Mike Flowers is a powerful gatekeeper. He often decides whether to send poultry workers to a doctor when they get hurt on the job or complain of chronic pain.

"I think we do a pretty good job of taking care of these folks," said Flowers, who treats workers at the House of Raeford Farms plant in West Columbia, S.C.

Ernestina Ruiz thinks otherwise.

In 2006, after months of deboning thousands of chicken breasts each day, her hands and wrists began to hurt. She complained to Flowers at least three times, she said, but each time he gave her pain relievers or a bandage and sent her back to work.

" 'You're going to be fine,' " she recalled him saying.

A large lump grew on her left wrist. The pain got so bad, she said, she went to a private doctor and had surgery.

Day after day, poultry workers are cut by knives, burned by chemicals or hurt by repetitive work, according to dozens of injury logs compiled by plants across the South.

Because many are illegal immigrants and can't afford private care, their health rests largely in the hands of company medical workers.

Those in-house attendants are supposed to help workers heal. Instead, some have prevented workers from receiving medical care that would cost the company money, an Observer investigation has found. And in some instances, the treatments they provide can do more harm than good.

At House of Raeford, some health-care workers lack medical credentials. At least two came to their jobs as convicted felons.

House of Raeford officials said they staff each plant with trained personnel who use accepted first-aid practices to handle minor injuries. Workers who need more advanced care are referred to doctors, the company said.

"I believe we have provided the care for our employees that's expected," said Gene Shelnutt, the company's human resources director.

In communities near four House of Raeford plants in the Carolinas, more than 30 workers told the Observer that company medical attendants did little to help them when they suffered injuries or complained of pain. More than a dozen -- including Ruiz -- said those attendants refused their requests to see a doctor.

Ruiz, who began working at the West Columbia plant about 2000, said her problems began about two years ago after she was moved to the deboning line, where workers make thousands of cutting and grasping motions each day.

She recalled how sharp pains shot through her hands and wrists each time she grabbed a piece of chicken streaming down the production line.

Medical experts say cysts such as the one that grew on Ruiz's wrist often result from repetitive work.

Flowers told the Observer that Ruiz never asked him to see a doctor. And the company had no proof her injury was work-related, he said, noting that the cyst wasn't on her dominant hand.

Ruiz said she used both hands on the deboning line.

Consultations costly

Companies aren't required to provide on-site medical staff, but many poultry plants have for decades.

In an industry known for the pain it inflicts on workers' hands, deciding when to send employees to doctors can have far-reaching effects. Companies must compensate workers if they are injured on the job and require a doctor's treatment or can't work. Productivity suffers. When injured workers require treatment beyond first aid, employers also must record those injuries on federal logs; too many such injuries can draw scrutiny from workplace safety inspectors.

In this environment, medical gatekeepers often face a choice: provide workers with the care they need or save the company money.

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