ISSN: 1391 - 0531
Sunday, October 08, 2006
Vol. 41 - No 19

Medical Council's Doubtful Delivery

Mystery shrouds SLMC’s reversal of its ruling on an Apollo Hospital "Consultant" Obstetrician and Gynaecologist

By Kumudini Hettiarachchi

Off the roll and in less than a month on the roll again.

How and why the Sri Lanka Medical Council (SLMC) first decided to erase the name of a so-called "Consultant" Obstetrician and Gynaecologist working at the Apollo Hospital Ltd. and not issue her registration and then less than a month later revoked its own decision and granted her a six-month registration remains a mystery, with both the SLMC and hospital authorities remaining tight-lipped.

The questions doing the medical rounds at the moment are: Was the revered SLMC pressurized or influenced to change its decision in favour of "Consultant" Dr. Vandana Bansal? Or does this case indicate incompetence on the part of the SLMC which is expected not only to uphold the highest traditions of the medical profession but also act as a regulatory body to maintain medical standards in Sri Lanka?

Even if Apollo Hospital, set up as a Board of Investment venture four years ago, does not see it as its responsibility to be accountable to the public, what of the SLMC, the watchdog of the medical profession, which has a duty by the people?

The Sunday Times understands that the saga of alleged incompetence, unethical practices and fee-splitting with regard to Dr. Bansal came out into the open around May this year, with complaints by other concerned doctors being directed to both the management of Apollo and its Ethics Committee.

The Ethics Committee report came out on July 12, 2006. Subsequently, a letter followed by an affidavit had been submitted by several senior doctors of Apollo on the same issue to the SLMC, it is learnt.

On August 23, this is what the SLMC wrote to Dr. J.M. Shahani, the Director of Medical Services of Apollo Hospital: ..... "Regarding Dr. Vandana Bansal, the Council considered all documents submitted on the matter and decided that she would not be granted any further extensions as her skills as a Gynaecologist was (sic) considered as inadequate and the hospital has the services of several competent Gynaecologists who are able to cover the demand."

The letter was signed by the Registrar of the SLMC, Dr. N.J. Nonis.

But on September 21, there was a sudden change, with the SLMC writing to Dr. Bansal that having considered her appeal and also the finding of the Ethics Committee (apparently referring to Apollo Hospital’s Ethics Committee) it had decided to grant her registration for six months commencing on September 20. “You are however requested to refrain from performing laparoscopic procedures either alone, with assistance from another person or assist anyone else perform laparoscopy.”

It had taken only four weeks for the SLMC, considered one of the most eminent and respected professional bodies in Sri Lanka, to revoke its decision. Whereas earlier it had found Dr. Bansal's skills as a gynaecologist "inadequate" suddenly it was only her ability to perform laparoscopies that was being doubted.

When The Sunday Times contacted Dr. H.H.R. Samarasinghe, the President of the SLMC, to request a meeting with him to discuss this crucial issue which concerns the public in the country, the hundreds of women who go to Apollo for treatment, he requested that we contact the Registrar of the SLMC, Dr. Nonis.

When we contacted Dr. Nonis seeking an interview with him, although he requested us to meet him at 9 a.m. last Wednesday at the SLMC, when we did so, he politely told us that he should not speak to the media on the Apollo issue.

However, later when contacted on the phone, he explained in detail, the procedure with regard to the granting of registration to foreign medical consultants who seek to work here.

Apollo's Acting Director of Medical Services, Dr. Rana Mehta, who is looking after the work of Director Dr. Shahani, who hospital authorities said was out of the country, was either at a meeting or unavailable for comment on this serious issue with regard to a "Consultant" whose name appears at the top of the list of Consultant Obstetricians and Gynaecologists at the OPD 2 on the first floor of the hospital.

Those who answered the calls on behalf of Dr. Mehta requested that we get in touch with Apollo's Marketing Manager Chammika de Silva, who meticulously took down the questions we posed. However, on Thursday morning, Mr. de Silva said that Dr. Shahani was expected on Friday and as he was the only person who knows the details about the registration of Dr. Bansal and connected issues, The Sunday Times would have to await his arrival for the answers.

This was despite repeated reminders that the PLUS section of The Sunday Times goes to print on Thursday night, and that the person who is looking after Dr. Shahani's work should answer these questions.

How did the SLMC, within a month, come to the conclusion that Dr. Bansal's "inadequate" skills were now "adequate" and that she should only refrain from engaging in laparoscopic procedures?

A senior member of the College of Obstetricians and Gynaecologists who declined to be identified said that laparoscopic (minimal invasive) procedures are part of the skills required of a gynaecologist, adding that these procedures and scans were first used by gynaecologists long before the other specialities.

The humble women of this country seek, an explanation from the SLMC in this matter of life and death.

News blackout

The hospital administration has given a ruling that no one should make statements to the media, was the reply of Dr. Vandana Bansal when The Sunday Times contacted her on Thursday.

When was this rule brought in? "About two months ago," she added.


How foreign doctors are registered

How does the Sri Lanka Medical Council (SLMC) grant registration to foreign 'Consultants' in the medical profession?

Sri Lanka Medical Council

Foreign medical 'Consultants' are registered under three different categories, according to SLMC Registrar Dr. N.J. Nonis who explains that registration under Section 67A of the Medical Ordinance is given only for a maximum period of one year, after which they have to seek renewal.

Here are the three categories:


  • Those who come to Sri Lanka for a short duration, ranging from a few days to two weeks, on the invitation of local universities and academic institutions. These Consultants who are invited to demonstrate new procedures are recommended by the Deans of the local Medical Faculties.
  • Consultants who come with NGOs and work in difficult areas such as the north and the east where local Consultants are reluctant to go. These doctors are given registration on the recommendation of the Ministry of Health, after the Director-General has checked their credentials. The SLMC also peruses the certificates with the relevant qualifications.
  • Consultants brought in by private hospitals set up under the Board of Investment (BOI) whenever these hospitals are unable to recruit full-time Consultants locally.

Earlier they were recommended by the Director-General of Health Services.

Later after the SLMC held many discussions during the time of Dr. A. M. L. Beligaswatte, a decision was taken that the 'skill, knowledge and expertise' of such foreign Consultants should be studied by experts in their own field, said Dr. Nonis, adding that it was agreed to set up a panel of experts from the relevant colleges (eg: College of Surgeons, College of Physicians or College of Obstetricians & Gynaecologists) to advise the Director-General.

It was agreed on but not implemented. However, it has now been implemented with effect from September 1, 2006.

When The Sunday Times queried from Dr. Nonis whether the SLMC checked out the certificates and credentials of such Consultants, he said it was difficult to do so as some of them were already in the country and it was "short notice".

But they had to produce the originals and certified documents which would then be perused by the '67A Committee' before registration is granted by the SLMC.


Issues and findings of the Ethics Committee

Here are the main issues as stated in a lengthy report on the Inquiry by the Ethics Committee of Apollo Hospital:

  1. Dr. Vandana Bansal (referred hereafter as VB) flouts herself as a Consultant Obstetrician and Gynaecologist.
  2. Dr. VB advertises herself as a specialist in "high-risk pregnancy", a title which she is unqualified to hold
  3. Dr. VB claims to hold a post-doctoral fellowship in foetal medicine.
  4. Dr. VB involves a gastrointestinal (GI) surgeon to carry out all major gynaecological surgeries.
  5. Dr. VB involves a GI surgeon to carry out all laparoscopies.
  6. Patients are unaware that their surgeries are being done by a GI surgeon.
  7. There has been a maternal death under Dr. VB.
  8. There have been a few post-partum haemorrhages where hysterectomies have had to be done.
  9. Dr. VB is an incompetent medical officer.

The findings are as follows:

On issues 1 to 3 - The originals of Dr. VB's Diploma in Obstetrics and Gynaecology (from Rothek University in India); an MD in Obs & Gyn; Diplomat of the National Board (Obs&Gyn); advertisement in the 'Hindu' newspaper and the Certificate of Post-Doctoral Fellowship had been inspected by members of the Ethics Committee.

Dr. J.M. Shahani by letter dated 10.06.06 has requested the National Board of Examinations, India to authenticate the degree certificates.

On issues 4 & 5 - The type of surgical procedures done had been categorized by the Convenor of the Ethics Committee into 4;

  1. Obstetric procedures (LSCS)
  2. Minor gynaecological procedures, eg. ERCP, D&C
  3. Laparoscopies
  4. Major (Open) gynaecological procedures. Eg. TAH, BSO, Myomectomy, VH, Oopherectomy

Type 1 & 2 procedures were done by Dr. VB herself and there were no allegations made against her on these procedures.

Type 3 procedures - Dr. VB at her interview with the Ethics Committee agreed that to all laparoscopic procedures she called Dr. RK (a consultant gastro-enterologist) to the theatre to insert the laparoscope as she felt that she is not trained or qualified enough to put in a laparoscope.

Analyzing the computer documentation, the Ethics Committee sets the percentage of cases where Dr. VB had got Dr. RK. involved to 91.8%.

Type 4 procedures - Of the files of 78 surgeries, Dr. RK had been involved in 24.3% and a surgical registrar in 11.5%. The Ethics Committee states that as to whether a GI surgeon should have been involved in these surgeries is a matter to be put forward to a forum of experts on this subject even though it may be a very subjective issue. Dr. VB had stated that in instances where another doctor was involved, the patient did not pay additionally but the fee was divided among the two surgeons.

Issue 6 - The Ethics Committee states that it is clear that during all her surgeries Dr. VB was actively present at the surgery. The question is when another consultant took part in her surgeries whether the patient was aware of that. When a surgeon is called to the theatre to attend to an emergency situation which has arisen during the surgery invariably prior consent is not warranted and is impractical. However, if another consultant is arranged prior to surgery to participate in a surgery, prior informed explicit consent from the patient is needed and the patient has to be told as to what aspects/sections of the surgery will be done by the other surgeon.

Of all the files of laparoscopies and surgeries inspected, only in 6 instances a written consent has been taken for a second surgeon's involvement. In all except two the second surgeon's involvement was in op (operation) notes which the patient did not have access to. In these two files, the second surgeon's involvement is not mentioned anywhere but his fee has been charged.

Issue 7 - The maternal death mentioned has happened sometime back and there has been an inquiry at the Regional Director of Health level without any adverse comments on it. As inquiring a maternal death is beyond the scope of an Ethics Committee this issue was not investigated.

Issue 8 - This issue was dropped at the discussion the signatories to the letter had with the Ethics Committee.

Issue 9 - The Ethics Committee feels that it is beyond the scope of the committee to pass judgments of competency of consultants as this has to be done by a panel of experts in that particular speciality and the clinical effectiveness committee may attend to it.

The Ethics Committee has also recommended to the management:

  • To request from all surgeons to adhere to the seven steps mentioned in the report on consent when involving a second surgeon in planned surgeries.
  • To request from doctors/staff members to provide the Ethics Committee with adequate evidence to substantiate all aspects of allegations when a complaint is made.
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Copyright 2006 Wijeya Newspapers Ltd.Colombo. Sri Lanka.