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Massive transfers of MOs may endanger crucial heart operations
Crucial heart surgeries at the premier National Hospital in Colombo will be cut drastically due to the lack of experienced Medical Officers (MOs), following a massive transfer scheme implemented by the Health Ministry. Only about 15 cardiothoracic surgeries will be performed every week from Monday (September 30) onwards, as against the usual 30 operations, raising the serious issue of disruption in patient care, the Sunday Times learns.
Where earlier the four Consultant Cardiothoracic Surgeons and three Consultant Anaesthetists carried out four operations daily throughout the week, on six days except Sunday, now they have been reluctantly compelled to reduce the number of surgeries to two a day, it is understood.
The lack of experienced MOs, both in the cardiothoracic and anaesthesia sections, due to the 2013 transfers being implemented by the ministry, will result in the surgical list being severely affected, sources said. The Consultants have been compelled to take this decision with regret, as the other side would be patient deaths on the operating theatre tables if they have to work with inexperienced MOs, it is learnt. For an MO to be able to assist in critical heart surgeries, he/she needs to have at least six months experience in this field.
GMOA calling the shots in transfers?
Another charge levelled against the Health Ministry is that it has allowed the Government Medical Officers’ Association (GMOA) to decide on the 2013 Transfer List for MOs, without the ministry itself playing the major role.
The three-member Transfer Board comprises a nominee of the Health Ministry Secretary, a nominee of the Director-General (DG) of Health Services and a GMOA representative, the Sunday Times learns. This year’s nominee of the DG is Dr. Panapitiya.
The GMOA representative on the Transfer Board is supposed to be the eyes and ears of the doctors, ensuring that seniority and fair play are the criteria followed by the ministry, a senior doctor pointed out. But what has happened is that like the tail wagging the dog, the GMOA representative has decided on the transfers, the doctor alleged, a view echoed by many in health circles.Although this was a charge refuted by Dr. Panapitiya, who said that the GMOA representative played a “supporting” role, the Sunday Times understands that there are complaints even from GMOA branch unions based in hospitals to the GMOA Executive Committee about the imminent disruption in patient care and hampering of health services.
Another instance cited by worried health sources which have been monitoring the situation is the Kalubowila Hospital where MO transfers from the Anaesthesia Section have resulted in about 25% of patient care being compromised. The Anaesthesia Section is crucial not only for the running of the Operating Theatres but also both the Surgical Intensive Care Unit (SICU) and the Medical Intensive Care Unit (MICU), it is understood.
The Sunday Times learns that two beds from the MICU have been transferred to the seven-bed SICU and the MICU is now working as a High Dependency Unit (HDU). Controversy has surrounded mass-scale MO transfers for this year, with many main hospitals reeling, but the Health Ministry refuting serious allegations of disruptions in patient care.
There is no disruption in hospital services, assured Dr. Lal Panapitiya, Director of Medical Services, in an interview with the Sunday Times recently, conceding however that sometimes all transfers in an institution cannot be implemented as MOs cannot be released especially from specialised units without replacements.
In such instances, Dr. Panapitiya said, if there were no replacements, to avert a crisis, transfer orders were given to the relevant MOs but they were re-attached to the same posts the following day.
Usually in the health service, the Sunday Times understands that post-intern doctors are known as MOs. These MOs are generally expected to stay in a posting for four years and gradually gain experience in the units they work in.
Dr. Panapitiya said that over the years the implementation of annual transfers was poor but when Dr. Nihal Jayathilaka took over as Health Ministry Secretary, a decision was made to implement them. This is as per the administrative requirements of the Public Service Commission (PSC).
“The need is to train the junior MOs to take the place of MOs who have completed their required four-year stints and should be sent on transfer,” he said. The annual transfers need to be implemented to allow MOs who have not been able to come to main areas from the peripheries to do so and also MOs from stagnating in the same position for a long time, Dr. Panapitiya added.
However, many in health circles, both former administrators and senior doctors were quick to point out that the attempt to clear the 10-year backlog in one go through the 2013 annual transfers of MOs has disrupted work in crucial spheres such as heart surgery, neurosurgery, anaesthesia and gynaecology and obstetrics and also ICUs. Even with all the assurances by the ministry, the Sunday Times was told in no uncertain terms by health sources of the “disastrous” consequences. They cited the examples of work disruption at the National Hospital’s Cardiothoracic Unit, the Colombo South (Kalubowila) Teaching Hospital’s Anaesthetic Section, the Maharagama Cancer Hospital, the Karapitiya Teaching Hospital, the Jaffna Teaching Hospital, the Anuradhapura Teaching Hospital and the Kalutara General Hospital, to name a few.
Tertiary-care centres from which patients cannot be referred to other hospitals cannot run without experienced MOs, was the simple argument of many health sources, while some hospital directors that the Sunday Times spoke to said they were managing without a problem.
Other sources, however, were insistent that tertiary-care centres already burdened by staff shortages were now facing MO transfers and management was becoming near-impossible. Even if we are to train inexperienced new MOs, there needs to be an overlap with experienced MOs for at least six months, they said.
How can we run “essential services” if experienced MOs are transferred out and the replacements are inexperienced MOs, for it takes at least six long months to get them into shape, they pointed out.
Patient care is in jeopardy, warned many doctors.
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