By Danielle

Despite first-class medical practitioners and technology in Singapore, some injured workers complain that they do not even get a reasonable standard of care. Moniruzzaman’s story suggests that employers’ desire to limit costs and reduce their exposure to work safety investigation by regulators can trump doing the right thing for another human being.  It also raises questions about the professional integrity of certain doctors.

Moniruzzaman suffered a leg injury – he said it was a fracture – but was shuffled between two private clinics before he decided to ignore company advice and show up at Tan Tock Seng Hospital. There, his injury was seen for what it was – a serious one, judging from the length of medical leave he was given.   The 23-year-old had been on duty at a road works site in Bukit Panjang in December 2012 when heavy construction equipment reversed into a steel pipe lying on the ground, causing it to hit Moniruzzaman’s legs with full force.

Although the impact of the steel pipe had caused considerable damage, he was only brought to the first clinic one day later. Moniruzzaman said that this clinic gave him just one day’s medical leave, something he didn’t appear to be happy about.

A week later, with no improvement, the company sent him to another private practitioner, reportedly a specialist in orthopedics.  It didn’t leave him any happier. Moniruzzaman told Transient Workers Count Too that he received neither medication nor medical leave. While TWC2 is in no position to make a medical judgement, it seemed to its senior volunteers looking at the worker and considering what later happened at Tan Tock Seng Hospital that, if true, it might not amount to due care.

As December turned into January, he remained in pain. Unable to bear it any longer, Moniruzzaman made his own way to to Tan Tock Seng Hospital. The attending doctor gave him a week’s medical leave. At the follow-up appointment, the hospital extended his medical leave by a month.

The huge difference in response between the two doctors in private practice and the doctors at Tan Tock Seng Hospital raises important questions about the standard of care and whether there are motives beside the best interests of the patient affecting a doctor’s response.

Moniruzzaman’s case is not an isolated one. Other workers, seen by the same second clinic that Moniruzzaman went to, have reported similar outcomes – very short or no medical leave that contrasts with what doctors in public hospitals consider appropriate.

Elaborating on other cases she has seen in her time co-coordinating the Cuff Road Project, TWC2 executive committee member Debbie Fordyce notes how workers sent to this clinic are generally given less than three days or no medical leave. Additionally, they are also disallowed from viewing their own medical reports. “We can only wonder whether this is in order to relieve the employer of the obligation to report the injury to the Ministry of Manpower,” she asks. Under MOM rules, workplace injuries necessitating more than three days of medical leave become reportable, and such reporting can trigger close scrutiny by ministry officials of workplace practices.

“Indeed,” continues Fordyce, “other workers have reported that their employers have tried to repatriate them or prevent them from making a claim for work injury compensation.”

Fordyce herself has been stonewalled by the clinic while attempting to obtain the medical report of a foreign worker she was assisting. “The clinic’s staff said that all records were passed through to the employer and they have nothing in the office. They have consistently refused to release medical information to patients on the grounds that the information is only to be released to the one making payment, not to the patient.” Not only does this make it difficult for the worker to explain the treatment he has had in order to seek further treatment, or present his case in detail to MOM, there is also the ethical question of who has the right to the information.

In relation to passing the medical file to the employer, Section 4.2.3 of the Ethical Guidelines issued by the Singapore Medical Council may be pertinent:

Responsibility to maintain medical confidentiality

A doctor shall respect the principle of medical confidentiality and not disclose without a patient’s consent, information obtained in confidence or in the course of attending to the patient. However,  confidentiality is not absolute. It may be over-ridden by legislation, court orders or when the public interest demands disclosure of such information. An example is national disease registries which operate under a strict framework which safeguards medical confidentiality.

TWC2 is in the process of compiling similar cases so that we can see how widespread the problem is. But whether or not these are isolated examples, it is no reason to be less concerned if it occurs even once. Appropriate and ethical medical care must be among the basic human rights enjoyed by anyone, migrant worker or not.