Is Sri Lanka Medical Council fit for purpose?

By Dr Upul Wijayawardhana

Quite a number of my distinguished colleagues have written about the Sri Lanka Medical Council (SLMC) or held press conferences lately, but all of them addressed only one issue; the removal, by the Minister of Health, of the president and four members of the council appointed by her predecessor. Whilst my colleagues are questioning the legality of this action, the Minister contends that she has the authority to do so and justifies her action on the basis of the findings of the five-member committee she appointed. As we, doctors, as well as politicians, being equally unaware of the finer points of law, perhaps, it is best left for the judiciary to decide on the legality or otherwise of this decision. However, if the courts decide that the Minister of Health acted illegally, surely, she should resign, not only because of this but also because of her erratic behaviour during the grave health emergency we are going through. We do not seem to be very lucky with our Ministers of Health; one with the infamy of a bogus ‘crocodile’ press conference being replaced by another who pollutes rivers with pots of a concoction devised by a faith healer and then, adding insult to injury, by promoting an untested remedy invented by a Kali Amma inspired kapuwa to get rid Covid-19!

After going through the website of the SLMC and making comparisons with the only other regulatory body I am familiar with, the General Medical Council of UK (GMC), I have a greater concern; whether the SLMC, as constituted at present and the way it seems to be functioning, is fit for purpose. Not being sufficiently distinguished, I have not had the pleasure of serving on either of these august bodies but have had dealings with both, after being reported by my colleagues.

I still remember the day my good friend Dr S. J. Stephen came rushing to my humble abode in the Summit Flats the moment he learned that I had been reported to the SLMC by a close colleague of mine. He was so concerned he offered to retain a top lawyer for me. I was reported for advertising myself by doing programmes on radio and television! Nowadays many doctors seem to be doing these but at that time I happened to be the pioneer in TV health education programmes. I remember Sanath Liyanage, who produced the very popular educational programme “Neth Sera” for Rupavahini, telling me that the medical programmes were widely watched even in Jaffna though my discussions with a panel of experts was in Sinhala.

When SLMC requested my comments regarding the complaint all I did was to point out that I did these programmes on behalf of the Sri Lanka Medical Association (SLMA), in keeping with its policy of public education and with the approval of the SLMA council. The matter did not progress further, but many infuriated colleagues of mine urged me to report the person concerned for his unethical action, malicious reporting, etc., but I did not want to descend to his level.

In addition to being the Consultant Cardiologist, for a time I was the Clinical Director of Medicine at Grantham Hospital in the UK. A doctor of Indian origin, whose name incidentally was Vaidya (Physician in Sanskrit), whom I appointed as a Staff Grade Physician (a position just below a Consultant) was behaving erratically and in spite of numerous representations by me, no action was taken by the hospital administration. He was once caught trying to put a nail under one of the tyres of my car! His ire got worse when post-graduate trainees from Sri Lanka who worked with me started winning the hearts and minds of the staff and patients with their ability as well as attitude. I must say I am very proud of the 10 trainees I had who have excelled themselves in Sri Lanka. Dr Vaidya reported me to the GMC on many counts including ‘import of illegal Sri Lankan labour’! After detailed written submissions the GMC decided that there was no case against me for further investigation. I must admit that I had few sleepless nights fearing a GMC investigation, which is a harrowing experience.

After it was proved that Dr Vaidya forged a letter from the Post-graduate Dean the hospital was forced to suspend him though they did not find him guilty of racism in spite of his circulating a letter condemning Sri Lankan doctors and the medical education system in Sri Lanka! Fortunately, the GMC took a different view when he was reported. I was the key witness at the GMC inquiry against him and one of the trainees who had returned to Sri Lanka was also present as a witness at the GMC expense. Dr Vaidya was found guilty of racism and forgery, as well as a number of other offences and his name was erased from the medical register.

In the UK, it is very easy for anyone, even a patient, to find out whether a doctor is registered and is in the specialist register as the GMC maintains an excellent website. Also, there are clear instructions in the website how to make a complaint against a doctor. All complaints are investigated by the Medical Practitioners Tribunal Service (MPTS) and all decisions of the MPTS are available on their website for public perusal. A quick glance shows at least three doctors receiving warnings each month and a few more getting undertakings/suspensions. Thus, there is an active process for patient protection.

I was aghast when I went through the SLMC website, not only for its primitive nature but for the paucity of information. The only detailed part in the website is the history of the CMC/SLMC, perhaps, reflecting our national weakness of harking on past grandiosity! Though it claims that the SLMC “is a statutory body established for the purpose of protecting health care seekers” there is not a word on the website how disappointed ‘seekers’ could raise concerns! There is no way of finding out whether any strictures were passed on any doctor or whether they are registered. As a test, I entered the names of some my trainees to find out the registration status but only a recurring message ‘no matches found’ appeared. As it is rumoured that there are many fraudulent practitioners, surely, this facility should be available.

According to the SLMC website, its President still is Prof. Carlo Fonseka! Carlo must be conducting affairs from heaven! But that is not possible because Carlo did not believe in an afterlife, a topic we discussed when I met him last, a few months prior to his death. In spite of the claim “it is a body corporate having perpetual succession and a common seal”, the last available annual report is for 2010!

I can go on pointing out many deficiencies on the website. I am surprised that many distinguished members of the profession who sat on the council did not realise the importance of an up-to-date website which, in this era of electronic communication, is the face of any organisation.

The most damning aspect, of course, is the constitution of the SLMC where there is a total disregard for the principle of ‘conflict of interest’. No office-bearer of a trade union should sit on the council of a regulator as it may compromise decisions. Justice becomes a mockery if the same counsel appears for both the prosecution and the defence! Any office-bearer of a trade union, even if not barred from contesting, should be mandated to give up such positions if they decide to sit on the council of the SLMC, as they cannot have it both ways. I am surprised that ex-officio members like the Deans of the faculties of Medicine and the Director General of Health Services did not take a principled stand on this issue. Had they declined to sit with those on whose part there was a conflict of interest, the government would have had no choice but to amend legislation. Or, is it that no government can defeat the rice-mafia or doctors’ mafia?

Not only the website but also the SLMC itself needs an overhaul but it should not go the way the GMC did. Many doctors in the UK are taking early retirement or exploring other avenues as they perceive that the GMC has become a body that harasses doctors, after it was revamped following public pressure. I am sure with the vast potential of talent available in Sri Lanka a middle way could be found and the SLMC can become a regulatory body fit for purpose.