SUPPLY OF ARTIFICIAL LIMBS TO INJURED WORKMEN

Mr Sia Khoon Seong (Moulmein): Mr Speaker, Sir, I rise to speak on the matter of artificial aids for persons who are unfortunate enough to suffer the loss of any portion of their limbs through accident or otherwise, and who are not fortunate enough to be able to purchase such aids which are necessary for them to earn their livelihood.

Any accident resulting in the injury to and eventual loss of a limb is a tragedy for any person. The tragedy, however, is greater where the person concerned belongs to the under-privileged class of manual workers whose very limbs are the means of supporting themselves and their families. I may safely say that it is not only a tragedy but also a calamity for a worker to have an accident to his limbs, because of his low level of wages and because of his invariably having little or no savings at all. Added to the physical agony and pain of his injuries, he has to suffer a great deal of mental agony and anxiety regarding his own future and the future of his wife, children, aged parents perhaps, and other dependants. His worries and fears about the future are very real and substantial, particularly if he is the sole bread-winner. Apart from the productive use of his God-given limbs, he has no other means or savings to depend upon for his livelihood. The plight of such an unfortunate victim deserves not only compassion and sympathy but also whatever help that can be given to enable him to face the future with a certain amount of hope and confidence .

Mr Speaker, Sir, in bringing up this matter of artificial aids for persons with amputated limbs, I am prompted by the need to rationalise the basis for determining the type of artificial aids to be supplied and the amount of charges to be levied, if the aids are so supplied. As an illustration, I refer to the case of a Public Works Department labourer who was admitted to hospital in February this year for diabetic gangrene of the left foot, resulting in his left leg being amputated below the knee. The hospital decided to fit him with a pylon or a wooden peg, and not with an artificial limb. The reason for this decision seemed to be on the following ground: as a Government employee, he would be fitted with a wooden peg free of charge, but if he wanted to have an artificial limb fitted, he would have to pay the full cost of the artificial limb. In terms of money, it means that he would have to find $250 to pay for the cost of such an artificial limb, which is made locally. Knowing the financial position of this P.W.D. labourer, I need not elaborate on his difficulty in finding this sum of money.

Hon. Members in this House may want to know what is the difference between an artificial limb and a wooden peg. An artificial limb has certain advantages over a wooden peg, namely, a patient fitted with an artificial limb will look in appearance very much like a normal person with natural limbs, and after some time he will be able to move about quite easily. But a patient fitted with a wooden peg is likely to feel dejected perpetually because of its unnatural appearance and will, in addition, find greater difficulty in moving about. An artificial limb is certainly far more superior to a wooden peg in terms of function and appearance.

A patient by reason of his being poor is not likely to be given a chance to be fitted with an artificial limb, simply because there is in existence at present a puzzling hospital regulation. The paradox of the whole situation is that if his condition requires him to have a wheel-chair, he is entitled, as a Government employee, to be supplied with one free of charge. I am sure hon. Members will agree with me that it is extremely paradoxical that, as a Government servant, while he is entitled to a free wooden peg which costs about $100, and a wheel-chair which has to be imported from the United Kingdom at a cost of $300, he is not entitled to an artificial limb which is made locally and which costs $250.

The reason for such a paradox is that there is a hospital regulation which classifies artificial limbs under the heading "Prosthesis", and wooden pegs and wheel-chairs under the heading "Appliances". According to this regulation or stipulation, items such as artificial limbs under the heading "Prosthesis" can only be supplied to a third-class patient if he pays the full cost of such items, irrespective of whether or not he is a Government employee. But such items as wooden pegs or wheel-chairs under the heading "Appliances" can be supplied to a third-class patient free of charge if he is a Government employee, and at a concessionary rate of 20 per cent of the actual cost if he is not a Government employee.

It is very difficult to follow the logic behind such a stipulation. To a layman particularly, artificial limbs, wooden pegs, or wheel-chairs, prosthesis or appliances all mean one thing, i.e., artificial aids for a patient who has had his limbs amputated. To split hairs by classifying one item under the heading "Prosthesis" and other items under the heading "Appliances" might be convenient for the purpose of administration, but certainly in this instance it is not to the advantage and interest of a third-class patient who has had his limbs amputated. This absurd stipulation deprives a poor patient of a chance to be fitted with an artificial limb which, as I said earlier, is far more superior to any other artificial aids in terms of function and appearance, simply because he cannot find the money to pay the full cost of an artificial limb that the hospital wants to charge him. Mr Speaker, Sir, I hope you will allow me at this juncture to mention in passing that, with regard to this P.W.D. labourer whose case I have just mentioned, the National Trades Union Congress decided to pay for the cost of an artificial limb to enable him to be fitted with one instead of with a wooden peg. The decision of the N.T.U.C. is only a symbolic gesture to ring out the cry of distress of this labourer and all those who happen to suffer the same misfortune. However, this must not be taken to mean that the N.T.U.C. has now been turned into a philanthropic organisation. It just does not have the financial resources to dole out assistance to all those who need help and charity -

The Minister for Health (Mr Chua Sian Chin): What about the hospitals?

Mr Sia Khoon Seong: - especially at a time when it needs all its own resources to strengthen the Singapore trade union movement. The responsibility of giving all possible care and assistance to the unfortunate must rest largely upon the State that has all the national resources at its command, and not on an organisation like the N.T.U.C.

I am sure hon. Members in this House will agree with me that requiring third-class patients, who are no more than humble and poor workers, to pay the full cost of artificial limbs, if they wish to have these fitted in place of their natural limbs that have been amputated, is both harsh and unnecessary. Fate has been cruel enough to them and, in addition to their agony and the pain of injury, they have grave worries and nightmares about their own future and the future of their loved ones and dependants. Their plight and distress are often shared and felt by well-meaning people who have shown and expressed their compassion and sympathy by making generous donations to assist them to meet the future with a certain amount of courage and confidence. Dedicated doctors and nurses have also done their bit by providing them with the best medical treatment and attention possible. Let there be no hospital rule or regulation that is harsher than is necessary. Laws and rules are made to serve mankind, not to enslave them.

I ask the Minister for Health to give his urgent attention and sympathetic consideration to my proposal to rationalise the various hospital stipulations governing the supply of artificial aids to orthopaedic patients, and to take steps to supply artificial limbs on the same basis as wooden pegs and wheelchairs are supplied to patients in third-class wards, whose limbs have to be amputated as a result of an accident or events beyond their control.

Mr Teong Eng Siong: (In Mandarin): Mr Speaker, Sir, I sympathise with the Member for Moulmein when he makes a request for the supply of artificial limbs. This is a matter of aftercare, because if a worker meets with an accident and has to have one arm or leg amputated, he will have to fit himself with an artificial limb in order to carry on his daily activities so as to look after the livelihood of his family. This brings me to the subject of better methods of safety in industrial firms.

There have been serious cases recently of industrial accidents. According to the statistics of the Ministry of Labour for 1968, there was a total of 8,147 cases, of which 109 were fatal. A total of 195 persons have become permanently disabled, and 1,343 persons have been disabled to the extent that they are unable to work further. From these statistics you can see the seriousness of the situation.

Singapore is peaceful. We have no wars. However, every year, unfortunately, we find that more than 100 people lose their lives and limbs. This is really a very serious matter and is a problem to ponder on. So a more practical attitude is not just to discuss the supply of artificial limbs but to adopt better effective measures. I think the Ministry of Labour should engage more inspectors to go to the factories and other places of work to make routine or surprise inspections to see whether the facilities there are safe and without hazards.

Mr Speaker: Order. Mr Teong, the debate is on the question of the supply of artificial limbs to injured workmen. The Minister for Health will be in no position to answer questions such as increasing the strength of the inspectorate, which should properly be directed to the Minister for Labour. Can you please confine your remarks to the supply of artificial limbs to injured workmen?

Mr Teong Eng Siong: (In Mandarin): Mr Speaker, Sir, I understand your ruling, and I will cut short my speech. As I have said just now, I feel that artificial aids are very necessary for these unfortunate people. But if the cost is to be borne by the workers themselves, it might be impossible for them to get artificial limbs because they draw a very low pay. According to calculations, an artificial limb costs about $2,000. If the worker happens to be working in a Government department, I feel that the authorities concerned should look into the matter and try to do all they can to enable him to maintain his livelihood and the livelihood of his family. This is what we, as a Government that looks after the welfare of the people, should do to help him discharge his responsibility.

Mr Chua Sian Chin: Mr Speaker, Sir, I quite understand the unfortunate plight of the victims who have lost their limbs. I personally do feel compassion and sympathy for them. But I would like to clarify certain points which have been brought up by the Member for Moulmein. He seemed to convey to the House the impression that artificial limbs are not supplied free to the unfortunate victims by the hospital authorities because the hospital administrators are splitting hairs and want to distinguish between a peg-leg and an artificial limb. He said they are slaves to rules and regulations. That is not the case. First of all, rules and regulations must be there and they must be applied. Obviously rules and regulations have been drawn up because there is a - and I underline it - rationale on which they have been drawn up. Perhaps if I may just explain, it will clarify matters. What is the difference between an artificial limb and a peg-leg or a pylon? As far as these aids are concerned, they are an artificial substitute for a lost limb. According to the experts, as far as peg-legs and pylons are concerned, they are the minimum substitute for a lost limb, whereas an artificial limb is something much more sophisticated and elaborate. Of course, the sophistication and the elaboration of artificial limbs can vary from type to type. Some artificial limbs can be electronically operated. But as far as the hospital rules and regulations are concerned, they are based on the policy that a peg-leg is the minimum substitute for a lost limb, and that is what the hospitals are providing at a subsidised price. Artificial limbs are something more than a minimum substitute. Of course, in any case, we must draw a line somewhere. If you say that a patient is entitled to a free artificial limb, then he may demand an artificial limb which is electronically operated.

There is another matter which I wish to point out to the Member for Moulmein - if he has not been aware of it, although he is a trade unionist. Under section 15 (3) of the Workmen's Compensation Ordinance, workmen who are injured are entitled to artificial limbs, but the price must be paid for by the employers. Why should the Government be held responsible for supplying a free artificial limb when, under the Workmen's Compensation Ordinance, it is the employers who should be liable to supply it? After all, they are the people who make a profit, whereas the Government does not make a profit. Of course, if the Government is the employer, it is a different matter.

Another point which hinges on policy is this. The Member for Moulmein said that in the case of the P.W.D. labourer, the N.T.U.C. had contributed some funds and, as a result, the labourer is now in a position to have the artificial limb. He also added that the N.T.U.C., although it helped in this instance, was not indicating that it was going to turn itself into a philanthropic organisation. On the same basis, I would say that a hospital is not a philanthropic organisation.

Mr Sia Khoon Seong: It is a State organisation.

Mr Chua Sian Chin: A State organisation is different from a philanthropic organisation. Is the Member for Moulmein suggesting that a hospital should be turned into a philanthropic organisation? Perhaps if I may bring up certain points, it may clarify the matter. According to the regulations, at the moment, a peg-leg or a pylon, which will cost about $100, will be supplied to a "C" class patient (who pays $1 per day) at 20 per cent of the cost of the peg-leg; that is, he will have to pay $20. In other words, it is subsidised; whereas if an "A" or "B" class patient wants a pylon or a peg-leg, he pays the full price of $100. However, I wish to point out that even the $100 is an economic cost. In other words, no profit is being made by Government. The $100 is the cost of the production of the peg-leg or the pylon.

Mr Sia Khoon Seong: Mr Speaker, Sir, I think the Minister for Health has missed some of my points in his reply. I am not quarrelling over the fact that there should be rules and regulations.

Mr Speaker: Mr Sia, you are not entitled to make a second speech. But if you will briefly enumerate your points without introducing any new argument, I will permit you to carry on.

Mr Sia Khoon Seong: I just want to tell the Minister that I am not talking about rules and regulations, or that they should not be there. What I am talking about is the rationale of the case. The rationale here seems to be a bit cock-eyed simply because, on the one hand, the Government allows a wheel-chair costing $300 to be given free and, on the other hand, it does not allow an artificial limb which costs $250 to be given free. That is the rationale that I am questioning, Mr Speaker, Sir.

With regard to the Workmen's Compensation Ordinance which was referred to by the Minister, I just want to point out that I am not referring to the cases under that Ordinance. I am referring to those labourers who, outside their work, happen to be knocked down by a car and are not covered by the Workmen's Compensation Ordinance. These are the two points I wish to mention.

Mr Chua Sian Chin: Mr Speaker, Sir, the way the Member for Moulmein has explained his case, of course, the rationale of it looks cock-eyed. But I think that is not the rationale on which the rules and regulations have been drawn up. I have made it quite clear just now that the rationale behind the rules and regulations is that, as far as the hospitals are concerned, they will give an artificial aid which will be the minimum substitute for a lost limb. According to my experts, the minimum substitute for a lost limb is a peg-leg. But if a person wants something more superior and sophisticated like an artificial limb, then he will have to pay for it.

May I just reply to the Member's other point? He has mentioned car accidents and so on. If a person involved in a car accident was not negligent, he can easily claim compensation.

Question put, and agreed to.

Resolved,

That Parliament do now adjourn.

Adjourned accordingly at Ten minutes past Six o'clock p.m. to a date to be fixed.