By Maheesha Mudugamuwa
Sri Lanka’s medical community has been sharply divided over the removal of the Head and several members of the Sri Lanka Medical Council (SLMC) by Health Minister Pavithra Wanniarachchi last week.
In a historic move, the Minister removed five SLMC members including its President Prof. Harendra De Silva based on recommendations by a five-member committee including specialist Dr. Prof. Hemantha Perera, former Ragama Medical Faculty Dean Prof. Prasantha Wijesinghe, specialist Dr. Anula Wijesundera, specialist Dr. Maithri Chandraratne, and specialist Dr. Darshana Sirisena, appointed by her to probe the conduct of the SLMC in September.
In a letter written to Prof. De Silva dated 27 November 2020, Health Minister Wanniarachchi had informed the former SLMC President of the revocation of his appointment as SLMC President.
It is stated in her letter that the committee appointed by herself had several sittings, and made inquiries, obtained statements from the complainants and various relevant stakeholders and officers, and afforded opportunities to the relevant representatives of the SLMC to make representations.
The committee concluded that Prof. De Silva is responsible for the allegations investigated by the committee based on five terms of reference including the undue delay of conducting elections for four vacant council member positions within the SLMC, current issues pertaining to the derecognition of foreign university degrees, registration of medical graduates with substandard qualifications, undue delay in conducting the ERPM (Examination to Register to Practice Medicine), and complaints regarding irregular disciplinary procedures conducted by the SLMC.
The committee further recommended that the responsible council members should be terminated to restore the independence and functions of the SLMC and to consider the appointment of a medical professional as the President of the SLMC, the letter stated.
“Therefore, based on the recommendations of the above committee, by virtue of the powers vested in me as the Minister of Health under the Medical Ordinance and the other relevant laws, your appointment as President, SLMC is revoked with immediate effect,” the Minister stated in the letter.
Historic probe
The probing of the council, which was established in 1924 and considered one of the oldest councils in the world, was described as a historical event by medical experts.
The SLMC was established by the Medical (Amendment) Act No. 40 of 1998, replacing the Ceylon Medical Council (CMC). The CMC was established by the Medical Council Ordinance No. 24 of 1924.
The Council is a statutory body established for the purpose of protecting healthcare seekers by ensuring the maintenance of academic and professional standards, discipline, and ethical practice by health professionals who are registered with it. As presently constituted, the Council has representation from the medical faculties of state universities as well as professionals in the state and private sectors.
However, several serious allegations levelled against the SLMC, including the foreign university issue which almost created a diplomatic issue between Sri Lanka and Russia, have paved the way for the Minister to get involved in matters of the independent body of medical education.
Appointing the committee in September, the Health Minister noted that the SLMC is an independent body established by a charter and its primary function is to maintain a quality medical service by protecting the rights of patients. But according to the Medical Ordinance, the final responsibility for the decisions of the SLMC is vested with the Minister of Health, she noted.
The Minister said the decision was taken after considering the number of complaints received from various quarters, on the conduct of the SLMC, with some parties calling for a restoration of its status as an independent body.
However, within two months, the committee submitted a comprehensive report on the investigation conducted on five allegations.
Furthermore, the report states, in its conclusion: “The committee understands the President and some council members (appointed by the Minister) had misunderstood, misinterpreted, and misused their powers in conducting inquiries against the 16 medical practitioners. According to the Medical Ordinance ‘infamous conduct in any professional respect in relation to the professional duties’. The committee observes the referring incident has no involvement whatsoever with professional duties.
“(The) Presidents (former and the current) and some members had misinterpreted their powers vested by the Medical Ordinance to take revenge against the respondents in the inquiry procedures disregarding the accepted practice in the case PPC (Preliminary Proceedings Committee) 398.
“According to the observed time frame, the delay of investigating this case is unacceptable where even after six years of the complaint (the) PCC (Professional Conduct Committee) had failed to issue charge sheets to the defendants.
“The committee observed there is unacceptable delays in the inquiry procedures of the SLMC in general so that all parties (complainants and defendants) are of great disadvantage for their careers (sic) as medical practitioners. The current delay of disciplinary procedures proves the famous legal saying ‘justice delayed equals justice denied’.
“(The) committee recommends revisiting this case and dropping the charges forthwith. However, an independent legal opinion is recommended and if the opinion is in favour of PPC recommendations, to take appropriate actions against the members of the President and members of the PCC for abuse of power. (The) SLMC should look into a practical approach of expediting the disciplinary procedures in a more transparent manner as the current delay is unacceptable. We recommend the increasing numbers (sic) in the PPC and PCC members to satisfy the quorum and increasing the number of legal officers,” it was stated in the report referring to the recommendations of the committee.
It also stated that there are unacceptable delays in the inquiry procedures of the SLMC in general, and that all parties (complainants and defendants) are at great disadvantage in terms of their careers as medical practitioners as a result. The current delay in disciplinary procedures echoes the famous saying “justice delayed equals justice denied”.
Medical experts divided
Nevertheless, following the official announcement of the removal of SLMC President Prof. De Silva, the interference of the Minister of Health into the independent body has been debated within the medical profession, as some experts criticised Minister Wanniarachchi’s political interference, stating that it would set a bad precedent and affect the independent nature of the council. They alleged that the SLMC is facing a crisis which has never been witnessed in its recent history.
In a statement issued last week, the Association of Medical Specialists (AMS) said that the appointment of a new president while the duly appointed President is in office by the Health Minister is a violation of existing provisions in the Medical Ordinance.
AMS President Dr. L.A. Ranasinghe stated that according to the Minister’s letter to the SLMC President, the removal of the President by her is based on the recommendations of the committee appointed by the Minister to inquire into irregularities in the SLMC.
“Personal communications we had with some of the committee members (Dr. Hemantha Perera, Dr. Anula Wijesundara) failed to single out any members or the President in their report as responsible person/s for the deficiencies of the SLMC and they have not recommended to remove anyone from the Council,” he stated.
Dr. Ranasinghe also stated that according to them, the whole council is responsible for their decisions and actions and not individual members (similar to the collective responsibility of cabinet decisions), adding: “To the best of our knowledge, there are no legal provisions for the Minister to remove the President or any member according to his/her wish without following the regulations stipulated in the Medical Ordinance.”
Hence, the AMS stated that the process the Minister followed here is completely flawed and purely based on the agenda of a trade union and this creates a very bad precedent and may be the first step in destroying the autonomy and independence of the medical council of our country.
Urging the Minister to reverse her decision immediately, the AMS has stressed that this kind of illegal action by the Health Minister may bring disrepute internationally, as Sri Lankan medical standards are well recognised overseas.
The AMS has requested a meeting with President Gotabaya Rajapaksa to give them a hearing to express their concerns, as they said the President had not been informed of the true sequence of events that led to the current status.
Meanwhile, the Government Medical Officers’ Association (GMOA) had written to President Rajapaksa regarding the current situation of the SLMC.
Justifying Minister Wanniarachchi’s decision, the GMOA’s letter signed by its President Dr. Anuruddha Padeniya and Secretary Dr. Senal Fernando, states that when the GMOA highlighted to Minister Wanniarachchi the serious concerns and irregularities of the SLMC, she obtained legal advice from three President’s Counsels and the Attorney General (AG) and appointed an expert committee which entertained the formal complaints in writing as well as verbally and gave an opportunity for those implicated to give explanations.
“We were reliably informed that the expert committee gave recommendations to discontinue the services of Dr. (Rajitha) Senarathne’s appointees, after considering all the representations,” the letter stated.
Hence, going by the recommendations of the committee and legal opinion, the Minister of Health terminated the services of former Health Minister Dr. Rajitha Senaratne’s appointees including the SLMC President, using the Medical Ordinance and Interpretation Ordinance in the best interest of patient care and the medical profession in the country, the GMOA stated.
When contacted by The Sunday Morning, SLMC Registrar Dr. Ananda Hapugoda said the Health Minister had removed five members of the SLMC including the SLMC President and new members have been appointed.
“I have received the names of the new members and the Council is to meet next Friday,” he said.
Final decision pending
The turmoil created within the SLMC basically erupted in September with the delisting of several Russian universities that were awarding scholarships to Sri Lanka since the 1960s, at the SLMC Annual General Meeting (AGM) on 26 June 2020. Soon after the decision was made, vehement opposition was expressed by existing university students as well as past pupils claiming the decision affected a number of Sri Lankan students currently studying in these universities.
They alleged that, as a result of the SLMC’s decision, the country was facing the risk of losing the scholarships issued to Sri Lanka by several Russian universities, while the only university the SLMC recognises doesn’t provide scholarships to Sri Lanka.
Furthermore, the decision was also described as affecting the bilateral relations of the two countries – Sri Lanka and Russia. Since then, the Government, Health Ministry, and all relevant state authorities were urged to immediately take action against the decision.
By this time, the SLMC was clear in their opinion that those who were not satisfied with the decision could appeal the same, and if these universities were willing to upgrade the quality of their degree programmes offered, the SLMC would reconsider the decision.
As learnt by The Sunday Morning, most of these students were awarded scholarships based on their performance at the Advanced Level (A/L) examination; the affected students are mainly those who obtained high marks.
It was learnt that the rejected universities provided medical scholarships to Sri Lanka since the 1960s, while the Government of Russia provided around 40 scholarships to Sri Lankan students so far this year, out of which five were medical scholarships.
It was also learnt that the objective of awarding these scholarships is to provide good-quality doctors for Sri Lanka as a means of strengthening the bilateral relationship between Sri Lanka and Russia.
However, when asked whether the new council has taken a decision on the universities in question, Dr. Hapugoda said the matter was also investigated by the committee appointed by the Minister and the Minister would take a decision based on the recommendation given by the committee.
As he explained, even if the universities are delisted, it would be done in a way that would not affect the existing students who were already enrolled in those universities.
Meanwhile, Prof. Narada Warnasuriya – one of the most senior members of the SLMC – told The Sunday Morning that the members who have been removed from their posts by the Health Minister intend to take legal action against the decision.
He also said that the report had not recommended the removal of the SLMC members and that the decisions taken by the SLMC are taken collectively.
However, Prof. Warnasuriya did not want to discuss more details about the intended legal action they are going to take.
Another member of the SLMC however said that the case would be filed next week and that discussions were currently being conducted with lawyers on how it should be done.
In a letter written to Prof. De Silva dated 27 November 2020, Health Minister Wanniarachchi had informed the former SLMC President of the revocation of his appointment as SLMC President.
It is stated in her letter that the committee appointed by herself had several sittings, and made inquiries, obtained statements from the complainants and various relevant stakeholders and officers, and afforded opportunities to the relevant representatives of the SLMC to make representations.
The committee concluded that Prof. De Silva is responsible for the allegations investigated by the committee based on five terms of reference including the undue delay of conducting elections for four vacant council member positions within the SLMC, current issues pertaining to the derecognition of foreign university degrees, registration of medical graduates with substandard qualifications, undue delay in conducting the ERPM (Examination to Register to Practice Medicine), and complaints regarding irregular disciplinary procedures conducted by the SLMC.
The committee further recommended that the responsible council members should be terminated to restore the independence and functions of the SLMC and to consider the appointment of a medical professional as the President of the SLMC, the letter stated.
“Therefore, based on the recommendations of the above committee, by virtue of the powers vested in me as the Minister of Health under the Medical Ordinance and the other relevant laws, your appointment as President, SLMC is revoked with immediate effect,” the Minister stated in the letter.
Historic probe
The probing of the council, which was established in 1924 and considered one of the oldest councils in the world, was described as a historical event by medical experts.
The SLMC was established by the Medical (Amendment) Act No. 40 of 1998, replacing the Ceylon Medical Council (CMC). The CMC was established by the Medical Council Ordinance No. 24 of 1924.
The Council is a statutory body established for the purpose of protecting healthcare seekers by ensuring the maintenance of academic and professional standards, discipline, and ethical practice by health professionals who are registered with it. As presently constituted, the Council has representation from the medical faculties of state universities as well as professionals in the state and private sectors.
However, several serious allegations levelled against the SLMC, including the foreign university issue which almost created a diplomatic issue between Sri Lanka and Russia, have paved the way for the Minister to get involved in matters of the independent body of medical education.
Appointing the committee in September, the Health Minister noted that the SLMC is an independent body established by a charter and its primary function is to maintain a quality medical service by protecting the rights of patients. But according to the Medical Ordinance, the final responsibility for the decisions of the SLMC is vested with the Minister of Health, she noted.
The Minister said the decision was taken after considering the number of complaints received from various quarters, on the conduct of the SLMC, with some parties calling for a restoration of its status as an independent body.
However, within two months, the committee submitted a comprehensive report on the investigation conducted on five allegations.
Furthermore, the report states, in its conclusion: “The committee understands the President and some council members (appointed by the Minister) had misunderstood, misinterpreted, and misused their powers in conducting inquiries against the 16 medical practitioners. According to the Medical Ordinance ‘infamous conduct in any professional respect in relation to the professional duties’. The committee observes the referring incident has no involvement whatsoever with professional duties.
“(The) Presidents (former and the current) and some members had misinterpreted their powers vested by the Medical Ordinance to take revenge against the respondents in the inquiry procedures disregarding the accepted practice in the case PPC (Preliminary Proceedings Committee) 398.
“According to the observed time frame, the delay of investigating this case is unacceptable where even after six years of the complaint (the) PCC (Professional Conduct Committee) had failed to issue charge sheets to the defendants.
“The committee observed there is unacceptable delays in the inquiry procedures of the SLMC in general so that all parties (complainants and defendants) are of great disadvantage for their careers (sic) as medical practitioners. The current delay of disciplinary procedures proves the famous legal saying ‘justice delayed equals justice denied’.
“(The) committee recommends revisiting this case and dropping the charges forthwith. However, an independent legal opinion is recommended and if the opinion is in favour of PPC recommendations, to take appropriate actions against the members of the President and members of the PCC for abuse of power. (The) SLMC should look into a practical approach of expediting the disciplinary procedures in a more transparent manner as the current delay is unacceptable. We recommend the increasing numbers (sic) in the PPC and PCC members to satisfy the quorum and increasing the number of legal officers,” it was stated in the report referring to the recommendations of the committee.
It also stated that there are unacceptable delays in the inquiry procedures of the SLMC in general, and that all parties (complainants and defendants) are at great disadvantage in terms of their careers as medical practitioners as a result. The current delay in disciplinary procedures echoes the famous saying “justice delayed equals justice denied”.
Medical experts divided
Nevertheless, following the official announcement of the removal of SLMC President Prof. De Silva, the interference of the Minister of Health into the independent body has been debated within the medical profession, as some experts criticised Minister Wanniarachchi’s political interference, stating that it would set a bad precedent and affect the independent nature of the council. They alleged that the SLMC is facing a crisis which has never been witnessed in its recent history.
In a statement issued last week, the Association of Medical Specialists (AMS) said that the appointment of a new president while the duly appointed President is in office by the Health Minister is a violation of existing provisions in the Medical Ordinance.
AMS President Dr. L.A. Ranasinghe stated that according to the Minister’s letter to the SLMC President, the removal of the President by her is based on the recommendations of the committee appointed by the Minister to inquire into irregularities in the SLMC.
“Personal communications we had with some of the committee members (Dr. Hemantha Perera, Dr. Anula Wijesundara) failed to single out any members or the President in their report as responsible person/s for the deficiencies of the SLMC and they have not recommended to remove anyone from the Council,” he stated.
Dr. Ranasinghe also stated that according to them, the whole council is responsible for their decisions and actions and not individual members (similar to the collective responsibility of cabinet decisions), adding: “To the best of our knowledge, there are no legal provisions for the Minister to remove the President or any member according to his/her wish without following the regulations stipulated in the Medical Ordinance.”
Hence, the AMS stated that the process the Minister followed here is completely flawed and purely based on the agenda of a trade union and this creates a very bad precedent and may be the first step in destroying the autonomy and independence of the medical council of our country.
Urging the Minister to reverse her decision immediately, the AMS has stressed that this kind of illegal action by the Health Minister may bring disrepute internationally, as Sri Lankan medical standards are well recognised overseas.
The AMS has requested a meeting with President Gotabaya Rajapaksa to give them a hearing to express their concerns, as they said the President had not been informed of the true sequence of events that led to the current status.
Meanwhile, the Government Medical Officers’ Association (GMOA) had written to President Rajapaksa regarding the current situation of the SLMC.
Justifying Minister Wanniarachchi’s decision, the GMOA’s letter signed by its President Dr. Anuruddha Padeniya and Secretary Dr. Senal Fernando, states that when the GMOA highlighted to Minister Wanniarachchi the serious concerns and irregularities of the SLMC, she obtained legal advice from three President’s Counsels and the Attorney General (AG) and appointed an expert committee which entertained the formal complaints in writing as well as verbally and gave an opportunity for those implicated to give explanations.
“We were reliably informed that the expert committee gave recommendations to discontinue the services of Dr. (Rajitha) Senarathne’s appointees, after considering all the representations,” the letter stated.
Hence, going by the recommendations of the committee and legal opinion, the Minister of Health terminated the services of former Health Minister Dr. Rajitha Senaratne’s appointees including the SLMC President, using the Medical Ordinance and Interpretation Ordinance in the best interest of patient care and the medical profession in the country, the GMOA stated.
When contacted by The Sunday Morning, SLMC Registrar Dr. Ananda Hapugoda said the Health Minister had removed five members of the SLMC including the SLMC President and new members have been appointed.
“I have received the names of the new members and the Council is to meet next Friday,” he said.
Final decision pending
The turmoil created within the SLMC basically erupted in September with the delisting of several Russian universities that were awarding scholarships to Sri Lanka since the 1960s, at the SLMC Annual General Meeting (AGM) on 26 June 2020. Soon after the decision was made, vehement opposition was expressed by existing university students as well as past pupils claiming the decision affected a number of Sri Lankan students currently studying in these universities.
They alleged that, as a result of the SLMC’s decision, the country was facing the risk of losing the scholarships issued to Sri Lanka by several Russian universities, while the only university the SLMC recognises doesn’t provide scholarships to Sri Lanka.
Furthermore, the decision was also described as affecting the bilateral relations of the two countries – Sri Lanka and Russia. Since then, the Government, Health Ministry, and all relevant state authorities were urged to immediately take action against the decision.
By this time, the SLMC was clear in their opinion that those who were not satisfied with the decision could appeal the same, and if these universities were willing to upgrade the quality of their degree programmes offered, the SLMC would reconsider the decision.
As learnt by The Sunday Morning, most of these students were awarded scholarships based on their performance at the Advanced Level (A/L) examination; the affected students are mainly those who obtained high marks.
It was learnt that the rejected universities provided medical scholarships to Sri Lanka since the 1960s, while the Government of Russia provided around 40 scholarships to Sri Lankan students so far this year, out of which five were medical scholarships.
It was also learnt that the objective of awarding these scholarships is to provide good-quality doctors for Sri Lanka as a means of strengthening the bilateral relationship between Sri Lanka and Russia.
However, when asked whether the new council has taken a decision on the universities in question, Dr. Hapugoda said the matter was also investigated by the committee appointed by the Minister and the Minister would take a decision based on the recommendation given by the committee.
As he explained, even if the universities are delisted, it would be done in a way that would not affect the existing students who were already enrolled in those universities.
Meanwhile, Prof. Narada Warnasuriya – one of the most senior members of the SLMC – told The Sunday Morning that the members who have been removed from their posts by the Health Minister intend to take legal action against the decision.
He also said that the report had not recommended the removal of the SLMC members and that the decisions taken by the SLMC are taken collectively.
However, Prof. Warnasuriya did not want to discuss more details about the intended legal action they are going to take.
Another member of the SLMC however said that the case would be filed next week and that discussions were currently being conducted with lawyers on how it should be done.