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Saturday, October 14, 2023

Medical history of my spine injuries

In response to clarifications requested following my reddit post which includes a case summary and my earlier article, I have put together a medical history of my spine injuries. 

  • No spine injury prior to serving national service. 

  • Aug 2006 - First service injury (“2006 Injury”) while serving full-time national service. I was subsequently issued a service injury certificate, for two prolapsed discs L4/5 and L5/S1, after filing a service injury report which included a statement being taken from me.

  • Jun 2012 - MINDEF confirmed 15% permanent disability (“PD”) attributed to the 2006 Injury.

  • I was working full-time as a MOE teacher before Jan 2015.

  • Jan 2015 - Second service injury (“2015 Injury”) on the first day of in-camp training, after my SGH and SAF medical certificates were amended. The post-injury MRI confirmed that one of the discs worsened while the other remained the same. This suggested a traumatic etiology. 

  • May 2015 - I went for surgery as there is no improvement in my condition despite being placed on medical leave. 

  • Aug 2015 - I was issued a service injury certificate even though no service injury report was filed yet, i.e., no statement was taken from me. This was in spite of my queries regarding the report form and the investigation.

  • I was on medical leave from Jan 2015 to Aug 2015. I returned to my school in Aug 2015 but was not given any teaching work since the school year was about to end. 

  • My symptoms returned in the first week of 2016. After consulting a specialist, he opined that I was not suited to be a school teacher. Following the medical opinion, I resigned in March 2016. I left for New Zealand in July 2016.

  • Mar 2019 - MINDEF confirmed a 10% PD attributed to the 2006 Injury (which is lower than the 15% PD assessment in 2012) and a 0% PD attributed to the 2015 Injury. MINDEF therefore concluded no additional award was payable under PD. MINDEF started to refer to the 2006 Injury as a pre-existing condition.

  • Nov 2019 - I filed an appeal to MINDEF Compensation Board for a higher award.

  • For the last few years, I have been employed on a part-time basis (0.25 full-time equivalent) and work mostly from home.

  • Sep 2023 - The compensation Board ruled an additional 5% PD attributed to the 2015 Injury. In making this ruling, I believe the Board would have carefully considered the full circumstances.

A non-zero PD percentage assessed for the 2015 Injury is a precondition in order to be considered for an additional award. The 2015 Injury would also need to be "an injury received under exceptional circumstances", such as, negligence by MINDEF officers. The Compensation Board has however made no ruling on the matter of negligence by MINDEF officers.


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Tuesday, October 10, 2023

1 minute case summary


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Sunday, October 8, 2023

MINDEF Compensation Board makes no ruling on the matter of negligence by MINDEF!

The “final and conclusive” decision served by the MINDEF Compensation Board (“Decision”) is outrageous. The Board made no ruling on the matter of negligence by MINDEF, which is unjust after strong arguments and solid evidence were submitted before the Board. The Board should have made either a finding or no finding. 


An appeal before the Courts is possible but it will be very costly. 


In what follows, I will demonstrate why there is a credible chance of a successful appeal, presenting before you the objective evidence.


Alternatively, click here for a summary of issue and evidence if you trust that my decision to appeal is made after a careful consideration and is not done on impulse.


Plea for help by donating or sharing this with others


If you would like to support my cause (which is not just about me, but all Singaporeans), please consider sharing this article and/or making a donation. Sharing can be done by clicking "More" at the very top of the page. Details are provided at the end of this article.



Background


I refer to the medical certificates below. The reservist medical officer had initially endorsed the SGH medical certificate (left) but later withdrew it (right) after a private conversation between the medical officer and the non-medical commanding officer. 



The SGH medical certificate stated “Excuse from reservist & downgrade permanently”. The reservist medical officer first wrote “Excuse ICT” (first SAF medical certificate) before amending it to “Light Duties x2/52” (second SAF medical certificate) hours later. There were clearly two contradictory conclusions made by the medical officer on that day. 


The Singapore Medical Council (SMC) Ethical Code and Ethical Guidelines (ECEG) – 2002 edition applicable at the time of incident – also explicitly states what a doctor can or cannot do with regards to amending the provisions of a medical certificate (see highlighted paragraph below). 



We submitted to the Compensation Board that the reservist medical officer, in arriving at two contradictory conclusions on the first day of the 2015 ICT, had shown that he was unable to arrive at a single conclusion, let alone a defensible one, thereby failing the “Bolam-Bolitho test”, a legal standard often used to assess medical negligence. 


The Compensation Board also articulated their official position during the first hearing in March 2022 that SGH’s light duties should be defined by SGH, and the SGH specialist clarified in my medical certificate that the light duties include “Exclude from reservist” (within the same section/box on light duties).  


Establishing negligence is pivotal in determining whether I am eligible for an additional award. The Compensation Board has already ruled that a 5% additional permanent disability is attributable to this 2015 injury.


Given our submission on the medical officer failing the “Bolam-Bolitho test”, you should expect the Compensation Board to launch an inquiry into the matter on negligence by MINDEF officers in the interest of justice and for the purpose of an additional award. 


This however did not happen.


Board issues no ruling on negligence


The MINDEF Compensation Board chose not to make a ruling on whether I “could successfully establish negligence” (paragraph 58 of “Decision”). Note that this is different from making a ruling of “no finding”



The Board also declined to transfer the case over to the Courts despite requests made through my solicitor during the hearings.


It is essential to address the Compensation Board's assertion that I "did not produce any other material evidence in support of its submission that there was negligence." The Board clearly did not find the amended medical certificate sufficient evidence to support my allegations. 


Contrarily, MINDEF itself supplied another critical evidence for the Board's consideration. We shall see why this critical evidence supports my submission.


MINDEF presented their medical directive before the Compensation Board. This directive outlines the procedure that must be followed by their medical officers when amending a non-SAF medical certificate. In my case, the reservist medical officer did not consult another medical specialist before issuing his SAF medical certificates, when he was required to consult. 


Furthermore, the medical directive specifies the steps that the commanding officer can take after receiving a SAF medical certificate from a medical officer. Amending a SAF medical certificate is not among the steps that the commanding officer or the medical officer can take.


Finally, the Minister for Defence has said the following about external medical certificates in 2018:


“SAF medical officers don't revoke MCs from external doctors: Ng Eng Hen”

20 November 2018



Clinical review and amendment to MCs


In his written response, Ng said, “Singapore Armed Forces (SAF) medical officers do not revoke medical certificates (MCs) issued by external medical practitioners. Unit medical officers may, however, conduct a clinical review of the SAF personnel’s medical condition and propose an amendment to the MC.


“To effect such an amendment, the medical officer either discusses the case with the medical practitioner who issued the original MC, or refers the SAF personnel to a relevant specialist who can advise on the proposed amendment.


“An amendment could include an adjustment to the duration of the MC, or exemption from specific activities. Personnel may at any point see the unit medical officer for a further clinical review.”


He added that instances of amendments to MCs are “infrequent in the SAF”.



Source: 

https://sg.news.yahoo.com/saf-medical-officers-dont-revoke-mcs-external-doctors-ng-eng-hen-012105770.html 


The procedure articulated by the Minister for Defence is consistent with MINDEF medical directive. 


Summary and conclusion


In any military institution, adherence to directives is paramount, and non-compliance carries consequences. On that fateful day, the medical officer, commanding officer, and battalion second-in-charge all failed to adhere to the procedures set forth in the MINDEF medical directive.


In particular, a change was made to a SAF medical certificate. This change was made without consulting the SGH specialist who issued the original SGH medical certificate (note that the SGH certificate was issued before the two SAF certificates).


Despite this, MINDEF / Compensation Board simply refused to order a further independent investigation on these MINDEF officers. An inquiry on the matter of negligence should have been convened a long time ago given all of the following objective evidence!

  • Medical certificates;
  • SMC ECEG (2002 edition);
  • MINDEF medical directive;
  • Bolam-Bolitho test (legal standard).


Instead, the Compensation Board makes no ruling on the matter of negligence. This is not the same as making the conclusion that I have no evidence. The evidence is clear and conclusive. The decision by the Compensation Board is simply unfair.


MINDEF is not merely answerable to me; MINDEF is answerable to all Singaporeans!



Plea for help by donating or sharing this with others


Kian Wee is reaching out for donations to continue his legal battle against MINDEF. Since the 2015 service injury, he has already spent close to $50,000 on the legal battle using his limited savings. His spine injury does not allow him to work full-time.


The next battle will be a complicated High Court matter and could be a high-profile case. Kian Wee has therefore been advised to seek a senior counsel who will assist his current lawyer. The cost of this case is estimated to be more than $150,000.


If you feel strongly about Kian Wee’s cause, please consider making a donation and/or sharing this article/plea with your friends. Sharing can be done by clicking "More" at the very top of the page.


Any amount of donation and any publicity will make a significant impact in holding negligent officers accountable, thereby creating a safer environment for our servicemen dedicated to the defence of Singapore. 


Account details: 


POSB 057-58243-0 

(to Kian Wee)


PayNow 92966780

(to Archippus who will then make transfers to Kian Wee regularly)