While the government seemed unable to come up with a solution for the SAITM crisis, a breakthrough in the impasse has come from an unexpected quarter – the Supreme Court. With the Supreme Court allowing the GMOA to become an intervenient petitioner in the appeal filed by the Sri Lanka Medical Council, a solution to the SAITM issue now seems closer than it ever was. Apart from the garbage issue, the standoff between the government on the one hand and the student unions and the GMOA plus a whole lot of other people over the SAITM issue was probably the most visible dissension against the government in the past several months. The main grouse of the GMOA was that they had never been allowed to present their side of the story to any court of law that had been hearing cases relating to SAITM.
The president of the GMOA, Dr Anuruddha Padeniya, is even facing contempt of court charges over comments made at an anti-SAITM meeting, saying among other things “…if the courts are unable to look at the two reports published by the GMOA and the five member committee appointed by the Health Minister, and they can look only at what is put before them by the Attorney General, what kind of justice can the people of this country expect?” In 2010, the GMOA had put out a 20 page document outlining the shortcomings in the medical course offered by SAITM. At the time this document was released, the Minister of Health was Maithripala Sirisena. The latter had seen the report and he had told the GMOA that he too agrees with the contents of that report and had asked what he should do about it as the Minister of Health.
The GMOA had suggested to him that since this was a report prepared by a trade union, he should appoint an official five member committee through the Health Ministry to go into the issues raised in that report. A five member committee made up of medical professionals, lawyers and administrators was duly constituted and the GMOA and other parties had made representations before this committee. The committee had put out their report in 2012 as the official view of the Ministry of Health and these had run parallel to the earlier report compiled by the GMOA. Padeniya’s complaint was that that the present Minister of Health and the AG who represented the government in the various court cases relating to SAITM, has not presented these two reports to any court of law. He stated that the reason why the GMOA has had to come on to the streets is because these two reports had not been taken into account in any case pertaining to SAITM.
The GMOA feels that the two reports on the SAITM medical course, by the GMOA and a five member committee appointed by the then Minister of Health, could tip the balance in favour of those agitating against the SAITM medical course. These reports were written many years ago in 2010 and 2012 respectively. However the contents of these reports are deemed to be still valid with regard to the most important essentials. What follows are slightly edited extracts from the original GMOA report on SAITM by an eleven member committee of the GMOA headed by Dr Padeniya.
Extracts from the 2010 GMOA report
The Malabe medical institute was started in 2009 to undertake the first four years of medical education leading to a five year medical degree to be offered from Nizhny Novgorod State Medical University, Russia. According to the website accessed on 04.10.2010, final year clinical training will be carried out in Russia. The Sri Lanka Medical Council (SLMC) is the statutory body established by the Medical Ordinance No. 24 of 1924, to safeguard and maintain the standards of medical education and medical practice. It is the ultimate responsibility of the Sri Lanka Medical Council to make sure the medical graduates, whom they entrust with medical practicing rights are ‘safe doctors’ who can be posted anywhere in the country to cater to the public. To accomplish this, they make sure the standards are well maintained in the field of medicine from medical education onwards.
The meaning of ‘twinning’ is where part of the medical education is done locally and the rest in some other part of the world. As a prime measure to maintain standards, it is clearly stated in the Medical Ordinance that twin programs are not accepted. Twinning is unacceptable in countries with a good reputation regarding the standards of medical education and medical practice. The General Medical Council of the UK and the Australian Medical Council web sites very clearly emphasize that the basic medical degree of a candidate should not be a twin degree, for them to sit the licensing examination. According to the SLMC website, the ‘Act 16’ (Examination for Registration to Practice Medicine) success rate is only 35% for Nizhny Novgorod State Medical University in Russia – the mother university of SAITM. It is hard to expect better results from its branch, which operates without minimum resources and standards.
The SLMC has refused to grant approval for the Malabe twin program. As such, the current operation of the Malabe PMC is illegal. The SLMC has repeatedly informed the Malabe institute through letters and the public via newspaper advertisements in all three languages of this. But the alarming fact is that they keep on recruiting students for a locally and internationally non accredited degree. A university alone cannot decide whether or not to establish an off-shore branch of the main university. It should be recognized by the Medical Council of the country where the main university is situated. With regard to the private medical institute in Malabe, the authorities could not provide evidence to prove such recognition of the Malabe PMC as a branch of Nizhny Novgorod State Medical University, Russia.
There should be minimum level of qualifications to become a lecturer in medicine. The majority of doctors who teach medicine at the Malabe PMC are foreign graduates with the basic degree. Out of them, the majority including the director of the institute are failures at the ‘ACT 16’ examination, which is the fundamental requirement to practice as a doctor in Sri Lanka.
According to their web page accessed on 01.10.2010, there is only one permanent professor for the whole medical college with two other visiting professors. In order to provide a quality medical education, there needs to be a number of essential departments in a medical faculty. Such essential departments are not available in this institute. It has only three main departments and some unusual departments. Out of them, more than four departments are under one retired professor and some of the departments are under visiting professors, which is grossly unsatisfactory. Present day Sri Lankan medical graduates are well recognized all over the world. The simple reason for this is that only best performing students at local examinations are selected to medical faculties and they are given a comprehensive and thorough training as undergraduates.
With the inception of substandard medical institutes without even minimum standards, international acceptance of Sri Lankan medical graduates will start to erode. Even the genuine, well qualified medical graduates will also be looked upon with suspicion. Postgraduate education also will suffer as a result since the prospects of foreign training for aspiring postgraduate trainees will be marred. According to the latest analysis done by the SLMC there are 20,000 – 23,000 active registered medical officers working in the country. Out of them nearly 14,000-16,000 are employed in the government sector. Usual cadre expansion is around 650 medical officers annually, in the government sector. Since 1,165 medical students are recruited annually to local medical faculties, they can supply the government requirement without any difficulty. Hence it is questionable whether there is a genuine requirement for medical graduates from local or international private medical colleges.
Until recently, everyone was under the illusion that SAITM had obtained BOI approval to establish a private medical college affiliated to a foreign university. But surprisingly BOI has replied in writing to the SLMC stating that they have not given any approval to establish a private medical college. The SLMC on behalf of the government of Sri Lanka has repeatedly informed the public via newspapers that the Malabe PMC has not been given its approval and that there is no room for the students of that institute to sit for the ‘ACT 16’ examination. But surprisingly the students have got themselves registered in this institute which has no local or international recognition.
Ministry of Health Committee report on SAITM
The above mentioned 2010 report of the GMOA on SAITM had been read by the then Minister of Health Maithripala Sirisena and he had at the request of the GMOA appointed a committee through the Ministry of Health to go into the matter. The five members of this committee were Dr. Ravindra Ruberu, Secretary, Ministry of Health – Chairman, Dr. H. R. U. lndrasiri, (a former Deputy Director General Health Services – Education Training and Research), Prof. Jayantha Jayawardana, Director (Post-Graduate Institute of Management), Dr. Palitha Abeykoon, former Director – World Health Organisation and Mrs. A. R. Ahamed, Legal Officer, Ministry of Health. The report of this committee was released in 2012. What follows is a slightly edited summary of its findings.
1. Application had been made to the Board of Investment (BOI) on 17 March 2008 to register what was then called the Asian Institute of Technology and Management and the training program offered were to be Information Technology, Management and Finance, Engineering, Vocational Studies, Nursing, Languages and Health Sciences. No courses in Medicine had been mentioned in the original application.
2. By a letter dated 31 March 2008, the BOI had granted approval for the enterprise on the condition that approval should be obtained from the Ministry of Health before providing training in Health Sciences.
3. An agreement was signed between SAITM and the BOI on 1 October 2008 and the earlier conditions of the BOI were reiterated in this agreement. The Committee observed that two batches had been admitted for the medical course by this time but no approval from the Ministry of Health or the SLMC had been obtained.
4. An agreement was entered into between SAITM and Nizhny Novogorod State Medical Academy (NNSMA) on 01 June 2009 following upon an earlier MOU signed on 21 January 2009. The Committee observed that the NNSMA degree is recognized by the SLMC to sit the Examination for Registration to Practice Medicine only in cases where full time training was provided in Russia.
5. SAITM authorities had written to the BOI on 26 January 2009 informing them about the MOU between SAITM and NNSMA and stating that Health Ministry approval had already been obtained. The Committee observed that however no formal approval has been given by the MOH.
6. The BOI requested SAITM on 13 February 2009 to obtain approvals from the UGC, SLMC, Ministry of Higher Education and the Ministry of Health and stated clearly that the BOI is not granting approval to undertake medical training leading to Doctor of Medicine degrees. In response to the above letter, SAITM wrote back on 25 February 2009 stating that approval of the Ministry of Health had been obtained and a copy of a letter dated 07 January 2009 from Dr. Amal Harsha De Silva who was the Director of Private Health Sector Development of the Ministry of Health which stated among other things that “the Ministry of Health approves the project in principle”. The BOI had thereupon requested SAITM to commence operations. The Committee observed that there is no indication that authority has been granted at a policy level by the Ministry of Health.
7. The SLMC by letter dated 26 February 2009, in reply to a letter dated 16 February 09 from SAITM, stated that the MD degree of NNSMA, conducted in Russia, was already recognized by the SLMC and has sought information with regard to the course of study, staffing, accommodation and facilities for training at SAITM. SAITM replied on 21 April 2009 and submitted the details requested and stated that they had planned to rely on private medical health Institutions for clinical training from the fourth term in the second year onwards. Clinical training in the fifth year will be in institutions attached to NNSMA in Russia.
8. On 15 May 2009, SAITM wrote to SLMC stating that they expected recognition for the four years local training program for the very reason that the MD degree of Nizhny Novogrod is recognized by the SLMC and the GMC of UK. On 28 May 2009, the SLMC wrote back to SAITM stating that the SLMC has recognized the MD degree awarded by NNSMA of Russia where the entire course is conducted in Russia and that they have not recognized any other program conducted in Sri Lanka or elsewhere by the NNSMA. This SLMC letter had further stated that, “the regulations for prescribed standards for the recognition of institutions awarding degrees other than a University established by the Higher Education Act No.20 of 1966 have been gazetted but have not been passed by parliament”. It further states that when these regulations are passed by parliament, SAITM could apply to SLMC and they will then determine whether SAITM meets the criteria for recognition.
9. Thereafter, on 17 June 2009, SAITM wrote to SLMC stating that they will commence the course on 07 September 2009 and that once the prescribed standards are accepted by parliament they will apply to the SLMC. The Committee observed that ‘It appears that the course has commenced prior to any formal approval or agreement from SLMC.
10. Once again on 31 July 2009, SAITM wrote to SLMC stating that, “SLMC is statutorily obliged to recognize the SAITM medical degree and requested the SLMC to continuously monitor the medical school until the gazette on prescribed standards is approved by parliament”. On 19 February 2010, the SLMC wrote to SAITM stating that the SLMC is unable to grant recognition to the SAITM medical Degree. They had stated that in accordance with the Medical Minute, there is no legal provision by which such recognition could be granted. The SLMC had also informed SAITM that they had not yet received any information from NNSMA with regard to official affiliation to SAITM and requested SAITM to inform any interested and concerned parties of this factual position to ensure that ‘no one is misled’.
11. On 14 June 2010, SAITM wrote to SLMC and drew reference to a letter from NNSMA dated 2 March 2010, where they approved the training conducted at Malabe. The Committee observed that students had been admitted to Malabe in September 2009 although the official confirmation of the affiliation with Malabe by NNSMA was only on 2 March 2010.
12. On 9 August 2010, the SLMC sent a letter to the Secretary Ministry of Health stating that SAITM cannot exist as the offshore campus of the NNSMA and that it may exist as a degree awarding institute as referred to in the Universities Act and the Medical Ordinance.
13. By letter dated 29 July 2010, the SLMC has requested information from the BOI about SAITM. The BOI had replied on 09 August 2010 stating that the approval of SAITM was made on the condition that it obtains MOH approval prior to providing training in Health Science, and that the initial application did not include a medical school, and further that it was a 100% local venture and not a joint venture with NNSMA.
14. The SLMC, referring to an advertisement in a newspaper to recruit staff to the Sri Lankan Campus of NNSMA, informed the UGC on 26 August 2010 that no one can set up a campus in Sri Lanka without complying with the stipulations of the University Act and that doing so would be an offence under section 128 of the UGC Act.
15. The Governor of the Western Province in a letter dated 13 October 2010 to the Provincial Director of Health of the Western Province, has granted his approval to SAITM and has further stated that he allocates the Homagama, Avissawella and Talangama Hospitals for practical training, as recommended by the Provincial Health Director. The Committee observed that this arrangement was not however implemented.
16. On 27 April 2009, an MOU had been signed between the Provincial Director of Health Services of the Western Province and SAITM outlining on the development of hospitals, patient care, facilities for the hospital staff and the teaching staff.
17. On 10 May 2009, several newspapers carried advertisements calling for applications to the Malabe Medical College affiliated to NNSMA and recognized by UK and SLMC. An advertisement in the Sunday Observer” of 28 June 2009 stated that “the programme will be closely monitored by SLMC for compliance with standards according to Law.” The Sri Lanka Medical Council informed the public by publishing a counter notice in the newspapers to the effect that there is no legal provision under the Medical Ordinance for the SLMC to monitor the Medical Education Program at SAITM or to recognize the degree awarded. The Committee observed that the SLMC had repeatedly cautioned the general public about the legal position of SAITM as the latter had published advertisements with misleading and incorrect information.
18. A review report of SAITM by a team appointed by the UGC released on 1 July 2011, had observed among other things that the minimum qualifications expected of the academic staff, the number of consultants and clinical hours and the SLMC registration number, and details of clinical training facilities had not been specified. The Committee observed that the MOU that has been signed between the Provincial Director of Health of the Western Province and SAITM has been interpreted as an agreement with the MOH.
19. A Gazette Notification dated 20 August 2011 was issued recognizing SAITM as a degree awarding institution “having obtained a report under Section 70 C of the Universities Act No.16 of 1978”, which is a reference to the above report. The Committee observed that the Gazette Notification stipulates many conditions to be fulfilled by SAITM and that the gazette does not have an operational date specified. The SLMC had pointed out that the Gazette Notification was premature because the recommendations of the UGC review team had not been met.
20. The UGC had upon an inquiry made by the Committee, explained that the Gazette notification conferring degree awarding status on SAITM was operational from the day it was signed by the Minister i.e. 29 August 2011. According to the UGC, SAITM had already complied with the conditions 1-7 of the Gazette notification and they had informed the UGC that they will complete the Hospital by April 2012.
The Committee observed that the Medical Ordinance does not contain a provision to recognize a twinning program between a University outside Sri Lanka and a Sri Lankan entity. The SLMC by its newspaper advertisements, in response to repeated advertisements by SAITM announcing that the degree it offered was recognized by the SLMC and that the program would be closely monitored by the SLMC, cautioned the parents and the general public regarding the true status of a medical degree granted by the SAITM. Following the Gazette notification on granting Degree awarding status to SAITM, students had been admitted before applying for accreditation for the new MBBS Degree from the SLMC.
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