SAITM vs GMOA :Hypocrisy over Hippocratic Oath

An issue that would have, in the ordinary course of events, become a debate for professional bodies and the legal system to engage in, is quickly snowballing into a political hot potato: the controversy over the South Asian Institute of Technology and Medicine (SAITM).

What has triggered the current debate is last week’s ruling by the Court of Appeal directing the Sri Lanka Medical Council (SLMC) to provisionally register graduates who have been awarded their medical degrees from SAITM. The much awaited verdict has led to howls of protest from the Government Medical Officers’ Association (GMOA) and medical students in state medical faculties but the issue is now threatening to spill over to the political arena.

It is unfortunate that an issue such as private medical education which is critical to the country’s wellbeing is being mishandled in this manner. In this exercise, the GMOA and the SLMC must take the lion’s share of the blame for their deplorable conduct but the SAITM has had its lapses as well.

There are a myriad of reasons why private medical education is warranted in Sri Lanka. The state universities produce just over a thousand doctors every year, which is not sufficient to meet the nation’s needs.

Private medical education

There is no bar to students studying medicine overseas and returning to Sri Lanka to practise their profession- although that is much more costly and results in the loss of valuable foreign exchange to the country.

Also, the method of selection to state medical faculties is not strictly on merit: it is on a district based system which can be justified for socio-political reasons but at the same time it deprives thousands of talented and competent young men and women of the opportunity to pursue a career in medicine.

The country’s first experimentation with private medical education came in the early ‘80s when J. R. Jayewardene was President. He gave his blessings to the North Colombo Medical College (NCMC) in Ragama. That too led to a tussle with the GMOA. Ironically, supporting the GMOA was the Government Dental Surgeons’ Association (GDSA) and its Secretary at the time was Rajitha Senaratne who is now Minister of Health and is supportive of SAITM gaining recognition.

The same slogans that are heard today – of ‘buying’ the medical degree from the ‘Veda Kadey’- were heard then but the NCMC went on to produce doctors who have performed creditably both locally and internationally and are indeed an integral part of the staff of many state medical faculties. Therefore, for those familiar with the NCMC saga, there is a sense of déjà vu about what is happening today.

The NCMC was eventually nationalised when Jayewardene passed on the Presidency to Ranasinghe Premadasa. It is understood that now, the GMOA and those aligned with it in their battle against SAITM, will be making the same demand from President Maithripala Sirisena.

However, it must be noted that the NCMC was nationalised under very different circumstances, when the country was in the throes of an insurrection launched by the Janatha Vimukthi Peramuna (JVP) in an era where corpses were a common sight on the streets and when the entire university system had come to a grinding halt.

The trigger for the current unrest, the Court of Appeal decision compelling the SLMC to register SAITM graduates, highlights several issues. The Court has arrived at its judgment based strictly on the legalities of the issue and observed that the SLMC has no power to take over the functions of the Higher Education Minister. It further observed that the SLMC had acted in violation of Section 19 of the Medical Ordinance when making regulations relating to SAITM without having any power to do so.

It ruled that recognition (or de-recognition) of SAITM was the prerogative of the Minister of Higher Education. Similarly, while the Medical Council can make recommendations regarding the registration of a medical degree, the authority for that decision finally rests with the Minister for Health.

SAITM students

More telling was the Court’s observations regarding the process followed by the SLMC in refusing recognition. It observed that the SLMC team inspecting the facilities available at SAITM for undergraduate training recommended that SAITM develop a working relationship with the Ministry of Health, so it could improve training in disciplines such as Forensic Medicine and Community Medicine; yet it recommended that the SAITM degree not be recognised. The court noted that “the observations do not match with the final recommendation”.

The court was even more scathing with regard to the conduct of the SLMC in recognising the medical degree awarded by the Kotelawela Defence University (KDU). It noted that the SLMC had inspected the facilities at SAITM at length and submitted a detailed report before recommending that its degree not be recognised.

However, with regard to the KDU, the SLMC had “considered the facilities at KDU in only two paragraphs of their report and come to the conclusion that the facilities provided for training were of a very high standard even prior to the construction of the teaching hospital”. The court observed that it appears “two different standards have been used when preparing these reports”.

In fact, when the SLMC recommended improvements to SAITM, the latter sought assistance from the Ministry of Health. In January 2016, the Ministry agreed in principle to provide facilities at its hospitals and clinics at Avissawella and Kaduwela to allow clinical training in Community Medicine, Forensic Medicine and Psychiatry to SAITM students following a fundamental rights application filed by students in the Supreme Court. However, the GMOA thwarted this move, instructing its membership not to teach SAITM students at these locations.

It is also well known that other state medical faculties in the country, most notably at the Rajarata University and Eastern University, are woefully understaffed even if their teaching hospitals provide adequate clinical facilities for students. As a result, authorities in these universities struggle regularly to conduct lectures and examinations, often transporting lecturers from other universities to Anuradhapura and Batticaloa on an ad-hoc basis in desperate attempts to complete their curricula.

In fact, the President of the GMOA, Dr. Anuruddha Padeniya is listed as a visiting senior lecturer at the Rajarata University in the Department of Paediatrics which has only a visiting professor and no other senior lecturers! However, the facilities provided by these faculties are somehow deemed adequate by the SLMC; nor has the GMOA ever raised concerns about ‘patient safety’ in view of the shortage of teaching staff at these state run medical faculties. Thus, the bona fides of both the GMOA and the SLMC in this entire exercise have to be questioned.

The integrity of the President of the SLMC, Carlo Fonseka has also been called in to question following the Court of Appeal decision. Previously a much respected Professor in Physiology, Fonseka served as Competent Authority for the NCMC when it was nationalised. He is on record vociferously advocating the need for private medical education during the previous government, when SAITM was set up. Now however, he sings a different tune.

Fonseka would argue that it is all about maintaining proper standards in medical education, but the Court of Appeal has now observed double standards being employed by the SLMC itself. If Fonseka has a fibre of decency remaining within him, he should have resigned forthwith for that is what honourable men do.

In all of this, SAITM has confined its battles to exploring legal avenues. However, in comparison to the NCMC thirty five years ago, it too appears to have made some blunders in its quest for recognition. The NCMC was administered by the College of General Practitioners, a non-profit making organisation while SAITM is owned by Dr. Neville Fernando, a doctor who took to politics and then successfully tried his hand at business. A frequent charge against SAITM is that it is a ‘business’. While profit should not be a dirty word, SAITM erred in enrolling two batches per year during recent years which only aggravated the claim that it was all out to make money.

The NCMC, using funds it realised from students built a teaching hospital in Ragama and donated it to the government to administer. SAITM’s Neville Fernando Teaching Hospital remains a private hospital, thus attracting low numbers of patients. While donating the entire hospital to the government may not be feasible financially at least a section of it will need to be operated on a non-fee levying basis, if it is to generate adequate numbers of patients required for clinical training.

Matters have now taken a turn for the worse following the Court of Appeal verdict when the GMOA began actively canvassing political support for its campaign against SAITM. It met with the JVP leadership as well as former President Mahinda Rajapaksa. The issues at stake- the principles of private medical education and ensuring proper standards in this process- will unfortunately pale into insignificance and politics will come to the fore, if political parties now dabble in this.

Rajapaksa has already been wrong-footed on this issue. He went public opposing the SAITM and posing the question as to whether only children of ‘powerful people’ should be allowed to become doctors. His statement attracted ridicule and derisive responses in the media asking whether only children of ‘powerful people’ should be allowed to become lawyers as well, a thinly veiled reference to his own circumstances. Besides, a video has emerged where he is seen distributing scholarships to SAITM students when he was President!

Home-grown doctors

The incident where the Chief Executive Officer of SAITM, Dr. Sameera Senaratne was allegedly shot at on Monday night adds an entirely different dimension to the issue.

‘It indicates that the battle is getting uglier by the day although the immediate step that is likely to be taken is appealing the decision of the Court of Appeal in the Supreme Court, which the SLMC is likely to do.

From what has transpired thus far, it appears that the laws relating to the registration of doctors in the country need to be reviewed and strengthened to allow the SLMC to retain its role of ensuring proper standards in the medical profession.

However, the SLMC and the GMOA are equally culpable of being on a malicious and vindictive witch hunt against SAITM, instead of using the powers and resources at their disposal to assist the institution to produce home-grown doctors. As a result, a few hundred young Sri Lankans are left in limbo after years of toiling hard for a medical degree and the medical profession is fast losing its standing as a noble calling.