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Cruise Ship Medical Care Spotty

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August 16, 2002
Vacationers out for a good time at sea don't usually spend much time considering the potential risks of an ocean cruise but, in fact, for the duration of the cruise passengers are beyond the protections they take for granted.

Cruise ships sailing from U.S. ports are almost without exception registered under the flags of Panama, Liberia and the Bahames. They are exempt from most U.S. labor standards, environmental regulations, security requirements and medical safeguards.

The $12 billion cruise industry pays no U.S. corporate taxes and in most matters is beyond the reach of U.S. courts. Passengers are truly on their own.

The issue of medical care is especially worrisome, especially for passengers who may have underlying medical conditions that can become life-threatening if not quickly and properly treated.

Consider these factors:

• Once on the high seas, it is seldom practical for cruise ships to turn back in a medical emergency; helicopter evacuation is extremely expensive and useful only if the patient is adequately stabilized by the shipboard staff.
• Most shipboard infirmaries are set up to handle sunburn and seasickness and may or may not be able to deal with a serious illness or injury, even though heart attacks are the most frequent cause of death at sea.
• Infirmaries are usually staffed by doctors who are not licensed in the United States. Regulation of shipboard medical care is largely non-existent. Most cruise lines have no formal procedure for reviewing doctors' work.
• Doctors and nurses are independent contractors, not employees. Thus, the cruise lines are generally not legally liable for their actions.
• There is no international oversight of medical care because martime law does not require cruise ships to provide medical care for passengers, only for the crew.

With more than five million tourists taking cruises from U.S. ports each year, it's inevitable that the number of medical emergencies is increasing, raising concern among American physicians. A few years ago, the American Medical Association conducted a study that found glaring inadequacies in shipboard care.

For example, the study found that 27 percent of shipboard doctors and nurses lacked advanced training in treating heart attacks, the leading cause of death on ships. More than half the doctors and 72 percent of the nurses lacked advanced training in dealing with trauma.

The AMA called on Congress to take action but the cruise industry's lobbying organization, the International Council of Cruise Lines, has so far kept the issue off the Congressional agenda.

Partly to deflect Congressional action, the industry has adopted voluntary guidelines written by the American College of Emergency Physicians. The guidelines do not require certification in emergency or critical care.

While most passengers recover from shipboard illness, about 20 die each year. Heart attacks are the most common cause of death.

In their defense, the cruise lines compare their ships to small towns and say the level of care onboard is comparable to most small towns. Perhaps, but small-town doctors must be licensed and are overseen by state licensing boards and the hospitals where they practice.

Perhaps more significantly, if someone becomes ill in a small town, it is a simple matter to transport them by ambulance to a sophisticated medical center in the nearest big city. On the high seas, it's not nearly that simple, fast or inexpensive. And the nearest hospital will often be in a foreign country with medical standards that may be significantly less stringent than Americans take for granted.

What can travelers do? The first step is to check with your physician before sailing. Be certain you have an ample supply of prescription medications and a copy of your medical history. Check with the cruise line to see if it complies with the ACEP recommendations.

It's also a good idea to check you medical insurance and credit card plans. Some may provide emergency evacuation if you become sick in foreign lands or on the high seas. Most, however, do not.

There are numerous other dangers that can befall cruise passengers, everything from onboard fires and epidemics to bad weather and mechanical failure. For an eye-opening look at what is and isn't regulated by U.S. authorities, see the Coast Guard's cruise fact sheet.

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