Medical justice

Last Friday, public medical services around the country came to a standstill after the Government Medical Officers Association (GMOA) went on a token strike. The list of demands included reducing taxes for doctors and increasing allowances. Strikes have become a staple of the GMOA, which, as a powerful union, is usually successful at getting what it wants, but is notoriously silent on accountability about malpractices by members of their profession.

Former Sri Lanka Medical Council (SLMC) Chairman Professor Colvin Gooneratne recently became the lone voice for patients, calling for sweeping legal reforms to protect patients against doctors committing malpractice, insisting existing regulatory bodies fail to hold doctors accountable as they are dominated by medical practitioners themselves.   

Prof. Goonaratne, speaking to reporters after stepping down as SLMC Chairman following a controversial nine-month stint, highlighted major administrative problems in the SLMC Constitution. He noted that the present legal structure under the Medical Ordinance Section 105 prevents the Council from making independent decisions regarding complaints of doctors who have made professional blunders in treating patients.

Under the present system, even though patients could submit complaints of malpractice to the SLMC, they were heard by a Court of Inquiry only comprised of Council members. This process prohibits independent evaluation of the complaints, and the unprofessional conduct of doctors is often overlooked. 

The SLMC governing body is made up of 25 members with about 16 from the two most powerful medical trade unions in the country, the GMOA and Faculty of Medical Teachers’ Association (FMTA). Not only does the GMOA ensure that it has a strong presence in the SLMC, it then has oversight over two committees that are tasked with processing complaints from patients before they reach the Commission of Inquiry. 

Prof. Gooneratne has gone on record saying in his five years as a member of the Council and nine months as Chairman, the SLMC never found a single doctor guilty of unprofessionalism even though at least three patient complaints were received each month. It is impossible that all these complaints are false, so where and to whom can patients turn to for justice? An important dimension of accountability is protecting future patients from similar experiences, but the existing system fails on both counts.  On the issue of accountability, the SLMC has to take the lead in maintaining standards. It is human to err, but that is precisely why there must be a balanced, transparent and accessible system that includes non-doctors to ensure patients are protected. Several years ago, the GMOA went on record acknowledging thousands of quacks in their profession, but they have also been instrumental in protecting malpractices, allowing mistakes to go unaddressed and thereby, worsening the problem.  Several other countries, such as Canada and Australia, as well as Britain, which earlier had a system similar to Sri Lanka’s, have since changed their process to have a balance between doctors and other professionals.  The British General Medical Council (GMC) has a dozen members with six doctors and six non-medical professionals. The administration appointed by the GMC to handle public complaints, which is called the Medical Practitioners Tribunal Service (MPTS), is similar to that of the Court of Inquiry in Sri Lanka, and also has non-medical professionals. If medical trade unions want the public to treat them with respect, then they must also address internal shortcomings within their profession with the same enthusiasm displayed when going on strike.