SLMC in crisis

The recent release of the report of a panel of inquiry that probed the affairs of the Sri Lanka Medical Council (SLMC) and the subsequent removal of its President and four members by the Minister of Health has brought to the surface many problems concerning this important statutory body. It is well known that the inquiry was initiated by a complaint made by the office-bearers of a powerful trade union who happen to be members of the council.

Many deficiencies, shortcomings and irregularities in the report itself have been exposed. The impartiality of the inquiring panel has also come into question. It appears that the inquiry, meant to be of a fact-finding nature, had erroneously recommended punitive action.

The confusion in the minds of many regarding the difference between the Sri Lanka Medical Council (SLMC) and the Sri Lanka Medical Association (SLMA) should be clarified at the outset.

The SLMC is a statutory body established, in 1924, on the Medical Ordinance based on the same format as the General Medical Council (GMC) of Great Britain. It is tasked primarily with ensuring the safety of the general public seeking medical treatment from doctors registered by the council. It does so by maintaining the standards of medical education and by supervision and disciplinary control of medical practitioners of all categories. The public are encouraged to bring any complaints, supported by affidavits, regarding the actions of the practitioners to the SLMC. It is illegal to practise allopathic medicine in the country without first getting registered with the SLMC.

The SLMA, on the other hand, is an association of doctors of all categories dealing with academic matters, and bringing doctors updated with advances in medicine for Continued Professional Development (CPD). Its membership is voluntary, not compulsory, and is open to all graduate medical practitioners registered with the SLMC. It plays an advocacy role in various health issues affecting the people, as well as assisting the government in matters of health policy. At present, it is actively involved with the health authorities in attempts to control the Covid pandemic. It promotes ethical practice of medicine.

As already mentioned, the SLMC is based on a Medical Ordinance 96 years old. Naturally, much amendment is necessary to suit the current requirements. Such changes have been formulated and proposed to the Ministers of Health, the ultimate authority, by the SLMC at various times during the past two decades. Unfortunately, no action has been taken in implementing them. This has led to the various allegations levelled against the Council, often for no fault of theirs.

At present, the SLMC is composed of 25 members: the Director General of Health Services (ex-officio), the Deans or their representatives of the nine medical faculties in the country, eight graduate doctors registered in the main section 67 of the Ordinance, elected by vote, one representative each of the dental practitioners and registered medical practitioners and the President and four members nominated by the Minister of Health.

Many controversies have arisen due to this composition. Much criticism has been raised about the way the elections are conducted to select the eight graduate members. The trade unions like the GMOA with a large membership have a near monopoly of getting their members elected to fill these posts. They conduct their campaigns like in national elections, spending vast resources at their disposal, in bringing bus loads of doctors to Colombo for voting and even intimidating opposing contestants. At present, the GMOA President is an elected member of the SLMC along with three other office-bearers of his union. Being a vociferous trade union, the GMOA does its utmost to impose its will on council decisions. On several occasions, they have been reprimanded by the President of the SLMC for disrupting the council proceedings.

The current controversy concerns the five members, including the President nominated by the Minister of Health. Although the Minister is the nominating authority, the Ordinance does not allow her to remove them until five years have lapsed since their appointments. (This situation is similar to that which empowers the President of the country to appoint judges of the apex courts, but he has no authority to remove them.) The recent dismissal of the President and four members is therefore considered illegal.

Reasons given for such action based on an adverse report of the panel of inquiry referred to the above are worth further analysis. As mentioned already, allegations were brought in mainly by the GMOA:

1. Improper conduct of disciplinary inquiries. As a significant number of the accused naturally happen to be GMOA members purely because of their vast membership, there is a conflict of interest if GMOA members in the council are to sit on disciplinary committees. Thus, barring them from sitting on such committees has caused much dissatisfaction among the union members.

2. Delay in conducting the ERPM examination for foreign qualified doctors. This is an ongoing problem. The examination schedule has been disrupted this year due to the Covid related restrictions. Matters have been made worse over the years by different groups of candidates getting court injunctions preventing the holding of examinations for various reasons. The examination branch of the SLMC has been working round the clock, headed by a respected emeritus professor of the Colombo Medical Faculty, with long term experience in conducting medical examinations. The high rate of failure at this examination is due to many reasons. It cannot be blamed on the examination process. The format of the examination has been improved on several occasions over the years. No doubt an ever-increasing number of candidates and a paucity of available examiners cause several logistical problems. Unreasonable calls from the politicians and others to do away with the examination altogether have been resisted effectively so far. In one instance, when the Minister indicated that a crisis situation had arisen due to the high rate of failures, the SLMC pointed out that a graver crisis would arise if poorly trained doctors are allowed to practise medicine!

3. Inability to maintain minimum standards for entry into foreign medical colleges. It was realized way back in 2011 that some students had gone abroad for medical education without even passing the GCE advanced level examination. These students have returned with their medical degrees. The SLMC could not disqualify them from sitting the ERPM exam, as such retrospective action was deemed illegal. However, corrective action has been taken to establish minimum standards for entry to medical schools. Up to now the courts have rejected applying such criteria without being passed by an Act of Parliament. Various proposals for such action have been ignored or delayed by the political authorities. The provisions were at last passed by an Act of Parliament a few weeks ago. Thus, it is unjustifiable to blame the SLMC for such deficiencies and delays.

The political authorities, over the years, have attempted to interfere with the vital functions performed by the SLMC. Requests for lowering the pass marks at qualifying exams, register foreign medical specialists with substandard qualifications, and recognition of local and foreign private medical colleges with many deficiencies were successfully resisted by the SLMC. In one instance, the lady president was forced to resign when she did not comply, as there was no provision in the ordinance for her removal. So far, the SLMC has been able act honourably due to the non interference by those in authority, guaranteed by the Ordinance.

The present situation where the Minister single-handedly and illegally removed five members, including its President, is bound to have serious repercussions for the future. It is not a question of the suitability or otherwise of the personalities who were removed or those who replaced them. It is the illegal violation of the independence and autonomy of a statutory body. Hence it is essential that this decision is reversed and status quo restored.

Once that is done the amendments to the Medical Ordinance should be framed and implemented without any further delay. Changing the composition of the SLMC, the way the members are selected or elected, and the inclusion of respected non-medical professionals are among the priorities to enable the SLMC to discharge its duties to the general public at large. If the current situation prevails, the SLMC will be a toothless tiger serving the selfish interests of politicians. Ensuring that the medical profession is well regulated maintaining high ethical standards, thus safeguarding the interests of the general public will be the least of their concerns.

A Former Member of the SLMC