Battle of wits

The SAITM issue is by no means over. The government is likely to go ahead with gazetting minimum requirements and then seeking court approval to implement them. Whether the GMOA will still stick to its guns at that stage remains to be seen, but this is a battle of wits that is likely to continue for many months to come. Meanwhile, patients at state hospitals will bear the brunt of the actions of the GMOA, whether they like it or not.

The crisis over the South Asian Institute of Technology and Medicine (SAITM) appears to be heading for a confrontation between the government and the major doctors’ trade union, the Government Medical Officers’ Association (GMOA) while opposition political parties are keen to get maximum political mileage out of the issue.

Late last week, the GMOA staged a crippling one day countrywide strike in state hospitals. It was reported that its doctors also kept away from private practice that day. That the trade union, which claims it is fighting to “protect the lives of innocent patients” did so at a time when the country is battling dengue and influenza epidemics, attracted much criticism and casts doubts on their integrity.

By early this week, the Ministry of Higher Education announced a series of proposals aimed at resolving the issue. It included the takeover of the Neville Fernando Teaching Hospital in Malabe which will now be run as a teaching hospital under the Ministry of Health. The government envisages that this would provide adequate numbers of patients for the clinical training of SAITM students.

In addition, several other measures were announced. The provision of additional clinical training at the Homagama and Avissawella hospitals, a mandatory examination conducted by the Sri Lanka Medical Council (SLMC) for students qualifying from private medical schools and the stipulation of minimum standards for medical education are among them.

Court of Appeal decision

The government was cautious to announce that these measures will be subject to any decision arrived at by the courts. It will be recalled that it was the Court of Appeal decision in late January this year that opened the floodgates for protests against SAITM.

That was after the Court of Appeal announced that SAITM students were entitled to have their degree registered with the SLMC. Since then, the SLMC has lodged an appeal in the Supreme Court against the decision by the Court of Appeal.

Legal experts say that while this has given some time for the SLMC to review its stance, the Court of Appeal verdict is extremely sound in law and is based on the strict interpretation of the Medical Ordinance and the Universities Act, as they stand now.

The government hopes that the measures announced earlier this week will provide the basis for a resolution of the SAITM crisis which is beginning to have its impact. Already, students of all state medical faculties are boycotting lectures. As a result, their final examinations will be delayed. This would necessarily mean that the graduation of the next batch of doctors from state medical schools will be delayed- and there won’t be a batch of new doctors available to take over when the current batch of interns end their one year of internship.

However, the GMOA appears to have pooh-poohed the government’s proposals and dismissed them prematurely. Its intentions were made clear when their spokesmen jumped the gun and stated that gazetting of minimum standards for medical education would only aggravate the crisis- even before the minimum standards had been announced!

In fact, it was the Court of Appeal which, in its judgement which noted that at present, there are no minimum standards for medical education, which could be considered to be legally binding. Only weeks ago, the GMOA was agitating for these standards to be announced. Now however, they have done an about-turn and are challenging the declaration of such standards, even before they have been officially revealed!

It is understood that these standards are now being prepared by the SLMC. They will cover the minimum Advanced Level qualifications for students studying Medicine as well as other issues including facilities for teaching such as lecture halls and library facilities, the cadre of the lecturers and professors, the number of beds and other facilities available for clinical training.

Neville Fernando Teaching Hospital

It is learnt that SAITM will meet most of these standards, once the Neville Fernando Teaching Hospital is taken over by the government. However, it has already declared that some of its students may have only three simple passes at the Advanced Level examination instead of the two credits and one simple pass which is likely to be the stipulation of the SLMC.

SAITM has pointed out that the SLMC announced its requirements only in 2011. Until then, SAITM had enrolled some students with three simple passes but since then all its students fall within the SLMC requirements, SAITM has said. No doubt, these claims will be subjected to the most rigorous scrutiny by the government, the courts of law and of course, by those opposed to SAITM.

Another potentially problematic issue is the minimum requirements of staff in medical schools. It is well known that some state run medical faculties- most notably the Rajarata, Eastern and Jaffna medical schools- lack adequate permanent staff. The question as to why the GMOA and the SLMC does not raise this, if they are indeed genuinely concerned with the standard of medical education has already been asked, but this will come to the fore when minimum standards are gazetted into law.

Demand for closure of SAITM

The current stance of the GMOA, in the wake of the government announcing what many would consider a reasonable solution, is puzzling if one considers it to be a merely professional trade union fighting for its rights. However, there are now indications that the GMOA, instead of securing standards for its profession, is keen on brow beating the government politically.

Its President, Anurudhdha Padeniya’s speech at the culmination of last Friday’s protest was a case in point. It appeared to be extremely political and described Leader of the House and Higher Education Minister Lakshman Kiriella and Health Minister Rajitha Senaratne as ‘amanayo’ or fools.

Padeniya was also treading on dangerous ground when he asked, “What is the point of having courts when it cannot deliver proper judgements?” Many interpreted this to be a reference to the Court of Appeal decision that was in favour of SAITM and that Padeniya could in fact be cited for potential contempt of court.

The GMOA’s current demand is for the closure of SAITM and for the institution to be nationalised. They want history to repeat itself because protests against Sri Lanka’s first privately managed medical college, the North Colombo Medical College (NCMC) in Ragama saw it being nationalised at the height of the insurrection launched by the Janatha Vimukthi Peramuna (JVP) by then President Ranasinghe Premadasa and affiliated to the University of Kelaniya as its medical faculty.

Indeed, the JVP- as well as the Joint Opposition (JO) - has joined the GMOA in its current agitation against SAITM. That is not surprising because that is what opposition political parties do: they join campaigns that are directed against the government.

Nevertheless, the JO will find itself in quite embarrassing situations if it actively takes up cudgels against SAITM. That is because SAITM was conceived and launched during the tenure of former President Mahinda Rajapaksa. Not only did Rajapaksa encourage SAITM, he also conferred scholarships to deserving students who entered SAITM. Given this background, how the JO now defends its anti-SAITM stance would be interesting.

For the government though, although the SAITM issue has the potential to become an enormous challenge, it is also about one of policy. That is whether it endorses private medical education in Sri Lanka or not. Sri Lanka’s first experiment with private medical education, the NCMC, fell victim to the political circumstances of that era. The government does not want that to happen again.

The best way forward for the government is to work with the SLMC and the state medical faculties to formulate a series of stringent guidelines that will allow private medical education but at the same time ensure a series of checks and balances that prevents medical education being devalued and exploited on a commercial scale.

Given the current strained relationship between the government and the GMOA, with the GMOA pursuing its own political agenda, the government is unlikely to get the support of the doctors’ trade union. However, this may not have a major impact as the actions of the GMOA are now increasingly being seen by the public to be self-serving rather than altruistic.

The SAITM issue is by no means over. The government is likely to go ahead with gazetting minimum requirements and then seeking court approval to implement them. Whether the GMOA will still stick to its guns at that stage remains to be seen, but this is a battle of wits that is likely to continue for many months to come. Meanwhile, patients at state hospitals will bear the brunt of the actions of the GMOA, whether they like it or not.