Part II, paragraph 3 of the Employment of Foreign Manpower Regulations says explicitly that employers are responsible for any medical care that foreign workers need:
The employer shall be responsible for and bear the costs of the foreign employee’s upkeep and maintenance in Singapore. This includes the provision of medical treatment . . .
Yet, time and again, workers come to Transient Workers Count Too complaining about the failure of their employers to live up to their legal obligation. These cases have a pattern from which we can discern a common cause. Despite the clarity of the language in the Regulations, the standard operating procedure (SOP) put in place by Ministry of Manpower (MOM) and the corporatised public hospitals leave a lot of loopholes which, when exploited, effectively abrogate this legal responsibility. Injured men and women are left in limbo even though in theory this is not supposed to happen.
To understand how this can occur, it is necessary to look more closely into actual cases. Shokor’s story is a typical one.
He was washing the deck of a ship with a high-pressure water jet in his hand, but set to medium pressure. Suddenly the pressure doubled, and by force of recoil, he was thrown backwards against a wall, slamming his head and back. He called out to his supervisor, who instead of helping him get medical attention, told him that since the company wasn’t doing well, going to the doctor was out of the question.
Shokor (not his real name) remembered the supervisor’s words. “He said to me, ‘If you tell anyone, we send you back to Bangladesh’.”
He was allowed to rest in his dormitory, but over next ten days, instead of the pain easing, it only got worse. Finally, he appealed to the foreman, a fellow Bangladeshi, who took Shokor to W K Koo Clinic, a private clinic in Jurong on January 18, 2012. After an X-ray, the doctor told him he should go to a hospital immediately. It didn’t sound good.
Shokor then made his way to the National University Hospital (NUH) where they performed an electrocardiogram. He was given three day’s medical leave, followed by four days’ light duties. He was asked to return for a follow-up appointment a week later.
By then, the pain had become even more intense, yet the doctor at the follow-up apparently touched his abdomen a few times and gave him one more day’s medical leave.
Up to this point, the medical bills had amounted to over $230, which Shokor paid himself. He took the receipts to the company office. They gave him the same amount in cash, but made him sign a piece of paper that said it was a loan.
The third NUH appointment was scheduled for February 15, on which date a procedure involving inserting a tiny camera down his throat into his stomach was to have been performed. Shokor had been told he should bring $800 with him, a sum he didn’t have. So when he showed up at the hospital without the money, they told him to go back.
He was by then in such pain, not only could he not work, he began to fear that the company might see him as a liability and, using thuggish repatriation agents, forcibly deport him. So he left the dormitory and made his way to TWC2, looking for help.
“Why did NUH want to put a camera down your throat?” TWC2 asked him.
“They think I have gastric,” said Shokor.
Not being medical professionals ourselves, we should not try to pre-judge the diagnostic process, though it sounds strange to a layman how a head and back injury became a cardiac investigation and then a gastro-intestinal possibility. Nonetheless, whatever the process of investigation may be, what seems clear is that NUH was of the view that investigation was necessary. Yet, when he turned up for the procedure on Feb 15, the hospital wanted him to show them the money first before they would do anything. For someone in pain, it appears quite heartless.
Shokor’s case illustrates several weaknesses of the present framework.
Firstly, public hospitals, post-corporatisation, are now acutely conscious of how they will get paid. This is quite understandable. The problem — and that’s the second point — is that the SOP designed by MOM gives employers plenty of opportunity to duck.
If the worker has his own cash in hand and is able to pay upfront, he has a hard time getting reimbursed by his employer. In Shokor’s case, the employer evidently refused to recognise his medical bills as the company’s responsibility. They gave him the cash alright, but cast it as a loan (that can be deducted from his salary) when it should have been a reimbursement. Will the ministry help Shokor recover this sum of money? From the numerous cases TWC2 has seen, the track record has been inconsistent.
TWC2 has heard of employers getting angry with workers presenting medical bills for reimbursement, tearing up the bills and slapping the worker for his audacity. Are employers penalised by the ministry for such behaviour? Don’t bet on it. There is a tendency for officialdom to first ask “Where’s the proof that it ever happened?” before they would lift a finger.
If the worker does not have enough cash upfront, the SOP calls for the employer to furnish a Letter of Guarantee (LOG) addressed to the hospital. Needless to say, getting such letters from employers is often akin to extracting blood from stone. Yet, this is supposed to be automatic once a public hospital considers a medical procedure or treatment necessary, in deference to the legal obligation to provide medical care. However, it is so often flouted and employers almost never penalised for their obstinacy, one has to wonder about the thinking behind such flaccid regulatory attitudes.
For example, Shokor’s employer might well be guilty of an offence already the very day that the accident happened and Shokor was thrown against a wall. He asked for medical attention but was refused. Yet the track record of non-enforcement leaves little hope that the employer will be taken to task.
This is not to say that MOM never takes action. They do, but the wheels turn very slowly, and need much pushing.
In Shokor’s case, when he went to the the Ministry of Manpower to get official help, he was simply asked to prove that he had ever been to NUH in the first place. And the poor man was sent back to NUH to ask for copies of the bills and medical certificates (he had not kept copies when he handed them to his employer earlier), for which the hospital charged him an administrative fee to dig up those copies. He was told that the administrative fee was his to bear and cannot be claimed back from his employer.
The third complication is that workers generally do not know about such things as LOGs. Shokor, for example, had not heard of it until he consulted with TWC2. As a result, they tend to make their way to hospitals without such a document, and the hospital then cancels the appointment, and everybody’s time is wasted.
TWC2 has proposed to MOM a way to streamline this matter. Employers of Work Permit holders are anyway required to buy medical insurance of at least S$15,000 a year, as can be seen from MOM’s website (see this page), the opening paragraph of which says:
Employers are required to purchase and maintain a minimum medical insurance coverage of $15,000 per year for each Work Permit holder for inpatient care and day surgery. This includes hospital bills for conditions that may not be work-related.
Employers are also required to lodge with MOM the insurance they have bought. That being the case, TWC2 has proposed that Work Permit holders be issued by MOM with a medical card, stating the name of their employer and medical insurer, at the same time that they are issued with their Work Permits. When a worker has to seek treatment at a polyclinic or hospital, presenting this card should be sufficient for the hospital or polyclinic to know whom to bill. All this going back and forth to get payment should no longer be necessary.
TWC2 has also proposed that the scope of medical insurance be expanded to cover outpatient treatment and prescription medicine as well.
The ministry has said they are reviewing the present systems, but TWC2 has not yet heard if our ideas will be adopted.