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Warning:Temporarily registered foreign medical ‘specialists,’ consultants’

By Kumudini Hettiarachchi
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The order by a top health official in early July to the Sri Lanka Medical Council (SLMC) to grant temporary registration to a so-called foreign medical specialist of a private hospital against the specific recommendation by an evaluation committee has opened a can of worms.
The order by former Health Ministry Secretary Dr. Ravindra Ruberu just before he relinquished duties on July 13, has brought to the fore the urgent and dire need, once and for all, to bring in strict guidelines to regularise not only foreign medical specialist appointments in Sri Lanka but also their recruitment process, the Sunday Times understands.

For, the victims of such unregulated appointments will, without a doubt, be the hapless Sri Lankan patients who will seek treatment including invasive procedures from so-called foreign medical specialists, and that too at a high financial cost, said a senior doctor, a view echoed by many.
The Sunday Times was unable to get the exact number of foreign medical specialists working in the country, with an SLMC source giving a figure of less than 50 and other sources more than 100, with the explanation that when there were moves locally to regularise the evaluations last year, most of these doctors who were Indian “ran away”. SLMC Registrar Dr. N.J. Nonis, when contacted, declined to comment.

Titled ‘Temporary registration under section 67A of the Medical Ordinance’, Dr. Ruberu’s letter (a copy of which is in the possession of the Sunday Times) to the SLMC categorically states: “The professional qualifications and experiences were evaluated at the committee ‘set up to discuss and recommend the temporary registration of foreign specialists’ but the recommendation was not granted. However, the hospital management met the Secretary Health and other officials to indicate the dair (sic) need of this specialist to continue the Cardiac Surgical services. Considering this as a vital need, the Ministry after evaluating the recognition of the specialist qualifications in his home country and the fact that no local applicant had come forward evan (sic) after the repeated advertisements, recommended the temporary registration for one year under clause 67A of the Medical Ordinance.

“It is pertinent that the said committee has been appointed to facilitate the Ministry in deciding on recommendations for registration. It is also pertinent that this committee and the guidelines under which it operated (are) yet to be made as a regulation.”
While the doctor around whom this controversy has erupted is a cardiac anaesthetist, a high-level source at the private hospital in question assured the Sunday Times that the doctor’s first degree and post-graduate degree were from a “reputable tertiary institution in India”.
However, the Sunday Times understands that the relevant Sri Lankan medical experts who screened his qualifications had serious doubts whether the Indian doctor in question has been practising as an “independent” specialist in his home country (India) and had the required expertise to attend on heart patients in Sri Lanka.

Whose interest is the Health Ministry and in turn the government of Sri Lanka and also the SLMC duty-bound to safeguard, is the question being asked not only in health circles but also in the public arena with some “terrible” fiascos at the hands of foreign so-called medical specialists being brought to the notice of the Sunday Times along with questionable qualifications of some of them. (See box)
Ironically, any Sri Lankan passport holder whether he be just an MBBS-qualified junior or a specialist who has foreign qualifications from a world recognized institution has to mandatorily sit the Examination for the Registration to Practice Medicine (ERMP – earlier known as the Act 16) if they wish to work here, the Sunday Times understands.

What many pointed out to the Sunday Times is that Sri Lanka must get its act together very soon, if it wishes to allow private hospitals to recruit foreign medical specialists, if there is a shortfall in certain specialities. They were fearful of an “Indian medical invasion” by substandard personnel. It had been in this direction that efforts had begun last year to regularize such granting of “temporary registration” to foreign medical specialists who are recruited mainly by the four big private hospitals in Colombo. (See box for their comments)

Under the Medical Ordinance enacted in 1924 and amended in 1997, these foreign medical specialists as well as foreign dentists or foreign nurses can seek registration for a period not exceeding 12 months from the date of registration under Section 67A if:

He is possessed of sufficient knowledge and skill for efficient practice

His application for registration is recommended by the Secretary to the Ministry of the Minister, the Director-General of Health Services or by a Dean of a faculty of medicine of a university established, or deemed to be established, under the Universities Act No. 16 of 1978.
The same section clearly states that the Medical Council shall allow the application if it is satisfied that the applicant is qualified to make the application under the preceding provisions of this section.

Up to last year, the practice had been for private hospitals to seek temporary registration from the Director-General of Health Services, who after having consulted the relevant professional medical body would forward it to the SLMC to grant temporary registration.
In July last year (2011), the Cardiothoracic Association, the Sunday Times learns, had made representations to the Government Medical Officers’ Association (GMOA) that cardiac surgeons who are not qualified but calling themselves specialists were being granted temporary registration.

These ‘specialists’ operate on patients in the private sector and when complications arise because of the lack of competence of the specialist, and the patient has exhausted the ‘financial package’ under which the procedure was carried out is dumped in the state sector hospitals such as the National Hospital and the Lady Ridgeway Hospital for Children, pointed out GMOA President Dr. Anuruddha Padeniya.

The then GMOA (now there is a new team) had presented its findings to the then Health Secretary Dr. Ruberu who appointed a ‘committee’ chaired by Director-General (DG), Health Services, Dr. Ajith Mendis, ‘to prepare a proper evaluation procedure’ to overcome these deficiencies. The committee had also included then SLMC President Prof. Lalitha Mendis, Private Health Sector Development Director Dr. Kanthi Ariyarathne, several senior consultants and GMOA representatives.

After many meetings and consultations, the Sunday Times learns that the committee had come up with the consensus that when such applications for temporary registration are sent by private hospitals to the DG, he would forward them to a Technical Evaluation Committee (TEC) comprising members of the Post-Graduate Institute of Medicine (PGIM) and members of the respective colleges (eg. College of Surgeons, Ceylon College of Physicians, etc.) which would screen the applications along with all the qualifications and then give its recommendation to the DG.
The mandate of this Evaluation Committee would be to check whether the foreign applicant’s basic and post-graduate degrees are from a university recognized not only by the national Medical Council of his country but also by the SLMC and whether he has been working as a specialist in his own country, Ss understands.

Here the term ‘specialist’ would be equivalent to a Sri Lankan ‘medical consultant’ who works independently and not under any other consultant, a source pointed out, adding that for Sri Lankans to become consultants, there are tough examinations as well as rigorous training.
Having checked out all this, the Evaluation Committee would recommend to the DG whether temporary registration should be granted or not.

Thereafter, the DG would recommend to the SLMC that temporary registration should be given. If these criteria are not met and the Evaluation Committee does not recommend the application, the DG would reject it and inform the relevant private hospital. Another suggestion of the ‘committee to prepare a proper evaluation’ had been to ensure that vacancies for specialists in private hospitals should be advertised prominently locally and only if there are no local applicants that they should be advertised internationally, it is learnt.

Until the Medical Ordinance is amended, and proper controls are brought in, this new system had been implemented since May 2012 (this year) but not for long, perturbed sources said, adding that it had been subverted by the stroke of a pen in the July letter of Dr. Ruberu, most probably due to pressure exerted by the powerful private hospital lobby.Meanwhile, a private hospital source was adamant that there are vested interests who are attempting to paralyse the invaluable health service extended by them to the public. Foreign doctors are necessary to man the emergency and important services of these hospitals 24 hours a day.

We are taking on a large part of the health burden of Sri Lanka, particularly in areas such as heart surgery, a private hospital source said, adding unqualified or half-qualified specialists would never be recruited.

As the GMOA and the professional colleges met at the Sri Lanka Medical Association yesterday to discuss this crisis, the main issue that has come to the fore from the latest controversy with regard to foreign specialists is that Sri Lanka needs an urgent and proper evaluation system.
The Health Ministry must act now to ensure that all Sri Lankan patients who come under the treatment or scalpel of these foreign specialists are in competent hands, a retired medical veteran who cannot be accused of indulging in private practice, added.

Lanka Hospitals not for sale

Lanka Hospitals will not be sold to an Indian company, Chief Executive Officer, Lakith Peiris told the Sunday Times.
Lanka Hospitals is a model and there is no move to sell it, he said, as speculation was rife last week that the Sri Lanka Insurance Corporation was about to sell its shares of nearly 55% to Fortis India which already has 28% of the shares.

No unqualified specialists on our staff

Four major private hospitals were strong in their assurance that they were not employing any unqualified or under-qualified foreign medical specialists in their hospitals.

Assuring in one voice that they had the interests of the patients at heart and their reputation at stake if they resorted to such practices, they also said they were compelled to seek foreign specialists because they could not get locals.
They needed doctors to be available on a full-time basis, and not those who were hopping from private hospital to private hospital, because it was the patient’s right to get such treatment, one source stressed.

Meanwhile, Lanka Hospitals CEO Lakith Peiris said there are 11 foreign medical specialists; Durdans Chairman Ajith Tudawe said there are two; Asiri Group’s Chief Operating Officer Dr. Manjula Karunaratne said there are two; and Nawaloka Hospital General Manager Prof. Lal Chandrasena said there are about five at their relevant hospitals. Most of the foreign medical specialists are from India.

While three hospitals said these specialists are from reputed institutions and also have certificates of Good Standing from the Medical Council in their country, Asiri’s Dr. Karunaratne went a step further and added that one of their specialists who was well-qualified was from a rare field and the other had qualified from the All India Institute of Medical Sciences.

The private hospital top brass requested that the applications for temporary registration from foreign specialists should be sent for screening either to an independent body or to the Post-graduate Institute of Medicine and its relevant Board of Study rather than the professional college.
These colleges are formed for a different reason and to look after the welfare of the members rather than for educational purposes, some of them said.

Allegations against foreign doctors

Some of the allegations against foreign medical specialists and private hospitals are:

n A 62-year-old patient who underwent a coronary artery bypass graft (CABG) in April 2011 had allegedly been later sent to the National Hospital with severe wound infection and the chest partly open. (The Sunday Times has the photos)
n A surgery for a congenital heart abnormality performed five years ago on an eight-year-old boy is still giving trouble with pus overflowing from the wound. On some days the discharge is so bad that the boy from a humble home is unable to go to school, while on other days he wears a huge pad of gauze over the wound.
n The alleged attempts to get two so-called specialists to work as Cardiothoracic Surgeons, when their qualifications were not up to standard.
n The alleged attempt to get a foreign doctor who only had a diploma in fertility procedures to work as a full-time Consultant Obstetrician & Gynaecologist.
n The alleged attempt to pass off a doctor holding a Diploma in Nephrology as a Specialist Nephrologist.
n In 2006, the Sunday Times highlighted the case of a woman doctor who was pretending to be a ‘Consultant’ Obstetrician & Gynaecologist at a private hospital.end

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