The vexed issue of ‘prescribed standards’

There were references to ‘Prescribed Standards for Medical Education’ in the media recently, particularly when discussing the issues regarding Malabe SAITM private medical school. Some persons in authority often stated that the Sri Lanka Medical Council (SLMC) has not done anything regarding `Prescribed Standards’ in the past. This is not true.

The requirement for ‘Prescribed Standards’ was shown by Attorney General, late Mr. K.C. Kamalasabeyson when the SLMC in 2005 requested the Minister of Health Nimal Siripala de Silva to de-recognize the MD awarded by St. Petersburg State Medical Academy (SPSMA), Russia to a group of Assistant Medical Practitioners after studying in that country for about one year (some even less). The SPSMA had earlier obtained recognition for its MD diploma for a six year course in Russia. The AG pointed out that to de-recognize a ‘recognized’ qualification requires ‘Prescribed Standards’ under the Medical Ordinance.

The SLMC set about drafting the Prescribed Standards using documents such as the Benchmark Statement on medical education of the University Grants Commission (UGC) and publications of the World Federation of Medical Education (WFME). Subsequently, the SLMC had discussions with officials of the Legal Draftsman’s Department and drafted standards regarding medical education. The document was circulated to all the medical faculties and their constructive suggestions were incorporated. The final document was approved by the SLMC and subsequently by the Cabinet of ministers and was published in the Government Gazette in 2006 as ‘Prescribed Standards’.

A private medical school (PMC) proposed to be established at Piliyandala challenged it in the Court of Appeal. This institution had earlier taken the SLMC to courts when the advertisements that the medical school was recognized by the SLMC were rejected by the Council. There were a series of incidents against the Council including an attempt to set fire to the office, an attack on the residence of the Registrar with firearms and finally a grenade attack on the residence of the President of the SLMC. The persons involved with the PMC were questioned by the CID but investigations were suddenly halted by “orders from the top”! Incidentally, Prof. Carlo Fonseka was named as the Medical Director of the PMC.

The Minister of Health, Nimal Siripala de Silva tabled the ‘Prescribed Standards’ for approval by parliament, Dr. Rajitha Senaratne, Minister for Engineering & Construction got up and started to criticize its provisions using the same arguments filed by the PMC in the case before the Court of Appeal. As the Minister was not in a position to reply to the arguments and the representatives of the SLMC who were in the officials’ box could not reply, the matter was referred to the Consultative Committee on Health of the parliament. Before the Committee, SLMC representatives met the arguments of Dr.Rajitha Senaratne but he was not willing to accept them. The Minister of Health suggested that the SLMC representatives meet Dr. Rajitha Senaratne in his office and settle the matter. When we met him at his office at Sethsiripaya, Battaramulla, the lawyer who represented the PMC was present as his legal advisor!

The SLMC agreed to compromise and a new draft was made and published in the Government Gazette in 2007 cancelling the previous one. It was taken up at another meeting of the Consultative Committee on Health but Dr. Rajitha Senaratne again brought out fresh objections. Then in desperation the SLMC obtained an appointment with the Attorney General and discussed the matter. After studying the drafts, he pointed out that the problems were due to having one set of standards for both local and foreign medical schools and suggested separating them because the SLMC could prescribe standards for local medical schools but could only accept the degree of a foreign medical school if their standards meet the criteria required by the SLMC. This was done and finally the ‘ Prescribed Standards’ were published in the Government Gazette for the third time in 2009.

A date was set for a meeting of the Consultative Committee on Health. Ministry officials informed the SLMC that attending the meeting was a mere formality and the Prescribed Standards would be approved. When we went for the meeting in Parliament, the Minister of Health announced that the cabinet of ministers discussed the matter the previous day and decided not to table it in Parliament. When requested, he stated that he is not obliged to give reasons and that there would not be any further discussions on the matter. These were the heydays of the Rajapakse regime, soon after the armed forces victory over the LTTE. A gazette notification was later published to rescind the Prescribed Standards by the minister.

That was the fate of the ‘Prescribed Standards for Medical Education in Sri Lanka’ and the reason why private medical schools and their Godfathers didn’t want to have them. It is also the reason why when two top level panels appointed by the UGC went to inspect and submit a report on the medical course at SAITM in 2011, a member of one of the panels who was a top official of the UGC informed the other members that his minister wanted approval granted to SAITM, even before the panels commenced their inspection!

Dr. N. J. Nonis Registrar, SLMC ( 2005 - 2013)