Why Are Migrant Workers Issued Inadequate Medical Leave?

A doctor from Raffles Hospital, Dr. Wong Him Choon, was recently suspended for professional misconduct because he had given a construction worker insufficient hospitalisation leave (only 2 days, during which a surgery was done) and found him fit for “light duties” at work immediately after surgery despite the severity of his injury, i.e. a fractured hand.[1]

How many other workers experience such situations where their interests are seemingly disregarded? And why does this happen? We analysed HealthServe’s past cases, spoke to a doctor and consider some perspectives below.

In the first 4 months of 2016, HealthServe saw 70 new injury-related cases of which 12 (17.1%) involved doctors allegedly issuing insufficient medical leave, causing the workers to have to approach public hospitals to get a second opinion on their injury.  The injuries range from workers’ hands getting sliced by metal cutting machines to fracturing multiple bones in their body. The average medical leave granted was 0-2 days. The numbers for the 2015 cases are similar at about 18%.

Errant employers are desirous of preventing their workers from being issued more than 3 days of medical leave. First, an employer is legally mandated to report a workplace accident to the Ministry of Manpower (“MOM”) if more than 3 days of medical leave was issued or the worker was hospitalized for more than 24 hours. In some situations, MOM may investigate into the accident and even issue a Stop Work Order (“SWO”) to do so. A SWO could result in the employer possibly paying liquidated damages amounting to up to tens or hundreds of thousands of dollars.

Second, if a worker succeeds in a claim against his employer under the Work Injury Compensation Act, part of his compensation is based on the days of medical leave he was issued.

However, when insufficient medical leave is issued, the worker would have insufficient time to heal from his injury before he is made to return to work. This could lead to potential life-threatening issues at the worksite or long-term repercussions on the worker’s health.

We will now discuss the perspectives of various stakeholders on this issue.

Given the employer’s impetus discussed above, HealthServe notes that some employers send their workers to private hospitals or clinics instead of a (public) restructured even though private hospitals may be more expensive. There are several plausible reasons for this, as explained to us by a doctor in a public hospital.

First, private hospitals do not share a universal record system with public hospitals, i.e. the Government. Therefore, the injuries are kept between the doctor and the patient instead of being in a universal hospital database. This reduces the possibility of MOM or indeed anyone else being alerted to alleged cases of inadequate medical leave being issued.

Second, employers may prefer that the matter be settled privately and that the government agencies not be informed of the accident. As mentioned above, if an accident is reported to MOM, MOM may inquire. This could slow down the progress of the employers’ work and potentially result in negative financial consequences.

Third, if employers’ safety ratings drop, insurance premiums would increase and their work permit quotas could also be affected. Thus, some employers would rather send their workers to private doctors who would otherwise be cheaper (compared to public hospitals) if the potential of a SWO can be avoided.

For the doctor, he may be engaged by an employer on a long-term retainer. The employer would send their workers to the doctor. It is the duty of the doctor to give an unbiased opinion on the worker’s injury, to issue the appropriate amount of medical leave required and recommend medical treatment for his recovery. However, when the doctor’s paymaster’s interests are potentially in conflict with his professional and ethical duties to his patient, i.e. the worker, what would the doctor do? This could explain the many cases HealthServe has seen where the doctor issued less than 3 days medical leave for seemingly serious injuries. The doctor should not allow the employer’s opinion to allow him to depart from the standards observed or approved by members of the profession of good repute and competency.

From the migrant worker’s perspective, it would depend on the individual but it is not uncommon for them to request that they be given no medical leave even when they are going through tremendous amounts of suffering. The reasoning is that the company is responsible for his medical fees, his salary and accommodation. Workers are concerned that if they are on medical leave for too long, their employers may cancel their work permits and repatriate them home. Such cases have occurred. Thus, many workers continue to work despite their injuries because they would rather compromise on their health rather than their families’ well-being back home. Additionally, migrant workers are typically unable to seek medical advice from doctors other than what their employer refer them because the employer is the one covering the medical expenses. Thus, if he wants to see a doctor in a restructured hospital, he may have to cover the expenses temporarily at first, which he may not be able to do so.

As long as cases like Dr Choon’s case appear only once in a blue moon, public awareness will never garner enough momentum to bring about change in the situation. There will only be moments of public scrutiny, which will wane over time until another scapegoat is chosen to be representative of the lenient punishment with respect to their wrongdoings.

In conclusion, doctors should not allow the performance of their professional duties to be influenced by external parties. How can we ensure that workers’ interests are protected given the many considerations above? While doctors have to play their part, employers should also be held to the proper standard of conduct in ensuring that their workers will not be fearful of having their employment terminated simply because they suffered a work injury. We are a long way away from finding appropriate means to address this, but we can begin by being vigilant in identifying cases of inadequate medical treatment or leave.

[1] http://www.straitstimes.com/singapore/courts-crime/orthopaedic-surgeon-suspended-by-court-of-three-judges-for-professional

By Ronald JJ Wong, Christopher Fong, Terence Tim, and Suah Boon Choong