The Company Physician and SSS/ECC claims

The company physician: legal duties and obligations in filling up SSS and ECC claims

By Roy Mangubat, MD, DPCOM

 

I find myself being very blessed to have a sister for a lawyer and accountant (CPA-Lawyer) at same time providing me legal and financial advices without having to pay a retainer’s fee for any legal and financial consultations. As the saying goes “you only need two important professionals in life, a good doctor to take care of you and a good lawyer to take care of the rest of your problems”.  

 

Company physicians are frequently required to fill up forms and certificates as to their findings and opinions in cases where employees' health is an issue such as SSS (Social Security) and ECC (Employees Compensation Commission) claims. It is advice to be judicious in filling up those forms and having supporting documents like medical records to back those claims. The integrity of the Physician is his best asset, always be truthful, objective and firm.

Sometimes, the company physician may face conflicting ethical obligations in weighing the physician-patient relationship against the needs of the employer or vice-versa. There is no dilemma if your decision is truthful and you have the conviction to stand with your opinion as a Professional.

If the employee seeks outside health care assistance, the company physician may have to testify against other health care professionals. Knowledge, experience and training will be the basis of credibility in this type of circumstances, are you qualified and train to do those types of examinations? Can it be reproducible? Currently in the country, disability evaluation is done by government doctors specially those in medical underwriting divisions of the SSS and the GSIS. Few outside the two agencies knows about disability or impairment evaluations, some specialist are confined with the knowledge of disability and impairment inline and limited only within their specialty (e.g. visual impairment are assess by an ophthalmologist to determine whether the patient can be legally blind even with some degree of vision still left). The Diplomate Course of the Philippine College of Occupational Medicine includes disability evaluation in its core curriculum.  There are 2 schools of thoughts in terms of impairment evaluation the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment and the WHO International Classification of Functioning, Disability and Health (ICF).

The three most common forums in which the company physician may be asked to submit medical reports and/or testify are

1.       arbitration hearings

2.        workers' claims for Social Security disability

3.        workers' compensation insurance benefits.

Company physicians should be aware of the nature of each type of proceeding and they should be prepared to render persuasive expert testimony.

My first experience to go in the stand was very pleasing having had the opportunity to be summoned by the court is quite exciting and interesting at the same time, that is… because I’m ready and prepared to answer what the counsels and the judge may ask me.

The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).

Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554

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E mail: rmmangubat@yahoo.com

Philhealth and Workers Health

Philhealth and Workers Health
By Roy Mangubat, MD, DPCOM

We all do know that the Philippine Health Insurance Corporation (Philhealth) is a form of social equity, wherein those who are healthy subsidises those who needs hospitalization and those who earns more pay more – in terms of premium. The premium coming from the workforce is the lifeblood of this institution compared to self contribution and the government’s indigent program since it gives the majority contributions through its shares of premiums. Interms of utilization of Philhealth, if we do believe in the “healthy workers effect” in occupational-epidemiological studies we could safely assume that the workers utilizes it less. On the other hand, Philhealth also covers the dependents of the Philhealth member and they could constitute a great portion of the utilization cost of Philhealth.

Philhealth has a lot of benefit packages for its members -this includes the maternity OB-package, cataract surgery, newborn care, HIV/AIDS treatment package, dialysis package, TB DOTS package and the Out Patient Basis OPB Package for Rural health Centers wherein among these free services are chest x-ray, sputum microscopy, fecalysis, urinalysis, complete blood count, breast examination, annual digital rectal exam, blood pressure measurement, visual screening and also consultations on “lifestyle modification" such as cessation of smoking are also covered. BUT IT IS IRONIC THAT THERE ARE NO PROGRAMS/PACKAGES DIRECTLY GIVING OCCUPATIONAL HEALTH PACKAGES FOR WORKERS, Clearly it is the premiums coming from the working sector that sustains the operation of this institution. The workers are the main milking cow yet there are no programs/packages to safeguard their health. Philhealth should developed programs/packages for the occupational health of the workforce like providing OPB and wellness packages for workers to company clinics that will encourage companies to set-up clinic in their premises. Philhealth therefore will help employers to finance the operations of company run clinics. Perhaps this would improve occupational health in terms of health access and quality since Philhealth has been practising Quality Assurance and Bench marking.

The Department of Labor and Employment (DOLE) should collaborate with Philhealth to device plans for an Occupational Health Program Package or Company Clinic based Outpatient benefit (OPB) Package for employees. It is included in the Occupational Health and Safety Standards of DOLE that every company should have a clinic, some employers see’s it as another added operational cost but at the expense of workers health. Philhealth can now aid the employers in financing the operation of the clinic, since certain procedures that can be done to sick/injured employees can be charge to Philhealth. Plus, PHILHEALTH will improve the standards of company clinics since the clinics will be needed to pass the qualification standards before being accredited. The workers are the “life blood” of our economy; workers health should be made a priority by the government if we want to achieve global competitiveness. Several studies have always pointed out that worker’s productivity is linked to their health, so –let us continue on protecting and improving the health and safety of the Filipino workers!

________________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).

Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
http://www.blogger.com/profile/09894396954767142226
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E mail: rmmangubat@yahoo.com

Motorcycle Safety for Workers

Motorcycle Safety for Workers
By Roy Mangubat, MD, DPCOM

Every time I watch the evening TV news, almost always you will hear a traffic mishap involving a motorcycle that either led to a serious physical injury or worst – death to the driver. So, what it has to do with workers health and safety? With the booming motorcycle sale in the country, an average of 7,000 motorcycle units being sold every week. Most of which are bought by no other than those who can afford it – the working class. This is evident in all parking lots of every factory and companies, wherein you see drones of motorbikes line the parking space. Motorcycle accidents averages around 150-200 per month, a lot of which involving drivers recklessness. Though the topic is not directly work related but it is an issue that is important to be discuss and find ways that the companies can help in preventing motorcycle accident, especially for its employees.

Common Causes of Motorcycle Accident
1. Poor driving skill
2. DUI
3. Bad roads/ road condition
4. Speed problem
5. Driver discourtesy
6. Poor vehicle maintenance
7. Unsafe acts (e.g. riding while ears are plug with earphones)

Health and Safety of Workers starts when the employee leaves home for work (directly) and from work (directly) to home. Most of the HR staffs and Safety Officers know this, that’s why a worker can be given compensation if the accident has occurred while travelling “to” and “from” work (w/ no other side trips). Most of the injured employees that I see will require rest and recuperation of an average of 4 weeks, with so many LTA (loss time allowance) – motorcycle accident is indeed an Occupational Health and Safety issue.
Companies usually give insurance (health and life) to their employees, but this is only valid if there is no co-negligent act committed by the insured worker. It is important for the workers to understand the fine prints in their insurance policies.

Ways that can nullify the insurance coverage of a worker involving in a vehicular (motorcycle) accident.
1. DUI (driving under the influence of – alcohol or drugs)
2. Non wearing of Helmet
3. Driving an unregistered vehicle or w/ expired registration.
4. Disregarding traffic rules like riding w/ more than 2 person in a motorbike and over speeding
5. Driving without a licence to drive / expired licence /inappropriate driving restrictions (1- for motorcycle 2- for cars and 3 and so on)

General Riding Tips
1. Learn to drive well first before hitting the open road
2. Get Licensed
3. Wear appropriate gear for comfort and protection.
4. Wear bright clothing and use reflective material.
5. Be awake and alert
6. be courteous
7. Fatigue and drowsiness can impair a motorcyclist's ability to react
8. Conduct a safety inspection of your motorcycle before each ride.
9. Alcohol and other drugs affect judgment and do not mix with riding
10. Don't speed; know the local traffic laws and rules of the road.

What can the companies do to prevent motorcycle injuries to their employees?
1. Give a Riding Safety seminar c/o the Health and Safety Team, some motorcycle dealership give safety courses for bikers.
2. Inform your workers about their insurance coverage and their limitations (pertaining to motorcycle accidents w/ co negligent acts)
3. Make sure that the employees who drives a bike has a drivers licence and is qualified to drive a motorbike. (important for insurance claims)
4. Make sure that the motorbike is duly registered. (important for insurance claims)
5. Employees with no drivers licence and no vehicle registrations should not be allowed to enter the company premises to ensure that employees are legally permitted to drive. Insurance companies will not be paying for the claims if there are legal infractions committed by the insured employee. A piece of advice, please do read the fine prints in your insurance policy.
6. Give a soft loan for helmets and other riding safety gear w/ no interest and be paid in a monthly basis for your employees.
7. Make Safe Driving as one of the company policy.

Lets keep on making the Filipino workforce safe and healthy!

_______________________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).

Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
http://www.blogger.com/profile/09894396954767142226
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E mail: rmmangubat@yahoo.com

Travel Medicine: Air Travel

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Travel Medicine Series:
Air Travel



By Roy Mangubat, MD, DPCOM






The start of the 20th is the beginning of air travel, the fascination of man to fly give way to the modern airliner’s era. Aviation travel is unquestionably the safest mode of travel compared to land and sea transport. Technological advances made air travel very safe, air pressure and humidity can be controlled unlike old WWII aircrafts that has difficulty in climbing high altitude flights.


Common nuisances and stresses during travel includes jetlag (short circuit in our built-in biological clock due to time zone differences between destination and origin), Airport Psychosocial stresses (1.Getting flight delays and flight cancellations, 2. customs and 3. astringent security procedures), motion sickness, ear pain/disturbance because of air pressure changes in the cabin and musculoskeletal complaint due to uncomfortable seats in the economy/coach class and long distance travel.






Fitness to Fly/Air travel


Traditionally, experienced airline physicians had a rule of thumb: those who were able to climb the stairs into a plane were fit to fly. This rule is still valid when assessing travelers with respiratory disorders, anemias, or heart failure.


There are few contraindications for travel by air:


Unstable angina


Myocardial infarction in past 2 wk (or 6 wk, if complicated)


Active bronchospasm


Neurosurgery or skull fracture in past 2 wk


Uncontrolled cardiac disease (congestive heart failure or arrhythmia)


Percutaneous coronary intervention in past 5 days (or 2 wk, if complicated)


Cerebral infarction in past 2 wk.


Pneumothorax in past 2–3 wk


Colonoscopy with polypectomy in past 24 h


Highly contagious diseases, including active tuberculosis


Major uncontrolled psychiatric disorders


Cyanosis


Pulmonary hypertension


Recent middle ear surgery


Scuba diving in past 24 h


Hemoglobin < 7.5 g


Heart, lung, or gastrointestinal surgery in past 3 wk


Noncommunicating lung cysts






Other Special Considerations:


• Pregnant women < 1 month before delivery for long-range flights but some authorities restrict air travel for > 7 mos. Pregnant women.


• Newborns (wait until 48 hours, preferably 2 weeks, as the lungs may not be fully expanded)


• Psychiatric/psychological Illness like fear of flying and claustrophobia.


• Infectious disease like TB, SARS, Pandemic Flu etc.. That’s why infrared thermal cameras are a standard in every international airport to detect febrile passengers that might spread a disease.


• Thromboembolism those with DVT are cautioned.






Those with existing illness are advice first to visit their doctor before travelling to give recommendations and precautions, also to give necessary certificates and prescription for those who would be carrying with them their medicines. This is to avoid unnecessary delay due to questioning/inquiry of airport authorities.














The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).






Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554


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Sore eyes Infection at Work

Sore eyes at Work

by Roy Mangubat, MD, DPCOM

The last two weeks in the office, not a single day did pass by that I didn’t encounter a patient without conjunctivitis or “sore eyes” and the only common cause of eye poblem that I see in the clinic before that is due to metal fume irritation secondary to hot works – welding. The infection is commonly from close contact at home from family members with sore eyes. Prior to the surge of cases that I saw in the company clinic, the Department of Health (DOH) a month ago, had issued a health advisory regarding the increasing spread of this infection in the Metro Manila and surrounding area.

I consider this type of illness -more of a health nuisance rather than a serious worker’s health matter. Though affects the productivity among employees by rendering them unable to work because of the highly contagious nature of the disease that may infect other workers. Yet being relatively benign and self limiting, this disease may bring production at a halt. Few years back, an outbreak had spread in a semiconductor factory rendering a stand still in its operations sustaining financial loses because of “sore eyes” infection. So what went wrong there? Health surveillance and disease prevention measures was not initiated on time. ”Sore eyes” is like the small David bringing the giant Goliath (the Semicon Co.) at its knees.

What is Conjuctivitis?
• Inflammation of the bulbar and/or palpebral conjunctiva 4 weeks duration (4-7 days)
• Synonym(s): Pink eye, sore eyes

Epidemiology
• Predominant affecting the pediatric population, mostly are viral infection. Adults are affected primarily by Viral followed by bacterial and allergic causes.

Signs and Symptoms
• General: Common to all conjunctivitis
- Red eye, conjunctival injection
- Foreign body sensation
- Eyelid sticking or crusting, discharge
- Normal visual acuity and papillary reactivity
• Viral
- Watery mucous discharge
- Inferior palpebral conjunctival follicles
- Palpable preauricular lymphadenopathy
- Severe viral: Herpes simplex or zoster
 Burning sensation, rarely itching
 Unilateral, with concurrent herpetic skin vesicles on eyelid or in distribution of ophthalmic branch of trigeminal nerve if herpes zoster
 Palpable preauricular node
• Bacterial, nongonococcal: May be epidemic
- Mild pruritus, mild discharge
- Conjunctival chemosis/edema
- No preauricular adenopathy
- If contact lens user, must rule out pseudomonal keratitis

Medications:
• Viral
- Artificial tears for symptomatic relief
- Vasoconstrictor/antihistamine
- Consider inexpensive, topical antibiotic ointments if suspecting coinfection
• Viral (herpetic): Should be supervised by opthalmologist
- Triflumidine and Acyclovir oral
• Bacterial
- Bacitracin ophthalmic, Erythromycin ophthalmic solution and Tobramycin ophthalmic.

Interventions to be done to avoid a company wide outbreak:
- A good health surveillance system.
- Health Education about Acute Conjuctivitis
- Formulating an Outbreak/Infectious Disease Contingency Protocol c/o OHS staff and HR
- Promoting frequent handwashing and avoid contact of eyes with hand.
- Gatekeeping of security personnel, by making sure that workers with reddish eyes are sent at the clinic for evaluation.
- Providing 5-7 days off for those who had been diagnosed with conjunctivitis and a return to work evaluation to make sure that the returning employee is considered well and non-infectious..
- Good Housekeeeping: sanitizing door knobs and other frequently touch furnitures and equipment inside the office or factory.
- Learning from the mistakes of others. Remember Goliath?



The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).


Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
http://www.blogger.com/profile/09894396954767142226
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The Travel Medicine Series



 The Travel Medicine Series
Introduction: Travel Medicine and OccMed
by Roy Mangubat, MD, DPCOM

It is expected for OccMed Specialist to give travel health advises and pre-departure vaccination to corporate executives, managers/supervisors, field marketing agents and other employees that will engage in local and foreign travel. Specialized travel clinics are not available here in the country to give appropriate vaccinations and health/safety reminders for the travelling employee and most of the time -travel medicine will just be an afterthought. It is important for an OccMed specialist to give accurate advice to the travelling employee about both pretravel preparation and how to deal with illnesses contracted abroad. Sometimes there is not enough time to obtain the required immunization status of the traveller in order to be protected. High risk behaviours must be identified immediately so that appropriate precautions be made.

Travel medicine is a multidisciplinary approach involving several health sciences including Tropical Medicine, Infectious Disease, Microbiology, Internal Medicine, Aviation / Maritime Medicine, Public Health, Preventive Medicine, Occupational Medicine, Migration Medicine, Pediatrics, Geriatrics, Obstetrics, Dermatology, Venerology, Psychiatry, Ophthalmology, ENT, Traumatology, Physiology (altitude, diving) and Pharmacology, etc.

Fitness to Travel
OccMed Specialist should do a health clearance evaluation prior to travel. Identify illnesses that are contraindicated to certain mode of travel. Provide appropriate medical certificates and drug medications for those with pre-existing illness that will bring with them medicines, to avoid embarrassing delay and questioning by airport authorities.

Travellers Emergency Kit
This would depend on the place where the employee will be travelling. The kit may include simple things like sunscreen, gauze, bandaide, hand sanitizer, alcohol etc.. to the not so common travellers e-kit w/ Chlorine tablet for water purification, Acetazolamide if travel is contemplated to elevate beyond 2500 m above sea level, injectible epinephrine and so on..

Insurance Coverage and Medical Evac (for contingency)
Make sure with the HR if sufficient coverage is given to the travelling employee/worker. Many insurances have links to international health groups and affiliated worldwide.

Immunization
No vaccines are currently required for travel, with the exception of yellow fever vaccine if travel is planned to an endemic area. But it is always be better if we are on the safer side by having immunity against hepatitis a, hepatitis b, Flu, meningococcemia, Influenza A H1N1, typhoid etc. Up-to-date immunization information can be obtained from the Centers for Disease Control and Prevention (CDC) web site, http://www.cdc.gov/travel, which contains a wealth of information.

Malaria
Most of the tropical region in the globe has cases of malaria, and certain new test assay for immediate detection of malaria is at the market and as simple as using a pregnancy kit. Four malaria prophylaxis medications are currently available: chloroquine, mefloquine, doxycycline, and atovaquone-proguanil. Primaquine has been used as a prophylactic medication, but this is not yet an approved indication.

STD Precaution
Most of the international travellers specially men, are advise to avoid promiscuous activities. Incidence of HIV/AIDS and other sexually transmitted infection are very high in some areas. Some Travellers kit may include condoms among the items included.

Other Travel Medicine concerns shall be discuss individually in succeeding articles.

The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).


Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
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Dengue Fever and Its Prevention at Work

Dengue Fever and its Prevention at Work
by Roy Mangubat, MD, DPCOM

Statistically, 90% of hospitalized dengue cases belong to ages 15 years old and below. Yet this may have an impact to the working population since dengue may present symptoms of any viral infection like flu that leads to several sick leave absences among employees. It is estimated that around 500,000 of dengue cases occur in the Philippines and most of which will present the milder form of Dengue fever that will not be needing hospitalization and is commonly mislabelled only as an acute viral infection.

The vector (insect) that transmit the virus is the Aedes aegypti and Aedes albipicti (mosquito) which are commonly seen around the archipelago. There are a lot of areas wherein there is high density of Aedes mosquito (Breteau’s Index), and risk for an mosquito borne outbreak like dengue is very high.

Dengue Fever and Dengue Hemorrhagic Fever are caused by any of the four (4) serotypes of Dengue Virus ( Type 1,2,3,4), and currently 3 of the 4 serotypes are spreading havoc in the population. An infected day biting female Aedes mosquito transmits this infection, and at this time of the day – employees are commonly at work. The mosquito vector may breed around the company’s premises since larvae can live in collection of water like storage tanks, cisterns, canals, clogged drains etc.. and even in small collections of water e.g.. soda cans, puddles, leaf stalk of palm trees and the banana tree. Dengue Fever is a severe disease with high epidemic potential and requires everybody in the community to fight against its spread including industrial complexes and companies.

Case Definitions
Suspected Case- a patient with an acute febrile illness of 2-7 days duration w/ 2 or more of the following symptoms:
• Headache
• Retroorbital pain
• Rashes hemorrhagic manifestation
• Myalgia
• Athralgia
• Leucopenia
• Thrombocytopenia
Probable cause- a suspected Dengue patient w/ one or more of the following:
• Supportive serology (reciprocal hemaglutination-inhibition antibody titter > 1280
• Comparable IgG EIA titer or Positive IgM antibody test in late acute phase
Confirmed Case- a uspected patient with positive viral genome sequence using Polymerase Chain Reaction (PCR).

Types
Dengue Fever – with symptoms of a suspected case as stated above, most cases are undocumented.
Dengue Hemorrhagic Fever- a probable or confirmed case of dengue and hemorrhagic tendencies evidenced by one or more of the following:
• + tourniquet test
• + petechiae, echimoses or purpura
• + bleeding
• Thrombocytopenia < 100,000 cells/mm3
• Evidence of plasma leakage due to increased vascular permeability
Dengue Shock Syndrome- the above criteria plus evidence of circulatory failure with rapid and weak pulse and narrow pulse pressure (20mmHg) or hypotension for age, cold clammy skin and altered mental status.

Recommended Interventions and Controls
• Educate the employee to promote behaviour to remove, destroy or manage mosquito breeding sites w/in the company premises and also to do this w/in the premises of their homes.
• Promote personal protection against day biting mosquitoes through the use of insect repellent lotions.
• Integrate in the Good House Keeping Program or 5’s Program the removal of water holding containers that may breed mosquitoes.
• Report to the Local Health Office if there are cases of dengue among the workers.
• Promote and participate to Blood Donation Drive of the Phil. National Red Cross and Local Blood Council in your area to ensure that the community has adequate source of Platelet and plasma concentrate whenever a need may arise especially during dengue outbreaks.
• Spraying of commercially available mosquito repelling agents in the walls and windows of buildings w/in the company premises.
• Regular site inspections of the Occupational Health and Safety Crew to ensure that mosquito breeding sites are eradicated.

Information Source: Manual of Procedure for the Phil. Integrated Disease Surveillace and Response. DOH
_______________________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).

Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
http://www.blogger.com/profile/09894396954767142226
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The Exit Medical Examinations for Workers

Exit Physical Examinations
by Roy Mangubat, MD, DPCOM

Few days ago I did an exit medical evaluation for a resigning employee, HR is more concern on the employees exit clearance if he has any liabilities left in the company. I got a chance to talk with an HR friend and was very surprised to know that many companiesdon’t do an exit medical evaluation for resigning/retiring or terminated employees not knowing the importance/implication of such evaluation. Exit Medical PE benefits both the employee and employer in the process, it basically prevents future litigation for the company and ensure the health and well being of the exiting employee.

Exit PE is just like any periodic medical evaluations but with focus on exposure and target organ damage that maybe work related, work induced or an occupational illness. Review of the worker’s past periodic examinations are very valuable specifically audiogram, PFT and other documented procedures done within the workers stay with the company. Also, the review of the medical records to document the frequency and severity of an specific illness from work is very valuable. Frequently these are used by employers to document that the employee has suffered no adverse health effects from employment or to establish the extent of any such effects.

The Exit examination is also recommended in the Occupational Health and Safety Standards of DOLE. But despite these requirements, exit or termination examinations are the least common occupational examinations that are being done. In my experience as an OccMed Specialist -employees often leave employment before an exit examination can be scheduled. For some it would be just moot and academic but for an OccMed Practitioner it is vital -for we are entrusted to take care of the health of the workers by ensuring that the exiting employee is in tip top health before finally leaving work or must be given just compensation for the illnesses that he/she gained through the course of his/her employment.
______________________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM). PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).

Our talent is our gift from God, and what we do with that talent is our gift back to God. For those Filipino Doctors that choose to stay and serve our people despite the difficulties, it is a sign that there is still Hope for our country…. Mabuhay ang Filipinong Mangagamot!
Doctors nowadays forget the very essence of Medicine being blinded of the material things around us, medicine is about service to mankind – its what makes the profession noble.

Food Safety at Work

Food Safety in the Workplace
by Roy Mangubat, MD, DPCOM

This is one of the most important part of the practice of Occupational Medicine yet the most neglected. Ever imagine a food borne outbreak in the company? This would spell disaster when occur. The risk of paralysis of production/operations is great, since this could mean hospitalization of several employees due to food poisoning. Food Poisoning is bad publicity for any company, when such an outbreak occur a public health investigation will be initiated- thus attracting media attention. Occupational Health Physicians seldom inspect the canteen premises for sanitary compliance and let self inspection be handled by the canteen concessionaires themselves.

Common Food-Borne Pathogens
Campylobacter jejuni
Campylobacter jejuni is found in the intestinal tracts of animals and birds, raw milk, untreated water and sewage sludge.
Clostridium Botulinum
Clostridium Botulinum is widely distributed in nature; soil, water, on plants, and intestinal tracts of animals and fish. Grows only in little or no oxygen.
Clostridium perfringens
Clostridium perfringens is found in soil, dust, sewage, and intestinal tracts of animals and humans. Grows only in little or no oxygen.
Escherichia coli - "E. coli"
E. coli is found in the intestinal tracts of some mammals, raw milk, unchlorinated water; one of several strains of E. coli that can cause human illness.
Listeria monocytogenes
Listeria monocytogenes is found in the intestinal tracts of humans and animals, milk, soil, leaf vegetables; it can grow slowly at refrigerator temperatures.
Salmonella
Salmonella is found in the intestinal tracts and feces of animals; Salmonella Enteritidis is found in eggs.
Shigella
Shigella is found in the human intestinal tract; it's rarely found in other animals.
Staphylococcus aureus
Staphylococcus aureus is found on humans (skin, infected cuts, pimples, noses, and throats).

Some key points to remember regarding Food Safety in the Company Canteen

4 Key Disease Prevention Factors to Employ in the Canteen
�� Practicing good personal hygiene
�� Preventing cross-contamination
�� Limiting time food is in the temperature
danger zone
�� Proper cleaning and sanitizing

Good Personal Hygiene is a must for foodhandlers, this includes- hand washing.
Proper Handwashing Technique
�� Wet hands with warm water, apply soap and rub hands together for
a minimum of 15 seconds (or the 2 happy bday song rule is better) before rinsing.
�� A clean nail brush can be used to scrub under fingernails and around nail beds. Dry hands well (with a paper towel if available).

Appropriate attire for food preparation employees
�� Clean clothing including closed-toe shoes
�� Hair restraint, hair nets
�� No jewelry, ring or watches
�� Trim fingernails without nail polish

Restrict Ill Canteen Employees with the Following Symptoms
�� Fever
�� Diarrhea
�� Vomiting
�� Sore throat with fever
�� Jaundice (yellowing of the skin and eyes)

Cross-contamination is the transfer of microorganisms from
one food or surface to another.
�� Physical barriers such as using different cutting boards, utensils, or gloves.
�� Clean and sanitize work surfaces, utensils and equipment when changing tasks.
�� Limit the amount of preparation needed by purchasing ingredients such as precooked items.

Time and Temperature Abuse
�� Cook food to the required minimum internal temperature
�� Cool properly
�� Reheat properly
�� Store food at the proper temperature

Rapid Cooling Requirements
�� 135ºF to ≤70ºF in ≤ 2 hours
�� ≤70ºF to ≤41ºF in 4 hours
�� Maximum total cooling time 6 hours
�� If food item does not cool to at least 70ºF in the first 2 hours ---
REHEAT TO 165ºF AND BEGIN COOLING PROCESS AGAIN!

Methods for Rapid Cooling
�� Put food in walk-in using an uncovered shallow pan maximum of 3 inches deep for thin broths and 2 inches deep for thicker foods
�� Use an ice water bath, ice wand, or blast chiller
�� Reduce the food mass by cutting or separating into smaller size portions

Reheating Requirements
�� Potentially hazardous, previously cooked food must be reheated to an internal temperature of ≤165ºF for at least 15 seconds within 2 hours.
�� Never reheat food using a hot holding device such as a steam table.
�� Reheat food just only one time!

Food Safety Management Systems
�� Proactive and systematic approaches to preventing food contamination during
the flow of food through an establishment.
�� Two such systems are:
• Active Managerial Control
• HACCP (Hazard Analysis Critical Control Points)
__________________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).


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Heat Stress at Work

Heat Stress at Work
by Roy Mangubat, MD, DPCOM

Living in a tropical region like the Philippines makes one acclimatize with the ambient heat in the environment much better, but working while exposed to heat stresses makes it more difficult since the humidity or high ambient humidity in the tropics increases the air temperature even more. High ambient humidity accompanied with heat impairs evaporative heat loss thus trapping the body’s internal core heat w/o dissipating; the body has difficulty in thermoregulation. Another factor is the physical activities at work that drives our body to elevate the internal temperature even more.

Hypokalemia, Dehydration and Heat Stress
In my years of practice as an OccMed Specialist I usually noticed peaked t waves and u waves in the ECG tracings of employees exposed to heat stress during their annual PE, accompanied with urine concentration in their urinalysis result with high specific gravity and partial hemo-concentration in their CBCs. This findings reflects some degree of hypokalemia and dehydration. Commonly workers with that findings always frequent the clinic complaining of muscle pain and muscle cramps.

Complications of Severe Heat Stress in the Body
• Heat Stroke
• Heat Syncope
• Dehydration
• Heat Exhaustion
• Heat Cramps

Risk Factors for Heat Related problem
• Obesity
• Signs of Dehydration
• Lack of Sleep
• Poor Physical Conditioning
• History of hypotension
• Fever
• Alcoholic intake
• Diseases that affects/impairs sweating
• Cardiovascular diseases
• Poor acclimatization
• Substance abuse

These risk factors can be use in determining if a worker can be assigned to task that will expose the employee to heat stress.

Controls and Interventions
Administrative
• Short work exposure
• Training on prevention of heat stroke and dehydration
• Regular water breaks
• Regular health monitoring for those at risk
• Regular rest period
Engineering
• Automation to reduce physical workload
• Good Insulation
• Good Ventilation
Others
• Use cool and comfortable clothing
• Avoid heavy protective clothing (if applicable)
• Provision of ORS (rehydrating salts) to avoid dehydration and electrolyte imbalance.
_____________________________________________________________________
The author is a diplomate of the Philippine College of Occupational Medicine (PCOM) and a graduate of The Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine. PCOM is an accredited Occupational Health and Safety Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE), a subspecialty society under the Philippine Medical Association (PMA). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH).
Link to my Other OccMed Blogs: http://www.doktorko.com/_blog/index.php?mod=blog_author&md=3554
http://www.blogger.com/profile/09894396954767142226

EMPLOYER'S GUIDE TO OCCUPATIONAL HEALTH SERVICES

EMPLOYER'S GUIDE TO OCCUPATIONAL HEALTH SERVICES
By Roy Mangubat, MD, DPCOM
We (Occupational Medicine Specialist) can give better idea for employers the whole spectrum of occupational health services in the perspective of compliance and adherence to DOLE and other governmental and International (ISO and OHSAS) regulations pertaining to occupational health and safety. We can provide a complete range of occupational medicine services, from the treatment of industrial accidents and the provision of pre-placement and periodic examinations. OccMed specialist are knowledgeable in occupational toxicology, travel medicine, ergonomics, disability/impairment evaluation, sickness-absenteeism monitoring etc... We can design company-wide programs to prevent health problems among employees.
Occupational medicine is our commitment and our specialty, not our hobby. We are the expert in this field of medical science. The Philippine College of Occupational Medicine (PCOM) is the only specialty society in the field of Occupational Medicine recognized by the Philippine Medical Association (PMA). PCOM is an accredited Occupational Health and Safety Training Organization of the Bureau of Working Conditions of the Department of Labor and Employment (DOLE). PCOM is also affiliated with the International Commission on Occupational Health (ICOH) and the Asian Association of Occupational Health (AAOH). Make sure that your Company Doctors are diplomate/fellow of PCOM as this would ensure that quality of care is at par with international occupational health standards. Board certified Occupational Health Physician is a requirement for ISO and OHSAS certifications.
We are committed to the following in the provision of occupational medicine services:
EXCELLENCE... Not mere adequacy.
EFFICIENCY...No fooling around.
FLEXIBILITY... The services you need, not the services we can sell you.
CONVENIENCE...Services when you need them, not just when we make them available
PREVENTION...Not waiting until the situation is out of control.

Occupational Health Services

Occupational Health Services
by Roy Mangubat, MD,DPCOM

Occupational health services may be divided into two broad divisions, curative and preventive.
Curative services
• intended to cure or limit disease or to manage on existing occupational health problems.
Preventive services
• seek to avoid exposure of the water to hazards
• detect disorders at an early and potentially curable stage
• to limit disability.
OccMed specialist are differentiated from other Primary Care Specialties since our field focuses more on dealing with work related illness and its prevention.
The disciplines in OccMed includes
• Ergonomics
• Disability Evaluation
• Travel Medicine
• Occupational Illnesses
• Occupational Safety
• Industrial Hygiene
• Occupational Toxicology
• Work Accident Investigation
• Compensation Medicine
• Fire Prevention and Control
• Disaster management and crowd control
• Environmental Medicine and Pollution Control
• Sanitation (industrial and food sanitation)
• Health education and Prevention
• Occupational Epidemiology and Biostatistics
• Health Management and Administration
• Sickness-Absence control

Roy Mangubat, MD, DPCOM

Diplomate, Philippine College of Occupational Medicine
Public Health Officer - CSJDM, Bulacan
Occupational Medicine Consultant - Steelasia Manufacturing Corporation, Meycauayan

Medical School: Pamantasan ng Lungsod ng Maynila - College of Medicine
Contact Number: 0917-856-01-77
E-mail: rmmangubat@yahoo.com
Website:http://www.doktorko.com/mxk3_beta/_data/md.php?md_id=3554&spty_id=32