By staff reporter Liu Jingjing

(Caijing Magazine) If not for a risky biopsy that confirmed his black lung disease -- nearly two years after an initial diagnosis that was nearly forgotten -- 28-year-old Zhang Haichao might still be struggling to justify his health compensation claim.

But Zhang pushed for proper medical attention and his legal rights as a victim of an occupational disease, eventually winning not only the compensation he deserved but a victory over a local health system that neglected sick workers.

Zhang's respiratory distress began in August 2007 after he spent two years working at a factory that makes fireproof bricks in Zhengzhou, capital of Henan Province.

Zhang was exposed to dust from the brick-making process at the Zhendong company factory. His sole protection was a face mask; that was the only worker safety gear provided by the company, and only some of the factory's 700 workers can get them.

At first, Zhang didn't know why his lungs appeared to be failing. Doctors diagnosed him with black lung – a potentially fatal disease typically contracted by coal miners, also known as pneumoconiosis – as early as summer 2007. But the medical findings were kept under wraps, and the brick company apparently liked it that way.

Without knowing why he was sick, and without an official medical report identifying him as a black lung victim, Zhang was legally barred from the monetary compensation available to workers who suffer from occupational diseases.

Zhendong's reaction to Zhang's case was predictable. China's law for occupational disease and injury puts the burden of proof on employers who, obviously, have no incentive to give evidence that could point to their own wrongdoing or negligence. 

"The determination process for occupational disease and work-related injury is way too complicated, making it very difficult for workers to make their case,"said Chen Bulei, an assistant professor at the China Labor Relations Institute.

Search for Answers

Actually, when his respiratory trouble began, Zhang thought he'd caught a cold. But as the symptoms persisted and, while still employed at Zhendong, he underwent three medical check-ups at an official disease control and prevention center in nearby Xinmi.

Never did the center's medical staffers mention finding anything abnormal. Zhang later got a check-up at Zhengzhou No. 6 People's Hospital, where doctors noticed a dark shadow after an X-ray of his lungs. But no one told him the cause.

A follow-up report from Zhendong later said doctors had failed to re-examine Zhang before his medical records were mistakenly sold for recycling during an office remodeling. 

Zhang quit the brick mill job in October 2007 and continued seeking medical help. He was examined at several hospitals over the following year. Tuberculosis and tumors were ruled out, but doctors told him the shadow was growing.

Doctors at some hospitals diagnosed Zhang's condition as black lung. But these hospitals lacked the power to issue the type of medical report required before a victim can receive compensation.

Zhang then went to Beijing hospitals but, again, doctors who confirmed pneumoconiosis said they were unable to issue an authorized occupational disease report that could make him eligible for compensation.

Paper Chase
 
Under Chinese law, Zhang needed an official report from the Zhengzhou Occupational Disease Institute based on exams at the Xinmi disease center. So he demanded the Xinmi center release its 2007 report about his medical condition, and in January 2009 he finally got a copy.

The Xinmi report, withheld from Zhang since summer 2007, described the abnormal lung condition that appeared on his initial X-rays. Indeed, Zhang was one of 53 Zhendong workers suspected of black lung based on 2007 medical tests. Company officials said they never received these health reports, but officials at the Xinmi center claimed otherwise.

Zhang then learned that the Xinmi report wasn't enough. Officials at the occupational disease office said they also needed from Zhendong his work history papers, as well as reports on factory health conditions and results from all of his medical check-ups.

Zhendong officials were uncooperative at first, initially denying that Zhang had been an employee and later dividing his work history into parts to argue that he hadn't been exposed to hazards for a lengthy period. Neither did the local government help Zhang.

According to a 2003 directive from the central government's Ministry of Health, authorized medical institutions are to take an active role in diagnosing occupational disease. When employers fail to provide necessary materials, the ministry said, occupational disease centers can make decisions based on other sources of information, such as victim accounts. The ministry rule also said public health authorities overseeing workplace safety have the power to punish uncooperative employers.

In Zhang's case, however, the 2003 rules were ignored by local authorities.

Truth Emerges

Finally in May, after a long delay, Zhang was given permission to undergo a check-up at the occupational disease institute. But despite what other doctors had earlier determined, he was diagnosed with tuberculosis.

Refusing to accept the institute's diagnosis, Zhang agreed to undergo a risky biopsy procedure that required open chest surgery. The procedure was carried out at the No.1 Affiliated Hospital of Zhengzhou University. It cost Zhang up to 30,000 yuan and left a 15-centimeter scar. But it proved that he had black lung.

Occupational disease institute and public health authorities claimed the biopsy was not legally binding. But media coverage of Zhang's case led to intervention by the Ministry of Health and the Zhengzhou municipal government.

Later, several government officials and medical institution directors were removed or suspended. Workplace safety inspections were carried out in Zhengzhou, and medical check-ups were arranged for workers in hazardous environments at Zhendong and other enterprises.

In July, officials at the occupational disease institute officials as well as Zhendong changed their minds about Zhang's diagnosis, acknowledging he had pneumoconiosis. And the company chief agreed to provide compensation.

Full article in Chinese:
http://magazine.caijing.com.cn/templates/inc/chargecontent2.jsp?id=110219624&time=2009-08-02&cl=10