Code of Conduct, Guidelines & Policies

PREAMBLE

THE PROFESSION OF OPTOMETRY

On completion of training in any of the approved Universities (usually six (06) years of UME/UTME students and five (05) years of ‘Direct Entry’ students), the Optometrist will be issued with a provisional license after swearing into an oath of professional practice administered by the Registrar of the Board during an induction ceremony. Thereafter he/she proceeds on a mandatory twelve (12) calendar month internship in a Board accredited Optometry clinic (public or private).

On successful completion of the internship, the Optometrist proceeds on a one (01) year National Youth Service Corp (NYSC) program, where applicable.

THE SCOPE OF PRACTICE (Optometry).

These are explicitly stated in part vi, section 29 of the Act viz:

• Eye examinations to determine refractive errors and other departures from the optimally healthy and visually efficient eye.
• Correction of refractive errors using spectacles, contact lenses, low-vision aids other devices.
• Correction of errors of binocularity by means of vision training (orthoptics).
• Diagnosis and management of minor ocular infections which do not pose a threat to the integrity of the ocular or visual system.
• Ocular first aid.

THE OPTOMETRIST OATH.

Next to Life, God’s most precious gift is sight, and to this great gift,

“ I, Dr. ………………………………………………………………………………………………………. freely and solemnly pledge that:

I WILL dedicate my life to the service of humanity.

I WILL practice the profession of Optometry with conscience and dignity, valuing the trust patients place in me.

I WILL uphold the highest standards of professionalism, honesty, and integrity in all aspects of my Optometric practice.

I WILL approach each patient with empathy and compassion, recognizing the uniqueness of every individual and their circumstances.

I WILL respect the confidentiality of patient information and will use my Optometric knowledge for the benefit of human health.

I WILL advocate for the well-being of my patients, preventing blindness and improving public health.

I WILL not be ashamed to say “I know not” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I WILL give utmost respect and gratitude to my teachers, mentors, and colleagues who have guided me in the art and science of Optometry, and will gladly share such knowledge.

I WILL strive continuously to broaden my knowledge and skills, seeking ways to enhance my professional competence and contribute to better health outcomes.

I sincerely and faithfully swear to uphold the law (Decree 34 of 1989, now CAP 09 Laws of the Federation of Nigeria, 2004) of the practice of Optometry as enshrined in the constitution of the Federal Republic of Nigeria.

I hereby commit myself to be steadfast in the performance of this solemn oath and obligation.

So, help me, God.

…………………………………………… SIGNATURE & DATE

THE PROFESSION OF DISPENSING OPTICIANRY

On completion of training in any of the approved instructions (usually, 2-3 years duration leading to the award of a board–certified diploma in dispensing optics (DDO) or a National Diploma (ND) in dispensing opticians) the Dispensing Optician will be issued with a provisional license after swearing an oath of practice administered by the Registrar of the Board during an orientation/oath-taking ceremony thereafter, he/she proceeds on a mandatory twelve (12) calendar months of Supervised Ophthalmic Laboratory Experience in a Board accredited ophthalmic laboratory (public or private).

THE SCOPE OF PRACTICE (DISPENSING OPTICIANRY).

These are explicitly stated in part vi. Section 29 of the act, viz:

• Sale of optical wares (e.g. lenses, frames, equipment, etc).
• Fitting of ophthalmic lenses on frames.
• Production of ophthalmic lenses (surfacing).
• Production of spectacle frames.
• Production of ocular prostheses.

THE DISPENSING OPTICIANS OATH

I —————————————————— freely and solemnly pledge that:

I will practice the profession of Dispensing Opticianry faithfully, conscientiously, and to the fullest scope of my competence.

I will uphold and honourably promote by example the highest standards and ideals of my chosen profession; and the honour of the certificate (DDO or ND) which has been granted me.

I will strive continuously to broaden my knowledge and skills to enhance the practice of my profession for the benefit of society; and serve my community and mankind professionally.

I will share information cordially and unselfishly with my fellow Dispensing Opticians and other eye care practitioners.

I hereby commit myself to be steadfast in the discharge of this solemn oath.

So help me God.

……………………………………. SIGNATURE & DATE

FOREIGN TRAINED PRACTITIONERS.

Foreign-trained practitioners are expected to undergo professional board assessment (i.e. proficiency test) of their qualification(s) before they can be registered with the Board under part 11, section 10(01) of (Decree 34 of 1989, now CAP 09 Laws of the Federation of Nigeria, 2004), special induction ceremony may be conducted by the Registrar of the Board where appropriate.

RIGHT & PRIVILEGES OF REGISTERED MEMBERS

• The provisions of the constitution of the Nigerian Optometric Association (NOA): the Association of Nigerian Dispensing Opticians (ANDO): their bye-laws and standing orders are binding on every registered member of both professions consequently, every financial member enjoys all rights and privileges as enunciated in their respective constitutions, bye-laws, and standing orders.
• Optometrists and Dispensing Opticians must see themselves as partners whose professional activities complement one another. The board therefore expects that they must work together in harmony as members of the eye care team.
• There should be mutual respect for one another at all times. In particular, junior members in both professions should accord due respect to their senior colleagues. Similarly, senior colleagues should avoid oppressive acts in their dealings with junior colleagues.
• Every registered member should cultivate the habit of paying all prescribed fees/levies, including annual license renewal fees on schedule.
• Relationships between professional colleagues should be based on ‘spirit de corps” even in the charging of fees for professional services rendered.
• The State Chairman of both Associations (NOA & ANDO) should encourage practitioners to agree on minimum charges for all professional services in their state.
• A registered member should not make derogatory remarks/statements on the examination/treatment procedure of another registered member in the presence of a patient or any member of the public.
• A registered member should not make derogatory remarks on the examination/treatment procedures of other health practitioners (e.g., General practitioner, Ophthalmologist, etc.) in the presence of a patient or any member of the public.
• A registered member should not instigate a patient to initiate legal proceedings against another registered member but should report any act of malpractice to the Association or Board.
• Advertisement of professional services is prohibited in any medium (i.e., print or electronic).
• The location of an Optometry clinic should not be in the midst of lock-up shops. Neither is any form the eye examination allowed in such environments.
• The Dispensing Optician’s shop should not be domiciled within an open market. Neither is the sale of prescribed lenses allowed in such locations.
• The signboard indicating the business location must not exceed the approved specifications by the Board.
• Where human subjects are examined for research work, there must be evidence of ‘informed consent’. They have a right to know the benefits or hazards that may be associated with any experimental work.
• Practitioners are advised to regularly update their professional knowledge and skills by attending Annual Conferences, Annual General Meetings, board-approved Continuing Education (CE) programs, and seminars/workshops of relevant professional associations for the renewal of annual practicing licenses.
• Optometrists are allowed to own a practice after a minimum of three (3) years post NYSC compliance with the minimum as specified by the Board.
• Dispensing Opticians are allowed to own an ophthalmic laboratory after a minimum of four (4) years post-qualification in compliance with the board.
• Only optometrists with a minimum of five (5) years post-NYSC are allowed to supervise interns in public or private clinics.
• Only Dispensing Opticians with a minimum of six (6) years post qualification are allowed to supervise those on Supervised Ophthalmic Laboratory Experience (SOLE).
• Fellows of the Nigeria College of Optometrists (FNCO) are specialists (consultants) in their chosen fields. They are clinically superior in status to non-fellows, irrespective of year of graduation.

RELATIONSHIP BETWEEN PRACTITIONER & PATIENT.

• Every piece of information obtained from a patient (e.g., history, examination, disposition, etc) is strictly confidential and must not be disclosed to a third party without the patient’s consent, however, such information may be disclosed to law enforcement agencies of the state if officially demanded.
• Every patient must be given equal /full professional attention no matter their social status, age, sex, or religion.
• Every patient has the right to know the form of treatment required for his eye condition including the name(s) of medication (s) given (where applicable). The practitioner must explain such conditions to the understanding of the patient.
• A patient reserves the right to accept or reject a particular form of treatment on religious grounds. However, a situation where a patient rejects a normal course of treatment for whatever reason should be properly documented in the patient’s record card and signed by the patient.
• Where a patient is referred from one colleague to another the recipient must give feedback on findings to the referee. Ditto in situations where a patient is referred to other health practitioners.
• There must be a cordial working relationship between eye-care practitioners and other healthcare practitioners.

RELATIONSHIP BETWEEN PRACTITIONER & OTHER HEALTHCARE PROVIDERS.

• Professional courtesies must be observed at all times in our dealings with other healthcare providers this must however be based on trust and mutual respect in the spirit of co-management which is the general trend in modern healthcare.
• Prompt referral must be made in a situation where an eye or health condition requires immediate intervention of other eye or health care practitioners.
• A professional act of negligence is when a practitioner fails to treat a patient with the standard of care and skill commensurate with his/her training, qualifications, and experience It is the practitioner’s duty of care to avoid any form of injury to a patient, to forestall litigation.

ACTS OF PROFESSIONAL MISCONDUCT.

• Any act of disrespect to a senior professional colleague, knowingly or unknowingly (e.g. use of discourteous or insolent language).
• Any form of indent or indecorous behavior amongst professional colleagues (especially between junior and senior).
• Any act of disrespect or disregard to constituted authority (e.g. board noa, Ando, etc)
• Any act of deception (including extortion) aimed at defrauding a patient/colleague.
• Improper relationship with patients under your care, including every definition of sexual harassment.
• Improper relationship with colleagues, including every definition of sexual harassment.
• Self-advertisement in the media (i.e., print or electronic).
• Instigating patients to institute legal proceedings against a colleague.
• Referral of patients to colleagues or other healthcare practitioners for a fee.
• Improper financial transactions amongst colleagues.
• Failure to pay annual subscriptions or renewal fees to the Board or Associations, including every other levy as approved by the Board or Associations. Any untoward professional association with quacks to undermine the professional code of conduct, (e.g., the sale of prescribed lenses in the open market).
• Use of billboards to advertise business premises.
• Location of practice in an unprofessional environment
• Lock-up shops, open market, etc).
• Deliberate act of under-charging (i.e., undercutting) in professional services.
• Running office beyond recommended business hours except in emergencies.
• The unhealthy professional relationship between colleagues and other healthcare practitioners (e.g., General practitioners, Ophthalmologists, etc.)
• Operating an Optometry clinic, Ophthalmic laboratory, or lens surfacing/manufacturing factory, that is unregistered with the Board.
• Practicing below approved minimum standard (i.e., Optometry clinic, Ophthalmic laboratory, or lens surfacing/manufacturing factory).
• Practicing without annual renewal of relevant documents/licenses (practitioner, premises, etc.).
• Failure to obtain “informed consent” before a patient (i.e. human subject) is used for research work or experimentation.
• Drunkenness and disorderly behavior capable of undermining the integrity of either profession.
• False allegation (s) against professional colleague(s).
• Organising professional activities without approval from State Chapters or the National body of Association(s).
• Impaired ability to practice due to substance addiction, physical or mental illness.
• Conviction for felony.
• Physical abuse of a patient.
• Eye examination in an unapproved environment.

ACTS OF MALPRACTICE.

• Practicing beyond the scope as defined in the Act.
• Wrong diagnosis and treatment.
• Unauthorized disclosure of clinical information about a patient.

ACTS OF NEGLIGENCE

A professional act of negligence is when a practitioner fails in his/her duty to provide adequate care for a patient to prevent avoidable damage or injury. It includes, but is not restricted to, the following:

• Failure to attend promptly to a patient requiring urgent attention when the practitioner was in a position to do so (e.g. providing ocular first aid).
• Failure to give proper advice to a patient who has a sight-threatening pathological condition (e.g. glaucoma, retinal detachment, etc.)
• Failure to refer or late referral of a patient to other healthcare practitioners even when such referral was crucial to the recovery or preservation of sight.

HEADSHIP OF TRAINING INSTITUTION

• Only a Fellow of the Nigerian College of Optometrists who is in good standing with the Board shall head a training school in Optometry.
• Only a registered Optometrist or Dispensing Optician (with a relevant university degree) who is in good standing with the Board shall head a training school in Dispensing Opticianry.

FAILURE TO PAY ANNUAL SUBSCRIPTIONS/RENEWAL FEES

• Where the practice license of a practitioner is withdrawn for failure to renew same, a fresh license shall be issued only on condition of full payment of all outstanding debts including administrative charges or fines, arising therefrom, to the Board.
• Where any premises (i.e. Optometry clinic, Ophthalmic laboratory, lens manufacturing/surfacing factory, etc.) is closed down for failure to renew operational license such premises shall resume business only on condition of full payment of all outstanding debts including administrative charges of fines, arising therefrom, to the Board.

UNREGISTERED PERSONS

• Following section 13(01) of the Act, a practitioner without a current practising license from the Board shall not be allowed to hold any appointment in the Civil service of the Federation or of a State or in any public or private establishment, body or institution in Nigeria, where such appointment will require him to perform acts of either of the professions.
• Any person who falsely claims to be a registered member as established in section 8 of the Act and holds himself/herself out to e be registered or uses any name, title, description, or symbol that is calculated to mislead any person is guilty of an offense and liable to appropriate sanctions ranging from a fine, years of imprisonment or both.

RESOLUTION OF INTERNAL PROBLEMS OF NOA/ANDO MEMBERS

• Any problem arising from the day-to-day professional activities of every registered Optometrist or Dispensing Optician shall be classified as the internal problems of NOA/ANDO members.
• For an aggrieved registered Optometrist or Dispensing Optician, the channel of communication for the resolution of internal problems shall be through the State Chairman, President, and the Board, in that order.
• Any registered Optometrist or Dispensing Optician, who seeks external intervention (e.g. through the Law courts, NGOs, etc) in ethical issues without internal conflict resolution of the Board, shall be guilty of misconduct.

STATUTORY ORGANS

INVESTIGATING PANEL

Following the provisions of Part V, Section 22(03), the Investigating Panel shall be charged with the duty of:

• Conducting a preliminary investigation into any case where it is alleged that a registered person has misbehaved in his capacity as such.
• Conducting a preliminary investigation into any case where a registered person is the subject of proceedings before the Disciplinary Committee.
• Deciding whether, or not the case should be referred to the “Disciplinary Committee”. Where the “Investigating Panel” finds a member guilty of an offense as charged, such a member is referred to the “Disciplinary Committee” for appropriate sanction(s).

DISCIPLINARY COMMITTEE.

The Disciplinary Committee is charged with the responsibility of appropriating commensurate sanction(s) against a member who has been adjudged guilty of an offense by the investigating Panel. The enabling Act (Part V, Section 24) empowers the Disciplinary committee to enforce any of the following penalties against a registered person guilty of professional misconduct, malpractice, or negligence:

• Reprimand (or admonish) the person.
• Caution him/her and place under “a period of binding over” (or close observation) for a period not exceeding one year. But where a person fails to comply with the conditions imposed during “the period of binding over” the Disciplinary Committee “may impose any one of the penalties mentioned in sub-paragraphs 1, 2, or 3 below: Order the person to pay the Board any cost incidental to the proceedings incurred by the Board.
• Suspend that person from practice for such a period as may be specified.
• Order the Registrar of the Board to strike off the person’s name from the relevant part of the register.

APPEARING BEFORE THE INVESTIGATING PANEL OR DISCIPLINARY COMMITTEE.

The conduct of a member appearing before the investigating Panel or Disciplinary Committee shall be the same as that of a person appearing before a Judge in a law court. He/she must display a reasonable level of good behavior all through the period he/she is standing before either committee while in session shall be adjudged as misconduct and shall attract appropriate sanction. Thus, a member standing before either committee must maintain a stable temperament (no angry altercations) while answering questions put before him/her.

CONDUCT OF MEMBER(S) APPEARING BEFORE INVESTIGATING PANEL.

• The investigating Panel is the court of first hearing in matters of alleged professional misconduct, malpractice, or negligence.
• A member invited by the Investigating Panel must be punctual whenever he/she is summoned to appear before it, during the investigation of any case which involves him/her, whether as the accused, respondent, or witness.
• Such a member must give prompt notice to the appropriate official of the Panel where unforeseen circumstances may cause him/her to appear late before the panel or where he/she may be unable to keep the appointment due to circumstances beyond his/her control.
• A registered practitioner who has been duly notified by the Panel on the necessity to appear before it, for whatever reason, shall attend relevant hearings as and when invited.
• In a situation where the practitioner has a compelling need to travel out of Nigeria whilst the matter is yet to be disposed of, he/she is required to duly notify the appropriate official of the Panel and obtain the necessary clearance before traveling out of the Country.
• A practitioner who has been duly notified that he/she is to appear before the Panel in an ongoing investigation, but who fails to appear whenever due, without an acceptable excuse shall be liable to a disciplinary action as will be determined by the Panel. A practitioner’s duty to appear before the Panel is continuous from the time of first notification until the matter under investigation is finally disposed of.
• Any attempt made by a member, being investigated by the Panel, to curry favor with members of the Panel by flattery, bribery, or any corrupt act constitutes professional misconduct.
• A practitioner should rise to his/her feet when addressing or being addressed by the Panel unless the Chairmen of the Panel directs otherwise.
• A member who fails to respond to the request of the Panel concerning a matter under investigation may be deemed to be contemptuous of the Panel and shall be appropriately disciplined.
• The Board may, on the recommendation of either of its disciplinary organs, communicate to a foreign regulatory body, when it is obvious that the Board in Nigeria, is being ignored on a matter for disciplinary process by a registered practitioner who has been duly notified but who decides to go into professional practice in another country. The purpose of such communication will be to compel the registered practitioner to assist the Disciplinary organs in Nigeria in treating the matter before them in which he/she is involved.

CONDUCT OF MEMBER(S) APPEARING BEFORE DISCIPLINARY COMMITTEE

• The Disciplinary Committee has the status of a High Court of the Federal Republic of Nigeria and practitioners who appear before it, whether as complaints, defendants, or witnesses, whether they are also represented by a lawyer, must conduct themselves as they would in a High Court.
• The code of behavior of a practitioner appearing before the Disciplinary Committee is the same as the investigating Panel. These codes are equally applicable to counsel who appears before the Disciplinary Committee.
• Practitioners who make public comments on cases pending before the Investigating Panel or Disciplinary Committee, or cases where the time for appeal has not expired, shall be guilty of contempt of the Investigating Panel or Disciplinary Committee case may be, and shall be liable to appropriate disciplinary action as may be determined by either disciplinary organ.

STRIKING OFF ENTRIES FROM THE REGISTER ON GROUND OF FRAUD OR ERROR

If it is proven to the satisfaction of the Disciplinary Committee that an entry has been fraudulently or incorrectly made in the register, the Disciplinary Committee may direct that the entry should be struck off from the register following section 26 (01).

RESTORATION OF REGISTRATION

• Where the name of a registered member has been struck off the register in pursuance of a directive given under section 25 of this Act, the Disciplinary Committee may, if it thinks fit, at any time, direct the Registrar to restore the person’s name to the appropriate register.
• An application for the restoration of a person’s name to a register can only be made to the Disciplinary Committee on the expiration of the period of sanction.
• A member who applies for restoration of registration shall pay to the Board all relevant fees or levies as applicable to fresh registration.

APPEAL TO THE FEDERAL HIGH COURT.

Where a registered member disagrees with the decision of the Disciplinary Committee, such a member could file an appeal against the Board to the Federal High Court. The grounds of appeal could be any of the following:

• Where the Disciplinary Committee makes a finding and imposes a penalty on a registered person under Section 24 of this Act.
• Where the Disciplinary Committee rejects an application for restoration of a name to the register under section 25 (02) of this Act.
• Where the Disciplinary Committee directs the striking off, of a fraudulent entry from the register under section 26 (01) of this Act.

By normal procedure, the Registrar shall give the person to whom the proceedings relate, a notice in writing and such a person shall, within twenty-eight (28) days of receiving the notice, appeal to the Federal High Court. Under such a situation, the Board shall be the respondent.

Adopted by the Board this 7th day of August 2010.

DEFINITION OF TERMS.

For a proper understanding of the content of this document, it is important to explain or define the meaning of some words/phrases used herein to avoid ambiguity.

Code of conduct: A set of rules or instructions meant to guarantee the good behavior of a practitioner.

Professional ethics: Code of conduct. Misconduct… improper or unethical behavior. Malpractice… Unethical or injurious treatment…

Unethical behavior: Any form of deviation from professional ethics: any form of behavior by a practitioner that undermines the dignity of the profession, a practitioner, or a patient.

Negligence: A branch of a legal duty of care for others. Practitioner. Optometrist, Dispensing Optician.

Optometry: As defined in part VI, Section 29. Cap 09 Laws of the Federation of Nigeria, 2004.

Board: Optometrist & Dispensing Opticians’ Registration Board of Nigeria (ODORBN).