【Case】Application for occupational disease assessment – refusal by chemical plant to cooperate

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Recently, a private chemical factory in Changsha received a letter from the Changsha Center for Disease Control, requesting relevant materials for the diagnosis and assessment of occupational diseases. The letter made it clear that if the company failed to provide such materials within the specified time frame, it would face legal consequences. This is the first document issued by the disease control authorities in Changsha urging employers to provide evidence, following the implementation of the newly revised Regulations on the Diagnosis and Identification of Occupational Diseases. The 2009 “lung examination by thoracotomy” incident remains vivid in memory. Due to the employer’s lack of cooperation, Zhang Haichao, a worker who suffered from pneumoconiosis, was unable to go to a occupational health center for assessment; meanwhile, other general hospitals do not have the authority to diagnose occupational diseases, so he had no choice but to undergo a thoracotomy to examine his lungs. Things like this will not happen again in the future; even if the employer deliberately refuses to cooperate, the new regulations stipulate that occupational disease diagnosis institutions can also initiate the diagnosis process and issue a diagnosis conclusion for occupational diseases. Tan Jianguo (a pseudonym), 48 years old, started working at a private factory in Changsha in July 2011, but in less than half a month, as a workshop operator, he began to experience symptoms of skin peeling all over his body. One day, while operating the machine, he experienced confusion that led to impaired behavior; he suddenly started the raw material furnace, which should have been shut down. It was only thanks to the urgent assistance of his colleagues that a greater disaster was averted. In August 2011, Tan Jianguo went to the Second Hospital affiliated with Xiangya Medical College for a medical check-up, accompanied by his family. The test results were surprising: not only was there a skin infection, but the electroencephalogram also showed abnormalities, and electromyography revealed damage to the nervous system. Subsequently, Tan Jianguo applied to the Changsha City Center for Disease Control for a diagnosis of an occupational disease. Staff from the center went to the chemical plant to conduct an investigation and found that there were no gas prevention facilities in the factory, nor were any gas masks, protective gear, or other protective equipment provided for the workers. The aerosol generated by the rapid rotation of chemical raw materials at a high temperature of 160 degrees Celsius does indeed pose a risk of causing damage to the human body. ”Zhang Yulian, head of the Occupational Health Surveillance Department at the Changsha Center for Disease Control and Prevention who was involved in the investigation, said that after discussion, the experts concluded that this situation met the criteria for diagnosing an occupational disease. At that time, the chemical plant cooperated actively in the patient’s treatment, and the incident was temporarily resolved. Recently, there have been new developments in the case. After more than a year of treatment in the hospital, Tan Jianguo’s skin condition has been cured and his brain wave patterns have returned to normal to a large extent, but abnormalities remain in his electromyogram results. At this point, the chemical plant stopped covering the medical expenses on the grounds that the patient had recovered. Tan Jianguo went to the Changsha Center for Disease Control again to request a diagnosis of an occupational disease. The Changsha Center for Disease Control and Prevention initiated the procedures for diagnosing occupational diseases; due to the lack of cooperation from the chemical plant, the diagnostic agency issued Changsha’s first letter urging the employer to provide evidence. Currently, frequent mobility of the working population and complex employment patterns make it difficult to determine workers’ occupational histories and exposure histories to occupational hazards. Zhang Yulian explained, \"Previously, if the employer refused to cooperate and deliberately created obstacles, by providing incomplete or no information regarding the worker’s employment history, we would not be able to conduct a proper diagnosis. As a result, the approval process had to be terminated, and it was impossible to proceed with the diagnosis procedure.\" ” Now, the new regulations stipulate the obligation of occupational disease diagnosis institutions to accept cases, eliminating the step of accepting applications for occupational disease diagnosis. In response to the non-cooperation of employers, it is also stipulated that if an employer fails to provide the materials required for diagnosing occupational diseases within the specified time frame, the occupational disease diagnosis institution may request the work safety supervision department to urge the employer to provide such materials. If, even after being urged by the work safety supervision department, the employer still fails to provide information such as the results of tests on occupational disease hazards in the workplace or occupational health surveillance records, or provides incomplete information, the occupational disease diagnosis institution may draw a conclusion regarding the occupational disease based on the worker’s clinical symptoms, the results of auxiliary examinations, the worker’s occupational history and exposure history to occupational disease hazards, as well as information provided by the worker himself/herself and data from routine supervision and inspection by the work safety supervision department. The place of diagnosis now includes the worker’s place of household registration. In the past, for occupational disease diagnoses, workers could only apply at occupational disease diagnosis institutions located in their place of employment or place of habitual residence, which caused a lot of inconvenience to them. The new regulations expand the range of institutions where workers can seek diagnosis for occupational diseases; workers can undergo such diagnosis at institutions located in the place where their employer is situated, in their place of household registration, or in their place of habitual residence. ”Zhang Yulian said. This move will help prevent local authorities from shielding employers. One diagnosis, two levels of verification: Zhang Yulian explained that the diagnosis of occupational diseases is usually carried out only once, and the diagnosis certificate issued thereafter has legal validity. If the employer and the employee disagree with the diagnosis result, they may apply for an assessment to the municipal health administration department where the occupational disease diagnosis institution is located within 30 days of receiving the diagnosis certificate. If they are not satisfied with the municipal-level assessment conclusion, they may apply for a re-assessment to the provincial health administration department within 15 days of receiving the assessment report, with the provincial-level assessment conclusion being the final one. That is, one diagnosis and two levels of verification.