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Medical
Council's Doubtful Delivery
Mystery shrouds SLMC’s reversal
of its ruling on an Apollo Hospital "Consultant"
Obstetrician and Gynaecologist
By Kumudini Hettiarachchi
Off the roll and in less than a month
on the roll again.
How and why the Sri Lanka Medical
Council (SLMC) first decided to erase the name of a
so-called "Consultant" Obstetrician and Gynaecologist
working at the Apollo Hospital Ltd. and not issue her
registration and then less than a month later revoked
its own decision and granted her a six-month registration
remains a mystery, with both the SLMC and hospital authorities
remaining tight-lipped.
The questions doing the medical rounds
at the moment are: Was the revered SLMC pressurized
or influenced to change its decision in favour of "Consultant"
Dr. Vandana Bansal? Or does this case indicate incompetence
on the part of the SLMC which is expected not only to
uphold the highest traditions of the medical profession
but also act as a regulatory body to maintain medical
standards in Sri Lanka?
Even if Apollo Hospital, set up as
a Board of Investment venture four years ago, does not
see it as its responsibility to be accountable to the
public, what of the SLMC, the watchdog of the medical
profession, which has a duty by the people?
The Sunday Times understands that
the saga of alleged incompetence, unethical practices
and fee-splitting with regard to Dr. Bansal came out
into the open around May this year, with complaints
by other concerned doctors being directed to both the
management of Apollo and its Ethics Committee.
The Ethics Committee report came out
on July 12, 2006. Subsequently, a letter followed by
an affidavit had been submitted by several senior doctors
of Apollo on the same issue to the SLMC, it is learnt.
On August 23, this is what the SLMC
wrote to Dr. J.M. Shahani, the Director of Medical Services
of Apollo Hospital: ..... "Regarding Dr. Vandana
Bansal, the Council considered all documents submitted
on the matter and decided that she would not be granted
any further extensions as her skills as a Gynaecologist
was (sic) considered as inadequate and the hospital
has the services of several competent Gynaecologists
who are able to cover the demand."
The letter was signed by the Registrar
of the SLMC, Dr. N.J. Nonis.
But on September 21, there was a sudden
change, with the SLMC writing to Dr. Bansal that having
considered her appeal and also the finding of the Ethics
Committee (apparently referring to Apollo Hospital’s
Ethics Committee) it had decided to grant her registration
for six months commencing on September 20. “You
are however requested to refrain from performing laparoscopic
procedures either alone, with assistance from another
person or assist anyone else perform laparoscopy.”
It had taken only four weeks for the
SLMC, considered one of the most eminent and respected
professional bodies in Sri Lanka, to revoke its decision.
Whereas earlier it had found Dr. Bansal's skills as
a gynaecologist "inadequate" suddenly it was
only her ability to perform laparoscopies that was being
doubted.
When The Sunday Times contacted Dr.
H.H.R. Samarasinghe, the President of the SLMC, to request
a meeting with him to discuss this crucial issue which
concerns the public in the country, the hundreds of
women who go to Apollo for treatment, he requested that
we contact the Registrar of the SLMC, Dr. Nonis.
When we contacted Dr. Nonis seeking
an interview with him, although he requested us to meet
him at 9 a.m. last Wednesday at the SLMC, when we did
so, he politely told us that he should not speak to
the media on the Apollo issue.
However, later when contacted on the
phone, he explained in detail, the procedure with regard
to the granting of registration to foreign medical consultants
who seek to work here.
Apollo's Acting Director of Medical
Services, Dr. Rana Mehta, who is looking after the work
of Director Dr. Shahani, who hospital authorities said
was out of the country, was either at a meeting or unavailable
for comment on this serious issue with regard to a "Consultant"
whose name appears at the top of the list of Consultant
Obstetricians and Gynaecologists at the OPD 2 on the
first floor of the hospital.
Those who answered the calls on behalf
of Dr. Mehta requested that we get in touch with Apollo's
Marketing Manager Chammika de Silva, who meticulously
took down the questions we posed. However, on Thursday
morning, Mr. de Silva said that Dr. Shahani was expected
on Friday and as he was the only person who knows the
details about the registration of Dr. Bansal and connected
issues, The Sunday Times would have to await his arrival
for the answers.
This was despite repeated reminders
that the PLUS section of The Sunday Times goes to print
on Thursday night, and that the person who is looking
after Dr. Shahani's work should answer these questions.
How did the SLMC, within a month,
come to the conclusion that Dr. Bansal's "inadequate"
skills were now "adequate" and that she should
only refrain from engaging in laparoscopic procedures?
A senior member of the College of
Obstetricians and Gynaecologists who declined to be
identified said that laparoscopic (minimal invasive)
procedures are part of the skills required of a gynaecologist,
adding that these procedures and scans were first used
by gynaecologists long before the other specialities.
The humble women of this country seek,
an explanation from the SLMC in this matter of life
and death.
| News
blackout |
The hospital
administration has given a ruling that no one
should make statements to the media, was the reply
of Dr. Vandana Bansal when The Sunday Times contacted
her on Thursday.
When was this rule brought in? "About two
months ago," she added. |
| How
foreign doctors are registered |
How does
the Sri Lanka Medical Council (SLMC) grant registration
to foreign 'Consultants' in the medical profession?
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| Sri Lanka Medical Council
|
Foreign medical 'Consultants' are registered
under three different categories, according to
SLMC Registrar Dr. N.J. Nonis who explains that
registration under Section 67A of the Medical
Ordinance is given only for a maximum period of
one year, after which they have to seek renewal.
Here are the three categories:
- Those who come to Sri Lanka for a short duration,
ranging from a few days to two weeks, on the
invitation of local universities and academic
institutions. These Consultants who are invited
to demonstrate new procedures are recommended
by the Deans of the local Medical Faculties.
- Consultants who come with NGOs and work in
difficult areas such as the north and the east
where local Consultants are reluctant to go.
These doctors are given registration on the
recommendation of the Ministry of Health, after
the Director-General has checked their credentials.
The SLMC also peruses the certificates with
the relevant qualifications.
- Consultants brought in by private hospitals
set up under the Board of Investment (BOI) whenever
these hospitals are unable to recruit full-time
Consultants locally.
Earlier they were recommended by the Director-General
of Health Services.
Later after the SLMC held many discussions during
the time of Dr. A. M. L. Beligaswatte, a decision
was taken that the 'skill, knowledge and expertise'
of such foreign Consultants should be studied
by experts in their own field, said Dr. Nonis,
adding that it was agreed to set up a panel of
experts from the relevant colleges (eg: College
of Surgeons, College of Physicians or College
of Obstetricians & Gynaecologists) to advise
the Director-General.
It was agreed on but not implemented. However,
it has now been implemented with effect from September
1, 2006.
When The Sunday Times queried from Dr. Nonis
whether the SLMC checked out the certificates
and credentials of such Consultants, he said it
was difficult to do so as some of them were already
in the country and it was "short notice".
But they had to produce the originals and certified
documents which would then be perused by the '67A
Committee' before registration is granted by the
SLMC. |
| Issues
and findings of the Ethics Committee |
Here are
the main issues as stated in a lengthy report
on the Inquiry by the Ethics Committee of Apollo
Hospital:
- Dr. Vandana Bansal (referred hereafter as
VB) flouts herself as a Consultant Obstetrician
and Gynaecologist.
- Dr. VB advertises herself as a specialist
in "high-risk pregnancy", a title
which she is unqualified to hold
- Dr. VB claims to hold a post-doctoral fellowship
in foetal medicine.
- Dr. VB involves a gastrointestinal (GI) surgeon
to carry out all major gynaecological surgeries.
- Dr. VB involves a GI surgeon to carry out
all laparoscopies.
- Patients are unaware that their surgeries
are being done by a GI surgeon.
- There has been a maternal death under Dr.
VB.
- There have been a few post-partum haemorrhages
where hysterectomies have had to be done.
- Dr. VB is an incompetent medical officer.
The findings are as follows:
On issues 1 to 3 - The originals of Dr. VB's
Diploma in Obstetrics and Gynaecology (from Rothek
University in India); an MD in Obs & Gyn;
Diplomat of the National Board (Obs&Gyn);
advertisement in the 'Hindu' newspaper and the
Certificate of Post-Doctoral Fellowship had been
inspected by members of the Ethics Committee.
Dr. J.M. Shahani by letter dated 10.06.06 has
requested the National Board of Examinations,
India to authenticate the degree certificates.
On issues 4 & 5 - The type of surgical procedures
done had been categorized by the Convenor of the
Ethics Committee into 4;
- Obstetric procedures (LSCS)
- Minor gynaecological procedures, eg. ERCP,
D&C
- Laparoscopies
- Major (Open) gynaecological procedures. Eg.
TAH, BSO, Myomectomy, VH, Oopherectomy
Type 1 & 2 procedures were done by Dr. VB
herself and there were no allegations made against
her on these procedures.
Type 3 procedures - Dr. VB at her interview
with the Ethics Committee agreed that to all laparoscopic
procedures she called Dr. RK (a consultant gastro-enterologist)
to the theatre to insert the laparoscope as she
felt that she is not trained or qualified enough
to put in a laparoscope.
Analyzing the computer documentation, the Ethics
Committee sets the percentage of cases where Dr.
VB had got Dr. RK. involved to 91.8%.
Type 4 procedures - Of the files of 78 surgeries,
Dr. RK had been involved in 24.3% and a surgical
registrar in 11.5%. The Ethics Committee states
that as to whether a GI surgeon should have been
involved in these surgeries is a matter to be
put forward to a forum of experts on this subject
even though it may be a very subjective issue.
Dr. VB had stated that in instances where another
doctor was involved, the patient did not pay additionally
but the fee was divided among the two surgeons.
Issue 6 - The Ethics Committee states that it
is clear that during all her surgeries Dr. VB
was actively present at the surgery. The question
is when another consultant took part in her surgeries
whether the patient was aware of that. When a
surgeon is called to the theatre to attend to
an emergency situation which has arisen during
the surgery invariably prior consent is not warranted
and is impractical. However, if another consultant
is arranged prior to surgery to participate in
a surgery, prior informed explicit consent from
the patient is needed and the patient has to be
told as to what aspects/sections of the surgery
will be done by the other surgeon.
Of all the files of laparoscopies and surgeries
inspected, only in 6 instances a written consent
has been taken for a second surgeon's involvement.
In all except two the second surgeon's involvement
was in op (operation) notes which the patient
did not have access to. In these two files, the
second surgeon's involvement is not mentioned
anywhere but his fee has been charged.
Issue 7 - The maternal death mentioned has happened
sometime back and there has been an inquiry at
the Regional Director of Health level without
any adverse comments on it. As inquiring a maternal
death is beyond the scope of an Ethics Committee
this issue was not investigated.
Issue 8 - This issue was dropped at the discussion
the signatories to the letter had with the Ethics
Committee.
Issue 9 - The Ethics Committee feels that it
is beyond the scope of the committee to pass judgments
of competency of consultants as this has to be
done by a panel of experts in that particular
speciality and the clinical effectiveness committee
may attend to it.
The Ethics Committee has also recommended to
the management:
- To request from all surgeons to adhere to
the seven steps mentioned in the report on consent
when involving a second surgeon in planned surgeries.
- To request from doctors/staff members to
provide the Ethics Committee with adequate evidence
to substantiate all aspects of allegations when
a complaint is made.
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