Medical Practitionersand Dentists Act 253 - as Plain Text by MWakili

L.N.182/1979, L.N.

288/1979, L.N.

289/1979, THE MEDICAL PRACTITIONERS AND DENTISTS (PRIVATE PRACTICE) RULES PART 1 PRELIMINARY Citation These Rules maybe cited as the Medical Practitioners and Dentists (Private Practice) Rules.

Interpretation In these Rules, unless the context otherwise requires advertise means to issue or cause to be issued a sign, notice, circular, label or wrapper or to make any announcements orally or by means of producing or transmitting light or sound; approved clinical laboratory means a private clinical laboratory which is covered on a full-time basis by a pathologist and is so equipped as to enable the carrying out therein of investigations in clinical chemistry, haematology and microbiology; approved medical institution means a Government or private hospital or nursing home which has been declared by the Board to be an approved institution; approved radiological laboratory means a private radiological laboratory which us covered on a full time basis by a radiologist and is so equipped as to enable the carrying out therein of investigations in general radiology in addition to special radiological investigations; clinical means consulting rooms, offices or an outpatient department without beds used by a practitioner for the diagnosis and treatment of disease or the giving of medical or dental advice and instructions; clinical laboratory means premises for examining specimens for the purpose of providing information on diagnosis, treatment or prevention of disease; clinical radiological laboratory means premises in which ionizing radiations are used for nuclear medicine, diagnostic research or therapeutic purposes; general practice means the practice of general medicine or chemistry other than specialist practice as defined in these Rules; hospital means an institution which has, in addition to resident medical practitioners or dentists, an operating theatre and a mortuary; immediate supervision means being available to give help and guidance when required; ionizing radiations means gamma rays, x-rays, alpha and beta particles, high speed electrons, neutrons, protons and other nuclear particles or electromagnetic radiation capable of producing ions directly or indirectly in their passage through matter; laboratory medicine means the practice of all or any of the following disciplines, namely pathology, clinical chemistry, microbiology and parasitology, haematology, morbid anatomy and histology, cytology, immunopathology, forensic pathology and other disciplines relevant thereto; license means a license to engage in full-time or part-time private practice; locum means a registered medical practitioner or dentist substituting and providing services for another registered medical practitioner or dentist; maternity home means any premises used for the reception of expectant women or of women who have given birth within the preceding six weeks; medical laboratory technician means a holder of a certificate in medical laboratory technology issued by the Medical Training Centre or similar institution which is recognized by the Ministry of Health; medical laboratory technologist means a holder of a certificate or a diploma in medical laboratory technology issued by the University of Nairobi or similar institution which is recognized by the Ministry of Health.

nursing home means any premises howsoever named or described which are used for the reception of, persons suffering from any sickness, injury or infirmity, and having a mortuary and an outpatient department, but does not include premises maintained or directly controlled by the Government or a Local Authority; pathologist means a specialist in one or all of the disciplines in clinical laboratory medicine;\ private clinic means a clinic where a private practice is carried out; private practice means giving medical, surgical or dental advice, attendance or performing an operation, or engaging in radiological or clinical laboratory medicine, for a fee; radiographer means a holder of a diploma in radiography obtained from the Medical Training Centre or such similar institution which is recognized by the Ministry of Health; radiographic film processor means a holder of a certificate, attesting to his proficiency in radiographic film processing, obtained at the Medical Training Centre or such similar institution which is recognized by the Ministry of Health; radiologist means a specialist in the use of ionizing radiation; single discipline pathologist means a medically qualified person whose training has not covered all the disciplines of clinical laboratory medicine, but who is a specialist in any of the disciplines in pathology; specialist means a medical practitioner or dentist who has completed an approved training programme in a particular discipline in medicine or dentistry, and who has acquired a recognized pot-graduate qualification or its equivalent, and who thereafter has gained sufficient experience and shown to the Boards satisfaction adequate clinical, radiological or laboratory skill, in his chosen discipline; specialist practice means the practice of medicine or dentistry in a specialized discipline as specified in these Rules.

PART II GENERAL PRACTICE Eligibility for license to engage in private practice.

(1) A medical practitioner or dentist shall be eligible for a licence to engage in private practice under section 15 of the Act on his own behalf either full or part-time or in the employment, either full or part-time, of a private practitioner or group or private practitioners, if he has worked continuously in Kenya on a full-time basis in a salaried post in a Government or private hospital or in any non-profit-making approved medical institution for a period of no less than three years.

Notwithstanding anything contained in paragraph (1), the Board may, if it is satisfied that it is in the public interest to do so, allow a medical practitioner or dentist who is not otherwise eligible for a licence to engage in private practice under paragraph (1) to be issued with a licence entitling him to engage in private practice as a salaried employee of a private practitioner or group of private practitioners.

Application for a licence.

Supra.

(1) An application for licence to engage in private practice shall be in the Form VI set out in the Medical Practitioners and Dentists (Forms and Fees) Rules, and shall be accompanied by the prescribed fee.

(2) An application for renewal of a licence shall be made under this Part and shall not less than six weeks before the date of expiry of the licence.

(3) An application for permission to change the premises to which the licence related may be made at any time.

(4) The Board may, on application a) for renewal of a licence; or b) for change of premises, request such further relevant information from an applicant as it thinks fit.

(5) A person who includes, or causes to be included, in an application, or in response to a request for information from the Board, information which he knows or has cause to believe is incorrect shall be guilty of an offence.

[Subsidiary] Conditions in licences.

(1) The Board may impose any conditions on a license under this Part and in particular may impose a condition that the private practice of the licensee shall not conflict with the terms and conditions of his employment.

(2) A licence shall be issued in respect only of the premises named therein and may not apply to any other premises unless the authority of the Board for it to do so has previously been obtained.

(3) A licensee shall display a license in a conspicuous position at the premises to which it relates and a licensee who fails to do so shall be guilty of an offence.

(4) The Board may cancel a licence if any of the conditions imposed under it are contravened.

(5) Where a licensee ceases his private practice he shall surrender his licence to the Board within thirty days of so doing.

Notice of refusal to grant a licence, e.t.c.

(1) The Board shall, before a) refusing to grant or renew a licence; or b) refusing to allow a change of premises to which the licence relates; or c) canceling the licence, give to the applicant or licensee not less than twenty-eight days notice in writing stating its intention so to act; and such notice shall inform the applicant or licensee that he may within twenty-one days of receipt of the notice inform the Board in writing whether he wishes to be heard on the question of the proposed refusal or cancellation.

(2) Where the applicant or licensee informs the Board in writing under paragraph (1) that he wishes to be heard the Board shall not effect a refusal or cancellation before it has given him an opportunity to show cause why the application or license should not be refused or cancelled.

(3) Where the Board, after complying with this rule, refuses to grant or renew a licence, or cancels a licence, it shall inform the applicant or licensee of its decision within fourteen days of the expiry of the period of twenty-eight days referred in paragraph (1) or, where the applicant or licensee has been heard, within fourteen days of the hearing; and the Board shall inform the applicant or licensee of the reason for its decision.

(4) An appeal to the High Court under section 15 (6) of the Act against the decision of the Board under this rule shall be made within thirty days of the receipt of the decision.

Locums (1) A medical practitioner or dentist who wishes to work as a locum for another practitioner shall be required to satisfy requirements for eligibility for a licence to engage in private practice specified in rule 3.

Supra (2) A prospective locum shall make an application in Form VI set out in the Medical Practitioners and Dentists (Forms and Fees) Rules stating the period during which he requires to work as a locum: [Subsidiary] Provided that in the case of an emergency a medical practitioner or dentist may act as a locum for a period not exceeding fourteen days during which time he shall inform the Board of his action and make a formal application under this paragraph.

(3) Where the duration of a locum practice is not to exceed six weeks the Registrar or Chairman may give his written consent to the applicant to practice as a locum in the form specified in the First Schedule and no fee shall be payable by the applicant.

Supra.

(4) Where an applicant wishes to work as a locum for a period exceeding six weeks he shall obtain a license to engage in private practice in Form VII set out in the Medical Practitioners and Dentists (Forms and Fees) Rules and pay the prescribed fees.

(5) A practitioner may not work as a locum for more than two periods each one of which is not less than fourteen days and does not exceed three months in duration in any one year without special permission from the Board to do so.

PART III PRIVATE CLINICS Interpretation.

In this Part, licensee means a medical practitioner or dentist licensed to operate a private clinic under rule 9.

Board to approve premises (1) No private practitioner shall operate a private clinic unless the premises where the clinic is situated have been approved by the Board.

(2) A private practitioner who wishes to operate a private clinic shall apply to the Board in writing for permission to use the premises intended fro use as a private clinic before applying for a license to engage in private practice; and the Board shall grant or refuse to grant a license under this paragraph within thirty days of receiving the application.

Supra.

(3) A licence to operate a private clinic shall be in Form VII set out in the Medical Practitioners and Dentists (Forms and Fees) Rules, and shall be issued on payment of the prescribed fee.

Conditions for issue of a licence under this part.

(1) A license under rule 9 shall be issued subject to such conditions as the Board thinks fit including in any case the conditions that the licensed premises shall - a) be kept in good order and a good state of repair; b) be kept reasonably secure from unauthorized entry; c) conform to the minimum requirements set out in Part A or Part B of the Second Schedule, as the case may be, and any other written law, and in particular the Public Health Act; and Cap.242 d) not be a residential building except with special permission from the Board.

(2) A private clinic licensed under these Rules shall be open for inspection at any reasonable time by an authorized officer of the Board and any person who willfully obstructs such an officer acting in the course of his duty shall be guilty of an offence and liable to a fine not exceeding one thousand shillings.

[Subsidiary] Restriction of a number of private clinics.

1.

(1) A private practitioner shall not be licensed to operate more than one private clinic, but the Board may permit a private practitioner to operate two clinics where both are situated in a rural area.

(2) If more than one private clinics is permitted under paragraph (1), a separate licence shall be issued and a separate fee be paid in respect of each clinic.

Licensee to indicate name, etc.

2.

(1) A licensee shall indicate his name and qualifications outside his clinic in an unostentatious manner and in accordance with the Code of Professional Conduct and Discipline and the name and qualifications so indicated shall conform to the provisions of paragraph 4 of the Second Schedule.

(2) A licensee who a) uses any words implying that a private clinic is a hospital or a nursing home; b) advertises a private clinic in any manner whatsoever to the general public, shall be guilty of an offence.

Licensees assistants 3.

(1) A licensee may employ as an assistant any person who has undergone a recognized training in medicine, dentistry, nursing or midwifery in an approved training institution, and who is not registered as a medical practitioner or dentist, to undertake defined duties under the immediate supervision of the licensee or a registered practitioner employed by him.

(2) Where any assistant employed under paragraph (1) undertakes or offers to undertake any form of medical or dental treatment independently without the immediate supervision of a medical practitioner or dentist he shall be guilty of an offence.

(3) Paragraph (2) shall be in addition to and not in derogation of the provisions of section 22 of the Act.

Keeping of essential drugs 4.

(1) A licensee shall keep in his private clinic adequate stocks of essential drugs listed in paragraph 3 of the Second Schedule.

Caps.

244 and 245 (2) A licensee shall keep an accurate record of all drugs to which the Pharmacy and Poisons Act and the Dangerous Drugs Act apply.

Notification of disease, etc 5.(1) A licensee shall immediately notify the medical officer of health of any of the notifiable diseases set out in Third Schedule which he treats in his clinic.

(2) A licensee shall immediately notify the police in the event of any death occurring in his clinic and supply to them all relevant information concerning the death.

Manner of dressing 6.

A licensee shall, whilst on duty, at all times be dressed and groomed in such a manner as to portray a respectable image to the public and in particular he shall observe the standards of ethics laid down in the Code of Professional Conduct and Discipline.

[Subsidiary] Clinical radiological laboratories 7.

(1) A private clinic may not include a clinical radiological laboratory unless the practitioner who operate the clinic is himself qualified in the use of ionizing radiation; or employs a radiographer, and in either case the person referred to in paragraph (a) or (b) personally undertakes the radiological examination of patients.

(2) A private clinic may not include a clinical laboratory unless a) examination of the specimens obtained from patients in that laboratory is undertaken by the private practitioner personally or a qualified medical laboratory technician or technologist; b) examinations are limited in the way prescribed in paragraph (3).

(3) A clinical laboratory may only be used for the purposes of undertaking investigations of the following nature a) haemoglobin; b) blood slides; c) urinalysis; d) stool microscopy; e) occult blood tests; f) gram stains; g) special smears.

(4) Neither a clinical radiological laboratory nor a clinical laboratory may be used as a referral laboratory for a practitioner who does not operate, or is not employed by the clinic concerned; and any person who in such laboratory a) undertakes the examination of patients or specimens from patients; or b) treats patients, who have been referred from outside the practice concerned shall be guilty of an offence.

PART IV NURSING HOMES AND HOSPITALS Inspection of nursing homes and hospitals 8.

(1) Nursing homes and hospitals shall be subject to inspection by the board.

(2) The operator of a nursing home or hospital shall submit to the Board once in every six months lists of a) all medical practitioners and dentists in their employment; and b) all medical practitioners and dentists who are authorized to use their premises, indicating in each case the authorized place for use as a private clinic.

[Subsidiary] Responsibility of owner, etc, of nursing homes.

9.

(1) It shall be the responsibility of the owner and the managing body of a nursing home or private hospital to acquaint themselves fully with a) the qualifications, and b) the professional conduct, of all medical practitioners and dentists working at the nursing home or private hospital and hey shall consult the Board in case of any doubt.

(2) The owner and the managing body of a nursing home or private hospital, as well as the medical practitioner of dentist concerned, shall be responsible for any instance of professional misconduct occurring within their premises about which they know or ought reasonably to have known.

Responsibilities of administrators of approved medical institutions 0.

The administrators of approved medical institutions shall ensure that no medical practitioner or dentist working there engages in private practice outside the areas of specialization and competency for which they have been licensed except a) in cases of emergency; or b) in cases where practitioners with the requisite specializations are not reasonably available.

PART V COMMITTEES Establishment of private practice committee 1.

(1) There shall be a committee to be known as the private practice committee which shall be composed, subject to paragraph (2), of not more than five members appointed by the Board from among its members.

(2) The committee shall elect its own chairman and shall have power to co-opt not more than two members from outside the Board whenever necessary.

(3) The committee shall be responsible for reviewing, wherever it is in its opinion necessary, applications for licenses to engage in private practice, fees charged in private practice and such other matters as shall be assigned to it by the chairman of the Board.

(4) The committee shall report its findings to the Board.

Establishment of specialist committee 2.

(1) There shall be a committee to be known as the specialist committee which shall be composed, subject to paragraph (2), of not more than five members appointed by the Board from among its members.

(2) The committee shall elect its own chairman and shall have power to co-opt not more than one medical practitioner or dentist from any specialty from outside the Board whenever necessary.

(3) The committee shall be responsible for reviewing the post graduate qualifications for inclusion in the list of approved specialist qualifications and shall also scrutinize applications for specialist practice and such other matters as shall be assigned to it by the chairman of the Board.

(4) The committee shall report its findings to the Board.

[Subsidiary] PART VI SPECIALIST PRACTICE Specialists in medical practice 3.

(1) The following are major specialists in medical practice general medicine; paediatrics; surgery; obstetrics and gynaecology; pathology; radiology; anaesthesilogy; and such other specialists as may be approved by the Board from time to time.

(2) Clinical Medicine a) In medicine: psychiatric, cardiology, neurology, gastroenterology, rheumatology, dermatology, venereology, geriatrics, communicable diseases, occupational medicine, tropical medicine, haematology, endocrinology, immunology, and such other sub-specialties as may be approved by the Board from time to time.

In paediatrics psychiatric, cardiology, neurology, nephrology, gastroenterology, rheumatology, dermatology, haematology, neonatology, communicable diseases, endocrinology, tropical medicine, immunology, and such other sub-specialties as may be approved by the Board from time to time.

In surgery General surgery, neurosurgery, cardiothoracic surgery, paeditric surgery, otorhinolaryngology, urology, ophthalmology and such other sub-specialties as may be approved by the Board from time to time.

(3) The following are approved sub-specialties in clinical radiological medicine radiodiagnosis, radiotherapy and nuclear medicine.

Specialties in dentistry 4.

The following are major specialties in dentistry oral and maxillofacial surgery, prosthetics, orthodontics, conservative dentistry and periodontology, ondodontics and such other specialties as may be approved by the board from time to time.

[Subsidiary] Board to recognize specialists.

5.

(1) The Board may recognize a medical practitioner or dentist as a specialist in any one or more of the disciplines referred to in rules 23 and 24 and shall publish a list of the specialists so recognized annually in the Gazette.

(2) A medical practitioner or dentist may be recognized as a specialist under paragraph (1) if a) he is a holder of a postgraduate qualification which is equivalent to the Master of Medicine degree if the University of Nairobi and has not less than five years training and experience after registration under the supervision of a recognized specialist in his discipline in a recognized institution: Provided that if a postgraduate qualifications is awarded after the normal period of training for the Master of Medicine degree of the University of Nairobi, no practitioner shall be recognized as specialist until he has had at least two years experience after obtaining the postgraduate qualification; or b) he possesses a diploma recognized by the Board, obtained before the 1st January, 1978, not being equivalent to the Master of Medicine degree of the University of Nairobi and has worked on recognized institution for at least seven years during which period he has gained experience and clinical skill under the supervision of a specialist in that field and has published papers in reputable medical journals.

(3) Unless the Board otherwise directs, before a medical practitioner or dentist can be recognized as a specialist in a subspecialty he must be in possession of a basic specialist qualification in the discipline, and must have at least two years experience under supervision in the subspecialty.

(4) For the purposes of issuing licences for private practice in any specialty, a medical practitioner or dentist who a) satisfies the requirements provided for in paragraph (2) shall be recognized as a specialist private practice in his chosen discipline; b) does not fulfill the requirements of paragraph (2) shall be issued with a license for general practice if he applies for a license for specialist private practice.

(5) Notwithstanding the requirements of paragraph (2) the Board may, in the public interest, authorize the Director of Medical Services to issue a letter of authority in the form set out in the Seventh Schedule to a person holding a postgraduate diploma, but not fulfilling the necessary requirements, to engage in specialist practice in approved medical institution in the discipline or subspecialty which is specified in the diploma for such period as the Board determine.

Application of Part II 6.

Part II shall apply to medical practitioners or dentists engaged in specialist practice.

[Subsidiary] PART VII PRIVATE CLINICAL LABORATORY MEDICINE License to practice clinical laboratory medicine 7.

(1) The Board may grant a license in the Form VII set out in the Medical Practitioners and Dentists (Forms and Fees) Rules to a medical practitioner to practice private clinical laboratory medicine if the practitioner is both eligible under rule 3 and a pathologist.

(2) The Board shall publish annually in the gazette a list of licensed private clinical laboratories.

Saving.

8.

(1) Subject to paragraph (2) and (3), a registered medical practitioner who was operating a private clinical laboratory before the commencement of these Rules may, notwithstanding rule 29 (1) b), continue to operate.

(2) A practitioner referred to in paragraph (1) shall make application in the Form VI set out in the Medical Practitioners and Dentists (Forms and Fees) Rules within three months of commencement for a license under rule 27.

(3) Where the Board refuses a license applied for under this rule the practitioner concerned shall cease from the date of refusal to operate the private clinical laboratory concerned.

Requirements for clinical laboratories 9.

(1) A clinical laboratory shall conform to the standards stipulated in the Fourth Schedule; be approved by the Board before starting to function as such; be at all times supervised by a pathologist.

(2) The Board may inspect any premises used as a clinical laboratory at any reasonable time.

(3) Any person who hinders or obstructs an officer of the Board acting in the course of his duty under paragraph (2) shall be guilty of an offence.

Investigations carried out on clinical laboratory medicine 0.

A general or single discipline pathologist, a general practitioner and a medical laboratory technician may respectively undertake such investigations in clinical laboratory medicine as are set out in rule 17 (3) and the Fourth Schedule.

Duties of a practitioner operating a clinical laboratory 1.

A medical practitioner operating a clinical laboratory a) shall provide diagnostic aid services for the community by meeting the needs of hospitals, medical and dental practitioners and other health services in so doing he may monitor individual patients, when requested to do so, by providing appropriate laboratory control of therapy; b) Shall provide consultant advisory services in all aspects of laboratory investigations, including the interpretation of results and shall advise on any further appropriate investigations; c) shall collaborate in systematic education and training for all members of laboratory staff; [Subsidiary] d) may collaborate in the development, study and laboratory control of new methods of treatment, whilst adhering to the laid down medical ethics; e) may provide laboratory facilities for and advice on approved research projects undertaken by clinicians.

f) may undertake basic or applied research on pathology problems.

Fees 2.

A private practitioner in laboratory medicine may charge fees in accordance with the Boards prescribed fees in private laboratory medicine.

Offences 3.

A person who contravenes any of the provisions of this Part shall be guilty of an offence.

PART VIII PRIVATE CLINICAL RADIOLOGICAL LABORATORY MEDICINE License to practice clinical radiological medicine 4.

(1) The Board may grant a license in Form VII set out in the Medical Practitioners and Dentists (Forms and Fees) Rules to a medical practitioner to engage in private practice in clinical radiological medicine if the practitioner is both eligible under rule 3 and a radiologist.

(2) The Board shall publish annually in the Gazette a list of licensed private clinical radiological laboratories.

Savings 5.

(1) Subject to paragraphs (2) and (3), a registered medical practitioner who was operating a private clinical radiological laboratory, other than a laboratory providing only screening facilities, before the commencement of these rules may, notwithstanding rule 34, continue to operate.

(2) A practitioner referred to in this paragraph (1) shall make an application in Form VI set out in the Medical Practitioners and Dentists (Forms and Fees) Rules within three months of commencement for a licence under rule 34.

Supra (3) Where the Board refuses a licence applied for under this rule the practitioner concerned shall cease from the date if refusal to operate the private clinical radiological laboratory concerned.

Requirements for a clinical radiological laboratory 6.

(1) A clinical radiological laboratory shall a) conform to the standards stipulated in the Fifth Schedule; b) be approved by the Board before starting function as such; c) keep an accurate record of all clinical radiological examinations undertaken by it.

Undertaking of operations in a clinical radiological laboratory 7.

(1) A radiologist, general practitioner, radiographer or radiographic film processor may undertake such operations in a clinical radiological laboratory as may from time to time be specified by the Board in guidelines to be issued by it.

[Subsidiary] (2) A practitioner operating a clinical radiological laboratory shall carry out radiological examinations only at the request of a registered medical or dental practitioner or a practitioner who is licensed under section 15 of the Act.

Duties of the owner of a clinical radiological laboratory 8.

(1) The owner and the management of a clinical radiological laboratory shall ensure that all staff and the public are protected from the hazards of radiation and that the staff comply with the provisions of the Fifth Schedule.

(2) All staff employed in radiation work shall undergo periodical medical examination at least once in every two years and a certificate shall be issued on respect thereof.

Screening facilities 9.

(1) No clinical radiological laboratory which provides only screening facilities shall be licensed under these Rules.

(2) A person who publicly offers or advertises screening facilities shall he guilty of an offence and liable to a fine not exceeding five thousand shillings or to imprisonment for a term not exceeding three months or both.

Fees A private practitioner in radiological work may charge fees in accordance with the Boards prescribed fees therefore.

PART IX MISCELLANEOUS Board to prescribe fees 1.

(1)The Board shall prescribe the fees to be charged for visits, referrals and consultations in general practice and specialist practice.

(2) A receipt shall be issued for any fee charged for any medical or dental services rendered, including laboratory and radiological services.

(3) The Board shall have powers to arbitrate in all complaints regarding fees in private practice.

Penalties 2.

Where a person is guilty of an offence under the rules for which no penalty is expressly provided he shall be liable to a fine not exceeding two thousand shillings.

Legal proceedings, etc 3.

Whether or not proceedings are brought against any person for an offence under these rules the Board may, where it is satisfied that there has been a contravention of any of these Rules or of the conditions of any license granted thereunder, and notwithstanding that such contravention is not an offence, cancel or refuse any licence granted thereunder, and in such case rule 6 shall apply.

Mode of serving notice 4.

Wherever under these Rules, notice is to be served on an applicant or information is to be supplied to him, the notice or letter containing the information shall be sent to him either by registered post or by hand delivery, whichever is convenient.

Post graduate qualifications 5.

For purposed of these Rules specialist qualifications recognized by the Board shall be as specified in the Sixth Schedule.

[Subsidiary] FIRST SCHEDULE (r.

7 (3)) Medical Practitioners and Dentists Board, P.O.

Box 30016, NAIROBI.

Dr.

(Reg.

No.

.) P.O.

Box Dear Sir, RE: APPLICATION FOR LOCUM I acknowledge your letter dated.

Ref.

No.

applying for a locum.

Permission is hereby granted for Dr.

.

Reg.

No.

to work as a locum in your place of practice during which your absence from.

to.

Yours faithfully, Registrar / Chairman _ SECOND SCHEDULE (rr.

10 (1) (c) 12 (1) and 14) PART A MINIMUM REQUIREMENTS FOR A GENERAL PRACTITIONER Premises: premises should contain the following accommodation waiting room; a consulting room which should be reasonably sound-proofed so that conversations taking place therein are not easily audible outside the consulting room; an examination room which should be either a separate room or a curtained-off part of a consulting room; a treatment room in which such procedures as the giving of medications and the carrying out of minor surgical operations can be done; adequate toilet facilities.

These rooms should be adequately furnished and clean there shall be sufficient sitting accommodation in the waiting room for the size of the practice; the consulting room shall have a desk for the doctor, a chair for the doctor and two or three chairs for the patient and persons accompanying the patient; and a consulting room should also have a facility for the practitioner to wash his hands, for example, where there is no running water there shall be a washing basin with a jug of water which is periodically topped up; there shall be an examination couch in the consulting / examination room and another couch in the treatment room and the couches shall be designed so that it is easy for an infirm patient to get on to them, and there shall be adequate lighting, either daylight or artificial light, to enable the practitioner to see his patient fully.

Equipment: The practitioner shall have the following equipment available at his place of work diagnostic instruments such as stethoscope, syphygmomanometer, foetal stethoscope, torch, patella hammer, auroscope, ophthalmoscope, proctoscope, viginal speculum, disposable tongue depressors; instruments for carrying out certain procedures, for example, opening abscesses and stitching wounds; sterilizers for surgical instruments and containers, etc; a facility to examine urine on the premises, for example, by the use of labstix or equivalent reagents; A cabinet for patients' records.

Stocking of Drugs: (1) The practitioner should attempt to keep in his premises a stock of those essential drugs which he considers should be administered to his patients in his premises and especially if his practice is not in a location where there may be a dispensing pharmacy.

The range of drugs that he should have is wide, but he ought to have at least the following - Injections of analgesics (for example, pethidine, Morphine, etc); antibiotics, antihistamines, bronchodilators, antiemetics, antispamodics, local anaesthetics and corticosteroids.

For the purpose of administering injections, he should have disposable syringes and needles and surgical spirit.

[Subsidiary] (2) Further the doctor should provide himself with a bag which he can carry with him when visiting patients, when traveling or to be available for him to use whenever his services may be needed.

This bag should contain as a minimum the following - Such drugs as injections of analgesics, antibiotics, bronchodilators, tranquilizers, local anaesthetics, antispasmodics, antiemetics, oral preparations such as antipyretics, analgesics, gastrointestinal sedatives, antidiarrhoeals, antihistamines, bronchodilators, antibiotics, muscle relaxants, etc.

(3) For the purpose of the doctors bag, it should be the practice to carry disposable syringes and needles rather than steel and glass syringes which require sterilization.

The bag will be adequately furnished if it carries a supply of 2ml disposable syringes and 25 g (1 in) and 21 g (11/2 in) disposable needles.

It is also convenient to carry strips of spirit swabs rather than carrying a supply of surgical spirit and pieces of cotton wool.

Practitioners shall take steps to destroy all disposable equipment to avoid their possible use.

Approved description of name DR./ MR.

.

MBBS, BDS* MEDICAL PRACTITIONER / DENTIST / CLINICAL LABORATORY / CLINICAL RADIOLOGICAL LABORATORY*.

DR.

/ MR.

MBBS, DCH, MRCP, FRCS, M.MED., FRCR* etc.

SPECIALIST* PHYSICIAN, PAEDIATRICIAN, DERMATOLOGIST, ANAESTHETIST, RADIOLOGIST, PSYCHIATRIST, PATHOLOGIST, OBSTETRICIAN AND GYNAECOLOGIST, SURGEON (*ORTHOPAEDIC, UROLOGIST, NEUROSURGEON, THORACIC, PLASTIC, OPHTHALMOLOGY) etc.

* Delete where not applicable.

PART B MINIMUM REQUIREMENTS FOR A DENTAL SURGERY WAITING ROOM: With basic furniture, telephone, etc.

LABORATORY / WORKSHOP: Basic Laboratory Requirement Investing flasks, Press and clamp, Polishing motor, Laboratory motor and hand piece, Bunsen burner, [Subsidiary] Pliers, wax knife, etc, Denture materials, Plaster for models, Model trimmer, Polishing brushes, cone felt, etc.

Basic Requirements in filling Materials Amalgams Dental cements; i) Zinc oxide Engenel ii) Zinc and copper phosphates iii) Calcium hydroxides iv) Silicate and silicophosphate cements v) Filling resins TOILET: - with basin and water borne sanitation.

SURGERY: - composed of the following basic essentials i) dental unit with low and high speed drills which are water cooled ii) wash-basin with running water iii) sterilizer unit iv) cabinet with basic dental instruments v) basic drugs and medicaments used in dentistry including antimicrobials, corticosteroids, analgesics, haemostatic and anaesthetic drugs, in addition to antiseptics disinfectants vi) lockable cabinet, containing essential emergency drugs vii) emergency oxygen cylinder viii) cabinet for patients records and card system.

INTRAORAL RADIOLOGICAL UNIT.

_ THIRD SCHECULE (r.

15) RETURN OF NOTIFIABLE INFECTIOUS DISEASES The following diseases are notified on Med.

25 Forms.

These forms are obtainable from Central Medical Stores or any Government medical institution.

Acute poliomyelitis Anthrax Celebro-spinal fever (meningococcal meningitis) Cholera [Subsidiary] Diphtheria Infective hepatitis Malaria S.T.

(in high altitude areas) Plague (human) Plague (rodent) Rabies Severe dierrhoeal diseases Sexually transmitted diseases Smallpox (Variola major) Smallpox (Variola minor) Trypanosomiasis Tuberculosis (all forms) Yellow fever _ FOURTH SCHEDULE (rr.

27 and 29) MINIMUM STANDARDS FOR A CLINICAL LABORATORY Categories and Responsibilities of Pathologists: a) General Pathologist: i) This is a specialist whose basic training has covered all the disciplines of clinical laboratory medicine and who ultimately has attained a recognizable higher qualification in any one or all other disciplines.

ii) General pathologists shall run laboratories that carry out the following investigations 1.

Morbid anatomy, histopathology and cytology.

Haematology and blood transfusion.

Clinical chemistry.

Medical microbiology and parasitology.

Immunopathology.

Forensic pathology.

Other allied laboratory investigations.

b) Single Discipline Pathologist This is a medically qualified person whose training shall not have covered all the disciplines of clinical laboratory medicine but who shall be a holder of a postgraduate qualification in only one discipline.

He shall practice only in his particular discipline of specialization.

Categories of Pathology Laboratories For purposes of the practice of clinical laboratory medicine, the following categories of laboratories shall be recognized i) Government hospitals and local authority laboratories; ii) Non-profit making missionary hospital laboratories; [Sunsidiary] iii) Non-governmental or private hospital laboratories which charge economical fees; iv) Private clinical laboratories not attached to hospitals; v) Nursing home laboratories vi) Other non-profit making laboratories.

.

Minimum facilities for a Private Clinical Laboratory (r.

29) i) A minimum of any three of the following disciplines should be offered.

Haematology and blood transfusion.

Medical microbiology and parasitology.

Clinical chemistry.

Morbid anatomy, histopathology and cytology ii) STAFF:.

At lest one Pathologist.

.

At lest one qualified technologist for each of the disciplines.

iii) PHYSICAL FACILITIES:.

Waiting room.

Specimen collection room with a couch.

Toilet facilities.

Adequate laboratory space dictated by activities.

iv) SAFETY REQUIREMENTS:.

Autoclave for sterilization of specimens before disposal.

.

Fire fighting equipment.

Sinks with both cold and hot water.

v) EQUIPMENT:.

At lest one microscope.

.

Refrigerator.

.

Incubator.

Centrifuge.

Haemoglobinometer.

Counting chamber.

E.S.R tube.

Disposable syringes and needles.

Calorimeter 0.

Water bath 1.

Still 2.

Burners 3.

Electrophoresis tank 4.

Necessary laboratory glassware 5.

Chemical balance vi) REAGENTS AND CHEMICALS: There should be minimum reagents and chemicals to enable a confirmatory diagnosis to be reached in each of the disciplines offered.

vii) DOCUMENTATION: All specimens must be recorded in a register.

Such registration should show the following: date, patients name, attending doctors name, nature of the specimen and tests requested.

_ FIFTH SCHECULE (r.

36).

Minimum Requirements for a Clinical Radiological Laboratory For the purpose of considering radiological protection facilities the following should be adopted as a general guide LEVEL 0 Clinics and health stations operated by a nurse or medical assistant without any direct medical supervision No radiological facility required LEVEL 1 Small clinics, health stations or general practices under supervision of a general practitioner who can undertake emergency work and refer patients to other levels radiography only for chest, fractures (mainly extremities), and in exceptional cases plain abdomen necessary.

No fluoroscopy should be undertaken.

LEVEL 2 District Hospitals or rural hospitals staffed by a small number of doctors and undertaking general medical care and minor surgery, some private hospitals, clinics and non-profit making hospitals may be included in this group radiographic examinations required include chest, simple abdomen, fractures, and possibly some fluoroscopic examinations.

LEVEL 3 Medium sized regional provincial hospital that undertakes routine hospital work such as general medical care and routine surgery including abdominal surgery.

The medical staff should include specialists in main fields as defined in these Rules All general radiographic work is needed which would include some special examinations e.g.

tomography, angiography, urography, etc.

[Subsidiary] LEVEL 4 & 5 Large central and general hospitals including teaching hospitals where all types of radiological procedures are required.

.

For a Properly Organized Radiation Protection Programme to Succeed, it is strongly recommended that - (1) In hospitals at levels 3, 4 and 5, all x-ray diagnostic examinations should be carried out by the diagnostic radiology department.

(2) Even when an x-ray equipment is installed in other departments, the head of the radiology department should have responsibility for radiological aspects of any examination performed.

(3) Level 1 refers to a rural or remote area where no other radiological service is available and the supervision is that of a general practitioner with limited skill in radiology.

A fully qualified radiographer may not be available at this level and the x-ray equipment may be operated by a nurse of laboratory technician.

Such a nurse or technician should have had traditional training in radiography.

(4) In areas where a more comprehensive radiological service is available, no attempt should be made to provide a level 1 radiological service.

.

Premises (1) The x-ray room should provide adequate radiation protection for people outside the room, who may have no knowledge of radiation or radiation requirements.

(2) The basic x-ray room for general purposes should be about 6x4x3 metres in size, with wall thickness in all directions of 2 mm.

lead equivalent.

(3) The doors, the darkroom hatch, and covers for services and other instructions through the wall should have the same lead equivalent protection.

(4) Windows should be at least 2 metres from the ground outside the x-ray room and 1.6 metres from the floor level of the room.

(5) If the control panel is within the x-ray room, the protective shield should be positioned such that neither once scattered radiation nor direct radiation can pass round the edge of shield from any part of the room where x-ray procedures are carried out.

(6) The darkroom should be at least 6 sq.

metres in area.

(7) There should be at least two protected changing cubicles of 1.5 sq.

metres minimum size, preferably outside the x-ray room.

(8) If ordinary building materials are used, they should be thick enough e.g.

in the range 70.25 KV, 15 cm of concrete or 25 cm of brick with plaster is sufficient.

(9) However, if a prefabricated wood or metal building is being planned, it will need lead lining, preferably supported by plywood to prevent sagging.

(2mm.

lead sheet is adequate).

(10) Converting a old building for an x-ray room will need a review by a radiation protection expert.

[Subsidiary].

Choice of X-ray Equipment (1) The x-ray equipment should be adequate for its purposes e.g.

at level 1 of radiological care, a good stationary x-ray tube and generator should be employed.

Improvisation of a mobile machine in an old room used for other purposes should not be tolerated under any circumstances.

(2) For routine general radiography, necessary ancillary apparatus should be provided e.g.

chest stand and a stationary couch with grid and film x-ray.

(3) To avoid mains voltage drops, the power supply to an x-ray unit should be separated from, say, that for lifts, etc.

(4) Where power supplies are particularly unreliable, battery operated or condenser discharge equipment should be used.

(5) An x-ray tube head of lower rating than that of generator should be installed.

(6) For exposure controls, meters giving clear indication of voltage, current, and milliampere-seconds at all times are required.

(7) The timing device must be capable of making sufficiently short exposures (say down to 0.04 sec.) must terminate a present exposure, and must be dead man type.

(8) All x-ray, fluoroscopic and dental equipment must further meet the protection standards as laid down by the International Commission on Radiation Protection.

(9) The normal output for radiographic units should lie from 60 KV and above with preferably not less than 50mA.

For fluoroscopic units without image intensifiers, 75 KV and 2-3mA is the normal order.

3mA should not be exceeded at 100 KV.

.

Safety Procedures Radiography (1) Staff positions should be behind protective shields preferably outside the x-ray room provided there is adequate view through a lead glass and communication device for speaking to the patient during exposure.

(2) During special techniques, where staff need be in the x-ray room, protective aprons and gloves should be worn.

(3) Films should be supported mechanically.

Beam size should be reduced to cover by means of light beam diaphragms or variable cones only areas under investigation.

Fluoroscopy (1) Only essential persons who must wear protective aprons, should be present in the room during fluoroscopy.

(3) A cumulative timing device that gives an audible warning and finally switches off after a few minutes to restrict the total switch-on time of the equipment.

[Subsidiary] (4) A properly darkened room.

(5) A fluoroscopy switch coupled with the rooms red light.

(6) If sufficient information can be obtained from radiography alone (e.g.

as in chest examinations) then fluoroscopy should not be done.

(7) There should be effective coning devices.

(8) With conventional equipment, adequate dark adaptation of at least 15 minutes prior to screening is necessary.

Room Layout (1) Primary x-ray beam should not fall on the darkroom wall and should not routinely point towards doors or windows.

(2) Where there is more than one piece of equipment in the same room - a) only one generator per room should be installed; b) a warning device should be mounted on each x-ray tube and control panel of the generator; c) an adequate protective screen should be provided between each x-ray tube area.

(3) For special techniques such as tomography, angiography, etc.

a special room should be provided.

(4) Record room, offices and waiting room should be provided outside the main x-ray room at all levels.

(5) Protective screens should be provided for all the positions in which staff are required to be during exposure in the x-ray room.

(6) Persons required to assist during fluoroscopic procedures should wear a protective apron of at least 0.25 mm lead equivalent.

(7) The physician performing the fluoroscopic procedures should wear a protective apron of at least 0.25 mm lead equivalent.

(8) When a new x-ray facility goes into operation, all staff members who at any time may enter the department should be issued with radiation monitoring badges.

(9) Site monitoring during the radiation surveys should be done before commissioning the unit.

(10) Persons likely to receive three tenths (3/10) of the annual maximum permissible dose should be monitored regularly.

(11) Radiation personnel should be medically examined on initial appointment and at any time when the exposure levels as indicated by personnel monitoring are sufficiently high.

Protection of the General Public (1) Careful attention must be paid to the protection of all areas around, above and below x-ray rooms.

(2) Apart from adequate protective thickness of walls, floors, ceilings and doors, unprotected windows should not allow the public outside to be irradiated.

[Subsidiary] (3) Stray radiation should not reach the waiting rooms or other occupied areas.

(4) One patient must not use a curtained corner of an x-ray room to change clothing while another is being radiographed in the same room.

(5) Separate protected cubicles should be provided preferably outside x-ray room.

(6) Lead-protected doors must always be closed during x-ray examinations.

(7) Particular care should be taken to avoid irradiating patients in adjacent beds during mobile radiography.

(8) Protective clothing should be worn by parents holding children undergoing x-ray examinations.

They should not stand in the path of a primary beam.

_ SIXTH SCHEDULE (r.

45) LIST OF APPROVED SPECIALIST POSTGRADUATE QUALIFICATIONS Specialty Kenya Foreign Equivalents.

Anaesthesia.

.

M.

Med.

(Anaesthesia).

F.F.A.R.C.S., F.F.A.A.R.C.S., M.D.

(Anaesthesia), Dip.

Am.

Board of Anaesthesiology, etc.

.

Internal Medicine.

M.

Med (Medicine).

M.R.C.P.

(U.K.), M.R.A.C.P., F.R.C.P.

(C ), Dip.

Am.

MD.

(Medicine) New Delhi, etc.

.

Obstetrics and Gynaecology M.

Med.

(Obs.

/ Gyn.).

M.R.C.O.G., F.R.C.S.

(O.B.S./ GYN.) M.D.

(O.B.S./ GYN.), M.R.A.C.O.G., Dip.

Am.

Board of Obst.

And Gynae., etc.

.

Paediatrics.

.

M.

Med.

(Paediatrics).

M.R.C.P.

(U.K.), M.R.A.C., F.R.C.P.

(C), Dip.

Am.

Board of Paediatrics, M.D.

(PAED).

New Delhi, etc.

.

Pathology.

.

.

M.R.C (Path.), M.D.

(Path.) New Delhi, Dip.

Am.

Board of Pathology, etc.

.

Psychiatry.

.

.

M.R.C (Psy.), M.D.

(Psych.) Dip.

Am.

Board of Psychiatry, etc.

.

Radiology.

.

.

M.

Med.

(Radiology).

F.R.C.R., M.D.

(Radiology), Dip.

Am.

Board of Radiology, etc.

[Subsidiary] Specialty Kenya Foreign Equivalents.

(i) Surgery General.

M.

Med.

(Surgery).

F.R.C.S., F.R.A.C.S., F.R.C.S.

(Canada), Dip.

Am.

Board of Surgeons, M.S.

(New Delhi), etc.

(ii) Cardiothoracis Surgery M.

Med.

(Surgery).

F.R.C.S., F.R.A.C.S.(C), Dip.

Am.

Board of Surgeons, M.S.

(New Delhi), etc.

(iii) Neurosurgery.

.

M.

Med.

(Surgery).

F.R.C.S., F.R.A.C.S., F.R.C.S.

(C), M.S.

(New Delhi) Dip.

Am.

Board of Surgeons, etc.

(iv) Ophthalmology.

M.

Med.

(Ophthalmology).

F.R.C.S., F.R.A.C.S., F.R.C.S.

(C), M.S.

(New Delhi) Dip.

Am.

Board of Surgeons, etc.

(v) Orthopaedics.

.

Trauma.

M.

Med.

(Surgery).

F.R.C.S., F.R.A.C.S., F.R.C.S.

(C), M.S.

(New Delhi) Dip.

Am.

Board of Surgeons, etc.

(vi) Otorhinolaryngology.

M.

Med.

(Surgery).

F.R.C.S., F.R.A.C.S., F.R.C.S.

(C), M.S.

(New Delhi) Dip.

Am.

Board of Surgeons, etc.

(vii) Plastic Surgery.

M.

Med.

(Surgery).

F.R.C.S., F.R.C.S., F.R.C.S.

(C), M.S.

(New Delhi) Dip.

Am.

Board of Surgeons, etc.

.

Dentistry.

.

.

F.D.S.E.C.S., M.D.S., (New Delhi).

Cert.

Am.

Board of Orthodontics, Cert.

Am.

Board of Endodontics, Cert.

Am.

Board of Prosthetics, Cert.

Am.

Board of Periodontology, Cert.

Am.

Board of Oral and Maxillary Facial Surgery, Cert.

Am.

Board of Conservative Dentistry, etc.

[Subsidiary] SEVENTH SCHEDULE (r.

25 (5)) The Medical Practitioners and Dentists Board, P.O.

Box 30016, NAIROBI.

Date:.

.

.

.

.

Dear Sir, This is to certify that Dr.

.

being a holder of a diploma in.

is hereby authorized by the Board to render services in the discipline of.

and that his authorized place of private practice is This letter of authority shall expire on 31st December, 19.

Yours faithfully, Director of Medical Services / Registrar.

_ PAGE PAGE 43 Rev.

1983] Medical Practitioners and Dentists CAP.

253.