case of the
OFW clinic facing suspension of license for alleged misdiagnosis?
What could have gone wrong? Balikbayan sleuth Jun G. Garcia
narrates his findings.
S.M. Lazo Medical Clinic is ISO-certified, proof that
its medical exam services is of high quality. But this
reputation is being challenged by the Department of Health
(DOH), which regulates such clinics, and an OFW who underwent
Hepatitis C screening at S.M. Lazo last December.
Lazo’s woes started when it released the test result
of Risheema Anduhol, 30. The examinee was found positive
of the Hepa C virus. Upon learning this, Anduhol no longer
pursued her re-application for the job as a Medical Technologist
in the Saudi embassy. Doubtful and angered by the findings,
Anduhol took re-tests from January to June at the Makati
Medical Center (MMC), St. Vincent Medical Clinic, Apostol
Medical Clinic, Medical City in Mandaluyong City and the
STD/AIDS Cooperative Central Laboratory (SACCL) in San
Lazaro Hospital. The SACCL is the National Reference Laboratory
of the DOH. All the results were negative, she said.
Anduhol then filed a complaint with Atty. Nicolas B. Lutero
III, director of the DOH Bureau of Health Facilities and
Services. On June 12, Lutero called a meeting between
the contending parties. To break the impasse, he ordered
a confirmatory test to be conducted on Anduhol at the
SACCL. The result of the test done on June 18 was negative.
On Aug. 12, Lutero ordered S.M. Lazo’s license suspended
for three months for violating Section 25.1.9 of Administrative
Order No. 85-A s. 1990, which penalizes clinics found
guilty of misinterpreting pre-employment medical/laboratory
exam that caused non-deployment or repatriation.”
He also ordered S.M. Lazo to refund Anduhol all medical
exam fees paid to the clinic amounting to over P3,000.
Anduhol was refunded the amount last August.
On Aug. 28, S.M. Lazo immediately wrote Health Secretary
Manuel M. Dayrit protesting and contesting the suspension
order. The clinic said the order is baseless, in fact
and in law and that due process was not served.
Fe Bacungan, medical director of S.M. Lazo, insisted that
they did not misinterpreted the laboratory result on Anduhol
since it is machine generated.
She revealed that S.M. Lazo tested Anduhol five times.
After the firs test on Dec. 19, 2001, she was tested again
on Dec. 20, 21, 26, and on June 18, 2002. “Positive
lahat even after six months. I think Anduhol knows it.
She is a medical technologist so I believe she knows the
process,” Bacungan said.
So why was Anduhol tested negative at the SACCL?
Dr. Dorothy May Agdamag of SACCL explained that the patient
was tested positive using Abbott Murex Anti-HCV (ver 4.0),
the latest solution that can detect the presence of Hepa
C virus in the blood. A month later, she was tested negative
by SACCL using another solution called Ortho-HCV.
The MMC and St. Vincent results are also negative but
Agdamag did not know the tests used. Six months later,
a repeat test by S.M. Lazo using Murex found Anduhol still
positive and the repeat test by SACCL using Ortho tested
her negative again.
Due to the conflicting results, Agdamag said they had
to perform strip immunoblot assay (RIBA), the confirmatory
test for Hepa-C. The result was negative.
Agdamag concluded that either the result from Murex might
be a false positive result, which can happen in a small
number of cases using such screening tests, or the patient
is infected but the laboratory tests not using Murex were
not able to detect the virus. The answer will be known
six months after the June re-tests or by December, when
the infections is expected to become full-blown.
She said it would be best to follow up the patient to
definitely say that the Abbott Murex Hepa-C test indeed
detected the virus or that the results obtained by the
said kit was actually a false positive result.
However, Lutero said, “That’s one of our problem
here. Most of these complainants ay hindi na bumabalik.”
Lutero disclosed that should S.M. Lazo prove that it is
correct in its findings on Anduhol and should the Health
secretary sustain its appeal, then he is willing to lift
the suspension order.
Anduhol is willing to submit to another test in December
but she said that the SACCL test, which is the final test,
already confirmed that she is negative from the Hepa C
virus. She is currently training as a caregiver and hopes
to get a new job in Canada.
Whether Anduhol is positive or negative of the virus,
whether S.M. Lazo’s license is suspended or not,
there are still a lot of questions that need to be answered.
Should medical tests that give confusing results be allowed?
How will Hepa C virus screen tests be made accurate if
it is imperfect? How many OFWs were given inaccurate medical
tests but don’t know it? How will government help
re-employ other Anduhols, who will no longer be accepted
by employers even if they are really healthy? How will
the public be protected against persons with Hepa C virus
but believe they have none because of inaccurate tests?
How can persons with Hepa C virus be cured if they believe
they have no virus because of inaccurate tests? How will
government compensate clinics that would be wrongly penalized?
If these will be answered, what Anduhol have gone through
will not be in vain.
certificate not exclusive to agency, employer
a local recruitment agency ask you to take a basic pre-employment
medical exam from a clinic even if you already have a
valid basic PEME certificate issued by another clinic?
If so, you can complain this to Atty. Nicolas B. Lutero
III, director of the Bureau of Health Facilities and Services
of the Department of Health (DOH-BHFS), said Nini Lanto,
director of the POEA Regulation (land-base) Division.
Lanto emphasized that basic PEME certificates of OFWs
are not exclusive to an agency or employer since there
is no regulation stating so. "It doesn't make one
unfit for work if an applicant presents his medical certificate
taken from his former agency to another employer, unless
it is within the 90 days validity period. That should
be the practice," said Lanto.
"Modem academe na iyun for agencies to recognize
the certificate and verify its authenticity so as not
expose OFWs from the hazards of radiation by being re-examined
and pay additional expense for the same process of medical
examination," added Lutero. A basic medical examination
An exception to the rule is when an employer requests
for a special medical examination of an OFW.
OFW clinics to lose license
Quality Standard System (QSS) or International Standard
Organization (ISO) certification, no license. This is
now the policy of the DOH on medical clinics serving OFWs.
The extended deadline for medical clinics to get an ISO
certification from the Philippine Council of Healthcare
Organization Offices (PCAHO) or Lloyds Register expired
last Sept. 15. But DOH-BHFS director Atty. Nicolas B.
Lutero III said there are still a number of clinics requesting
another extension of the deadline. " No more extension!
I cannot give them another extension. Tama na. Nakakahiya
naman doon sa mga nag-comply. Tatlong taon na nga itong
pinag-uusapan eh," said Lutero.
"The medical certificates or examination of OFWs
from non-compliant clinics would be void," he said.
But in case an OFW holds a medical certificate taken from
a non-compliant clinic prior to Sept. 15, he said, "They
can come to my office, I will make a certification that
his medical certificate is still valid for 90 days and
must be honored by any agency."
Non-compliant clinics can still apply for QSS/ISO certification
without paying any fine if it still wants to cater to
OFWs. Otherwise, these clinics can only conduct medical
examination to local job applicants. New clinics applying
for accreditation have six months to get a QSS/ISO certification.
PCAHO charges up to P30,000 fee for a QSS manual while
Lloyds Register charges P100,000.
Lutero assured that the failure of some clinics to be
accredited would not delay the deployment of OFWs. "We
have enough certified clinics that can accommodate the
growing numbers of OFWs," Lutero told Balikbayan.
therapy removes body toxins
26 years of research, the Japanese medical community has
found a way to flush out toxins in the human body. The
health care therapy called Kinotakara has been proven
to improve health and even cure diseases by eliminating
toxins that the body gets from environmental pollution.
Kinotakara is a sachet that contains the essence of wood
vinegar, the same substance that keeps trees strong and
lush. Before sleep, the sachet is pasted to the soles
of the feet, where more than 60 acupuncture points linked
to organs are located. The wood vinegar works like a sponge
and suck out toxins that accumulates in the soles.
The Kinotakara absorbs toxins efficiently and fast without
any side effects. In turn, the blood stream is purified,
circulation is improved, tissues are activated and the
immune system enhanced.
With Kinotakara, health and long life is promoted.
RP’s lead in occupational and maritime medicine
the Philippines’ economic woes continued to worsen
in 1980, the country found yet another savior with the
flourishing of the OFW industry. So propitious it was
that a lot of enterprising individuals exploited the situation.
And one particular area in which these nefarious syndicates
capitalized in was the pre-employment medical examination.
Though non-medical practitioners themselves, they were
issuing medical certificates to aspiring migrant workers
exposing the poor applicants to possible arrests and deportation
back to the Philippines upon reaching their countries
of destination. Aggravating the matters further, was the
increase in the rate of morbidity and mortality among
OFWs deployed abroad since many of them were not actually
examined by competent medical practitioners. Hence, their
employers were forced to shoulder whatever expenses incurred
for their repatriation. However, some were less fortunate
as they were left with no employers at all, totally abandoned
with no direction in a foreign land. It was then that
the foreign employers called the attention of the Philippine
government regarding that matter.
With the distress call sounded off, we, representing about
a dozen medical clinics, spearheaded a move to unite the
industrial medical clinics and save the profession’s
image from the repulsive activities of several erring
colleagues and non-colleagues. Thus, the Associated Medical
Clinics for Overseas Workers (AMCOW) was born in 1980
with the primary objective of regulating and professionalizing
the issuance of pre-employment medical certificates to
OFWs by only accredited medical clinics with competent
staff and facilities.
During my term as AMCOW president in 1983, through the
instigation mainly of the organization, a body composed
of the then Labor Minister Blas Ople (now Foreign Affairs
Secretary), Health Minister Jaime Azurin, the administrator
of the Philippine Overseas Employment Administration and
representatives from the medical clinics was formed to
oversee and regulate medical clinics in accordance with
the provisions of Administrative Order No. 85. Stringent
measures were undertaken to ensure that only those capable
of carrying out professional pre-employment medical examinations
were given the accreditation to do so. Slowly but methodical
as a surgeon’s knife, the illegal and incompetent
practitioners were flushed out from this very sensitive
area of pre-employment medical examination.
Nonetheless, our quest for competitive and professional
occupational medicinal practice does not end here. The
onset of globalization, while opening up broader horizons
for our field of profession, has exposed us to stiffer
competition on a worldwide scale. Now, we have to adapt
to the standards set by internationally recognized bodies.
In 1989, in my humble capacity as the then president of
the Philippine College of Occupational Medicine, I was
invited to the International Symposium on Maritime Health
in Hamburg, Germany, representing the Philippines and
the Asia-Pacific Region. Problems and issues concerning
maritime health, safety of life at sea, the increasing
rate of morbidity and mortality and how to resolve them
were tackled. More important, the symposium focused on
how to further improve the screening of seafarers’
fitness for rigorous sea duty.
However, all efforts to come up with an organizational
manifestation of the symposium proved futile as most of
the participants at that time still has yet to see the
need for such action. This indifference continued with
the resumption of the biennial activity in 1991 in Turku,
Finland; in 1993 in Antwerp, Belgium; and in 1995 in Maryland,
USA. Until things took turn for the better in Oslo in
Norway 1997, when the symposium finally took its organizational
expression, giving birth to the International Maritime
Health Association, with representations coming from all
sectors concerned with maritime health including the medical
practitioners, the principals, manning agencies and the
P & I Clubs.
The formation of IMHA is one great leap forward for the
sectors concerned in maritime health as it has adopted
measures for the improvement of healthcare and medical
services in the maritime industry, encourage and support
scientific researches in maritime healthcare and to promote
the exchange of data and results from the research project
undertaken among many others.
Being an active participant in the ISMH and the IMHA since
its inception helped us a lot in bringing the Philippines
in the limelight of maritime health. In the 1999 edition
of the biennial ISMH activity in London, I was able to
convince the important personalities in the ISMH convenor’s
group to bring the maritime health convention in Manila
in 2001. Our dream materialized. Tapping the support of
known personalities in the Philippine maritime industry
like Doris Theresa Magsaysay-Ho of the Philippine Seafarers
Promotion Council, Carlos Salinas of the Filipino Shipowners
Association and Captain Gregorio Oca of the Associated
Marine Officers and Seamen’s Union of the Philippines,
ensured the success of the convention. We were able to
attract hundreds of delegates from all over the world.
Most important, it served to showcase the professionalism
and competitiveness of the maritime health practitioners
in the country. And to top it all, I was elected to the
IMHA Board of Directors, the very first Asian elected
to the post representing the Asia-Pacific Region.
But then, the task of professionalizing the occupational
medicine in the country is not a one-man crusade. It should
be a collective and concerted action among all concerned.
Occupational and maritime medicine in the country has
matured a lot throughout the years. We have learned to
police our own rank. We have survived the threat of unscrupulous
in-dividuals who tried to capitalize and exploit the fragility
of maritime medical practice in our country. We have set
up our own standards in collaboration with proper government
agencies and in accordance with the paradigm set by international
bodies. In fact, to say that occupational and maritime
medicine in the country is most competitive globally would
be an understatement. It is an accepted fact that we,
in the Philippines, have the most stringent measure compared
to other countries in getting accreditations for our clinics,
making Philippine pre-employment medical examination the
most policed medical field all over the world, thanks
but no thanks to the ‘over’ efficient government
We are most competitive, yes. But that doesn’t mean
we can simply rest on that. Competition is fast catching
up. The Philippines is the largest exporter of manpower
for both sea and land-based requirements. And if we are
to maintain our edge over our competitor, all sectors
with concern in the OFW industry, including us in the
medical profession, should get our acts together to further
improve our craft. We, in the medical profession, should
continue to professionalize and see to it that we only
send the fittest for work deployment abroad.
Then and only then, could we, Filipino occupational medical
practitioners, say that our profession is truly in the
pink of health.
Dr. de Guzman
is the president of the Accredited Medical Clinics for
the Royal Embassy of Saudi Arabia and the Accredited
Medical Clinics for Taiwan Economic and Cultural Office.
He is chairman of the GCC Accredited Medical Center
Association, a group of medical clinics for Gulf states,
and the Specialty Board of the Philippine College of
Occupational Medicine. He is also the medical director
of port operator International Container Terminal Services
Inc. and OFW clinic Physicians’ Diagnostic Services
BOMB GIRLS. Fourteen boob-tube babes would like
to help fight lawlessness and evil in our crime-infested
communities. How are they going to do it if they have
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