FIU (Medical Examinations) Regulation
The Administration's Responses to the
Submissions made by 18 Organizations to
LegCo Subcommittee on 27.9.1999

A. Estate Doctors Association Ltd.

(1) The reasons why medical examinations for workers exposed to hazardous substances and physical agents should be undertaken by AMPs are given in item (2) of the Administration's main response to the Subcommittee.

B. The Hong Kong Small & Medium Business Association

(1) It is estimated that the cost of medical examinations will give rise to only a 0.01% increase in the total operating cost in industries other than construction. This cost is small in comparison with medical expenses, compensations, sickness allowances, etc. that a proprietor has to bear if his worker suffers from an occupational disease.
(2) In order to avoid too much variance in the recommendations by AMPs, the Labour Department would issue a guide to assist all AMPs in giving their advice.
(3) It is inappropriate for the Department of Health, the Labour Department and the Hospital Authority to take over such medical examinations because public resources should better be used in enforcement activities and curative care. The Labour Department will assist duty-holders in discharging their obligations under the proposed Regulation.
(4) The fee for a particular type of medical examination should be negotiated between a proprietor and an AMP. It is estimated that the average cost per worker is $400 for those exposed to excessive noise and ranges from $200 to $600 for those exposed to other agents.
(5) Out of the 195,000 workers required to take medical examinations, it is estimated that only 26,000 workers (i.e. 13%) are in the manufacturing industries. The financial implications to the manufacturing industries are small when compared with the health gains to the workers. We do not consider it appropriate to temporarily exclude the manufacturing industries. However, we would monitor the adequate supply of AMPs and implement the Regulation in phases with those occupations involving excessive noise exposure to be covered in the last phase.

C. The Hong Kong College of Family Physicians

(1) The reasons for medical examination to be carried out by medical practitioners trained in occupational medicine and the supply of and training arrangement for AMPs are covered in items (2) and (3) of the Administration's main response.
(2) We would encourage more academic institutions to run more occupational medicine courses in Hong Kong to further enhance the training capacity of AMPs.
(3) The Occupational Health Service of the Labour Department would liaise with all AMP, and monitor their performance to ensure that the medical examinations are properly carried out and not delegated to untrained doctors. In fact, the Regulation has a provision on offence relating to making a false medical examination report. The issue of medical certificates not conducted by the AMP himself is considered a breach of section 15 of the proposed Regulation. Prosecution actions may be initiated if there is sufficient evidence.

D. Society of Registered Safety Officers

(1) The reasons why the proposed Regulation is not made under the OSHO have been given in item (1) of the Administration's main response.
(2) If a worker is exposed to more than one hazardous substances or physical agents, he is required to undergo all the relevant medical examinations in accordance with the requirements specified in Schedule 2 of the proposed Regulation. For example, a construction worker who is exposed to both silica and excessive noise above 90d(BA) is required to undergo a general medical examination, including signs and symptoms of silicosis and auroscopic examination, chest X-ray and audiometric examination prior to employment and then at 12-month intervals throughout the employment.
(3) It is not our intention to require workers in contact with very small amount of hazardous substances to undertake medical examinations. Medical examination is basically a system of monitoring the health status of persons, to determine departures from normal health and to take the necessary preventive measures early. As a general rule, medical examinations should be conducted for workers who are exposed to concentrations of the chemical, in elemental form or compound, in the air, which are liable to exceed half the occupational exposure limit or are at significant risk of ingesting the chemical. In these circumstances, medical examinations directed to assess the health impact of these impurities are required. Moreover, the FIU (Safety Management) Regulation would complement this proposed Regulation in developing a self-regulatory framework for workplace environmental monitoring. In the meantime, we would issue a guide giving a comprehensive list of occupations in various industries where medical examinations are required for the employers, employees and AMPs to follow.
(4) It is our intention to analyse the results of the medical examinations in our future planning of occupational health service and development of occupational safety and health legislation.

E. Hong Kong Construction Industry Employees General Union

(1) For the construction industry, Construction Industry Training Authority (CITA) is the organization selected to appoint a list of AMPs as service providers for the medical examinations of construction workers and meet the expenses. There should thus be no conflict of interest between the AMPs and the proprietors. In any case, all medical practitioners have to follow the professional code of ethics and only essential information about the workers' fitness for work would be given to the proprietors concerned. Inappropriate information passed to the third party without consent from the workers will be taken seriously by the Medical Council as a disciplinary matter. Moreover, proprietors or workers who are aggrieved by an AMP's recommendations may appeal to an Appeal Board to be appointed by the Commissioner for Labour.
(2) Section 6 of the proposed Regulation has stipulated that all medical examinations, investigations and certifications required shall be arranged and conducted at the expense of the proprietor. This would include arrangement for time-off for the required medical examinations. We would clarify this intention if necessary. However, it is not our intention to give "paid leave" as this would mean a whole day free from work which is not considered justified for taking medical examinations.
(3) The arrangement for workers found medically unfit for work is given in item (5) of the Administration's main response.
(4) If a worker is diagnosed as suffering from occupational diseases, the medical expenses, sickness allowances and other benefits will be covered under the Employees' Compensation Ordinance, the Occupational Deafness (Compensation) Ordinance or the Pneumoconiosis (Compensation) Ordinance as appropriate. In addition, workers suffering from financial hardship could also seek social security assistance from the Social Welfare Department.

F. Hong Kong Industrial Safety Association

(1) See item E(3) above.
(2) Experience in Singapore's Ministry of Manpower in running the statutory medical examination scheme for over 10 years is that permanent suspension from further exposure to hazardous substances or physical agents is very rare. The AMPs with special training in occupational medicine would advise workers to take special preventive measures such as the proper use of personal protective equipment to reduce further exposure to the hazardous substances or physical agents. This would not result in difficulties in recruiting experienced employees, causing hindrance to the work progress production or safety problem to the remaining staff.
(3) For the construction industry, the AMPs are required to issue the medical certificates to the proprietors, workers and CITA. This would allow the proprietors to carry out the AMP's recommendations.
(4) The arrangement is that when requiring a construction worker to go for medical examination, a proprietor has to seek the principal contractor's endorsement of the employment status of that worker and specify the worker's job title to CITA prior to the medical examination. This arrangement would minimize abuse of the CITA's agency service.
(5) We do not anticipate a lot of compensation claims. In fact, in the long run, early detection of adverse health effects at work and early treatment would reduce the incidents of permanent disability and hence compensation claims. Society at large will ultimately benefit from a healthier workforce.
G. Pneumoconiosis Mutual Aid Association

(1) The comments and recommendations in the second submission are similar to the first submission. Please refer to the Administration's response to the Association given on 21 September 1999.
(2) See item E(2) above.
(3) The Appeal Board's function is to reconsider the medical recommendations of the AMPs, in particular the worker's fitness for work, and not any other employment-related issues. It is therefore considered not appropriate to include representatives from the employers, the employees or the Equal Opportunity Commission.
H. Hong Kong Institute of Occupational & Environmental Hygiene

(1) The concern on the adequate supply of AMPs is covered in item (3) of the Administration's main response.
(2) We totally agree that workplace environmental monitoring is of equal importance to medical examination. Please refer to item (1) of the Administration's main response for details.
I. The Hong Kong Occupational Deafness Association - further submission

(1) There is already an obligation for medical practitioners to notify the Commissioner for Labour on detection of suspected or confirmed occupational diseases. This would allow the Labour Department to enforce the necessary preventive and control measures. Please refer to item (1) of the Administration's main response for details.
(2) See item F(2) above.
(3) See item G(3) above.
(4) In the Singapore's Factories (Medical Examinations)(Amendment) Regulation 1997, section 10(2) stipulates that "the designated factory doctor shall, when appropriate, advise that a person whose health is likely to be or has been affected injuriously by his employment in a hazardous occupation should not be employed in that occupation or that he be suspended from such employment for a period as determined by him or permanently". Therefore, permanent suspension from further exposure to hazardous substances, although uncommon, is included in Singapore's Factories Act.
(5) As AMPs have received adequate training in conducting audiometric tests including the requirements for proper audiometric equipment or booth, we consider it more appropriate to put such responsibilities on the AMPs rather than other technical staff.
(6) See item E(2) above.
J. The Federation of Hong Kong & Kowloon Labour Unions

(1) The reasons for not extending the coverage to all workers are given in item (1) of the Administration's main response.
(2) Trichloroacetic acid, the biomarker for perchloroethylene, is considered not sensitive enough to monitor the absorption status and the adverse health effect in the worker. We are presently conducting a joint study with the Centre for Environmental & Occupational Health, National University of Singapore, and Sun Yat Sen University of Medical Sciences, China for other better biomarkers. The medical examination for employment in the use and handling of perchloroethylene will be considered later.
(3) See item E(2) above.
(4) See item E(3) above.
(5) We have consulted the Equal Opportunity Commission, which has also supported our view that there is no breach in the Disability Discrimination Ordinance.
K. The Hong Kong Polytechnic University

(1) The need for medical examinations rests with exposure liable to exceed half the occupational exposure limit for a chemical, which is usually assessed on an 8-hour working day, or with significant risk of ingesting the chemical. The Regulation does not specify the number of days of exposure to the hazardous substances prior to the need for medical examination, otherwise it cannot be enforced. Accordingly, a worker should undergo a pre-employment examination, and periodic examinations at specified intervals if he continues to be employed in that occupation.
(2) Medical examination is of equal importance to workplace environmental monitoring. The proposed FIU (Safety Management) Regulation, which incorporates the requirement for self-regulatory risk assessment for determining the level of exposure, will complement this proposed Regulation. The safety management regulation will be introduced into LegCo on 27.10.99. In the meantime, we will issue a guide to the employers, employees and AMPs listing out as comprehensively as possible the occupations in various industries that medical examinations are likely to be required.
L. Hong Kong College of Community Medicine

(1) We are pleased to have the strong support to the FIU (Medical Examinations) Regulation from the Hong Kong College of Community Medicine.
(2) We agree to the reasons for requiring medical examinations to be carried out only by AMPs.
(3) We are pleased to note that the College is open-minded and ready to accept family physicians as AMPs when the Hong Kong College of Family Physicians re-examines and changes its vocational training programme.
M. Hong Kong Occupational Safety & Health Association

(1) We fully agree that a well-designed engineering system can help eliminate the health hazards at work. To this end, the other subsidiary regulations under the FIUO would serve the purpose of minimizing health hazards by various engineering means. Medical examination is of equal importance to other preventive and control measures for ensuring the safety and health of workers.
(2) The proposed Regulation has put together the medical examination requirements under various subsidiary Regulations into one regulation. This would facilitate any future changes to medical examination requirements. However, to be more cost-effective, medical examinations should be directed at occupational diseases which have relatively longer latent periods and where reliable biomarkers are available. This will allow early warning of adverse health effect for preventive and control measures.
(3) See item E(3) above.
(4) On detecting an occupational disease, either suspected or confirmed, all doctors including AMPs are required to notify the Commissioner for Labour under section 15 of the Occupational Safety and Health Ordinance. Statistics on confirmed notified occupational diseases are kept and monitored by the Labour Department. It is therefore not necessary to make a similar provision to record and establish the statistics under the proposed regulation.
(5) The proposed FIU (Safety Management) Regulation will incorporate the self-regulatory requirement for workplace environmental monitoring.
(6) The Appeal Board aims to re-examine the recommendation of the AMPs, in particular the workers' fitness for work. Should re-examination on the health condition of the worker be required, the medical examination would be undertaken by the Occupational Health Service of the Labour Department and the cost borne by the Government.
(7) A medical examination certificate remains valid until the next periodic examination is due, irrespective of any change of employment during the validity period so long as the worker concerned works in the same occupation.
(8) The purpose of the proposed Regulation is to detect early absorption of hazardous substances in the worker's body and any other occupational diseases covered in the law, particularly those with long latent periods, at an early stage. Insofar as occupational asthma is concerned, the most common sensitising agent is isocyanate. Medical examinations of workers exposed to isocyanates have already been covered under item 15 of Schedule 1 of the proposed Regulation. As regards hepatitis in catering workers, this refers to hepatitis-A, which is an acute disease caused by eating food contaminated with the virus. As there is little medical justifications for the medical surveillance of this disease among catering workers, it has not been included in the proposed Regulation.
(9) An auroscopic examination is part of a medical examination, and therefore should be carried out by an AMP. As for audiometric examinations, an AMP or a competent technical person who has undertaken training in audiometric screening is qualified to perform the test.
(10) All occupational diseases identified during medical examinations have to be notified to the Commissioner for Labour for investigation and statistical analysis. As all of them are compensable under the existing Employees' Compensation Ordinance (ECO), the Pneumoconiosis (Compensation) Ordinance and the Occupational Deafness (Compensation) Ordinance, adequate compensation arrangement is already in place. There is therefore no need to amend the ECO.
N. City University SCOPE OSH Alumni Association

(1) See item M(2) above.
(2) See item C(1) above.
O. The Occupational Safety & Health Council
(1) The medical examination scheme under the FIU (Medical Examinations) Regulation to be made under the FIUO was first proposed by the Expert Working Group on Occupational Health Services in 1992. The subsequent consultation process was completed long before the enactment of the Occupational Safety & Health Ordinance (OSHO) in 1997. If the proposed regulation is to be made under the OSHO which has a much broader scope than the FIUO, the whole consultation process as well as the law drafting process have to be done all over again. This will certainly cause significant delays to the legislative timetable. In order that workers engaged in hazardous processes in factories and industrial undertakings can benefit from the proposed medical examination scheme as soon as possible, the Administration considers it more appropriate to proceed with the original proposal expeditiously. The feasibility of extending the proposed scheme to cover similar hazardous processes in the non-industrial settings will be examined at a later stage when the proposed regulation, if passed, is fully implemented. It would also be useful to gain some operational experience under the FIUO before it is fully extended to cover the non-industrial sector.
(2) See item C(1) above.
(3)As AMPs have adequate training in audiometric tests, it would be more appropriate to put the responsibility of performing audiometric tests on the AMPs. We would hope that the Occupational Safety & Health Council can run more competency courses on industrial audiometry to facilitate AMPs to delegate such responsibility to competent audiometric technical personnel.
(4) As the cost of medical examinations is to be borne by the proprietors, it would be more appropriate for the proprietors to appoint their AMPs. However, a list of AMPs would be made available for proprietors for appointment and reference, and for the information of all employees.
(5) The CITA is now working on the administrative arrangements for the medical examinations of construction workers. CITA would ensure transparency in the nomination of AMPs and monitor their performance. The initial proposal is that the CITA will appoint a list of service providers, by tender, which will employ appointed medical practitioners for providing the required medical examination service. On referring a construction worker for medical examination, a proprietor will have to seek the principal contractor's endorsement of the employment status of that worker, and specify on a request form the worker's job title and recommend the types of medical examination required by reference to the guide to be published by the Labour Department. The examination requested will be verified by the AMP when he examines the worker and goes through his employment history. On completion of an examination, the AMP will furnish the medical examination report to the proprietor, with a copy to the worker concerned and the CITA. The worker will not be charged for the examination fee which will be settled, in accordance with a package rate, between the AMP and the CITA.
P.Occupational Deafness Compensation Board

(1) We fully agree with the Occupational Deafness Compensation Board that in the long run, there should be less applications for compensation for occupational deafness and that the Board's resources can be channeled more for preventive, promotive and rehabilitative activities related to hearing conservation.
(2) We are pleased to have the Board's full support for the medical examinations to be carried out by AMPs with training in occupational medicine.
(3) We fully agree with the Board that the fear over losing employment is unfounded. Experience in Singapore in running the statutory medical examination scheme for over 10 years is that permanent suspension from work is very rare.
Q. Construction Industry Training Authority

(1) We are pleased to have the Authority's full support to the proposed medical examination scheme, and the view that the scheme will further enhance the protection of the health of construction workers concerned.
(2) We agree that the Authority is well poised to take on the agency role for the medical examinations of construction workers, and are pleased to note that it has agreed to take on this new role.
(3) The proposed regulation, if passed, will be implemented by phases, allowing sufficient time for the affected parties to prepare themselves for the new requirements.
(4)A bill to amend the Industrial Training (Construction Industry) Ordinance to give effect to the new role for the CITA and the collection of additional levy will be submitted to the Legislative Council later in the 1999-2000 legislative session.
R.Joint Statement made by 12 Organisations/Individuals

(1) - (5)These points are similar to those made by the Hong Kong Workers' Health Centre. See the Administration's response to the Centre given on 21 September 1999.
(6) See item E(2) above.
(7) On the receipt of a medical examination report, a proprietor is required to ensure that the employee concerned is medically fit for the designated occupation. They can do so by any means they consider appropriate, for example, keeping that employee's examination report certifying his fitness for work, or recording in that employee's personnel file to the effect that the relevant medical examination report has been checked. So long as the proprietor has done so, he has discharged his obligation under the law. In this regard, we consider it not necessary to compulsorily require proprietors to keep valid medical examination reports.