• Report finds unfair allocation of theatres to surgeons, lack of certain surgeons 
• Need to reduce surgical patients’ waiting list  

An audit report on the Cardiothoracic Unit of the Teaching Hospital in Karapitiya has revealed the unfair allocation of operating theatres to cardiothoracic surgeons, the lack of efficiency and performance of certain surgeons, and the need to introduce a programme to reduce the number of patients on waiting lists to undergo surgeries at the said unit.

The allocation of only two days a week to the cardiothoracic surgeon who performs surgeries on 84% of the patients who are on the waiting list to undergo surgeries at the said unit of the Hospital, and three days to another three surgeons who perform surgeries on the remaining 16% of the patients had been done without any reasonable basis, and the same has resulted in the number of patients on the waiting list greatly increasing, the report states. 

An audit report dated 15 May 2023, which was seen by The Daily Morning, states that the Cardiothoracic Unit had three operating theatres for which four cardiothoracic surgeons – including one on a temporary basis – had been assigned. According to it, the seniormost consultant had been allocated theatres on Monday and Tuesday, the second most senior consultant on Wednesday and Thursday, the third most senior consultant on Friday, and the fourth most senior consultant on Tuesday and Wednesday.

The report goes on to mention that an approved plan regarding the allocation of the respective operating theatres had not been submitted to the audit. It had been observed that operating theatres had been allocated among consultants on verbal agreement, and that the theatres had not been segregated in line with the number of patients on the waiting list under each consultant.

It had been further observed that due to the non-availability of an approved plan, one or two operating theatres had been idle every day of the week, delaying the performance of surgeries, and thereby increasing the number of patients on the waiting list day by day. Two operating theatres each on Monday, Thursday, and Friday, and one operating theatre each on Tuesday and Wednesday, had not been used.

The report further reveals that out of a total of 5,697 patients on the waiting list for surgeries as at the date of the audit, only two days per week had been allocated to the consultant to whom 4,784 patients (84%) had been referred, and three days to the remaining three consultants to whom only 823 patients (16%) had been referred. While there had been no reasonable basis to do so, the report reveals that the responsible authorities of the hospital had not worked to utilise the operating theatres efficiently and effectively for patient care services.

According to the report, the aforementioned seniormost consultant had performed 225 surgeries in 2022, and 54 surgeries in 2023; the percentages of patients who died following the surgeries he performed had been 2.7% (seven) and 3.7% (two), respectively. The second senior most consultant had performed 22 surgeries in 2022, and 94 surgeries in 2023, and the percentages of patients who died had been 3.9% (five) and 13.6% (three), respectively. Another consultant had performed eight surgeries in 2023 with an associated mortality rate of 50% (four), while yet another consultant had performed three surgeries in 2023, and had an associated mortality rate of 66% (two).

It is also mentioned in the report that it cannot be ruled out that there are problems with regard to the quality and efficiency of the services of two consultants as they have performed an unusually low number of surgeries, and that the patients' mortality rate after the performance of the surgeries is as high as 50% and 66%, respectively.

The number of surgeries performed by Dr. Namal Gamage (the most senior surgeon) and Dr. Tolusha Harischandra (the second most senior) since 2010 is also mentioned in the report. Accordingly, a total of 6,933 surgeries have been performed by Gamage, and 1,573 by Harischandra during the said period of 13 years. The report states that reasonable grounds and evidence regarding the purported low number of surgeries performed by Dr. Harischandra had not been presented to the audit.

Considering the findings, the audit report compiled by the Audit Superintendent of the Senior Assistant Auditor General's Office in Matara, B.M. Sisira Kumara, recommends the introduction of a formal programme regarding the evaluation of the performance of consultants at the said Cardiothoracic Unit. It also states that it was observed that attention should be paid to preparing a suitable programme to make patient care services efficient by introducing a formal method of expediting surgeries to reduce the number of patients on waiting lists.

The Daily Morning also learns that Dr. Gamage is currently on pre-retirement leave. Sources close to the hospital said that the number of patients on the waiting list to undergo surgeries will increase further, and that patient care services will be greatly affected with his retirement, which is to take place soon.

Dr. Harischandra was not available for comment.