Calls for prompt amendments to laws to strengthen SLMC as sole regulatory authority for medicine By Kumudini Hettiarachchi President Maithripala Sirisena yesterday re-assured health services unions of an equitable solution to the furore over SAITM amidst growing unrest in state medical faculties and a group of university teachers stepping in to offer a mitigating solution [...]


President re-assures “equitable solution” to SAITM issue


Calls for prompt amendments to laws to strengthen SLMC as sole regulatory authority for medicine

By Kumudini Hettiarachchi

President Maithripala Sirisena yesterday re-assured health services unions of an equitable solution to the furore over SAITM amidst growing unrest in state medical faculties and a group of university teachers stepping in to offer a mitigating solution to the crisis.
After a near 90-minute discussion with the Government Dental Surgeons’ Association (GDSA) and the Government Medical Officers’ Association (GMOA), President Sirisena repeated an assurance he made earlier this week at a public meeting outside Colombo that he “would speak to all parties concerned and take a fair decision”.

The unions presented a comprehensive update including all the background stating that the South Asian Institute of Technology and Medicine (SAITM) was an “illegal, unethical and immoral institution”, the GDSA Secretary Dr. Vipula Wickramasinghe said.
As students from the eight state medical faculties boycotted lectures following a Court of Appeal ruling that the Sri Lanka Medical Council (SLMC) should provide provisional registration to SAITM students, Deans from the medical faculties recommended a set of urgent measures including the “minimizing” of the likelihood of “substandard” medical graduates from entering the health force, to mitigate the possible negative impact from the court ruling.

The eight-year saga over the private medical college at Malabe — with opponents of SAITM including a section of the medical education community and also clinicians on grounds that it was set up illegally and clinical training for students was inadequate — came to a head two weeks ago after the court ruling. The SLMC is considering appealing to the Supreme Court over the decision.
While several ministers in the government back SAITM’s efforts to provide medical degrees, a proportion of the medical profession, medical educationists and unions are strongly opposed to SAITM. They argue that SAITM was set up in an ‘illegal’ manner and has only substandard facilities, especially for clinical training.

On Wednesday, eight Deans met Higher Education Minister Lakshman Kiriella and hoped to seek a meeting with the President too, to discuss the situation. The Deans have expressed fears that Sri Lanka “would descend into chaos and mayhem like in 1988-89, if this crisis is not resolved, quickly”.

At yesterday’s meeting, the GDSA and the GMOA urged the President to stop admissions to SAITM with immediate effect, a proposal that was made earlier by the Deans and repeated in their latest intervention. (There are nearly 900 medical students at SAITM with over 50 who have apparently passed the purported final MBBS set by SAITM, sources said.)

The two trade unions had offered short and long-term proposals. This included endorsing the recommendation of the SLMC that SAITM should not be recognized (short term) and on the long term removal of the Health Minister as the final authority in recognising medical educational institutions and entrusting that sole authority to the SLMC through prompt amendments to the Medical Ordinance.

This week, the Deans repeated an earlier plea for the Higher Education Ministry to direct SAITM to suspend the admission of medical students until the necessary compliance certification is obtained from the SLMC. Sources close to the Deans, meanwhile told the the SundayTimes that Minister Kiriella has agreed to meet student representatives, the President and the Secretary of each state Medical Faculty tomorrow (Monday), while agreeing on the need to tighten up regulations with regard to medical education.

Dealing with the ‘implications’ of the Court of Appeal order (CA/WRIT/187/2016) on the standards of medical education as well as in the provision of safe healthcare services in the country, the Deans have laid down the following suggestions.
Graduates from all private medical schools in Sri Lanka should be required to pass a licensing examination (similar to the examination that foreign medical graduates must pass), before they are awarded provisional registration by the SLMC. This will require an amendment of the Medical Ordinance.

Regulations prescribing minimum standards for medical education in all higher education institutes that are empowered to award medical degrees in Sri Lanka must be gazetted by the Minister of Health and approved by Parliament as soon as possible.
The legislation governing professional bodies such as the SLMC, the Sri Lanka Nursing Council and the Ceylon Medical College Council should be amended in order to empower such professional bodies to grant compliance certification to degree-awarding institutes.

Degree-awarding institutes should not be empowered to award medical and other health professional degrees by the Ministry of Higher Education, unless such an institute has obtained compliance certification from the relevant professional body. Compliance certification should be subject to renewal at regular periods, e.g. every 5–10 years.

SAITM should be compelled by the Ministry of Higher Education to suspend admission of medical students until it obtains the necessary compliance certification from the SLMC. · The other measures recommended by us in our Joint Statement issued in July 2016 could form the basis for resolving the broader concerns within the medical profession with regard to the functioning of SAITM as a higher education institute and with regard to current students and graduates.

Medical graduates from state universities, who have been provided with free education, should be compelled to serve the Sri Lankan state health system for some minimum period of time, whereas graduates from the private medical schools need not be compelled to do the same.

The eight Deans are Prof. Jennifer Perera of the Faculty of Medicine, University of Colombo; Prof. Vajira Weerasinghe of the Faculty of Medicine, University of Peradeniya; Prof. Sarath Lekamwasan of the Faculty of Medicine, University of Ruhuna; Dr. S. Raviraj of the Faculty of Medicine, University of Jaffna; Prof. Nilanthi de Silva of the Faculty of Medicine, University of Kelaniya; Prof. Surangi Yasawardena of the Faculty of Medical Sciences, University of Sri Jayewardenepura; Dr. A. Arulpragasam of the Faculty of Healthcare Sciences, Eastern University of Sri Lanka; and Prof. Sisira Siribaddana of the Faculty of Medicine, Rajarata University of Sri Lanka.

The Deans’ joint statement issued this week also states that as per the court order, the SLMC is required to grant provisional registration to the applicant under Section 29 (2) of the Medical Ordinance because she meets the stipulated conditions of a good character and a degree of Bachelor of Medicine from a degree-awarding institute (SAITM).

Although the SLMC had informed Health Minister Dr. Rajitha Senaratne in August 2015 that it did not recommend granting of provisional registration to graduates of SAITM because the programme of study leading to the award of the MBBS degree by SAITM was not up to the required standard (as found by an Inspection Team appointed by the SLMC), the court order found that:
Even though Section 19 of the Medical Ordinance empowers the SLMC to inspect medical schools, de-recognition of schools that do not meet the required standard is dependent on the Minister of Health publishing an order to that effect, and cannot be enforced by the SLMC without such an order, which was not issued in the case of SAITM.

The report submitted by the SLMC Inspection Team was without legal basis, exceeding the powers conferred on the SLMC, because there are no prescribed minimum standards for medical education by any university or degree-awarding institute in the country, which have been gazetted and approved by Parliament, as required by the Medical Ordinance.

Although regulations published in 2013 under Section 137 of the Universities’ Act require non-state degree-awarding institutes which offer study programmes leading to professional qualifications to obtain compliance certification from the relevant professional body and SAITM has not obtained a compliance certificate from the SLMC (which is the relevant professional body in the case of medical degree programmes), the consequences of not obtaining such certification can only be addressed by the Minister of Higher Education, who is empowered to revoke degree-awarding status, and this was not done either.

The joint statement of the Deans points out that; “in effect, this means that any medical graduate from a private Higher Education Institute (HEI) in Sri Lanka, which has been recognised by the Ministry of Higher Education as a degree-awarding institute, and empowered to award medical degrees by the same ministry, must be automatically granted provisional registration by the SLMC, regardless of the quality of training”.

(Please see full Joint Statement of the Deans and AMS statement)

Danger of ‘automatic’ registration for substandard medical degree holders – AMS
The Association of Medical Specialists (AMS) this week stressed the major weaknesses exposed in the monitoring/maintenance of standards in medical education through the court ruling on SAITM, while emphasising that the SLMC should be the formal body that decides on standards for the purpose of registration.The AMS, however, said it believes the students who are currently enrolled at SAITM should be provided with a solution to complete their education and noted that the proposals by the Deans of the eight state medical faculties would provide a basis for formulating a plan for this purpose.The AMS expressed concern about the threat to the independence of the SLMC, recalling many instances in the past where the SLMC and its staff were intimidated and threatened when private medical institutions were trying to establish themselves in Sri Lanka. “We regret that the authorities have turned a blind eye to these incidents,” it stated, pointing out that the 42-page Court of Appeal judgment is an eye-opener in regard to the state of the monitoring and maintenance of standards in medical education in this country. Some of these need urgent correction to assure patient safety in the Sri Lankan health system.Taking up the issue of a compliance certificate from the relevant professional body, the AMS citing the court ruling states that the Higher Education Minister has not taken any action on this matter. “This has exposed that the Minister has ignored the non-compliance of his own regulation by SAITM which has not obtained this certificate and has permitted SAITM to issue an MBBS without obtaining the compliance certificate. This is an immoral, unjustified and unethical act by the Minister. This effectively removed the monitoring/scrutiny process by the professional body. This action might allow substandard institutes to issue an MBBS degree. This has also created a bad precedent so that in future some other institution might demand that they also can function without this certificate,” states the AMS.Addressing another observation by court that the SLMC Inspection Report on SAITM as stated by the Additional Solicitor-General (on behalf of Attorney General) has no legal basis, the AMS pointsout that this is because there are no regulations on ‘Prescribed Standards’ needed for assessment. The only gazette available on these standards was removed on 21.10.2010 by EO gazette no1637/22.“This has virtually crippled the SLMC in monitoring the standards/scrutiny of medical degree courses. It is then obvious that the SLMC cannot either approve or disapprove any degree programme due to the lack of these regulations on prescribed standards. This will allow persons with substandard degrees to get ‘automatic’ Medical Council registration. This will seriously put patients’ lives in danger,” underscores the AMS, strongly urging the government to bring about necessary legislation to empower the SLMC to carry out its regulatory function without any external interference.

President to appoint expert committee
“I will appoint a committee of experts to consult all parties and advise the government on the SAITM issue,” President Maithripala Sirisena tweeted yesterday afternoon, referring to the meeting he had with the GMOA and the GDSA earlier in the day.

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