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January 16, 2019

New law set to erode autonomy of medical regulator

Top Story

January 16, 2019

ISLAMABAD: An ordinance has been promulgated which is set to erode the autonomy of Pakistan Medical and Dental Council (PMDC) as its decision-making body, the council, will be heavily politicised owing to the newly prescribed selection process.

The PMDC Ordinance 2019 was promulgated last week. Instead of getting the legislation passed through Parliament, the government hurried to introduce ad hoc legislation through the ordinance that will expire in 120 days.

The new council which will run the PMDC affairs is comprised of 17 members, according to the ordinance. Five of them will be nominated by the prime minister, ten by the four provincial governments and only one each by the president of the College of Physicians and Surgeons of Pakistan (CPSP) and the Surgeon General of the Armed Forces Medical Services.

There is no representation of the professional bodies of medical and dental practitioners at a time when the number of registered professionals with the PMDC are near to 200,000. According to the official statistics of 2014, as many as 176,701 doctors and 15,430 dentists are licence holders whose number may have exceeded manifold due to growing number of graduates passing out from private and public institutions. Right now, there are 134 medical colleges and universities; 85 of them are private.

Although there is equally competing argument suggesting the council should be formed through nomination in order to bring at the helm of affairs the professionals of repute and integrity; however, the selection process is not left at the at the sole discretion of the selectors. Instead, nominations are invited and then made public for scrutiny in order to choose the best among them.

In contrast, the newly promulgated ordinance doesn’t spell out any such criteria. The prime minister has been empowered to name three members of the civil society “from amongst nationally recognised philanthropists, professionals or persons of known repute.” However, no procedure has been laid out for their public scrutiny. The PM has been made the final judge of their competence.

Likewise, the PM has been authorised to select two members from the private medical colleges who are at the rank of associate professors with ten years of experience as a teacher and ”of outstanding merit” but the entire selection process will be kept secret unless the names are finalised.

The provincial governments will forward ten nominations for the council from the clinical and basic science faculty; again there is no public scrutiny. Eventually, the ones enjoying good relations with the political government will make ways to the council and remain there so long as they enjoy their goodwill.

The experts say the government could form council partly through nomination and partly through election process in order to accommodate the bodies of medical professionals. It was also suggested by a commission formed by Islamabad High Court in 2015 in order to look into the PMDC affairs. “The Commission recommends that both elective and nomination systems may be utilised for establishment of the Council. Thus the procedure of election is considered appropriate for the category of registered medical and dental practitioners,” its report reads.

There is no representation of other stakeholders like patients, human rights activists as is the norm in the western countries. One can find many complainants against doctors’ negligence and the bias of the PMDC’s disciplinary committee in favor of the accused, they find no representation in the council. In contrast, private medical colleges have been given representation notwithstanding the fact they have a direct conflict of interest as the PMDC regulates them. They have been involved as stakeholders, not the patients.

In the new ordinance, the federal minister has been empowered instead of the ministry which operates through its secretary. Whenever it appears to the ministry that the council is not complying with any provision of the ordinance, “the federal minister may refer the particulars of the complaint to a commission of inquiry….to inquire in a summary manner and to report to the Federal Minister.”

As the PMDC had in the past been run by the individuals having direct conflict of interest with owners of private colleges held key positions, this issue has been partly address in this ordinance. “No member shall enter upon office of the member of the Council until he signs and submits a declaration of no conflict of interest,” the ordinance reads. However, neither this conflict of interest has been explained in detail nor such information has been prescribed as public.

However, the ordinance directs the PMDC to public on its website the names of all registered medical and dental practitioners which was kept secret until now. Another positive step is the establishment of medical tribunal to deal with matters relating the council meaning thereby any issue falling in the jurisdiction of the PMDC will not be dealt by any other court unless it is first dealt by the tribunal. Many private colleges, in past, got stay orders from high courts against the PMDC’s actions.

After the president of the PMDC Council, two other key positions are of the registrar and director finance. While the president is elected from amongst the nominated members of the council, no criteria has been laid down for the registrar who is the chief executive officer and the director finance who is responsible of all financial affairs. They are to be picked by the council.

Likewise, the inspector of medical colleges are of significant importance as they inspect the institutions to see whether or not they are complying with the criteria set by the PMDC. No criteria of their selection have been laid down. The council can assign this role to anybody. “The Council shall approve a list of inspectors and the President shall commission such numbers of medical or dental inspectors from the approved list….”

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