ARD UNTH: UNTH Doctors cry out

21st October, 2015

PRESS RELEASE BY THE ASSOCIATION OF RESIDENT DOCTORS OF UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU OZALLA, ENUGU STATE (ARD UNTH) ON THE REASONS BEHIND THE PRESENT INDUSTRIAL DISPUTE IN UNTH.

Preamble

The Association of Resident Doctors, University of Nigeria teaching Hospital, Ituku Ozalla, Enugu State recommenced total and indefinite strike action on Friday, 16^th October, 2015 to press home our various demands which border on the inability of the Chief Medical Director (CMD) of UNTH, Dr Christopher C. Amah to maintain an acceptable level of sincerity and uprightness in the management of affairs of the hospital.

The current CMD has destroyed what is left of UNTH through corruption and gross insensitivity to the plights of the patients and staff of the hospital. His incompetence, corrupt practices and high handedness has reached the level that can no longer be condoned by doctors in UNTH.

The CMD’s continued boast/brag that he can neither be sacked nor queried by the President of the Federal Republic of Nigeria irrespective of how long any group remains on strike has become an issue for the listening ear of President Muhammadu Buhari and the general public.

Current Issues

1) Gross and unimaginable degeneration of hospital facilities and quality of services

It is not exactly out of place to classify UNTH as a death trap, because it barely has what it takes to qualify for a primary healthcare facility, say for manpower. As it is now, a UNTH that is on strike is more beneficial to the masses than a UNTH that is not, this is because a working UNTH exposes both patients to untold and unimaginable risks and health hazards.

A situation where common medical diagnostic equipment, as simple as sample bottles for blood and urine collection, syringes and needles are unavailable, is most appalling to say the least. Dying patients are forced to travel a distance of over 20kilometres to private facilities to access these basic investigations. The laboratories in UNTH lack appropriate reagents and equipment to conduct basic and near complex laboratory investigations despite having very well trained laboratory physicians and scientists ready to offer these services.

A hospital as big and supposedly prestigious as UNTH cannot offer continuous x-ray services for 3 consecutive days in week, forcing patients to leave the hospital for an investigation as basic as this. More sophisticated equipment are acquired through dubious means and sabotaged thereafter, such that equipment like CT Scan Machines and Radiotherapy machines are available in the hospital but in a non-functional state for months now. These patients who obviously have no choice are forced to either move to Enugu urban, over several kilometers away, to access CT-Scan and MRI or even travel as far as UCH Ibadan, LUTH Lagos, and National Hospital Abuja to get radiotherapy services for the treatment of cancers.

Most patients who come in with mild to moderate injuries/ailments, become victims of UNTH by the time they are tussled and ruffled down to Enugu urban, over 40 kilometers, to access these basic and almost mandatory investigations which has epileptic and unstable availability in UNTH. Many of these patients either die in transit or have their injuries/ailments further complicated and worsened, while the health workers look on helplessly, most of them afraid of speaking up for fear of victimization. The hopelessness of the situation has created job dissatisfaction for health workers, with some of them being inpatient to retire and ago, feeling in part responsible for these demises.

Even sheets for taking clinical notes, forms for drug prescriptions and laboratory requests are most times nowhere to be found in UNTH. In some cases especially for laboratory forms, patients are given that one remaining copy to photocopy compulsorily before submitting samples to the labs.

Poor and dilapidated state of the consulting rooms and hospital wards are better imagined than experienced. Bed bugs, rodents and even reptiles thrive in these areas. Torn insect proofing on windows have not been changed for a long period of time, ensuring adequate spread of insect borne diseases across board. As we write, there are no bathrooms in the wards in UNTH, patients and their relatives are forced to take their baths in the open bush surrounding the hospital complex. Males and females, old and young are all subjected to this most dehumanizing condition. Patient relatives who come in healthy most times go home with malaria and other contagious diseases.

With a heavy heart, we inform Nigerians that as at today, there is no available running water in the major areas of the hospital. For example, the general and private wards, clinics and laboratories, despite the much ado by the hospital management that they have sunk ultra-modern boreholes in the hospital, do not have available running water. Even theatres do not have access to running waters, as such scrubbing before surgeries are improvised in a hospital supposedly as prestigious as UNTH.

Most disheartening, patients in UNTH are forced to draw water from a relatively shallow well as old as the name UNTH itself for their basic needs. The implication of this on the health of the patients and their relatives who use it should be better imagined. Even primary health care centres have moved beyond in line with the Millennium Development Goals.

So far, we are happy to inform Nigerians that following our cry out and in a desperate attempt to cover his numerous ills and acts, Dr C. C. Amah brought in borehole drillers on Tuesday, 20^th October, 2015 to continue the abandoned borehole project. It pains us that Dr C. C. Amah would wait till services are withdrawn before doing the needful. In this, we are happy that our cry out to and for the masses has already started yielding results.

Basic and emergency drugs are not always available at the pharmacies as patients travel these same distances to assess drugs prescribed for them from private pharmacy outlets in Enugu town. Many patients die due to unavailability of emergency drugs in the emergency rooms. Most times, doctors and other health workers have to contend with unavailability of hand gloves and even methylated spirit for months, without explanation, with resultant stress being transferred to patients and their relatives. Several reports by Heads of Departments and their representatives on these pressing issues to the Dr C. C. Amah led hospital administration have been to no appreciable or palpable avail. The risks which medical and health workers in UNTH are subjected to, the travails they pass through in a bid to provide healthcare services in UNTH is quite enormous, and has now been pushed beyond limit.

This has greatly affected negatively, the outcome of patients being treated in the hospital when compared to those treated in private hospitals in Enugu. This has also most negatively affected the training and psyche of resident doctors and medical students, and has led to the loss of accreditation of the Medical and Dental Council and the National and West African Postgraduate medical colleges in different departments, particularly Paediatrics and Dentistry.

The fact that UNTH has become grazing grounds for cattle is no longer news. UNTH has become an abode for animals, both wild and domestic, due of the gross irresponsibility of the UNTH management to sustain the proper level of grasses around the main hospital complex and staff quarters. While patients and UNTH staff are exposed to all forms of infections being transmitted by these animals, others are exposed to the deadly attacks of wild animals especially snakes and scorpions.

2) Illegality and disregard for due process in employments

Job racketeering in UNTH is a fact that cannot be swept under the carpet. The fact that people pay to get jobs in UNTH is an open secret that cannot be overemphasized.

It is only in UNTH that employment letters are most times backdated and people are made to also backdate their acceptance letters and dates of resumption, a dirty way of siphoning funds from federal government coffers. Some of these staff at the point of employment even received pay slips of the money they never received, and these were for months they did not work but were covered by the backdated appointment letters they so received. The employments have even become so petty that appointment letters are now issued in hotel rooms. This is better imagined.

In UNTH, people even start work without due process of filing and mandatory medical examination and arbitrary grade levels are assigned to them without due consideration and reference to the extant laws as enshrined in the public service handbook. Many staff in UNTH as we speak are even yet to do the mandatory pre-employment medical examination. Others did so after having worked for many months. These people, of course, were not reprimanded by the Dr C. C. Amah led hospital management, lending credence to the fact that they may have paid heavily for the jobs and are as such untouchables lest they expose their route of entry.

3) Over bloated Service charges and Corrupt financial practices in UNTH

Patients are made to pay through their noses to assess the substandard healthcare services offered in UNTH. They pay such exorbitant fees for little or nothing offered them in return.

For example, every patient entering the ward or theatre is forced to pay an enormous amount of N7, 500 for oxygen whether they need it or not. Fees are fixed with so much impunity and without regard to the poor helpless Nigerian masses that depend on UNTH for their healthcare needs.

The Hospital theatre is run by a cartel that collects monies for disposables and lab tests without issuing hospital receipts for them. Even after collecting these monies from patients, surgeries end up being cancelled because of unavailability of the same disposables patients had paid exorbitantly for. When surgeries are re-booked, patients go through the same process of paying fresh bills for them.

Details of the fraud on-going in the open heart surgery charade in UNTH will be a story for another day.

4) Unlawful withholding and misappropriation of Staff Salaries

In a display of gallantry in the field of corruption, the management of UNTH led by Dr C. C. Amah has mastered the act of diverting salaries of staff of UNTH. There is an age long practice in UNTH where by newly employed residents and houseofficers will be denied their call duty allowance for their first month in the hospital. When the going was good in UNTH, once the staff finishes his/her program and exists the system, the staff is paid this withheld money immediately with the last salary or at most by the successive month.

Now, this money once deducted will automatically become the property of the UNTH management to misappropriate. To cover their ills, they will subject people who have left the system with all forms of letter, begging from one office to the other for their legitimate salaries.

As we write over 100 house officers that finished their one year housemanship are still being told stories and denied their legitimate salaries up to 8months now. Many of the resident doctors who have exited the system are also begging for their unpaid salaries years after they left the system.

This is just a tip of the iceberg of the magnitude of misappropriation of funds ongoing in UNTH. Fraudulent award of contracts to close relatives of the CMD and his cronies as a safe haven for diverting funds from UNTH will be exposed in time.

5) RENUMERATION OF DOCTORS

A) Proper placement of Doctors

The Federal Government of Nigeria, through the Head of Civil Service of the Federation (HCSF), in Circulars referenced HCSF/EPO/EIR/63755/11/192, dated 4^th November 2013 and reference No: HCSF/EPO/EIR/63755/T1/195, 19th of December, 2013, and the Director of Hospital Services, Federal Ministry of Health (FMOH) through a letter with reference no: C.3884/Vol. 1 dated 19th of December, 2013, explicitly and clearly approved the skipping of salary grade level for Medical and Dental Officers in Federal Civil Service. It was clearly directed that the equivalent of CONHESS 10 should be skipped for the CONMESS structure following a National Industrial Court judgment which directed that CONHESS 10 and its equivalents should be skipped for federal health workers.

Since this Judgment and subsequent directives were given, most Chief Medical Directors (CMDs) and Medical Directors (MDs) of federal tertiary health institutions commenced immediate implementation for other health workers since 2013 but not for medical doctors. The NMA and NARD made various attempts to correct this anomaly, when in 2014, the CMDs and MDS were yet to start the implementation. This was one of the cardinal reasons NMA embarked on a 2months nationwide strike in July and August 2014. The strike was called off based on the promise by the Federal Government that the financial implication of skipping of CONMESS will be captured in the 2015 personnel cost budget as the main reason then was that CMDs/MDs did not capture it in the budgets of their respective MDAs.

In UNTH, we were initially informed by several high ranking members of UNTH Management team including the Chief Medical Director Dr C. C. Amah, the Deputy Director of Finance Mr C. C. Onuchukwu and the officer in charge of budget in the accounts department of UNTH, that Doctors in UNTH were properly placed/captured in the 2015 personnel cost budget.

At first, UNTH Management, after initially feigning ignorance of properly capturing doctors in the 2015 personnel cost budget, claimed that the reason why they can't implement the budget which has been approved is because of the global short fall in release of funds to MDAs, this was debunked by the fact that personnel cost budget can only be tampered with if it will be replaced by the supplementary budget, otherwise you leave civil servants without salaries. More so, having captured Doctors correctly, we expressed concern why only Doctors should bear the brunt of a shortfall, if FG cannot sustain the salaries of civil servants, you either pay everyone a percentage of their salaries or pay full salaries up till where the funds released can cover.

When our superior argument on the excuse of shortfall prevailed, the UNTH management craftily moved to non-availability of template for implementation of skipping for Doctors as their handicap for paying skipping. Again we referred them to the Federal Government Circulars which made exclusive and clear reference to the equivalence of CONHESS 10 as the level to be skipped for CONMESS. It took the Permanent Secretary of the Federal Ministry of Health another circular released on 29^th July, 2015 with reference C.2262/T/111 to explain simply English Language to our hospital management, clearly stating that CONMESS 2 is the equivalent of CONHESS 10 and expressly directing them to commence payment and guide their future budget articulation.

With this again put to rest, our CMD has now come up with another gimmick, that the Chairman, National Salaries Incomes and Wages Commission (NSIWC) gave a verbal directive against skipping as such he will not pay us our proper emoluments lest he be prosecuted; we want to draw the attention of Mr. President on the following points as regards this fraudulent claim:

i) The circular for skipping of Doctors emanated from the highest level of civil service hierarchy, the Head of Civil Service of the Federation (HSCF) and it followed an industrial court judgment. We believe NSIWC should be under the HCSF and as such will not issue directives contrary to the directives HCSF. More so, since the circular from the HCSF followed a NIC judgment, making such statements as Dr C.C.Amah claimed is making an attempt to challenge the Court. This simply explains why The Chairman NSIWC could not have said that talk more of committing it in writing least he will be held in contempt of Court.

ii) As at now, more than 24 Federal Tertiary Health institutions in Nigeria are paying doctors their appropriate salaries based the court ruling and appropriate FG circulars. To limit the examples to the south east region of Nigeria where UNTH is situated, all federal tertiary hospitals have started implementing the FG directive either in full or in part. While the managements of National Orthopaedic Hospital Enugu and Federal Teaching Hospital Abakaliki have continued to comply fully with directives of Federal Government as per the proper placement of Doctors, those of Nnamdi Azikiwe University Teaching Hospital and Federal Medical Centre Owerri have done so in part. This is another clear show of shame on the part of Dr C. C. Amah.

We as Resident Doctors of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu have after following due process for dialogue, spent over 45 days after our first notice of strike making every attempt to prevent service disruption in the hospital, was forced to embark on an indefinite strike following the Hospital Management's inconsistent position on proper placement of Doctors, reneging on their several promises to pay our due entitlements as covered by relevant laws of the land.

B) 2014 Teaching allowance arrears

Early last year, the Federal Government issued a directive stopping teaching allowance for house officers and junior residents, this was firmly opposed with valid reasons from the NMA and NARD leading to the Federal Government immediately reversing her directive. The federal government thereafter gave a clear directive that resident doctors should be paid teaching allowance.

Almost every institution in Nigeria followed this directive and started paying their doctors teaching allowance as directed by the federal government. Our CMD, Dr C. C. Amah remained adamant and refused to pay doctors the teaching allowance as directed. Following repeatedly failed negotiations, ARD UNTH embarked on strike in March last year to demonstrate their dissatisfaction with their rights being trampled upon by the tyrant CMD, Dr C. C. Amah. It took the intervention of well-meaning Nigerians and the Medical and Dental Consultants Association of Nigeria (MDCAN) UNTH Chapter, to convince us to resume duties, since this was a legal issue concerning our emoluments, that they will prevail on the CMD to pay us our due allowances, for us to suspend the two weeks old strike.

Despite these interventions, the CMD as we write, did not pay the teaching allowance throughout last year, and has also not paid the arrears till date. Little wonder, those who prevailed on us during the last industrial action over 18months, had no moral justification to approach us this time.

The CMD claimed the hospital had no resources to pay teaching allowance in 2014, yet after paying normal December 2014 salaries, the hospital had over four hundred million naira (N400, 000, 000.00) left in her personnel cost envelope in the GIFMIS account which was taken back into the federal government coffers, meanwhile the whole teaching allowance owed all deserving members in UNTH would have cost just about twenty four million naira (N24, 000, 000.00).

As we write you Sir, UNTH is the ONLY federal health institution in Nigeria where residents were not paid Teaching allowance in 2014 and are still being owed the arrears.

C) Advancement of Residents/Promotion Arrears

The unnecessary bureaucratic bottlenecks experienced by resident doctors in their advancement and that experienced by other healthworkers in their promotion have become enormous and unbearable. A situation where a registrar will pass the prescribed exams and apply for advancement and it takes the hospital management over 9months to process same has called for a public outcry.

To make matters worse sir, when the advancement/promotion are processed and dated back to the effective date the doctor became qualified for the promotion, the accounts department will still refuse to pay the accrued arrears.

In a recent and daring show of shame, the CMD and his cohorts, after misappropriating personnel cost funds of UNTH, ventured into unlawful demotion of some recently promoted members of staff in UNTH including Residents. Though they claim this was as a result of high wage bill as against available funds, they have refused to make available the nominal roll used to disburse personnel funds to ascertain the true financial state of the hospital as claimed.

Their continued refusal to expose this document to ascertain the claim further gives credence to the massive corrupt practices ongoing in UNTH. Full details on this will follow this press release.

D) Two months relativity arrears

Last year, there was an adjustment in the CONMESS salary structure to reflect relativity, which was supposed to be effective from January 2014. The Federal Government in the last quarter of 2014, released two months arrears for such payments, but UNTH management only paid some doctors and left a good number of deserving doctors either under paid or not paid at all. These people were properly and duly captured in the budget submitted for the arrears and funds released in full, but in their usual act of impunity, they only paid some people and left the funds for the remaining people yet unaccounted for

6) Lack of Due Process in the re-appointment of Dr C.C Amah as CMD

We have noted with great dismay, the gross irregularities in the re-appointment of Dr C.C Amah. There was a wide shift from the routine advertorial for the office, followed by an interview process that will select three people, for the honorable Minister for Health to present to the President from which he would make an informed selection. The appointment however remains the prerogative of the President of the Federal Republic of Nigeria.

We have reasons to believe that the appointment of Dr C.C Amah was not unrelated to the over four hundred million Naira (N400, 000, 000. 00) the hospital intentionally left in their accounts till December 31^st, 2014 which got sucked back into the FG coffers. We believe this was a premeditated action, an indirect way of paying for his second tenure. They caused the return of these monies despite enormous and legitimate arrears being owed to all cadres of staff in UNTH as at December 2014.

Truth be told, there is no CMD in UNTH. The tenure of Dr C.C Amah ended on 16^th may, 2015. He is in that office on the erroneous authority of a fraudulent document which we believe he bribed his way to get through the then Minister of State for health, Dr Khaliru Alhassan who signed the document. This document dated 4^th December, 2014 is reappointing Dr C.C Amah almost 6months in advance, an anomaly of the greatest order! To lend credence to this fraud, the Hospital PRO, Mr Keleze communicated the staff and general public of Dr C. C. Amah’s reappointment 6 months after the letter was signed and delivered, painting a picture that Dr C. C. Amah was just reappointed.

The fraudulent manner in which Dr C. C. Amah went about his charade re-appointment and succeeded may have given him the courage to continue with his impunity with reckless abandon. Little wonder, Dr Amah has boasted in several quarters that he is untouchable and can neither be queried by the Federal Ministry of Health nor the President of the Federal Republic of Nigeria, no matter how much any person or group of persons in UNTH cry out. There is the saying that ‘every day is for the thief but one day is for the owner of the house’, the real owners of UNTH are the Nigeria and we do not in all honesty believe that the President, who has maintained a track record of zero tolerance to corruption, will look the other way especially now that the several ills in the Dr C. C. Amah led UNTH has been brought to fore.

Our Prayers

Our demands are simple, logical and straightforward;

1) ARD UNTH calls for the immediate sack of the Chief Medical Director, Dr Christopher C. Amah over allegations of high wired corruption, seizure of staff salaries, high level of extortion of patients, purported sale of appointments, high handedness and reckless looting of hospital funds resulting in gross lack of facilities and poor working conditions in UNTH Enugu.

2) We are calling for an overall probe of the administration of Dr C. C. Amah with an aim to giving justice to the numerous patients who have died or suffered undue morbidity in UNTH because of the poor working/service condition imposed on them by the incompetent CMD.

3) That while we demand for a total overhaul/rebooting of UNTH with an aim to delivering appropriate tertiary healthcare services for Nigerians, doctors in UNTH should be brought at par with their counterparts in other tertiary health institutions by properly placing and paying them as directed by the Federal Government.

Signed:

Dr Ugwuoke Aloy Ifedinso

President

ARD UNTH

Dr Ndiokwelu Chibuzo