Coronavirus pandemic: Pakistan has no health sector regulator as PMDC stands suspended

ISLAMABAD: While Pakistan prepares to cope with the severest coronavirus pandemic, the government is keeping the apex health sector and medical education regulator suspended and its offices sealed despite Islamabad High Court (IHC) judgement to immediately restore the Pakistan Medical and Dental Council (PMDC) as it stood under the Supreme Court orders in 2018.

Senior health sector professionals say this state of affairs is unprecedented and unheard of anywhere in 193 countries in the world that a country doesn’t have a health and medical education regulator.

The recognised former principal of a medical college told The News that he was appalled. “Can you imagine a nation of 220 million people not having a health system regulator at this critical time of emergency? Pakistan origin medical professionals are highly ranked in North America, Europe, Britain, Ireland and in Gulf Cooperation Council (GCC) countries and the PMDC has great contribution in achieving the distinguished position in which the medical education and professional standing of our doctors is second to none globally.”

Key functions of a public sector regulator like PMDC are regulation of medical and dental education, registration of all medical colleges, policy pertaining to admission to medical colleges, registration of Pakistani and foreign qualified doctors, and standards of medical practice and health service providing facilities, including private hospital, and teaching hospitals.

The PMDC also has a statutory duty of coordination and collaboration with international health regulation institutions. It verifies degrees, qualifications and does good standing certification of Pakistani doctors, who get fellowships, employments and advance training opportunities abroad.

Background interviews with health sector professionals, legal experts, and PMDC employees say the government soon after taking office, with the approval of the prime minister, established a health sector Reform Task Force, led by a person, who is a medical practitioner in the United States, and has been a key associate in the establishment of Shaukat Khanam Cancer Hospital (SKCH).

They say the task force mostly consisted of medical professionals, legal experts and philanthropists, who have been part of the prime minister’s team in the SKCH. According to them, one of the key reforms the task force undertook was abolishment of the PMDC functioning since 1962 through a law, drafted by the task force without any input from ministries of health and law, or provincial health departments.

The government on the advice of the task force tabled a law called “Pakistan Medical Commission [PMC] Bill, 2019”, and got it passed through the National Assembly. However, it has not been approved in the Senate till date.

In order to achieve its reform agenda, the federal cabinet decided to put an end to the PMDC, and set up the PMC through an ordinance, while the legislation for the same purpose was being debated in the Senate.

With the promulgation of the Ordinance 2019, the government scrapped the PMDC, took over its record and assets, sacked all 200 plus staff of PMDC, and established the PMC. The new PMC composed of health sector experts, lawyers and philanthropist associated with the ruling party and its task force on health reform. Prominent members appointed by Prime Minister were Ms Roshaneh Zafar, Ali Raza, Tariq Ahmad Khan, Dr Rumina Khan, Dr Asif Loya from SKCH, and Dr Anis Rehman, a dentist from Islamabad.

The government’s move was declared “undemocratic” by the Pakistan Medical Association and led to a series of protests. Following the shutting down of the PMDC, its sacked employees challenged their termination and dissolution of the body in IHC. They contended that the government had not followed the criteria set by the Supreme Court in the 2018 verdict for the promulgation of ordinances.

The petition requested the IHC to declare the ordinance for the establishment of the PMC unconstitutional and allow the PMDC employees to continue working in the newly-formed PMC.

Meanwhile, the government was also not able to get the PMC ordinance approved by Parliament within the required time-limit and was seeking its extension for another 120 days from the National Assembly.

The IHC on February 11, restored the PMDC and declared illegal the formation of the PMC–a body formed through the presidential ordinance in its place. IHC judge Justice Mohsin Akhtar Kayani announced the decision on identical petitions filed against the dissolution of the PMDC. The IHC dissolved the PMDC on October 19, 2019, and dubbed the ordinance as “ultra vires to the Constitution”. It ruled that the PMDC affairs have to be regulated under the PMDC law, which stands revived in its original shape. It further declared that actions, and decisions, taken by the newly formed PMC, are unlawful.

Justice Kayani passed an elaborate judgement and questioned the practice of law making through ordinances, when legislation to same affect is pending in parliament. The choice of prime minister of persons nominated to the PMC was also questioned in the verdict.

The judge ruled that the prime minister, being the executive head, is bound to follow the spirit of fair competition, equal opportunity and merit in all respects while holding the prestigious position. The court further held that the best of the best formula has not been adopted. It questioned nomination of Dr Asif Loya of the SKCH and ruled that it spells out “conflict of interest”.

The Health Ministry did not allow even the ad hoc council established on the orders of Supreme Court, headed by Justice Shakirullah Jan, to resume its functions.

The aggrieved employees again moved a contempt petition against the health ministry and federal government. While hearing the plea, the IHC observed that the ministry will have to eventually restore the terminated employees of PMDC and give them salaries in compliance with the IHC judgement.

Justice Kayani inquired how the ministry can seal an institution which regulates the affairs of doctors and expressed astonishment whether there was any law and order issue which had led to sealing the PMDC offices.

The judge remarked that the Health Ministry should not make an issue of restoring the PMDC and its employees a matter of its ego. He said the officers who ordered to lock the PMDC offices committed an offence and ordered the health secretary and other respondents to appear in person before the bench to answer on March 25.

The matter was also agitated in the Supreme Court. On Feb 3, a three-member panel, headed by Chief Justice Gulzar Ahmed, observed that the PMC had derailed all the apex court efforts to streamline the issues related to private medical and dental colleges.

The Supreme Court had earlier capped the fee of medical colleges but through the presidential ordinance these institutions were not only allowed to charge fee of their choice but a number of checks on private colleges were also removed. “It seems that the PMC has been established to provide benefit to private medical and dental colleges,” the court observed.

However, as the court was informed that the IHC had already reserved its decision on the PMC ordinance, it directed to let the IHC decide the case.

After having lost the legal and constitutional battle, the Health Ministry briefed the federal cabinet, which decided on March 3 that the IHC orders should be implemented. The health secretary informed the IHC that the federal government is in the process of implementing the judgement and the PMDC will be restored. However, till this day, the PMDC has not been revived.

Healthcare professional voiced their disappointment on the state of affairs saying that, while Pakistan fights a global pandemic, its national health sector regulator does not exist. This, they said, has serious implications like no new doctor can be registered; no foreign qualified doctor can practice in Pakistan, and the medical education is totally unregulated. If any citizen is not satisfied with the quality of services being provided by hospitals and doctors, he has no legal forum to seek justice from. At the same time, thousands of doctors working abroad are also suffering because the PMC was not being acknowledged anywhere in the world while the PMDC doesn’t exist.