By Nirmala Kannangara
This little girl suffers from a post operative complication, Five years after his operation on a conginital abnormally, this patient suffered chronic discharging from the surgery wounds, A 62 year old patient faced an unsuccessful CABG operation by a foreign surgeon. and 1. Letter sent by the Health Secretary to the Registrar SLMC instructing to give registrations. 2. Letter to DGHS from president College of Surgeons recommending Assistant Cardiothoracic Surgeons. 3. Letter from president GMOA to SLMC president to suspend registrations.
Questions have been raised as to why the Health Ministry officials have refused to comply with the recommendations of College of Surgeons and want the Sri Lanka Medical Council (SLMC) to issue provincial registration to unqualified foreign doctors to practice in Sri Lanka.
College of Surgeons (CS) on many occasions has instructed Director General Health Services (DGHS) Dr. Ajith Mendis not to issue provincial registrations for certain foreign doctors to practice in Sri Lanka after scrutinizing their qualifications, skills and knowledge.
However, despite this recommendation the DGHS on instructions from the ‘top’ has continued to instruct the SLMC to issue provincial registration to unqualified doctors.
“This is the most pathetic situation. Politicians can dance to the tunes of hospital owners who are ‘wealthy’- businessmen. But the Health Ministry officials who know what the ultimate consequences would be, should not give such instructions to the SLMC which are harmful for the peoples’ health.
“It is a known fact that the Health Minister, the Ministry Secretary or the DGHS are not concerned about the well- being of the sick but work to an agenda to please private hospital owners,” a member of the College of Surgeons said on condition of anonymity.
As a result of the Health Ministry officials’ ignorance, there were many instances where the patients of these unqualified doctors had to seek post- operative treatment from qualified Sri Lankan Surgeons at the National Hospital Colombo and Lady Ridgeway Hospital for Children.
Reliable sources from the SLMC, College of Surgeons and Government Medical Officers Association (GMOA) on conditions of anonymity said that the Health Ministry’s stance to give temporary registrations to such doctors have brought detrimental results over the years.
“Most of these doctors are from India and have come here to work as Cardio-thoracic Surgeons.
According to their experience and qualifications they cannot work as Cardio-thoracic Surgeons even in India.
When their applications were forwarded for evaluation what we understood was that they have experience as medical officers or junior doctors in their country but not as surgeons.
So how can these private hospitals that claim that they provide the best health care service to the people, employ such unqualified doctors as their surgeons.
Doesn’t that mean their primary objective is to earn money but not the safety of their valued customers,” the sources claimed.
According to the sources there is a dearth of Cardiothoracic Surgeons in Sri Lanka, which does not mean that unqualified doctors have to be ‘imported’ from India to practice as Cardiothoracic Surgeons and putting the lives of patients at risk.
“When the private hospitals are losing income once registrations are not given to these ‘parachute’ doctors, the politicians who benefit from these businessmen are unhappy.
But do they show the same concern when patients die or when their operation are not successful? Neither the Health Ministry nor the ministry officials call for explanations from these hospital owners and the surgeons when such cases are reported.
If the ministry cannot take responsibility when these unqualified doctors mess up with the patients’ lives then why do they want to interfere with the SLMC who has the power to issue registrations considering the skill and knowledge,” said the sources.
According to SLMC sources, services of foreign doctors were earlier taken for various purposes in the north and the east during the war since the Sinhalese doctors could not reach those areas.
It was then the private hospitals started recruiting these doctors for surgeries sans proper qualifications.
According to the Medical Ordinance, SLMC is the regulatory body that has authority to give temporary registrations for foreign doctors who have the proper skill and knowledge to practice here.
“When the applications were forwarded to us for temporary registrations that we requested the DGHS to recommend us the qualified doctors which would make it? easy for us to give the registration as the 25 SLMC members do not have the time to evaluate these foreign doctors’ qualifications.
Although the SLMC had faith on the Health Ministry officials it was later revealed that these recommendations have been made to please their superiors but not on the basis of the doctor’s expertise knowledge and skill to perform operations on local patients,” said the sources.
It was at this point according to the sources, that specialist doctors have protested over the evaluation process and called the ministry to streamline the process by preventing the DGHS from recommending unqualified doctors.
After the protest in October last year, the ministry appointed an expert panel to evaluate the qualifications of these doctors.
“When the expert panel was appointed there was a huge outcry from private hospitals.
First they did not want to re-forward the qualifications of their foreign ‘Surgeons to the expert panel’s perusal.
But since it was made compulsory for them to forward the qualifications in order to issue registrations some doctors forwarded their applications while most of the doctors went back to India.
That alone showed that these doctors were not qualified to work as surgeons here,” said the sources.
GMOA sources meanwhile accused the DGHS for further ignoring the recommendations of the expert panel.
“Even though a decision was made in October last year to give the full powers to this expert panel to evaluate the applications and to decide whether or not to give temporary registrations for the foreign doctors, it was breached openly by the Health Ministry officials.
This was because the expert panel after thorough scrutiny rejected most of the applications forwarded by the foreign doctors. As a result, a meeting was summoned on July 4, by the Health Minister with ‘big shots’ from private hospitals,” SLMC sources said.
According to the sources, the Health Secretary, the DGHS, SLMC President Prof. Carlo Fonseka and Dr. Lalanka Ranasinghe too have taken part at this decisive meeting.
“Although there were many objections against issuing temporary registrations, private hospitals representatives have urged the minister to give temporary registration for these unqualified doctors considering the dire need of Cardiothoracic Surgeons.
From the way this meeting was handled it was clearly noticeable that the Health Minister had decided to grant registrations for unqualified doctors at the request of the hospital owners well before the meeting started.
That was why he came to such a decision in no time,” alleged the SLMC sources.
As a result, by a letter dated July 9, 2012 to Dr. N.J. Nonis Registrar, SLMC by Dr. Ravindra Ruberu Health Secretary has wanted the SLMC to grant temporary registrations to the foreign doctors considering their service as a ‘vital need’.
The letter further states that the private hospital managements have met him (Health Secretary) to indicate the dire need of these specialists to continue their Cardiac Surgical Services.
“Considering as a vital need, the ministry after evaluating the recognition of the specialist qualifications in their home country and the fact that no local applicants had come forward even after the repeated? advertisements, I recommend the temporary registration for one year under clause 67A of the Medical Ordinance,” says the letter.
Meanwhile the GMOA, the SLMA and representatives of professional colleges have met last Saturday to decide whether the SLMC should be given the powers to decide whether the temporary registrations should be given to the unqualified foreign doctors or not in future.
“Although it is the SLMC that has this power, it always worked on the DGHS’s recommendations.
Since we have noticed that the Ministry officials and politicians are getting involved in the decision making process which is detrimental to the people’s health and safety? we will? meet and take a final decision. Once all the stakeholders come to an agreement we will send a report to the minister in this regard,” said the sources.
However Dr. Kanthi Ariyaratne Director Private Health Sector Division Ministry of Health on behalf of DGHS Dr. Ajith Mendis said that on the request of the private hospitals Health Minister had to take a decision to grant temporary registration for the doctors that were not recommended by the College of Surgeons.
“Since these hospitals do not have enough of local doctors to attend on their patients during 8 am to 4 pm on weekdays and since these hospitals are duty bound to provide good health services to their patients they have no other options but to recruit foreign doctors,” said Dr. Ariyaratne.
According to Dr. Ariyaratne, Health Minister’s request to the SLMC to grant temporary registration only for one year was mainly considered due to the dire need of doctors in private hospitals.
“The government cannot stop private hospitals from functioning due to lack of doctors.
These hospitals have hi-tech facilities that government hospitals do not have.
At the July 4 meeting, the Minister specifically told the private hospital representatives that he will grant their doctors one year registrations but not beyond that period unless they have the required qualifications and skills,” said Dr. Ariyaratne.
Meanwhile Registrar, SLMC Dr. N.J. Nonis when contacted said that he cannot make any comment in this regard. However Director Medical Services, Lanka Hospitals Dr. Wimal Karandagoda said that their hospital has not faced any difficulty from the health authorities since the foreign doctors have the required expertise qualification in their respective fields.? “As there are no local doctors to attend on our patients during working hours on weekdays, we are compelled to take the service of foreign doctors.
Our doctors have met the required qualifications to practice as specialists here.
Even in future we will obtain their services as we do not have any other options,” added Dr. Karandagoda.? Although several messages were left for Director Medical Services Durdans Hospital Dr. Ruwan Senathilake for a comment in this regard, Dr. Senathilake did not return the calls until the paper went to print.
Foreign Doctors Recruited As There Were No Permanent Local Doctors
Meanwhile Senior Manager Medical Allied Services Durdans Hospitals Dr. Vibash Wijeratne said that there were no other options but the hospital had to recruit well qualified foreign doctors to work for Durdans since there were no local doctors to work permanently at the hospital.
When we called foreign doctors for interviews it is our Director Board that initially go through their qualifications. Once we are happy with their qualifications and knowledge we forward the application to the Health Ministry.
Up to October last year there was no issue in granting registrations to foreign doctors but things started to worsen since then,” said Dr. Wijeratne.
According to him it was the expert committee that raised unnecessary issues with the private hospitals alleging that they employ unqualified foreign doctors.“Although we are stakeholders we were not informed about the appointment of this expert committee.
They would have appointed private hospital representatives also to this committee which would have been an independent team. What we now request the health ministry is to revert the evaluation process to pre October 2011 period where the Ministry officials evaluated the foreign doctor applications and got the registration from the SLMC.
We do not want the expert panel- College of Surgeons to evaluate the applications and not recommend registrations.
Until an agreeable procedure is adopted we want the DGHS to evaluate the application as how they did until October last year,” he said.