinical practice in an institution owned and run by full time private practitioners or hold consultations only in his own consulting clinic.”
From the above rules, it is crystal clear that neither the state governor nor the Kaduna State House of Assembly possesses the powers to bar government doctors from private practice. On the basis of what the above rules stipulate, it is beyond the powers of the governor and the state lawmakers to determine what doctors should do with their spare time. Any attempt at barring them from engaging in private practice could be viewed as tampering with their indisputable rights to their dignity and personal liberties as guaranteed in sections 34, 35, 38 and 41 of the Nigerian constitution.
It is a tragedy of monumental proportion that medical doctors who should be in the business of saving lives have become businessmen and women in search of filthy lucre. The urge to become wealthy has beclouded their sense of professionalism. As in other national sectors, the nation’s health sector has been invaded by people who worship money and will do anything to compromise their professional calling. The governor may be right in his motive, but he cannot achieve his objective in the face of dearth of health personnel and facilities, both of which threaten the well-being of the citizenry.
At a personal level, I have been a victim of the amoral disposition of these government doctors who have turned the public service into a marketing platform to enrich their private practice at the expense of poor Nigerians. One of my kids in 2009 had a minor problem and we were recommended to meet an experienced orthopaedic doctor at the Asokoro Hospital. After examining my child, the doctor recommended a cast on my child’s leg. When later we returned for a review after two weeks as recommended, the doctor was nowhere to be found, as he had zoomed off to only-God-knows where. The other doctors on duty and those in charge of the cast insisted we wait until he returned. Alarmed by the discomfort of my child, I approached a private orthopaedic doctor in Abuja who immediately removed the cast that had created a bigger problem. He eventually recommended an operation that sorted out the problem.
Again, in 2011, there was another need for medical attention for another of my kids. Without a waste of time, I returned to the private hospital. Surgery was recommended and I had to cough out good money. Unfortunately, we were not as lucky this time around. After several years of hoping for the leg to straighten, I reluctantly decided to try my luck after I paid the sum of N10, 000 as consultation fee. When I finally met the doctor, I was transfixed as I came face-to-face with the man who abandoned my child in 2009 in a public hospital. I reminded him of my experience in the past; he profusely apologised and said: “I had to travel for a course to update my knowledge. As for your kid’s leg, it was poorly handled. I can fix it for N500, 000 without any form of surgery.”
I left with an intention to return, but I never did. Just few months ago, I approached a consultant orthopaedic in Abuja. He recommended urgent action in a public hospital as the fees charged in his hospital were exorbitant. Some of us are no strangers to the recklessness of some doctors in public service.
We will be too glad to welcome any development aimed at dealing with the criminal neglect and, sometimes, wrong diagnoses of patients that have dispatched thousands to early graves.
What is needed now is not barring doctors from private practice, but evolving effective regulatory measures to ensure that doctors in public service are made to perform their jobs during their official hours. Those who cannot do their jobs should be shown the way out. Any attempt to bar doctors from private practice will breach existing laws and lead to further complications. Two wrongs do not make a right.