UNIVERSITY COLLEGE HOSPITAL ACT

UNIVERSITY COLLEGE HOSPITAL ACT ARRANGEMENT OF SECTIONS

SECTION

1. Short title.

2. Establishment of the Hospital.

3. Establishment of the Board.

4. Composition, functions, etc., of the Board.

UNIVERSITY COLLEGE HOSPITAL ACT

An Act to provide for the establishment of a Teaching Hospital and for a Board of Management for the hospital.

[26 of 1952. lOaf 1954, 32 (2) and (3). Schedule 16 of 1954. 3 of 1955. 10 of 1956.

L.N. 131 of 1954.120 of 1957.]

1. Short title

[Commencement.]

[16th October, 1952]

This Act may be cited as the University College Hospital Act.

2. Establishment of the hospital

There shall be established at lbadan a teaching hospital to be known as the University

College Hospital, which shall be capable of providing such facilities as are usually provided in medical schools forming part of a university for the instruction of medical students in such subjects as are usually taught in such schools.

3. Establishment of the Board

There shall be established for the management of the hospital a Board of Management to be known as the University College Hospital Board of Management, which shall be a body corporate with perpetual succession and a common seal, and may in its corporate

name sue and be sued and, for and in connection with the purposes of this Act, may acquire, hold and dispose of movable and immovable property.

4. Composition, functions, etc., of the Board

The composition, functions and powers of the Board established under section 3 of

this Act shall be as provided for in the University Teaching Hospitals (Reconstitution of Board, etc.) Act.

[Cap. U15.)

UNIVERSITY COLLEGE HOSPITAL ACT

SUBSIDIARY LEGISLATION

List of Subsidiary Legislation

1. Medical Laboratory Trainees Regulations.

2. University College Hospital (Hospital Fees) Regulations.

MEDICAL LABORATORY TRAINEES REGULATIONS

[L.N. 76 of 1958.]

under sections 4 and 16

[Commencement.]

[10th April, 1958]

1. Short title

These Regulations may be cited as the Medical Laboratory Trainees Regulations.

2. Students in medical laboratory technology

It shall be permissible for the University College Hospital to accept nominees of the

State governments or of the Federal Government as students in medical laboratory technology.

3. Fees

There shall be payable by the Government concerned an amount of N200 per annum in respect of each such student and a proportion thereof in respect of any portion of a year.

UNIVERSITY COLLEGE HOSPITAL (HOSPITAL FEES) REGULA TIONS

[L.N. 42 of 1973.]

under sections 7, 14 (3) of Cap. U1 and section 4

1. Fees chargeable

[Commencement.]

[3rd July, 1973]

The University College Hospital shall charge the fees specified in the Schedule to these Regulations in respect of the facilities referred to in the said Schedule.

2. Short title

These Regulations may be cited as the University College Hospital (Hospital Fees) Regulations.

SCHEDULE

[Regulation I.] PART I

In-patients

A. Exemption from all charges

1. No charges shall be paid under Part I of this Schedule for accommodation, maintenance or medical or nursing attention, by patients in the following categories-

(a) members of the staff (both established and unestablished) employed by the University College Hospital, their wives and children;

(b) persons certified as paupers by the Head Medical Social Worker;

(c) persons receiving treatment or advice for pulmonary tuberculosis or incurable malignant disease;

(d) persons who, on the certification of the head of the department concerned are admit- ted into the hospital solely for the purpose of specialised research;

(e) the holder of a post in the permanent establishment of the Faculty of Medicine of the University of Ibadan.

B. I

Charges for maintenance and accommodation only

Charges for maintenance and accommodation only shall be levied on the persons listed below-

(a) members of the medical, dental, para-medical and nursing professions employed in their professional capacities by the Governments of the Federation and mission hospitals;

(b) all children under the age of sixteen years (with the exception of charges made for spectacles and dentures);

(c) a member of the Board of Management of University College Hospital, his wife and children;

(d) the servants of officers holding senior appointments in the University College Hospital.

Charges for accommodation and maintenance of persons referred to above shall be at the following daily rates-

Any patient-

N k (i) whose income exceeds N7,000 per annum……………………………………………………………………….. 4.00

(ii) whose income exceeds N 4,000 per annum but does not exceed

N7,000………………………………………………………………………………………………………. 3.00

(iii) whose income exceeds N 2,000 per annum but does not exceed

N4,000………………………………………………………………………………………………………. 2.00

(iv) whose income exceeds N 1,000 per annum but does not exceed

N2,000………………………………………………………………………………………………………. 1.00

(y) whose income does not exceed N 1 ,000 per annum …………………………………… 50k

Children under sixteen years, school children and students undergoing full-time education shall be charged at half the rates applicable to adult patients.

B. II

Charges for treatment, accommodation and maintenance

Charges at the following daily rates shall be paid by all other in-patients in respect of accommodation, maintenance and treatment inclusive of charges for medical and nursing attention-

Any patient-

N k (i) whose income exceeds N 7,000 per annum………………………………………………………. 8.00

(ii) whose income exceeds N 4,000 per annum but does not exceed

N 7,000………………………………………………………………………………………….. 6.00

(iii) whose income exceeds N 2,000 per annum but does not exceed

N 4,000………………………………………………………………………………………….. 4.00

(iv) whose income exceeds N 1,000 per annum but does not exceed

N 2,000………………………………………………………………………………………….. 2.00

(v) whose income does not exceed N 1 ,000 per annum………………………… 1.00

NOT E.-After 30 days, fees under B. I and B. II above are to be reduced as following for long staying patients-

(a) after 30 days, fees are to be reduced to 50 per cent of normal

(b) charges;

after 90 days, fees are to be reduced to 25 per cent of normal charges.

B.Ill

Amenity beds

Inclusive charges for medical and nursing attention, accommodation and maintenance shall be levied on all persons admitted to private wards at their own request (and irrespective of whether they are included in any of the categories in section A and B above) at the daily rate of N 1 0.

B. IV

Charges for maternity cases

The following additional charges shall be levied on in-patients whether or not occupying an amenity bed but not on in-patients under section A (a) who are to pay 50 per cent of the charges-

Any patient-

(i) whose income exceeds N 7,000 per annum ……………………………

(ii) whose income exceeds N 4,000 per annum but does not exceed N7,000  …………………………………………

(iii) whose income exceeds N 2,000 per annum but does not exceed N 4,000 ………………………..

(iv) whose income exceeds N 1,000 per annum but does not exceed N2,000 ………………………………

(v) whose income does not exceed N 1 ,000 per annum ………………..

B.V

Charges for surgical cases

The following additional charges shall be levied on in-patients whether or not occupying an amenity bed but not on in-patients under section A or B. I (a) and (b) of these Regulations-

Any patient-

Operations

(i) whose income exceeds N 7,000 per annum ……………

(ii) whose income exceeds N 4,000 per annum but does not exceed N 7,000 ………………………………………………… .

(iii) whose income exceeds N 2,000 per annum but does not exceed N 4,000 ………………………………………………… .

(iv) whose income exceeds NI ,000 per annum but does not exceed N 2,000 ………………………………………………… .

(v) whose income does not exceed N 1,000 per annum .. .

Provided that charges are made not more than twice for patients operated upon on more than two occasions during the course of one admission.

For the purposes of this regulation “Major” and “Other” operations are the operations respectively so described in the Schedule to these Regulations and any other kind of operation which

the House Governor may from time to time classify as falling under one of these headings.

B.VI

Charges for patients from outside Nigeria

Inclusive charges for medical and nursing attention, accommodation and maintenance shall be levied on all persons (not being citizens of, or employed in, the Federal Republic of Nigeria) admitted into hospital irrespective of whether or not they are included in sections A (b) and (d) above.

The daily rate charge shall be N20 excluding cost of Surgical operations, etc.

B.VII

Charges for special appliances

Charges for all appliances including artificial limbs supplied to any patient by the hospital shall be at cost price.

In case of people who fall ill while attending conferences organised in Nigeria, either by the hospital or the University of Ibadan, charges shall be made both as out-patients and in-patients. In-patients will be charged at the rate of N10 a day.

B.VIll

Charges for non-standard diet

An additional charge of N1 per day shall be levied on all in-patients who elect to have wholly or in part a non-standard diet. This additional charge shall be made regardless of the income of patients and whether they are included in any of the categories in section A or B above.

PART II

Out-patients

A. Exemption from charges

No charges shall be paid under this part of this Schedule for out-patients treatment of any kind by the persons detailed in sections A and B. I of Part I of these Regulations.

B. Charges shall be levied on all other persons as follows-

(i) General out-patients-On first attendance a fee of 50k will be charged to cover all treatment for one week from the date of payment.

A further charge of 50k will be made for each subsequent period of one week or part thereof.

(ii) Casualty department-Medical attendance- Between 7.00 a.m. and 5.00 p.m. 50k on first attendance;

(b) Between 5 p.m. and 7 a.m. N I on first attendance provided that the medical officer on duty shall have power to authorise payment of the normal charge of 50k in cases of trauma and medical emergencies;

(c) For non-emergency cases on Sundays and public holidays N I on first attendance.

The payment of the prescribed fee will be valid for treatment for a period of one week, or part thereof in either casualty or the G.O.P. department.

Operations for out-patient day cases will be at the following rates- Any patient-

(a) whose income exceeds N 7,000 per annum ……………………………….. N10

(b) whose income exceeds N 4,000 per annum but does not exceed N 7,000 6

(c) whose income exceeds N 2,000 per annum but does not exceed N 4,000 6

(d) whose income exceeds N 1,000 per annum but does not exceed N 2,000 4

(e) whose income does not exceed N I ,000 per annum ……………………. 2

(iii) Patients referred to consultant clinics (including those referred directly from casualty general out-patient, outside hospitals or medical practitioners).

Any patient-

(a) whose income exceeds N 7,000 per annum……………………………………….. 10

(b) whose income exceeds N 4,000 per annum but does not exceed N 7,000 8

(c) whose income exceeds N 2,000 per annum but does not exceed N 4,000 6

(d) whose income exceeds N I ,000 per annum but does not exceed N 2,000 4

(e) whose income does not exceed N 1,000 per annum…………………………… 2

NOTE.-This charge to cover attendance at consultant clinic for the first month.

Patients continuing to attend consultant clinics after a month shall pay half the above charges for each month except those with incomes of under N 1,000 who will pay the same as general out- patients, i.e. 5Ok for each week (attendance).

NOTE.-If a patient is referred to two out-patient clinics, he will have to pay at the two clinics.

(iv) The payments stated in paragraphs (i) and (ii) may be deferred at the discretion

of the doctor or sister in charge at the time of attendance of a seriously ill patient. In such a case, the charge becomes payable at the time of the next visit.

(v) Ante-natal clinic-A fee of N10 will be payable at the time of booking to cover all attendances during pregnancy and attendance at the post-natal clinic until

discharged. The fee charged will not include maintenance or delivery in hospital, for which the charges laid down in section B of Part I of these Regulations will be applicable.

(vi) The following additional charges shall be levied on all outpatients irrespective of the attendance fees they may have paid under section B (I)-(III) above for services outlined at (a)-(g) below-

(a) Radiological services-N

(i) For each routine x-ray …………………………………………………….. . 1

(ii) For each minor special examination ……………… 5

(iii) For each major special examination ……………………………… 10

(iv) X-ray examination and report for outside agencies………………………. 10

(v) For reporting on outside agencies x-ray films …………………. 2

(b) Physiotherapy services-

(i) For physiotherapy treatment for one week or part thereof……………. 1

(ii) Provided that a complete course of treatment shall not exceed………. 16

(iii) Charges for plaster of Paris, etc. (immobilising appliances)…………….. 2

(iv) Charges for cervical collar …………………………………………………. . 1

(v) Charges for cervical collar (children)………………………………………………. 0.50

(vi) Aeroplane splints for children plaster………………………………………. 1

(vii) Aeroplane splints for children plastic……………………………………… 1

A deposit of N 3 shall be charged for a pair of crutches. If they are returned in good condition within a period of six months, there will be a refund of N I.50k. After a period of six months, the deposit is forfeited.

(c) Pathological services- N

(i) For each examination (per unit) provided that the maximum amount

to be charged for a single examination shall not exceed N 10………… 1

The number of units depends on the complexity of the test as shown in the Appendix.

(d) Ophthalmic services-

N

Refraction………………………………………………………………………………………………………. 2

(e) Pharmaceutical services-

Expensive drugs ………………………………………… 25 per cent of cost

Medium ……………………………………………………. 20 per cent of cost

Cheap ……………………………………………………….. Full cost

The classification of drugs under this heading in the Appendix.

(f) Injections-

N

For each injection administered in hospital ………………………………………..20k The fees for all the injections must be paid in advance.

(g) Mortuary-

Charges for keeping corpses of persons who died not as in-patients of the hospital in the mortuary are as follows-

N

For the first week or part thereof……………………………………………………….. 14

For each day thereafter………………………………………………………………………. 3

Simple embalming…………………………………………………………………………….. 25

In the case of in-patients who died in the hospital, the above charges shall apply after 7 (seven) days of death.

PART lII

General

1. Fees payable by an in-patient shall be assessed on the basis of the income of such patient; a married woman shall be charged at the rate applicable to her husband or according to her own income, whichever may be higher.

2. Except where otherwise provided, payment of fees is required to be made as follows-

(i) All sums due from out-patients must be paid before patients are allowed to see the medical officer in the clinic except in cases of medical emergencies.

(ii) Patients admitted are required to pay a deposit equal to the assessed charge for a 14 day stay in the hospital but in exceptional cases the house governor may authorise deposit for a lesser period. Subsequent accounts are to be raised weekly in advance; if the final total charge is less than the deposit, the balance shall be refunded to the patient.

(iii) Payment for services to be rendered to outside agencies must be made before such services are rendered in the laboratories, etc.: Provided that in the case of government hospitals, this stipulation may be waived at

the discretion of the House Governor as long as previous debts have been settled.

3. All sums received by the hospital authority shall be paid into the account of the hospital and shown in the annual financial accounts of the hospital. No department is allowed to receive fees for services rendered on behalf of the hospital.

4. Any person who considers that his income has been assessed at an excessive figure shall have the right of appeal to the house governor against such assessment.

5. Notwithstanding anything contained in Parts I, II and III of these Regulations, the house governor may waive or reduce the fees chargeable if he is satisfied that in all the circumstances of the case the financial position of the person warrants such a waiver or reduction.

6. A senior appointment in the University College Hospital for the purpose of these Regulations is one carrying an initial basic salary of N 2, 140 per annum or more.

APPENDIX I

Expensive drugs – 25 per cent of cost

Antibiotics (Colomycin, Ampicillin, Cloxacillin, Erythromycin, Nystatin, Fucidin, Lincomycin, Spectinomycin)

Antihypertensives (Methyldopa, Debrisoquine) Anti-inflarnatory (Brufen)

Antileprotics (Lamprene) Antiobesity (Ponderax, Lucofen)

Asthmatic preparations (Isoprenaline Spray, Ventolin Tabs and Spray Medihaler) Chemotherapeutics (Septrin)

Corticosteroids (Oral) Hydrocortisone, Cortisone

Corticosteroids (Topical) Synalar, Betnoviate, Vioform (with Hydrocortisone) Decongestant nasal sprays (Tyzine)

Cytotoxics and Antitumour (Methotrexate, Purinethol, Natulan) Vincristine Psychotropics (Surmontil, Melleril, Sinequan, Nobrium)

Urinary Antiseptics (Naladixic Acid)

Cheap drugs – full cost

Analgesics Antacids Anthelmintics Antidiarrhoeals Antimalarials Antipyretics

Cough Expectorants and Sedatives

Calenical Mixtures (B.P.C. and B.N.F.)

Iron Tabs (see exceptions under medium price drugs) Laxatives

Vitamin Tabs/Caps

APPENDIX I—continued

Medium price drugs – 50 per cent of cost

Antiamoebic

Antibiotics (with the exception of drugs listed under Expensive Drugs) Anticoagulants

Anticonvulsants Antidepressi ves Antiemetics Antihistamines

Anthypertensives (with the exception of drugs listed under Expensive Drugs) Antileprotics

Antiseptics Antispasmodics Antitubercular Asthmatics Cardiac reactants

Dermatological Preparations (with the exception of drugs listed under Expensive Drugs) Diuretics

Filaricides Hypnotics

Hypoglycaemics (Oral) Hypoglycaemics (Parentral)

Ophthalmic Preparations (with the exception of drugs listed under Expensive Drugs) Sedatives

Sui phanomides

Thyroid and Antithyroid preparations

Tranquillisers (with the exception of drugs listed under Expensive Drugs) Ear/Nose Preparations (with the exception of drugs listed under Expensive Drugs) Pancreatic Extracts (Oral)

Urinary Antiseptics (with the exception of drugs listed under Expensive Drugs)

Chest X-Rays Abdomen X-Rays, etc.

I.V.P.

APPENDIX II

Classification of radiological examinations

A. Routine plain films

B. Minor special procedures

Oral Cholecystogram Intravenous Cholecystogram Fistalogram

Venograms Sinogram Barium Swallow Barium Meal Barium Enema

Cystogram Dacrocystogram

Hystero-Saplingogram All Angiograms Pneumoencephalogram Air Ventriculogram Spenoportograms Pelvic Pneumogram Tomogram

Chemical pathology-

C. Major special procedures

Pathological examinations

Bilirubin

CSF or Blood Sugar………………….. I unit Urea

Cholesterol

B.S.P. Amylase ……………………………………………………… . 2 Units

Uric Acid ………………………………………………… 2 Units

APPENDIX Il–continued

Acid Phosphatase

Alkaline Phosphatase 2 Units

Electrolytes

LFT (full-investigations)

Enzymes- Transaminases or Aldolase or CPK, Ca and P04 Latex Tests

17 Ketosteroids Pregnancy Test

Immunoglobulins ………………………………………………………… . 3 Units

Protein + Electrophoresis Creatinine

Glucose Tolerance

d-Xylose Excretion Renal Function

Gastric function-s-

Kay’s Augmented Histamine Hollander’s Post Vagotomy

Endocrine function-«

Water Loan and Dilution……………………………. 3 Units Insulin Tolerance

Stimulation or Suppression 1¹³¹ Neck Uptake

Schiling Test …………………………………………………………. . 4 Units

Radio-immunoassay

Medical microbiology

Microscopy only-

Blood Films

Stools for Intestinal Parasites

Urine Deposits ………………………………………………………. . 1 Unit

Sputum for A.F.B.

Other Investigations as relevant

APPENDIX II -continued

Microscopy, culture and sensitivity tests

Where relevant-

Urine Examinations Wound Swabs

Throat Swabs ………………………………………………………… . 2 Units

Sputum Samples (excluding TB.) Vaginal Swabs

Pus and Exudates (excluding TB.) …………………………… .

Microscopy, Culture of Faeces with Identification of Pathogens and

Sensitivity Tests where relevant ………………………………………………………….. . 4 Units

Blood Cultures, including Sensitivity Tests where relevant ….. . 3 Units

C.S.F. Examinations, including Protein, Microscopy (Culture and

Sensitivity (excluding TB.) ………………………………………………. . 3 Units

Serological examinations-

V.D.R.L. Test Widal Test

Weil-Felix Test …………………………………………………….. . 4 Units

Brucella agglutinations

A.S.O. Titres

Latex Agglutination Test

Special investigations-

Complement Fixation Tests including R.P.C.F.T. …………. 6 Units Fluorescent Antibody Tests, including FTA-200 ………. . 8 Units

Identification of Bacterial Cultures sent from outside

sources ………………………………………………………………… . 6 Units

T.B. examinations-

Microscopy and culture only on Sputum, Urine, etc ….. . 3 Units

Mycology samples-

Microscopy and Culture ……………………… 4 Units

Identification of Cultures sent from outside ……………… . 4 Units

Venereology samples-

Examination of Discharges, Serology, etc., during entire

course of treatment …………………………………………………. … 10 Units

APPENDlX ll–continued

Miscellaneous Samples for outside Agencies, not listed above ……………………………………………………………………

Pathology-

Biopsy …………………………………………………………………..

HaemalOlogy-

PCV, WBC, Platelet Count ……………………………………. .

Blood Film Report ……………………………………………….. .

Haemoglobin Electrophoresis ………………………………… . Prothrombin Time ………………………………………………… .

G6PD Screening Test

Bone Marrow Report ………………………………………………

Serum Iron and Iron binding Capacity ……………………….

Blood transfusion-

Charge to be determined according to nature of samples to be examined

A.B.o. and Phesus Grouping 2 Units

Crossmatching …………………………………………………………………. 3 for 6 Units first 2 pints

2 for each subsequent pint Direct Coombs’ Test ………………………………………………………………..2 Units

Antenatal Antibody Screening …………………………………………………..3 Units

Investigation of Blood Transfusion Reaction ……………………………..10 Units

Abscess of brain

Acute appendicitis Adenoma of Thyroid Amputation of hip

SCHEDULE

[Section B. V.] Surgical operations Major

Amputation of limbs, except fingers and toes (other) and thigh, shoulder and hip (major) Amputation of penis (total)

Amputation of shoulder Amputation through thigh

Any operation involving intestinal suture Appendicitis (non-acute)

Biliary fistula Carcinoma of the colon Cholecystectomy Cholescy stenterostomy

Closure of faecal fistula or artificial anus

Complete prolapse of rectum involving laparotomy, colostomy or intestinal anastomosis Complicated fistula

Craniotomy Cystectomy Depressed facture Diverticulitis

Double inguinal hernia Drainage of bile ducts Drainage of gall bladder Empyema

Enterotomy, colotomy, colostomy Epithelioma of the anus

Epithelioma of lip with excision of glands

Epithelioma of the tongue with radical operation upon the glands Excision of cysts or tuberculous glands of neck (deep to deep fascia) Excision of larger joints

Excision of rectum Gastrectomy Gastro-enterostomy Gastrostomy

Hernia (strangulated or irreducible) Haemorrhoidectomy

Hydatid of lung or liver

Implantation of radium or randon seeds in the cranium, chest, abdomen or bladder Intestinal obstruction (including Intussusception)

Laminectomy

Hernia-inguinal, femoral umbilical or ventral (simple) Imperforate anus

Nephrectomy Litholapaxy

Meningeal haemorrhage Nephrectomy

Perforated ulcer of the alimentary tract Peritonitis (tuberculous, pneumococcal) Prefrontal leucotomy

Prostatectomy

Pyelo or nephro-lithotomy Radical removal of breast Rammstedt’s operation

Radical operation for anal fissure

Removal of stone from ureter

Rupture of bladder Rupture of urethra Splenectomy

Sacro-coccygeal dermoid sinus Suprapubic cystostomy Sympathectomy Thyroidectomy Transplantation of ureters Tumour of the brain

Subphrenic abscess requiring trans-thoracic or trans-peritoneal access

Other

Abscess of prostate Abscess

Amputation of fingers or toes Amputation of penis (partial)

Any condition treated by surgical diathermy under general anaesthesia, other than mouth, or tongue, or bladder

Blood transfusion (grouping and expenses of donor extra) Castration

Cystocopy

Dilation of anus for fissure

Dilation of rectal stricture Dilation of urethra

Diathermy to growths of bladder Division of fibrous anus Examination under anaesthetic

Hydrocele (radical)

Other

Implantation of radium or randon seeds for treatment of skin tumour Implantation of radium or randon seeds except where included under “Major” Induction of pneumotharax

Injection of Gasserian ganglia Injection for pruritus ani Prolapse of rectum

Rectal polypi

Simple removal of whole breast Ischiorecta abscess

Lupus

Pyelography (not including service of radiologist) Removal of anal warts and anal papillae

Removal of needles from hand or foot or elsewhere

Rodent ulcer not involving bone or eye Sebaceous cysts

Tuberculous caseous glands of neck (curetting) Varicocele

Gynaecological operations Major

Vulva-vaginal

Anterior and posterior colporrhaphy with amputation of the cervix (Manchester operation) Anterior and posterior colporrhaphy with vaginal hysterectomy (Mayo-Palmer operation)

Any vaginal operation when combined with coeliotomy, viz, colpoperineoplasty with ventrofixation

Radical excision of vulva and glands Repair of vaginal fistulae

Vaginal hysterectomy Relief of atresia vaginae

Uterus and adnexa

Cyst of the borad ligament Hysterectomy Myomectomy

Salpingectomy (acute inflammation, complicated pyo- or hudro-salpinx, extra-uterine gestation) Ovariotomy

Salpingectomy or Salpingostomy

Anterior and posterior colporrhaphy Colporrhaphy and/or perineorrhaphy Cauterisation

Other

Vul vo- vag inal

Cysts or simple tumour of the vulva and vagina Removal of caruncle

Urethral prolapse Colpotomy

Uterus and adnexa

Dilatation with intra-urane operations Evacuation of retained products

Dilatation Insufflation Removal of polypi

Cervix

Note: EV A, Biopsy of Cervix, Diagnostic Curretage are excluded, as they count as biopsies and are therefore free.

Ear, nose and throat operations

Major

Extensive operative treatment of malignant disease

Open, i.e. external, operation on the larynx and pharynx (exclusive of laryngotomy)

SCHEDULE-continued

Open operations on the nasal accessory sinuses

Operations on the temporal bone exclusive of simple Mastoidectomy Simple tracheotomy

Mastoidectomy

Reduction of long standing facial bones

Operative treatment of malignant disease involving skin of face only

Other

Diagnostic peroral endoscopy Opening of quinsies

Mastoidectomy-Drainage of mastoid abscess Myringotomy

Reduction of fractured nose

Operative peroral endoscopy (i.e. bronchoscopy, oesophagoscopy and laryngoscopy) Intra-nasal operations

Removal of tonsils or adenoids Simple removal of nasal polypi

Corneal grafting Conical cornae

Corneal abscision or tattooing Corneal wound

Detachment of retina Epicanthus

Ophthalmic operations Major

Exenteration of lachrymal sac, all methods Exenteration or orbit

Excision of rodent ulcer

Excision of evisceration of eyeball Exploration of orbit

Extraction of senile cataract Glaucoma, acute or chronic Iridectomy

Kronlein’s operation

University College Hospital Act SCHEDULE-continued

Operation for dislocated lens

Ptosis

Reconstruction of eyelids

Needling capsule after senile cataract Needlingjuvenile cataract

Orbital abscess

Randon applications for neoplasm Removal of intraocular foreign body Removal of intraorbital turnours Strabismus

Other

Canaliculus and lachrymal dUCI exploration Cauterisation of coneal ulcer

Chalazion Ectropion Entropion

Excision of pterygium Lachrymal abscess Paracentesis Trichiasis

Peritomy

Removal of superficial dermoid

Removal of foreign body embedded in cornea Suturing lid wounds

Amputation through thigh

Orthopaedic operations Major

Amputation of limbs, except fingers and toes (other) and thigh, shoulder and hip (major) Closed reduction and fixation of fractures involving joints or shafts of larger bones Congenital club foot

Congenital dislocation of the hip Disarticulation of the hip and shoulder

Emergency operations for acute osteomyelitis and acute suppurative arthritis

SCHEDULE—continued

Excision of cervical rib Excision of larger joints

Internal derangement of the knee and other joints Laminectomy

Open reduction of fractures

Operative treatment of compound fractures Radical operations for bone tumour

Reconstructive operations on bones and joints-arthrodesis arthroplasty

bone grafts

Repair of intricate tendon injuries Secondary nerve sutures

Severe congenital and actuired deformities requiring open correction Spina bifida

Tendon transplantation

Other orthopaedic operations requiring an equivalent degree of surgical skill

Other Excision of bursae communicating with larger joints Manipulation of larger joints

Open correction of simpler deformities- Hallux valgus

Hallux rigidus

Pes cavus unilateral Torticollis

Primary nerve and tendon repairs Amputations of toes and fingers

Application of plaster of Paris casts with or without anaesthesia Hammer toe

Manipulation of smaller joints Removal of exostoses Removal of small bursae

Simple manipulation of.tenotomy and plasters

SCHEDULE-continued

Plastic surgery operations

Major

Repair of hare-lip and/or cleft palate Repair of syndactyly

Repair of hypospadias Excision of maxilla Excision of mandible Tube pedicle repairs Flap repairs

Major skin grafting operations Skin grafting of major burns Excision of bums

Excision of malignant lesions with plastic repair Macillo-facial injuries, needing plastic repair

Major cosmetic work: e.g. on breast, nose, ears, etc.

Major reconstruction work following cancerous, leprosy infections Vaginal reconstruction

Other

Scar excision Excision of Keloids

Dressings under anaesthesia Dental extractions

Eyelet wiring

Z-plastics and minor flap repairs Excision of sloughs

Excision of benign lesions with plastic repair Minor skin grafts