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Some Question Health Care on Cruise Ships | Associated Press

by John Pain
AP Business Writer


MIAMI (AP) - The man in his 40s was thrilled when he hit a big jackpot at one of a cruise ship's slot machines. Ten minutes later, his jubilation was abruptly ended by chest pains. Dr. John Bradberry performed an electrocardiogram and quickly determined the Carnival Cruise Lines passenger was having a heart attack. Bradberry gave him a thrombolytic, a clot-busting drug that increases the survival chances for heart attack victims.

"We treated him with all the basic treatments he would have in an emergency department on land," Bradberry said. "He subsequently did well."

Cruise companies point to such stories as examples of the high-quality medical care they provide at sea, on ships that carry nearly 5,000 people. But critics say that despite recent improvements in care, passengers are still at risk if they become seriously ill.

Some doctors say onboard care has a long way to go, pointing out that most ships only have one or two physicians with up to four nurses and that most infirmaries don't have surgical equipment.

"The facilities are as good as they can be for a ship but it's not an emergency department," said Dr. Marshall Silk, a former cruise doctor for two decades who now has a private practice in Fort Lauderdale.

The vast majority of the more than 9 million people who take cruises each year never need medical care. If passengers need help, it's usually for treatment of minor injuries such as cuts, cruise companies say.

But the three biggest cruise companies - Carnival Corp. and PLC, Royal Caribbean Cruises Ltd. and Star Cruises PLC - have all been sued over alleged shoddy care on ships that led to passenger deaths or permanent health problems. Many of those cases have been quietly settled, while others are still pending. U.S. law generally favors cruise companies, which argue they should not be held liable because most doctors are independent contractors.

One pending case was filed in 1998 by the parents of Elizabeth Carlisle, of Ann Arbor, Mich. They claimed a Carnival doctor diagnosed the girl's abdominal pains as flu when she actually had a ruptured appendix. She underwent surgery and was left sterile by infection, the lawsuit said.

Dr. Arthur Diskin, medical director of Carnival Cruise Lines, said many of the passengers who have sued either came aboard already sick or did not inform ship doctors of their health problems, which can make treating them difficult.

"The majority of the cases I've seen have resulted from unrealistic expectations of the passengers," he said.

Medical care on cruise lines was also questioned when gastrointestinal viruses struck ships recently, sickening hundreds of people.

Bradberry, who has been a full-time cruise doctor for about three years, said those outbreaks were blown out of proportion, but he acknowledged that they can be a challenge:

"It certainly can overload the health care system on a ship. You end up working 'round the clock," he said.

The average shipboard doctor's salary is about $50,000 a year, according to the International Council of Cruise Lines, an industry group. That's less than half of what the average general practitioner makes on land.

Still, Bradberry said he enjoys working on a cruise ship, with perks that include free travel to vacation spots. It's also satisfying to help people who might have to wait days to see a doctor on land, he said.

Bradberry and others contend medical care is better because of the industry's self-imposed improvements.

In the 1990s, the American Medical Association unsuccessfully tried to get Congress to regulate medical care in the cruise industry. Most cruise lines are incorporated outside the United States and most ships fly foreign flags, which shields them from U.S. law.

Since then, the International Council of Cruise Lines has created nonbinding guidelines to have better trained doctors and to put modern X-ray machines, medications and other equipment on board.

"Our ability to police ourselves as an industry in the medical profession has increased and is more than adequate at this point," said Diskin, who is also chairman of the emergency department at Mount Sinai Medical Center in Miami Beach.

Two Florida doctors who found many problems with cruise ship health care in a 1996 study now say the industry has made great strides with its medical guidelines. At the time, the study found many doctors lacked emergency training and ships lacked equipment and medicine for treating problems such as heart attacks.

"The guidelines are excellent. The only challenge is that's all they are - guidelines. There is no outside agency looking to make sure that they're doing that," said Dr. Bradley Feuer, of West Palm Beach, who co-authored the study with Dr. Richard S. Prager, of Miami.

Diskin acknowledged that one flaw is that there is no residency program for cruise line medicine. Silk agreed that was a problem, but said more important was that some older ships have outdated infirmaries and medical equipment.

Critics believe the industry needs government oversight.

"I wouldn't want to get sick on a ship," said Charles Lipcon, a Miami attorney who has represented passengers in lawsuits against cruise companies and doctors. "I've just seen too many horror stories, although I do think it's improving."

But one passenger thought the care she received on board was as good as what she would have received on land.

Jennifer Campana, 31, of Los Angeles, was several months pregnant when she started bleeding heavily on a Royal Caribbean cruise in fall 2002, leading her to think she was having a miscarriage. She went to the infirmary, and the doctors calmed her down and gave her medicine to stop the bleeding until the ship reached Cozumel, Mexico.

An ultrasound at a hospital showed she and her baby were fine. She said she felt so comfortable under the care of the ship's two doctors that she decided to stay on board.

"I honestly believe that I have my daughter today because of those doctors on the cruise ship," she said.


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