Nimal Gamage, a previously little known doctor made headlines last week for all the wrong reasons when a botched cosmetic surgery procedure carried out at his private clinic in Colombo resulted in the death of a lady doctor, who ironically worked in the plastic surgery unit of a state-run hospital.
Gamage has been remanded, his clinic has been sealed and a full scale investigation has been launched into his conduct where he allegedly performed cosmetic surgical procedures on unsuspecting clients for several years apparently without having the proper credentials to do so. This is the latest scandal to hit the medical profession --which only a few weeks ago was shaken by the news that two factions of its major trade union, the Government Medical Officers’ Association, engaged in fisticuffs at the National Hospital in Colombo. In this instance however, the medical community has been unequivocal in its condemnation of Gamage.
"This is the latest scandal to hit the medical profession, which only a few weeks ago was shaken by the news that two factions exchanged blows"
The Association of Plastic Surgeons of Sri Lanka held a media briefing and its officials stated that Gamage was not a qualified surgeon, let alone being a qualified cosmetic surgeon. These disclosures lead to many questions as to how Gamage carried out cosmetic surgical procedures, not clandestinely but in the full glare of the media, often appearing on television talk shows, some of them on state-run television networks and performing procedures on celebrity clients. Apart from the judicial and criminal investigations into the death, the Ministry has launched its own investigation into the fiasco. Health Minister Maithripala Sirisena has admitted that, the Association of Plastic Surgeons had complained about Gamage’s unprofessional conduct three years ago. Records indicate that Virittamulla Nimal Nagitha Gamage graduated from the University of Colombo as a doctor in 1982. He is registered in the Sri Lanka Medical Council as a doctor but not as a specialist surgeon or a cosmetic surgeon. He also has no Sri Lankan post-graduate qualifications. Gamage maintains a website that advertises his clinic, ‘Lanka Cosmetic Surgery’. His website describes him as ‘an Associate of the American Academy of Cosmetic Surgeons’ with ‘extensive post-graduate training in… General Surgery, Internal Medicine, Cardiology and Cosmetic Surgery’. Gamage is indeed a member of the American Academy of Cosmetic Surgery but he is listed as a ‘Physician member’. This membership can be purchased for US$750 a year by ‘any physician who performs cosmetic surgery’ and does not require any training or qualifications in that specialty. Gamage’s website claims that he “made his money in USA and came to Sri Lanka to provide a service to his community. He has done extensive research in nutrition and is currently writing a book on nutrition for Sri Lankans.” In the United States, he practised as ‘Kevin Nimal Gamage’. Gamage describes himself as a ‘world expert’ on ‘anti-ageing and nutrition’ and that ‘following his recommendations, patients are able to cure and prevent heart disease, cancer, diabetes, hypertension, auto-immune diseases among many other diseases’.
"The Board in its Registry states that while Gamage was initially certified in 1989, he is currently not board certified. Gamage’s registration with the Medical Board of California, where he practised prior to returning to Sri Lanka, is also interesting. His licence there too remains revoked"
Gamage claims to have performed ‘more than 12,000 liposuction procedures, 2,000 facial fat grafting, 1,800 breast fat grafting and 1,800 buttock fat grafting procedures without any malpractice’ in the United States and that he has carried out more than 2,000 procedures in Sri Lanka. Ironically, Gamage claims that the training he received in the United States helps him to “evaluate patients pre-operatively and conduct surgeries safely” and that he does not use general anaesthesia for any of his surgeries due to “complications of general anaesthesia including death”. It is clear that Gamage has had a running battle with Sri Lankan trained specialists.
“Beware of extreme professional jealousy of the current plastic surgeons in Sri Lanka who are totally inexperienced in safer and newer cosmetic surgical techniques”, his website warns. In his website, Gamage also claims that he is ‘board certified in Internal Medicine by the American Board of Internal Medicine.’ However, the Board in its Registry states that while Gamage was initially certified in 1989, he is currently not board certified. Gamage’s registration with the Medical Board of California, where he practised prior to returning to Sri Lanka, is also interesting. His licence there too remains revoked and there is a record of action taken against him, containing details of his transgressions while working in the United States. Since inquiries began into Gamage’s conduct in Sri Lanka last week, there have been many other revelations as well. It appears that the nurses at his clinic were not trained to work as nurses and that there were no facilities to deal with medical emergencies. It was also alleged that some of the medications used were past their expiry date.
The electronic media has also been heavily criticised for portraying Gamage as a qualified and renowned cosmetic surgeon when he was not one. Clearly, his clients would have been influenced by this media exposure and would have been lulled into desisting from questioning his credentials. Moreover, this incident highlights the loopholes in Sri Lanka’s health system where doctors returning from overseas pose as specialists and engage in lucrative private practice with little or no regulation or monitoring by the Ministry of Health. Private hospitals are also eager to employ them as ‘specialists’.
The Post-Graduate Institute of Medicine of the University of Colombo is the authority tasked with training and recognising medical specialists in Sri Lanka. While the Institute does maintain a website that lists specialists, the general public does not seem to be aware of this. Nimal Gamage has opened a can of worms in Sri Lanka’s medical system. As he awaits the verdict of the justice system on his actions, authorities would do well to reflect on what led to the unfortunate death of a doctor and more importantly, what could be done to prevent such a tragedy occurring again.