THE POLICE HOSPITAL: A LEAP INTO MODERNITY

(EXCERPTED FROM MERRIL GUNARATNE’S “COP IN THE CROSSFIRE”)

At the time the Police Hospital was placed in 1996 under my supervision, it was an appendage of the Department of Health Services. In fact it had been so for well over 30 years. The Health Services had actually relegated the institution to the status of a “rural” hospital. As a result, only the buildings and furniture belonged to the police; the medical and paramedical staff were answerable entirely to the National Health Services. To have designated the institution a Police Hospital was therefore a ‘misnomer’. The Health Services also supplied the required drugs and medicines to the Police Hospital. It had been assigned 10 medical officers, of whom four were registered medical practitioners. None of the medical officers had post graduate qualifications.

The Police Hospital thus was hopelessly placed to cater to a service of over 50,000 officers and men. Due to poor resources and facilities, officers injured in the war had invariably to be warded in the National Hospital. Many policemen were reluctant to visit the hospital for even outdoor treatment at that time. Since medical and paramedical officers as well as minor staff were members of trade unions, a strike orchestrated by trade unions in the health sector affected the Police Hospital as well. There had been occasions when pharmacists had locked the pharmacy and taken the keys away at times of strike.

Since the National Health Services administered the hospital, senior police officers attached to it were unable to maintain good disciplinary standards. All that could be done was to report complaints of shortcomings observed to the health authorities. The medical lab technologist at the time even dipped the needle in dettol before extracting blood from a patient’s arm! Disposable plastic syringes had not even been introduced to the hospital. It was therefore not surprising that daily attendance of patients was extremely poor at the time I was assigned the task of administering the hospital. Officers did not place confidence in the hospital since only extremely basic OPD treatment was provided by it.

After 1994, when I found it increasingly difficult to perform duties as Senior DIG (Ranges) due to the prejudices entertained by the government, I informed the Inspector General of Police, W.B. Rajaguru, that I would like a change, preferably to a post which would enable me to administer the hospital as well. It was my desire to accept the challenge of raising it’s standards. The desired change in my duties came about in 1996. The IGP informed me of the government wished to shift me out of what I would describe as “territorial functions” which was my familiar terrain. He therefore thought it appropriate to assign the “Support Services” arm to me which included “inter alia”, the administration of the Police Hospital. I was extremely happy to accept this change, since I could then settle down to work without constraints and fetters which had earlier inhibited my work. Once the administration of the hospital came into my hands, Senior Superintendent of Police Lionel Gunatillake, was appointed Director of Welfare, following a proposal made by me to the IGP. Upon being appointed, Lionel figured actively and enthusiastically in the rapid transformation that was set in motion.

As a first step, I decided to request Dr. Reggie Perera, Director General of Health Services to post more medical officers to the hospital. At the time of my visit to him, I had not thought of plans for the Police Department to take full control of the hospital. Perhaps if Dr. Perera had looked at my request favourably, I may not have embarked on such a radical course of action, as took place later. The Director General assured me that he would post more doctors, but a few days later informed me that it was not possible to offer more medical officers since the Government Medical Officers Association (GMOA) was opposed to it, being disinclined to upgrade the hospital from the status of a rural hospital. I then realized how helpless we were in regard to our efforts to improve the quality of our own hospital.

It was in these circumstances that I decided to seriously explore ways of achieving the total transfer of the hospital to the Police Department. At this time, the Sri Lanka Police Reserve (SLPR) was also under my supervision, and I was aware that there were several vacancies in the ranks of Senior Superintendent, Assistant Superintendent, Inspector and Police Sergeant in it. Funds were allocated annually to the SLPR but returned, since these vacancies remained unfilled. I made a written proposal to the IGP that we obtain the approval of the Ministry of Defence to have the hospital transferred to the department. I also proposed the enlistment of medical and para-medical officers as police reservists under the Sri Lanka Police Reserve Act, in view of the availability of vacancies in ranks from Sergeant upwards. The IGP approved the blueprint submitted. We prepared and sent off a memorandum to Secretary of Defence with a request to obtain the approval of the Cabinet for the hospital to be transferred from the Health Services to the Police, and for authority to enlist medical and para-medical officers as police reservists. The approval given by the cabinet to our memorandum set the stage for the radical transition I had in mind.

Dr. Keerthi Gunaratne, the Chief Medical Officer, played a prominent and valuable role in achieving the transition from the Health Services. Once the formal transfer from the Health Services to the police department was effected in mid 1997, it became necessary to formulate appropriate schemes governing enlistment, promotions, and terms and conditions of service. Several from medical ranks including physicians, an anaesthetist, a surgeon and a large number of medical officers were enlisted to the ranks of Senior Superintendent police, Superintendent of Police and ASPs’ respectively. In respect of para-medical ranks, viz. nurses, pharmacists, lab technologists, radiologists, physiotherapists etc., certain obstacles relating to financial matters had to be surmounted. Basically the problem was that a Sub-Inspector’s total emoluments ran below what para-medical categories in the National Health Services earned.

Although difficulties were not experienced in enlisting medical officers, prospects of attracting para-medical officers therefore remained dim so long as this matter was unresolved. To bridge the gap and attract para-medical officers to join the hospital, special allowances for them were recommended by the department to the Treasury. The payment of these allowances was later approved after a series of discussions with Treasury officials. With the transition, giant strides were also made in installing a wide range of technical facilities for tests, diagnosis and treatment.

The OPD of the Police Hospital, as a result of improvements, became a hive of activity daily. Large numbers began to flock to the hospital for “in house” as well as outdoor treatment. Patients also began to benefit from the clinics of a large number of Visiting Consultants whose services were entirely honorary. They were offered police ranks as incentives. An operating theatre and an intensive care unit were also completed. Police patients were as far as possible provided drugs and medication free of cost.

Dr. R. Ellawela (Surgeon), Dr. G. Nanayakkara (Anaesthetist), Dr. Mrs. Harshini Fernando and Dr. Mrs. Manjula Ranaweera (Physicians), as well as Medical Officer Dr Sunil Pathmasiri were pioneers who actively contributed to the successful transformation of the hospital from it’s rural status to a modern one and to be identified as a police institution. These qualified professionals were so exemplary that their enthusiasm, commitment and efficiency had an infectious impact over the medical and paramedical staff in the hospital.

In conclusion, it must be pointed out that the transformation of the hospital was not achieved easily. It was a story of sweat and toil, with impediments placed by the Health Services trade unions from outside, and fears and concerns expressed about the planned transformation by certain serving senior officers of the Police Department. The hospital became a boon to all officers, the retired ranks in particular, with extensive arrangements in force for treatment of varied ailments, and the availability of free drugs and medicines. Then IGP Rajaguru provided enthusiastic patronage to the project. The vision of a modern hospital could not have become a reality without his inspiration and support.

POSTSCRIPT

THE HOSPITAL, 25 YEARS AFTER. ( This is not part of the book)

I do not know whether a police service elsewhere in the world could boast of a police hospital. I had in mind, plans to improve it in course of time to reach the heights of the military hospital. But I retired not long after its creation.

It is sad but true that the hospital has declined considerably over time. Commitment to the work ethic of a disciplined service, output, a sense of urgency, speed and quality in respect of repairs, renovations, innovations, procurement of drugs, materials and equipment are areas which have seen a serious deterioration of standards. The availability of the two physicians to treat patients is acutely inconsistent. In fact, a retired Senior DIG Leo Perera died in the hospital due to strongly suspected medical negligence. Clinics by Visiting Consultants are being arranged in respect of a number of illnesses. Unfortunately, most of them arrive extremely late, or do not sometimes arrive at all. It is possible that this shortcoming is due to the authorities failing to look after them adequately. Worst of all, the retired police lower ranks who travel from far out to the hospital for treatment receive a poor service.

I would attribute the current plight of the hospital to three major factors. First, all medical and para medical staff do not hold ranks in the police reserve now. Of 58 medical officers in the hospital, as many as 26 are civilians. They no doubt enjoy trade union rights, anathema to a uniformed service. The work ethic required in a disciplined service invariably suffered, with the hospital assuming the appearance of a civilian organization. At the time of the inception of the hospital, it was made mandatory for all medical and para medical ranks to be police officers so that those enlisted would imbibe the discipline required in the service and work with a sense of urgency. Those enlisted as police officers should, before being assigned such ranks, go through proper training and orientation as well. It would be preposterous to offer a police rank without the beneficiary being trained. The required work ethic therefore suffered still further with untrained medical officers merely carrying police ranks.

Second, the key slot, Director of Police Medical Services (D/PMS) is held by a police officer.The Chief Medical Officer (CMO) is a doctor, but he carries only responsibility, whilst the director enjoys power and authority. ‘Dual control’ is repugnant to the efficiency of any institution. The CMO who holds a police rank should be appointed as Director so that he could administer the hospital. I think this serious drawback should be remedied without delay. A hospital cannot be run by a police officer, as much as a police station cannot be administered by a doctor!

Third, police headquarters should treat the hospital like a department, with a separate administrative apparatus. It should have an Establishment Branch (for enlistment and Promotion schemes etc) a separate Tender Board, Finance Branch etc, so that speed and quality would be achieved in postings, reforms, progress, renovations, and procurement of drugs and materials. If such a structure is not in place and the hospital is serviced with structures familiar with police ranges and divisions, there would be danger to life and limb of officers requiring urgent medical attention because of inadequate attention and inordinate delays. In view of chronic inadequacies by police headquarters to put the hospital back on it’s feet, I now begin to wonder whether my enterprise to pioneer a modern hospital had been futile. At the time of inception, the ambitious project envisioned hopes of reaching the standards of the Military Hospital. 25 years later, it appears a distant and elusive goal. Rather, what the hospital now requires is plenty of oxygen for it’s mere survival.