Docs told to give injured workers enough leave

Manpower and Health ministries send out reminder; SMC probing some of the complaints

By Radha Basu, The Sunday Times, 7 Jul 2013

The Manpower and Health ministries have acted on complaints that some injured workers are getting too little medical leave from doctors because their bosses want to avoid reporting workplace accidents.

Now all doctors here have been reminded to give injured workers the days off they deserve and warned of the consequences if they fail to do so.

The Singapore Medical Council (SMC) is investigating some of the complaints, director of medical services K. Satku and commissioner for workplace safety and health Ho Siong Hin said in a joint letter sent out last month.

They did not provide details, but groups helping foreign workers told The Sunday Times they see a steady stream of injured workers who seek help after getting too few days off from private doctors.

Some get only two or three days off at clinics usually contracted by their employers, but when they seek further treatment at restructured hospitals for the same injury, they get weeks or even months off to recover.

The help groups welcomed the government action to get doctors to do the right thing.

The government letter reminded doctors that workplace safety regulations require all accidents which make a worker unfit for work for more than three consecutive days or result in death to be reported to the Manpower Ministry.

"To avoid reporting these accidents, some employers may request medical practitioners to issue less than four consecutive days of medical leave or to issue light duty instead of medical leave," it said.

Issuing medical leave carries with it the "responsibility of ensuring that the patient deserves it on proper medical grounds".

Rather than be influenced by employers or workers, it said doctors should rely on good clinical assessment and give medical leave "commensurate with the nature and severity of the worker's injury".

"Medical practitioners who have issued medical certificates inadequate for the nature of the medical condition and are complained against may be the subject of disciplinary inquiries by the SMC," it warned.

Doctors were also urged to report employers who try to circumvent accident-reporting rules by influencing how much medical leave their injured workers should get.

There were 11,113 workplace injuries reported here last year - almost 1,000 more than in 2011.

Dr Andrew Chin, who heads the department of hand surgery at the Singapore General Hospital, told The Sunday Times he sees between one and two injured workers every month who were given less medical leave at a private clinic than they clinically deserve.

"The medical leave given should depend on the specialist's assessment at the time of the worker's presentation, test results and relevant previous medical data and records available," he said.

Singapore Medical Association ethics expert Dr T. Thirumoorthy said medical certificates (MCs) should be based on objective medical assessment and not other considerations, such as who is paying for the treatment.

"A doctor's commercial relationship with the company may come in conflict with his professional obligations to the patient," he said. "Without a doubt, a doctor's primary obligation should be to serve the welfare and best interests of the patient."

Injured workers tell stories of leave denied
TWC2's check with 150 injured workers finds nearly 1 in 3 got less leave than warranted
By Radha Basu, The Sunday Times, 7 Jul 2013

When construction worker Bolai Kumar Ghosh, 42, injured his left wrist in a worksite accident in May last year, his employer took him to a clinic in a well-known private hospital.

The Bangladeshi, whose work involves lifting heavy loads, was given just two days of medical leave and five days of "light duty".

After a week, still in pain and fearing that returning to work would worsen his injury, Mr Ghosh returned to the clinic but he was not given more medical leave.

He eventually sought treatment at Singapore General Hospital, where he underwent tests and was given 76 days off plus six months of light duty. He has also been offered $8,400 as compensation.

The worker, who has been here for 16 years, believes the clinic gave him only two days off initially so his bosses could avoid reporting his accident to the Ministry of Manpower.

Last Friday, migrant workers' group Transient Workers Count Too (TWC2) checked with about 150 injured Indian and Bangladeshi workers in Little India and found that 42 - roughly one in three - received fewer than four days' medical certificate (MC) after being taken to a private clinic or hospital. All the men then sought treatment at restructured hospitals, where they were given an average of 94 days' medical leave for the same injury.

Accidents must be reported only if a worker gets more than three consecutive days off.

Several of the men, including Mr Ghosh, echoed their complaints to The Sunday Times.

In the worst cases reported to TWC2, workers claimed they were given fewer than four days off even after suffering fractures, amputations and undergoing surgery.

In the wake of such complaints, the Health and Manpower ministries wrote to all doctors last month to remind them of their duty to give injured workers the medical leave they deserve.

Doctors have also been warned that they might face disciplinary inquiries if they fail to do so.

Groups such as TWC2, which have long sounded the alarm on such alleged malpractices, welcomed the government action. "This is a longstanding problem that has not gone away," the group's vice-president, Mr Alex Au, told The Sunday Times. "We are glad that MOM and MOH are paying attention to it."

Referring to TWC2's checks with workers, he said that on the basis of the initial MCs given by the private clinics or hospital, one-third of all employers involved would be freed from having to report the accident to the work safety authorities.

"This is quite shocking," he said.

Of the 64 men sent to a private hospital first, almost all were later treated for the same injury at a public hospital. "That is a colossal waste of health-care resources," said Mr Au.

Another migrant workers' group, Healthserve, said roughly one in five of 180 injured workers it has helped since January last year also reported receiving only a few days of medical leave at private clinics, compared to weeks or even months off at restructured hospitals.

If doctors are giving injured workers too few days off to help employers, it may not be only to help the bosses avoid reporting accidents.

Leave might also be cut short so that employers do not have to pay workers when they are not working. Under Singapore laws, workers must be paid while on medical leave.

Chinese carpenter Zhang Feng, 46, got three months of medical leave after fracturing his leg in March.

He needed surgery and two metal clips were inserted. But although he was still in pain and could barely walk, his company doctor refused to extend his medical leave.

He went to Tan Tock Seng Hospital which, after tests, extended his MC by another 40 days.

He said: "I work so hard for the company, but they did not care for my welfare."

RULES ON WORKPLACE MISHAPS

Under the Workplace Safety and Health (Incident Reporting) Regulations, and the Work Injury Compensation Regulations, employers must report to the Ministry of Manpower (MOM) within 10 days if an accident:

- results in the death of an employee; or

- leaves an employee unfit for work for more than three consecutive days or he is hospitalised for at least 24 hours.

The Manpower and Health ministries said any doctor who encounters an employer attempting to get around the rules by influencing how much medical leave a worker is given may inform the Manpower Ministry in confidence at mom_oshd@mom.gov.sg.

Don't dictate sick leave, employers told

MOM reminds them not to request less leave than is needed for injured workers

By Radha Basu, The Sunday Times, 21 Jul 2013

The Ministry of Manpower (MOM) has told employers not to influence doctors to give injured workers less sick leave than they need.

The e-mail reminder which went out to 28,000 workplace safety and health practitioners on July 11 follows an earlier reminder by MOM and the Health Ministry telling all doctors to give injured workers appropriate medical leave.

The ministries acted after complaints that some workers were getting too little leave so that their employers could avoid reporting accidents to MOM.

All accidents where a worker dies or is given more than three consecutive days of medical leave must be reported.

MOM's bulletin to employers said: "You should not request medical practitioners (to) prescribe less than the requisite length of medical sick leave or issue light duties instead in order to avoid incident reporting."

It also points out that doctors have been asked to report employers who try to influence how much medical leave workers should be given.

Groups helping migrant workers have long reported a steady stream of workers given fewer than four days of sick leave by private hospitals and clinics that their employers take them to.

Unable to work and in pain, many then seek treatment at restructured hospitals, only to receive weeks or even months off for the same injuries.

A spokesman for construction and civil engineering conglomerate Koh Brothers, Mr David Tay, acknowledged that there were some "bad eggs" in the industry. "But we should not use the same brush to tarnish all employers," he said.

The errant ones were likely to be small firms, he said, urging them to be more "humane" towards injured workers.

"If they don't do so, workers may be unmotivated and jump ship, and the company will eventually lose out both in terms of productivity and costs," he said.

Singapore Contractors Association Limited's (Scal) president Ho Nyok Yong said most of its 2,500 members are law-abiding. "But Scal is concerned about the recent government reminders. We will advise all our members to respect the professional judgment of doctors," he said.

* Hospitals give too much sick leave for injuries: Bosses

But doctors say they are objective in assessing workers' conditions

By Amelia Tan, The Straits Times, 9 Nov 2013

BOSSES are crying foul that foreign workers are getting too much medical leave from hospitals, which in turn insist that their doctors are simply doing their jobs.

More than 10 companies in the marine and construction industries showed The Straits Times injury reports from the last two years of 20 foreign workers, who received several months to a year off for cuts and fractures.

For instance, Sin Norm Engineering highlighted how one of its workers, who fractured his finger in March last year, was given one day's medical leave and a few days of light duty after an operation at Jurong's West Point Hospital, which is near shipyards.

But when he went to Singapore General Hospital (SGH) on his own, he received nearly a year of medical leave.

The employers believe these workers exaggerate their injuries to fool doctors.

"Some of them can act better than film stars," said Mr S. Jiwa, director of Mobco Marine.

One of his workers who received six days of medical leave from West Point Hospital after fracturing his hand in August, got almost four months' leave from Tan Tock Seng Hospital (TTSH).

Kiat Seng Shipbuilding and Engineering director James Lee said: "They can walk fast and hop off and on lorries. But in front of the doctors, they will suddenly become weak."

In another case, a worker employed by Guan Soon Heng Marine Engineering cut his finger at work in February last year and got a day's medical leave from Gleneagles Medical Centre. But subsequent visits to Changi General Hospital (CGH) and SGH got him almost seven months off work.

When contacted, hospitals rebutted claims that their doctors are too lenient in issuing medical leave, insisting that everything is done objectively.

They also reviewed the medical certificates issued by their doctors for the above three cases, and found them to be appropriate.

"The duration of medical leave depends on the specialist's clinical assessment of the injury, test results and relevant medical history available," said Dr Andrew Chin, who heads the department of hand surgery at SGH.

"It also depends on what the patient has communicated to the doctor about his nature of work and environment."

TTSH head of orthopaedic surgery Ganesan Naidu said: "Fractures of the hand would normally take a few months to heal sufficiently to allow for heavy duty work after surgery."

Referring to the Guan Soon Heng case, a CGH spokesman explained that the injury was "more serious than a minor cut", adding that hand injuries can be more complicated than they seem.

The employers say they have seen a rise in injured workers running off to get a second opinion. They used to have one or two workers running away each year.

But since the start of this year, each has seen an average of six workers who refused to stay in company housing after being injured. Employers have to shell out about $1,200 every month for workers on medical leave - the money going to salary, government levy, and cost of housing, food and medical treatment.

But they also have to pay higher insurance premiums if more of their workers seek injury compensation. The Manpower Ministry (MOM) also may not allow them to hire more foreign workers if they have many runaway cases.

Ms Debbie Fordyce, a volunteer at migrants' organisation Transient Workers Count Too, believes some workers are advised by various parties to exaggerate their injuries to claim a bigger injury payout.

In other cases, workers end up making their injuries worse by moonlighting to earn more money even while on medical leave - a point also raised by employers.

She said: "Many injured workers are still in pain after a few days of medical leave. But they dare not tell their employers as they worry about being seen as skiving. So they decide to run away but have to moonlight to survive."

Singapore Medical Association ethics expert T. Thirumoorthy said doctors should exercise good clinical and ethical judgment when giving medical certificates. "How much sick leave a worker gets should be based on objective assessment," he said.

Meanwhile, the bosses say they are not backing down. They hope MOM will crack down on moonlighting workers and those who exaggerate injuries. Said Sin Norm Engineering managing director Wong Chan Ching: "This problem must stop. It is like a disease that keeps spreading."