Dr. Murali Vallipuranathan
The Sri Lanka Medical Council (SLMC) stands as the primary regulatory body for medical professionals practicing Western medicine in Sri Lanka. Its crucial mandate includes upholding educational standards, ethical practices, and ensuring patient safety. As the SLMC marks its centenary, this milestone is unfortunately accompanied by a history of significant criticisms and challenges, which have led to a perceived decline in its effectiveness and public trust. This article aims to critically examine key areas requiring urgent attention and substantial reform to safeguard the integrity and efficacy of the SLMC.
1. Prioritizing Practitioner Protection Over Public Interest: The Complaint Procedure Dilemma
A persistent criticism leveled against the SLMC by the public is its perceived prioritization of medical practitioners’ interests and privileges over its fundamental duty to protect the general public and healthcare seekers. This concern is most acutely manifested in the SLMC’s complaint procedure, which mandates the submission of complaints in affidavit format. While Justices of Peace (JPs) are theoretically expected to provide affidavits free of charge, this is often not the reality. Personal observations indicate numerous instances where individuals seeking affidavits from lawyers were charged at least Rs. 5,000. Victims of medical negligence and malpractice are frequently from socio-economically vulnerable populations, for whom such fees, coupled with subsequent legal proceedings, represent a significant and often insurmountable financial barrier. Consequently, the convoluted affidavit requirement effectively obstructs equitable access to justice for affected individuals.
In stark contrast, regulatory bodies like the General Medical Council (GMC) in the UK maintain a relatively accessible and cost-effective public complaint procedure. A complaint can be initiated through a simple letter, and in some serious, easily verifiable cases, the GMC even considers anonymous complaints when there are legitimate reasons for the complainant to remain unidentified. The SLMC’s rigid policy of rejecting all complaints not in affidavit format appears to be an anomaly among medical councils globally. This persistent procedural barrier and inherent inequity in the complaint process have severely undermined the credibility and overall effectiveness of the Sri Lanka Medical Council as a regulatory body.
2. The Shadow of Political Interference: Erosion of Autonomy
The independence of a medical regulatory body is paramount to its effectiveness. In the UK, the President of the GMC is appointed by the Privy Council, an independent body. Similarly, in countries like Canada and Australia, Presidents of Medical Councils are elected by their membership, fostering a sense of autonomy. In Sri Lanka, however, the Minister of Health appoints the SLMC President along with several other members. This system has unfortunately led to numerous instances of ministerial intervention, resulting in SLMC Presidents prematurely vacating their posts.
A notable example occurred in 2017, when a conflict arose between the SLMC and the then Health Minister, who was perceived to favor a private medical college lacking adequate academic standards. This disagreement ultimately led to the resignation of the SLMC President before the completion of her five-year term. Another serious conflict in 2020 saw the illegal removal of the SLMC President, who was subsequently reinstated by the Court of Appeal. Given that several Health Ministers have faced indictments for corruption and misuse of public funds, it is imperative that the law enabling ministerial appointments of SLMC Presidents be amended to ensure the SLMC’s crucial independence and autonomy.
3. Trade Union Infiltration: Compromising Impartiality
Recent events suggest a concerning infiltration of the SLMC by the Government Medical Officers’ Association (GMOA). During the 2023 SLMC elections held at the BMICH, the GMOA reportedly transported its members en masse in buses, providing them with pre-determined lists of candidates. This systematic effort allegedly resulted in the defeat of several eminent medical specialists and the election of junior doctors who may lack sufficient knowledge in professional ethics and standards.
Consequently, the GMOA‘s perceived infiltration of the SLMC has raised serious concerns about conflicts of interest. There are allegations that elected members, due to their union affiliations, are more concerned with protecting GMOA members from public allegations, thereby undermining public trust in the SLMC. This has further manifested in claims of improper conduct during disciplinary inquiries, casting a shadow over the SLMC’s impartiality.
4. Failing to Uphold Medical Education Standards
Beyond the contentious issue of maintaining academic standards for foreign medical graduates seeking licensure in Sri Lanka, the SLMC has also faced criticism regarding its oversight of local medical faculties. In 2018, the Supreme Court ruled that the SLMC had applied “double standards” and exceeded its powers by denying registration to graduates of a private medical college, while reportedly showing greater leniency towards the Faculty of Medicine of Kotelawala Defence University. While the SLMC has produced documents outlining academic standards for medical faculties, several newly established state medical faculties reportedly operate below these required benchmarks. The SLMC’s apparent failure to take decisive action to ensure these institutions adhere to the necessary academic standards is a serious concern for the future of medical education in Sri Lanka.
5. Internal Governance Deficiencies: The Need for Accountability
Recent audit reports have brought to light significant internal issues and governance failures within the SLMC. In 2024, audit findings revealed substantial financial irregularities within the SLMC’s Legal Unit. These included large disbursements of funds to external lawyers without formal agreements and a lack of proper approval procedures. Such findings point to a concerning lack of transparency and accountability within the organization.
To restore public trust and reaffirm its independence and accountability as a vital regulatory body, the Sri Lanka Medical Council must urgently rectify the aforementioned issues. Comprehensive reforms addressing the complaint procedure, political interference, trade union influence, oversight of medical education standards, and internal governance deficiencies are not merely desirable but essential for the SLMC to effectively fulfill its mandate in safeguarding healthcare in Sri Lanka.
*Disclaimer: The author of this article is Dr. Murali Vallipuranathan, who serves as a visiting lecturer at the Universities of Jaffna, Peradeniya, and Colombo, and as a Senior Medical Specialist within the Ministry of Health. Additionally, he is a Council Member of the Sri Lanka Medical Association. The opinions articulated in this article are presented with social responsibility, intending to improve public confidence in medical practitioners and to advocate for good governance and professional standards in the medical field. These perspectives are solely his own and do not represent his official capacities or affiliations.
