Nearly one in three work accidents might not have been reported to the authorities due to doctors in private practice under-issuing medical leave, a TWC2 survey has found. Only because the worker subsequently makes his way to a public hospital does he get enough medical leave to make it a reportable incident.
The Workman’s Injury Compensation Act states that any accident resulting in a worker getting more than three consecutive days of medical leave (commonly known as ‘MC’) must be reported to the work safety authorities in the Ministry of Manpower (MOM). When doctors give just one, two or three days’ MC, employers are not obliged to report the safety lapse to MOM.
Transient Workers Count Too has long noticed that a significant number of workers with substantial injuries have been getting just one or two days of MC when treated at private clinics and private hospitals. Typically, workers report that their bosses negotiate with doctors as to the number of MC days they are given, and few get more than three days. This even if bones have been fractured or muscles torn. We’ve even come across a case where a chest operation was performed in a private hospital, and the worker given only two days’ MC afterwards.
Yet workers are often allowed to rest in their dorms for far longer than the official number of MC days, indicating that employers are fully aware that the injuries would not have healed within the short length of the medical leave. Then why negotiate with doctors for shorter medical leave? TWC2 has long suspected that the chief motive is to avoid having to report an accident to the authorities.
Fortunately, workers themselves are not entirely helpless. As recounted in many stories within our website, they quickly realise that they have been under-issued medical leave, often under-prescribed medication as well. With continuing pain and anxious that with the expiry of the MC they may be forced to go back to work even when they are in no condition to do so, they soon realise they must make their way to a public hospital for more attentive medical care.
In case after case, the injury that had been considered so slight as to merit just one or two days’ MC by a private clinic or private hospital is determined to be serious enough by a public hospital to merit a far longer period of medical leave. This difference reinforces the suspicion that the first MC has been heavily influenced by employers’ motives.
TWC2 conducted a survey of all injured workers who showed up for a free meal at our Cuff Road Project on the evening of 5 July 2013. They were a mix of Indian and Bangladeshi workers, mostly from the construction industry.
Of 148 workers surveyed, 62 of them (42%) were sent by their employers to a private clinic or private hospital after the accident. Of these, over two-thirds (43 workers) got three days or fewer of MC.
Twelve workers were sent to polyclinics, and seven of them (58%) got three days or fewer of MC.
The remainder (74 workers; 50% of workers surveyed) were sent directly to a public hospital.
When these workers — the 62 who had been sent to a private clinic or hospital, and the 12 who had been sent to a polyclinic — made their way to public hospitals, they got MCs lasting weeks and months. For example, the 43 who were given three days’ MC or less by private practitioners got an average of 94 days from the public hospital they eventually went to.
Typically, they get 10, 20 or 30 days after seeing the doctor, who, at follow-up appointments, extend their MCs depending on progress. That’s how the total MC days add up.
Examples of cases that showed up in our survey:
- Case #4138: Broken right foot. Seen at private clinic, no MC issued. Later seen at National University Hospital, 90 days’ MC.
- Case #0532: Minor fractures left leg, back shoulder, jaw, hand. Seen at private clinic, 2 days’ MC. Later seen at Tan Tock Seng Hospital, 50 days’ MC.
- Case #8493: Amputated right thumb. Seen at a private hospital, 2 days’ MC. Later seen at Tan Tock Seng Hospital, 69 days’ MC.
- Case #6865: Right foot and little finger broken. Seen at a private clinic, 2 days’ MC. Later seen at Changi General Hospital, 210 days’ MC.
- Case #0794: Fractured rib and chest injury: Seen and operated on in a private hospital, 2 days’ MC. Later seen at Tan Tock Seng Hospital, 108 days’ MC.
Workers sent directly to a public hospital do not report similar experiences with short initial MCs. As can be seen from the table above, all but one of the 74 men who were sent directly to a public hospital after an accident got MCs exceeding three days; in total, their MCs averaged 113 days. Only one man’s injury was considered minor enough to merit less than three days’ MC.
TWC2 confirmed through this survey what had hitherto been our gut feel: 42 of 148 workers surveyed — nearly a third of them — might not have had their accidents reported to work safety authorities if not for the fact that they made their own way to a public hospital.
TWC2 and other migrant organisations have been raising this issue for quite a while.
Ministries send letter to all doctors
In June 2013, MOM and the Ministry of Health sent a joint letter to all registered medical practitioners on the subject of issuance of medical certificates to injured workers. It said:
“Recently, there have been a number of complaints alleging that medical practitioners have been issuing medical certificates to injured workers that are inadequate in relation to the nature and severity of their injuries. Some of these cases are currently under investigation by the Singapore Medical Council (SMC).”
The letter reiterated the legal requirement for reporting workplace accidents. The letter then noted that,
“To avoid reporting these accidents, some employers may request medical practitioners to issue less than 4 consecutive days of medical sick leave or to issue light duty instead of medical sick leave.
Medical practitioners are reminded that . . . the length of each medical sick leave should be based on good clinical assessment and be commensurate with the nature and severity of the worker’s injury. Adequate medical certification ensures that the worker is medically fit to perform his tasks at work, without jeopardising the health and safety of himself or his colleagues. Medical practitioners should not be influenced by requests from workers and employers in determining the medical sick leave given. 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.”
The letter, dated 19 June 2013, concluded by asking doctors to report to MOM any employer who attempted to circumvent reporting requirements through applying pressure over medical leave.
In order to meet the press deadline, the survey was restricted to just one night at the Cuff Road Project, as the Straits Times needed the results by the next morning. Thus, the limited number of cases we counted in the survey does not represent the total.
TWC2 sees over a thousand injury cases a year. In 2012, we saw 1,512 injured Indian and Bangladeshi men at our Cuff Road Project, and more through our Chinese worker outreach. The total for Singapore as a whole is some multiple of TWC2’s case total since not all injured workers come to us. We have been informally told by MOM that in 2011, there were about 12,000 work injury claims.
Based on the ratio we found in our survey — nearly one in three of these might represent an attempt to evade having to report a workplace accident — TWC2 believes that the problem is of significant scale, with such cases totalling thousands annually.
Besides the stress and suffering inflicted on workers, when attempts at circumvention occur on such a scale, it follows that there is duplication and waste of precious healthcare resources. When workers make their way to public hospitals, diagnostic lab tests and X-rays are performed all over again. This would not have been necessary if workers stayed with the initial treating hospital.
However, when the doctor gives the impression that his first duty is not to the patient but to the employer (often reinforced in the worker’s mind when all his medical documents are handed directly to the employer as if he does not exist) it is not fair to insist that the patient stays with that clinic or hospital. One cannot demand that workers remain with doctors in whom they have lost confidence. This is a problem that can only be solved when doctors and employers are mindful of their ethical duties, and punished when they violate them.
See also Sunday Times articles Doctors told to give injured workers enough leave (7 July 2013) and Don’t dictate sick leave, employers told (21 July 2013), and results of a follow-up survey Broken bones but no medical leave.