A Pygmy Confronts a Giant on the Saitm Crisis


by Prof.Carlo Fonseka


At one point in your insightful editorial titled "Terror in Nice" in The Sunday Island of 17 July 2016, you felt impelled to remark that the relevant countries should "unite in a concerted bid against global terror, instead of quibbling about who did what, when." I respectfully submit that in my trade (medicine) to deal purposefully and effectively with a case of a critically ill patient treated by one or more doctors, it is vitally important to ascertain precisely who did what and when; as with a critically ill patient, so with the SAITM in crisis.



Mr. Editor, page 12 of the newspaper illuminated by your editorial, carries an article on the financier who invested in the SAITM business, which identifies him as a "giant". Why so? Because in 2013 by hook or by crook he succeeded in getting his family business recognized as a Degree Awarding Institute by the Government, bypassing the compliance certificate from the Sri Lanka Medical Council (SLMC) required by law. Those who have a statutory duty to ensure patient safety by maintaining the traditionally high standards in medical education in our country, are contemptuously dismissed by the writer as "pygmies". Why so? Because they refuse to expose patients to inadequately trained medical graduates of SAITM, by giving them provisional registration to practise medicine. In this context please remember that a team of 10 medical academics and specialists appointed by the SLMC inspected SAITM in July 2015 and judged that as presently constituted SAITM lacks the facilities to provide adequate clinical training to medical students. I cannot believe therefore that The Sunday Island should publish an article according to which, members of the SLMC are "pygmies" compared with the financial "giant" of SAITM.



Mr. Editor, in my dealings with The Sunday Island it has hitherto been my experience, especially as the Founder Chairman of NATA (National Authority on Tobacco and Alcohol) that your newspaper has invariably pursued a policy of "justice as fairness" a la John Rawls. Your newspaper never compromised itself by taking the side of financial might, when might confronted right. It is because I am acutely aware of your admirable past that I crave your indulgence for space to place on record the point of view of a "pygmy" on this matter.



To set the background let me remind readers that the first avowedly non-profit making private medical college in Sri Lanka – North Colombo Medical College (NCMC) – was established by The College of General Practitioners in 1981. After much ado, the NCMC was transformed into the Faculty of Medicine of the University of Kelaniya (UKFM) in 1991. I was the Founder Dean of the UKFM which is celebrating its glorious Silver Jubilee this year. Several parents with their children at SAITM have asked me whether the SLMC has no plan to deal with the SAITM crisis. In The Island of 15 July 2016 Rohana R. Wasala, a humane independent intellectual, has made a rational plea for a just and fair solution to the SAITM crisis. He rightly says that non-recognition of the SAITM’s medical degree under its current management must not be taken "as a death sentence" on its graduates. May I tell all concerned that considering the way the family business called SAITM has been maximizing profits since 2009, I foresaw the coming inevitable crisis. As a confidante of President Mahinda Rajapaksa, I wrote him a confidential memo about SAITM in 2014. For good or ill the memo did not remain confidential. In it I identified the major problems that must be addressed if SAITM is to become an institute that will produce safe doctors. As a pygmy’s response to the Sunday Island’s article about the giant of SAITM, please allow me to submit the essential points in the memo I sent President Rajapaksa in 2014. Before that, however, I must allude to the contribution to the SAITM issue made by my friend R.M.B. Senanayaka (RMBS), the free-market economics pundit.


Free-Market Medical Education

In the Business Section of The Sunday Island of 17 July, RMBS argues for a role for free enterprise in medical education. He says that provided students fulfil the required minimum educational entry qualifications and the regulators of medical education maintain the minimum academic standards in medical colleges, anyone should be free to enter the medical profession. The SLMC has no serious objection to this point of view. Let me emphasize to RMBS once again that a team of 10 medical academics and specialists appointed by the SLMC inspected SAITM and reported that the Teaching Hospital at Malabe is grossly deficient in the numbers of patients and in patients with different kinds of diseases, necessary for students to acquire adequate practical clinical training to become safe doctors. That is why the SLMC had to recommend to the Hon. Minister of Health that the degree awarded by SAITM should not be recognized for the purpose of registration under the Medical Ordinance.


Medical Council of India (MCI)

RMBS may care to know that a high-powered Parliamentary Committee submitted a Report to the Parliament of India in March 2016. It was titled "The Functioning of the Medical Council of India." Chapter XII of the Report is headed "Corruption in the MCI". Paragraph 12.3 reads as follows: "On being asked about the kinds of corruption that is happening in the MCI, the President MCI… admitted that corruption was there when there was sanctioning of medical colleges or increasing or decreasing seats … the Committee has also been informed that private medical colleges arrange ghost faculty and patients during inspection by the MCI, and no action is taken for this irregularity." I can lay my hand on my heart tell the world that the SLMC has never been guilty of that sort of corrupt practice, not because we are moralists, but because we take seriously our statutory responsibility for ensuring patient safety.


Points from the Memo to President Rajapaksa

1. As I briefly told you during our telephone conversation recently Dr. Neville Fernando’s enterprise called the South Asian Institution for Technology and Medicine (SAITM) at Malabe appears to be pursuing a course of activities which is almost certain to precipitate sooner or later a major crisis in the country. Dealing with this crisis will stretch the government’s disaster management skills to breaking point. … A fierce conflict will ensue between the SLMC, the UGC and the Ministry of Higher Education on one side, and students in the State Medical Faculties backed by students in other faculties and actively supported by most members of the Federation of University Teachers’ Association (FUTA), a majority of the members of the GMOA and a large number of ordinary doctors concerned about professional standards of doctors, on the other side. I fear that the crisis might be as serious as the situation that arose in regard to the NCMC from 1987 to 1989.


2. The reason for the crisis is that Dr. Neville Fernando … is acting as though he was hell-bent on maximizing the return on his investment in SAITM without bothering much about conforming to anything like the minimum educational standards prescribed by the SLMC locally and the World Federation of Medical Education (WFME) internationally. The outcome would be that the majority of the 25 members of the SLMC would not be in a position to certify in all conscience that the graduates of SAITM can be considered competent to practise medicine safely and effectively …


3. If Your Excellency asks me to tell you in one sentence what I consider to be the real problem at SAITM demanding urgent solution my answer is this. There is reliable information that SAITM with a total teaching staff of 67 and a fee-levying Teaching Hospital of 250 beds with a bed occupancy rate of about 15%, had enrolled (at excessively high fees) 938 students by the end of 2012 (In our state medical faculties, whatever their other shortcomings may be, there are large numbers of patients in our hospitals for students to learn how to diagnose illnesses and treat patients. That is why Sri Lanka has a well-deserved reputation for producing quality doctors.)


4. Despite their best efforts the UGC and the Ministry of Higher Education do not appear to have been able to regulate the number of students admitted annually to SAITM and to establish minimum student/staff ratios and student/hospital bed ratios required to produce competent doctors. Accordingly, I urge Your Excellency to appoint a Special Presidential Committee with the following terms of reference.


i. To assess the current status of SAITM and to see whether it is equipped with the minimum facilities and resources required to produce graduates competent to practise medicine safely and effectively.

ii. To estimate the maximum permissible annual intake of students to SAITM … and to inquire whether the fees charged by SAITM are unconscionably high …

iii. To devise a mechanism for arriving at a consensus between different stake-holders for the role of the non-state sector in the provision of medical education in Sri Lanka.

iv. To examine the validity of the view that to ensure the competency of graduates of SAITM they should be required compulsorily to sit for a licensing examination conducted by the SLMC before they are registered as medical practitioners.

As my lawyer friends say "circumstances alter cases." The above Memo may no longer be valid to deal with the SAITM crisis. I present it here only to tell the public that for my part I tried my utmost to avert the current SAITM crisis.

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