Minister and GMOA cross swords over medical specialists’ standards

Public questions how substandard institution gained recognition

By Kumudini Hettiarachchi and Hansini Munasinghe

As the private medical college fiasco simmered with an advertising war between its owners and the Sri Lanka Medical Council (SLMC), allegations and counter-allegations also erupted between Higher Education Minister S.B. Dissanayake and the Government Medical Officers’ Association (GMOA).
The controversy raged on with the SLMC publishing a huge advertisement on its stance last week, followed the next day by Malabe Medical College owner, Dr. Neville Fernando, giving his version.
This was while Minister Dissanayake allegedly went on record, casting serious aspersions against medical specialists in the country with the Health Ministry promptly issuing a statement that “media reports” gave the wrong impression about the standard of specialist doctors serving in Government hospitals.

GMOA Assistant Secretary Dr. Upul Gunasekara waves the SLMC advertisements refuting SAITM claims, with Assistant Secretary Dr. Sankalpa Marasinghe by his side at the news conference on Friday. Pic by Mangala Weerasekera

All specialist doctors serving in the Health Ministry have obtained a postgraduate qualification from the Postgraduate Institute of Medicine of the University of Colombo, gone for training abroad, been assessed, come back and been appointed as specialists to the health service through the Public Service Commission in a transparent process, stated Health Ministry Secretary Dr. Ravindra Ruberu in a statement, adding that Specialist Dr. Anuruddha Padeniya also falls into this category.

Dr. Padeniya, who is President of the GMOA, has been in the eye of the storm, with Minister Dissanayake linking him with corruption allegations and that he allegedly used influence to secure his postgraduate qualifications.

The GMOA, meanwhile, announced at a media briefing on Friday that it has sent a letter of demand for Rs. 300 million to Minister Dissanayake over this issue and also called a special general meeting of the GMOA’s Central Committee today, after an emergency meeting of its Executive Committee last Thursday (September 22).

We will discuss the allegations made by Minister Dissanayake against Dr. Padeniya as well as private medical education in the country, GMOA’s Assistant Secretary Dr. Upul Gunasekara said, pointing out that Dr. Padeniya did his postgraduate studies at the University of Oxford. “He is the first Sri Lankan Oxford-qualified Paediatric Neurologist,” he said.

As the web around the Malabe MC issue thickened, many academics, doctors, other professionals, students and public pointed an accusing finger at the fact that the right procedures had not been followed or loopholes in the procedures have been used to wriggle a substandard institution into the system as a degree-awarding institution.

Why is the Government not cracking down on an institution which seems to have blatantly misled the public, was the question on the minds of many, with others being very vocal about why strict guidelines, like in India, cannot be brought in for the setting up of private medical colleges.

According to some of the Indian conditions the “eligible persons shall qualify to apply for permission” if the applicant is an autonomous body, registered society or charitable trust; have a suitable single plot of land measuring not less than 25 acres, owned and possessed or possessed by way of a 99-year lease for the construction of the college; owns and manages a hospital of not less than 300 beds (for 50 student admissions) with necessary infrastructural facilities capable of being developed into a teaching institution in the campus; has not admitted students to the proposed medical college; provides two performance bank guarantees from a scheduled commercial bank valid for five years, in favour of the Medical Council of India, New Delhi, one for Rs. 100 lakhs (for 50 admissions) for the establishment of the medical college and its infrastructural facilities and the second bank guarantee for Rs. 350 lakhs (for 400 beds) for the establishment of the teaching hospital and its infrastructural facilities.

In Sri Lanka, draft guidelines (minimum prescribed standards) were drawn up thrice but have been consigned to limbo and not passed by Parliament to come into effect, the GMOA stressed, while other sources explained that such guidelines were not adequate. They should be more comprehensive and cover both private and state medical education, the source pointed out.

Going back to the origins of the Malabe Medical Faculty, the Sunday Times attempted to pare away the dead tissue and focus on the sore which has resulted in this malaise that is stifling private medical education.

Documents by the Board of Investment (BOI) dated August 2010 in the possession of the Sunday Times reveal that the South Asian Institute of Technology and Management (Pvt) Ltd., (SAITM) had been granted BOI approval on March 31, 2008 to set up a “higher education institute to provide training programmes” for information technology; management and finance; engineering; vocational studies; nursing; languages; and health science. The investment was US$ 5 million.

“This approval was granted subject to the condition that approval from the Ministry of Health and Nutrition be obtained prior to providing training in Health Science,” the BOI states categorically, indicating that SAITM’s application did not include a “proposal to set up a medical school”. It was also a 100% locally-owned venture, according to the BOI, and no joint application was submitted with the Nizhny Novgorod State Medical Academy (NNSMA) in Russia. Neither had the BOI received a separate application by NNSMA to set up an offshore campus in Sri Lanka.

The BOI further states that the SAITM application was not referred for scrutiny to an educational authority.
Meanwhile, the Dr. Neville Fernando Investment Company (Pvt), the owners of SAITM, by letter dated May 21, 2008 had informed the BOI that he had requested the Health Minister, the Sri Lanka Medical Council and the University Grants Commission to permit him to commence a private medical college and had forwarded the copies of letters sent to them.

This had been followed up with a letter dated January 26, 2009, where Dr. Neville Fernando had informed the BOI that they had been able to affiliate with a prestigious university in Russia, namely NNSMA, to offer Doctor of Medicine (MD) Degrees. He had informed the BOI that the degree (MD) had already been recognized by the SLMC and the General Medical Council of the United Kingdom and the World Health Organization, according to the BOI.

The BOI documentation also indicates that on a request made by Dr. Neville Fernando, the company was granted approval to change the main investor as Dr. Neville Fernando instead of Dr. Neville Fernando Investment Company (Pvt) Ltd., and SAITM signed the agreement with the BOI on October 1, 2008.

An intriguing aspect of this fiasco is how and when the South Asian Institute of Technology and ‘Management’ dropped its ‘tail’ and became ‘Medicine’ advertising heavily in the process. It also boasted (when calling for the 2010 second intake) that pre-clinical studies for the first batch would begin in well-known private hospitals with over 800 beds, even after repeated advertisements by the SLMC that it had not granted recognition to the Malabe MC.

When the Sunday Times checked with Malabe MC’s Dr. Fernando how they would handle the clinicals for their first few batches without a hospital, he said a 1002-bed Teaching Hospital was being constructed close-by. Until it was completed, he said, they had arranged with three private hospitals for their students to go to, last week.

However, when the Sunday Times, contacted Malabe MC’s Director Dr. Sameera Senaratne, he said the students would only begin their clinicals in November.

To the query from the Sunday Times about the academic staff, Dr. Fernando said they had about 50 lecturers and demonstrators, with every 10 students having one demonstrator. But Dr. Senaratne was unable to give the exact numbers, when questioned closely.When allegations that medical graduates who have qualified abroad but not passed the Examination for Registration to Practice Medicine (ERPM or Act 16) in Sri Lanka were teaching at the Malabe MC, were made, Dr. Fernando said that they had to pass the ERPM only to practise medicine but not to teach. This was the same view echoed by Dr. Senaratne (himself believed to be a foreign medical graduate) and SAITM’s Vice Chancellor Prof. Malkanthi Chandrasekera. “We use them to teach Latin and medical terminology, philosophy, history of medicine and Russian,” said Dr. Senaratne.

In the latest volley fired last week, the SLMC has highlighted “serious deficiencies” pointed out by the review teams which visited the Malabe Medical College before provisional recognition as a degree-awarding institution was granted to it. These include: No facilities for clinical training, no heads of clinical departments, no clinical departments and professorial units and no proof of adequate financial resources.

We never expressed satisfaction about the facilities at SAITM nor did we give any assurance that recognition would be granted to SAITM very soon, the SLMC says in no uncertain terms.

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