Many private medical institutes yet to be registered:

Patients die despite stringent laws

By Manjula Fernando

It is no exaggeration that almost every person in Sri Lanka has at least once in a lifetime been intimidated and swindled at private medical institutions. This is to say the least. All major private hospitals in the country, have a merry time minting money and making an entire nation sick rather than cure, with little or no regulation, or a responsible authority, to discipline them and protect patients' rights.

Although it has been repeatedly said that Sri Lanka lacks proper law and a body to supervise and regulate the functions of the private medical institutions, a close scrutiny of the Private Medical Institutions (Registration) Act No. 21 of 2006 gives a different story altogether. The laws indeed have been there all along, to be precise, since July 14, 2006.

The laws to punish, take the faltering institutions to Court and ultimately fine and if that is not enough, close down the miscreant institution are already there, but amazingly it has not been put to proper use. Why? is the pertinent question that we need to ask the authorities. The provisions in the Act have allegedly never been exercised to take legal action against private hospitals ever since it was passed in Parliament. The Act has given birth to a Private Health Services Regulatory Council to exercise, perform and discharge its powers, duties and functions under this Act.

The Objectives of the Council as stipulated in the Act include, the development and monitoring of standards, ensure minimum qualifications for recruitment and minimum standards of training of personnel and ensure the quality of patient care services rendered or provided. The Act says the Council is empowered to discharge an authorised officer 'without prior notice, at any time by day or night, to enter any Private Medical Institution, or any premises appertaining thereto, and do all such acts as may be reasonably necessary for the purpose of carrying out any inspection, examination, investigation or survey, for the purposes of the Act'.

The law says any obstruction to this authorised inspecting officer is a 'punishable offence'. Under the Act, it has also been clearly stated that any person or body of persons who contravenes or fails to comply with these provisions can be convicted in a summary trial before a Magistrate. In such an event the case the convict will be liable to pay a fine not exceeding fifty thousand rupees if 'such offence involves the causing of injury to human life or seriously jeopardising public health or public safety'. For other offences the fine ranges from Rs. 20,000 to 1,000. If the fine meets present day requirements is a matter to be reviewed but most importantly, it has been clearly stipulated that a second conviction on similar offence allows the Magistrate to 'outright cancel the permit issued' to the convicted person or persons. [Section 16 (2)]

The Registrar of the Sri Lanka Medical Council Dr. N.J. Nonis who is an ex-officio member of the Private Health Services Regulatory Council (PHSRC) speaking to the Sunday Observer said currently the Council is more into development of the private medical sector than fulfilling its obligations as a regulating body. "If they are serious about regulating the private medical institutions and conduct raids, an authorised officer has to be appointed to work full time carrying out this responsibility".

The Act has empowered the Provincial Directors of Health Services as Authorised Officers who can enter private hospitals for inspections. But, Dr. Nonis is of the view that this is a stumbling block. "It is questionable if the Provincial Directors have the capacity and time to do that".

"The Council must have its own competent authority. They know the provincial directors are too busy to attend to these matters. They are required to inspect the State health institutions, many issues to attend to and even the MOH officers come under their purview. That is a heavy workload on their shoulder".

"The Council members are stressing on the development of the private sector more than regulation. But I think being a regulatory body, regulation should be our main focus. The Act provides for appointing a competent authority to carry out regulatory functions". He made another alarming revelation to the Sunday Observer. Dr. Nonis said there is no supervision on the training of nurses, attendants and other staff at Private Hospitals. "We proposed that the Ceylon Medical College Council should be entrusted with the registration of nurses in the private sector. Let it supervise their entry criteria, training duration and facilities as well as their eligibilities to be registered as nurses. But the private hospitals have not accepted this proposal".

Nine members of the Regulatory Council are elected representatives of private medical institutions. Are we to surmise that the voice of these corporate entities stand far superior to other members when it comes to key decisions. The PHSRC comprise four members representing the fields of Accountancy, Management, Law and Nursing and the following ex-officio members: The Director General of Health Services functions as the President and the Director in-charge of development of the Private Health (Secretary), Registrar of the Sri Lanka Medical Council and Provincial Director of Health Services of each Province. Dr. Nonis disclosed that in contrast where Government sector nurses are recruited with GCE A/L qualification, the private institutions lament that they cannot get A/L qualified nurses. "The reason in my opinion is the very low salary paid in private hospitals compared to the Government service. In the Government sector the start up salary for a qualified Nurse is about Rs. 20,000."

"This is an area the Council has put a lot of effort into. For the training, girls with minimum qualifications are enrolled and recruited by the private sector. Then there are a large number of drop-outs who find better paying jobs and abandon the training.

There is no State supervision on the training of attendants and minor workers as well." "There are a lot of deficiencies. Nursing Homes are not keen on being regulated. That is one thing, they resist outside supervision and regulation. They are reluctant to give the breakdown on a bill." He said the Regulatory Council has to take these things up. "Although there are nine Provincial Directors very rarely do all nine directors attend the meetings of the Regulatory Council held every month. Six directors are the maximum attendants at a given meeting. On an average it is 3-4. They have to travel from far and most are heavily burdened with work." He said there is little discussion about complaints at Council meetings, and there is no link in the Council website where people's complaints can be directed. He said there is indeed a Complaints Committee and they get reports from the provincial directors."But there has been no Court cases initiated by the Regulatory Council to date, despite the powers vested in it under the Act."

According to the Act all private medical institutions have to be registered, but it is alarming to learn that still there are lots of such institutions which are yet to be registered. And, the action that can be taken against such institutions if a wrongdoing is suspected is unclear. Allegedly, nothing has been done against these unregistered institutions although the Council has every authority and powers to do so. It is the bitter truth that deaths or injuries that occur in private medical institutions due to negligence or any other irregularity are unaccounted for and patients have to pay through their noses for the services the hospital is unwilling to expose. Isn't it outrageous that hospitals have almost equated their charges to that of the doctors' fee in consultation payments? Isn't it a crime that a nation has been made to think that Sri Lanka's law did not permit action against these licensed corporate swindlers?