SLMC Tardy In Registering Foreign Doctors

• The hidden danger to patients

By Faraz Shauketaly

Foreign doctors practicing in Sri Lanka without registering with the Sri Lanka Medical Council have become the cause of many complaints with very little recourse to a satisfactory appeal process or accountability. The full extent of the lackadaisical registration process and enforcement is fully experienced unfortunately after an event – leaving the patient with little recourse – apart from turning to the local private hospital and local medical staff. That in itself presents a conundrum to those patients who have paid heavily for the services of a foreign doctor as opposed to a local doctor.
A retired consultant paediatrician, Dr Asoka Thenabadu (68) told The Sunday Leader of his own experience. After suffering from chest pains whilst on safari in Sri Lanka’s deep South, he was advised to get his heart checked out. Eventually it was decided that he needed a simple procedure called an angiogram. He chose a cardiologist Dr Vajira Senaratna. During the time that the procedure was being carried out Dr Senaratna had informed his patient that although ‘this procedure’ would do, he could if the patient wished, have a ‘stent’ put in. This is a more involved procedure than an angiogram and clearly costs more. On inquiring about the cost of such a procedure, Dr Senaratna had said ‘around a million’. Whilst the patient who was on the table contemplated this, he was offered the services also of a Mark Silvestri who he said was a reputable man in the field, and a Frenchman to boot.
On being asked if Mark Silvestri was a registered practitioner in Sri Lanka he was told, ‘oh, it’s ok if he is working with me it is ok’. For a man who had spent 37 years of his working life in Europe and more used to adhering to the rules and procedures in place, it struck him that Dr Senaratna was not only trying to sell a service which by his own admission was not essential (but could help) but was also being rather flippant about the regulations – and therefore respect for the rules in Sri Lanka – applying to foreign doctors practicing in Sri Lanka, however suitably qualified they may be.
Incensed by this almost callous attitude especially over the timing of the offer of putting in a stent – at considerable cost – which Dr Senaratna was careful to qualify by saying was not essential but could help, Dr Thenabadu complained to the Sri Lanka Medical Council (SLMC). Initially, by letter dated January 1, 2013, Dr.Thenabadu was told by Dr N. J. Nonis the Registrar that Dr Mark Silvestri was not registered with them. He had also stated that he had written to the hospital asking if such a person had practiced there. The complaint against Dr Senaratne was referred back to Dr. Thenabadu asking him to have the complaint resubmitted in the form of an affidavit.
Subsequently by letter dated January 23, 2013 enclosing a letter from the private hospital, the SLMC confirmed that Mark Silvestri was on a private visit and during that time had been asked to demonstrate the use of a rotablator. The SLMC confirmed that though he was not temporarily registered at the time on a previous occasion he had been an observer and advisor with temporary accreditation.
Dr Thenabadu of course chose not to have the stent inserted.
However for Mrs. Matyana Rupasinghe matters ended disastrously with her untimely demise. She had consulted Dr Senaratne who had advised her to have a stent inserted. There have been unconfirmed allegations that Dr Senaratne directly or indirectly represented a company supplying stents. To those like Dr Thenabadu this appeared to be a conflict of interest if indeed Dr Senaratna was representing the company supplying stents. Whilst there is absolutely no inference that Dr Senaratne was the cause of Mrs. Rupasinghe death, sources close to her family have indicated that Dr Senaratne treated her high sugar levels at the time with a dose of insulin and was ‘hell bent’ on carrying out a procedure to insert the stent as well.
Whether Dr Senaratne ever used the services of foreigners visiting Sri Lanka privately is not clear. In the case of Mark Silvestri however we have an indication of the rather grey area that has encompassed the process of registering foreign doctors practicing in Sri Lanka – before they can go ahead and treat patients in Sri Lanka at huge cost – many times above what a Sri Lankan specialist would charge.
The SLMC claims that the procedure and process is simple. However after some palpitations the process of registering a foreign doctor is carried out by a Committee which will decide on whether the particular doctor is suitably qualified and experienced. The Committee was established after it was found that many foreign doctors remain in Sri Lanka just for a short period and are not always available for aftercare. Many patients would prefer continuity with the doctor of their choice and for whose services they would have paid significantly more in any event.
Dr Thenabadu spoke of a need to tighten up the process and its enforcement. The current flippant ways must be addressed as a matter of urgency he urged. In Sri Lanka with its penchant for valuing things foreign far higher than anything local, the quest to ensure firm commitment from foreign doctors in terms of aftercare and also suitability, is likely to be a long and arduous task.
(faraz@thesundayleader.lk)