Health Care Often Misses the Boat


Peter S. Greenberg, Special to the Herald
The Miami Herald

A cruise ship was sailing between Nassau and Fort Lauderdale. According to allegations in a lawsuit, a little after 6 p.m. the ship’s doctor received an urgent telephone call from a woman passenger. The woman’s husband had just collapsed in his cabin.

Witnesses said the doctor arrived 20 minutes later, performed a cursory examination and had the man taken to the ship’s infirmary. They said he diagnosed stomach cramps. Two and a half hours later the passenger died. The apparent cause of death: a heart attack 2 1/2 hours earlier. The cruise line has declined to comment because the case is still pending.

According to another suit, a crewmember aboard another ship died from heatstroke after jogging in the Dominican Republic. Investigators for the plaintiff’s attorney say they researched the deceased’s medical treatment on board the ship as well as the credentials of the ship’s doctor.

“What we found,” says one attorney involved in the case, “was that the doctor had been licensed by a foreign medical school then being investigated for selling diplomas.”

Again the cruise line has declined to comment pending the outcome of the case.

How serious is the problem of medical care on board cruise ships? “Actually, it’s quite scary,” says Charles Lipcon, a Miami-based personal injury attorney specializing in Admiralty law. “Most of the cruise lines boast they have a doctor and an onboard clinic,” he says. “But many of the cruise lines I’ve investigated have foreign doctors not licensed in the United States. And the ones I’ve looked at couldn’t even get their licenses in the United States.”

Lipcon is one of a number of Florida lawyers who make a living suing cruise lines in wrongful death and injury cases, and he represents both passengers and crewmembers.

Invariably, Lipcon‘s cases are settled out of court. “In fact,” he says, “every case I have has settled.” Why? Some legal observers feel that the cruise lines settle these cases not just to avoid the publicity of a trial, but to avoid setting new legal precedent. Under current law, shipping companies are not liable for the conduct of the ship’s doctor relating to the ship’s passengers.

Indeed, most cruise ship doctors are hired as independent contractors. With the exception of the dispensing of seasickness tablets, which is usually free, passengers pay the doctor — not the cruise line — for medical visits/examinations/treatment on board.

There are no published statistics (nor will any cruise line make them available) that indicate how many passengers get sick, or die, aboard cruise ships each year.

“Actually,” says Dr. Carter Hill, medical director for Holland America Lines, “the number is exceedingly low. But that doesn’t mean we’re not concerned about the problem of care aboard our ships.”

Holland America is one of the cruise lines that have traditionally maintained high medical standards for its ships’ doctors. All Holland America doctors must be North American- licensed, trained in emergency medicine and family practice, and a majority of them must currently be in active practice when not serving on the ship. Each Holland America ship has three nurses (most ships have one). And while there is no U.S. legal policy requiring Holland America — or any other cruise line — to always have a doctor on board, it is corporate policy that no Holland America ship will sail without one.

“Providing proper medical care has not been a problem for us,” says Roderick McLeod, executive vice president of Royal Caribbean Cruises.

“Traditionally,” he reports, “most of our medical cases involve sunburn, colds and the requisite amount of seasickness. Historically, most people don’t get sick on cruise ships. If they did, we wouldn’t be in business.

“But industry wide, medical care is a problem, because if one line looks bad, then we all look bad.”

In recent months, Carnival Cruise Lines has moved to upgrade the quality of the doctors it hires as well as to upgrade medical facilities.

“Our policy,” says Carnival’s Gallagher, “is to hire more American-licensed physicians, and that number is increasing.” Of the line’s seven doctors, three are now American. And medical facilities on board are now state-of-the-art. On Carnival’s new ship Fantasy (making its inaugural cruise early next month), medical facilities include an operating room, trauma room (with special emphasis on cardiac care and life support), and both a female and male isolation ward.

“Passengers need to be responsible, too,” says Royal Caribbean’s McLeod. “Some of them need to be reminded the reason why they are traveling with us. They are taking a cruise vacation, not boarding a hospital ship to continue the treatment they received on land.”