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Cruise Ships Ill-Equipped For Medical Emergencies

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Published:   |   Updated: May 29, 2013 at 10:38 AM

TAMPA - With bars always open, buffet lines that never end, and decks bustling from activity, cruise lines offer to fulfill your every vacation need.

Unless you become sick or injured.

Two weeks ago, 89-year-old Jack Clevenger of Ruskin experienced what he portrayed as minor internal bleeding and was put off a cruise ship at a Honduran port. Last month, a 91-year-old New Port Richey woman with dementia and high blood pressure was forced to go ashore in Cozumel.

In both cases, these Carnival Cruise Lines passengers didn't want to leave and had to make their own arrangements to get home.

"They told us we had one hour to pack and get off the ship," said Georgene Wells, 65, of New Port Richey, who sailed from Tampa on the Inspiration and was dropped in Cozumel with the friend who had dementia. "They didn't try to accommodate us; they couldn't have cared less."

Carnival said that isn't how cruise lines usually work - that an agent accompanies people when they must go ashore for medical reasons to make sure arrangements are made.

But these crises at sea point up the differences that can emerge between expectation and reality when cruise lines trade in dream fulfillment.They may be packed to the gunwales with fun, but don't expect these seagoing resorts to include the latest in emergency care, said Andrew Malbin, a 53-year-old doctor who lives in Tampa and has practiced emergency medicine in the air and on the sea.

Still, Malbin said, cruise passengers need to take responsibility for themselves. Reading the fine print of a Carnival contract, for example, would reveal that the cruise it covers might not even have medical personnel aboard.

What's more, Malbin said, people often bring problems with them.

"Typically what happens is the passengers forget their bodies may not have left all their diseases at home."

Being Put Off Not Uncommon

ConsumerAffairs.com said that most people who fall ill on a cruise ship recover with no complications. At the other end of the scale, about 20 people die each year aboard cruise ships, mostly from heart attacks.

On any given week, Carnival alone has more than 54,000 guests and more than 20,000 crew members at sea on 22 ships, said cruise line spokeswoman Jennifer de la Cruz. That adds up to about 3.7 million passengers a year.

Several times a month, de la Cruz said, a passenger must be put ashore.

"It is never our practice to leave guests without a contact for assistance in a port of call," she said.
In cases where passengers are in critical shape, a special protocol kicks in.

A ship's nurse escorts the patient until the patient is in the care of qualified shore medical personnel, de la Cruz said. The nurse also comes along in life-or-death situations when a passenger is taken off the ship by the U.S. Coast Guard, in a helicopter or vessel.

But a helicopter is rarely an option, in part because of its fuel limitations, de la Cruz said. Cruise ships venture far from civilization and can travel for days between ports.

And if a ship is in a port that does not have adequate medical care - a lower standard of care than aboard the ship - the patient will not be sent ashore, she added.

Onboard Infirmaries Limited

The medical care aboard ship has its limitations, said Malbin, the Tampa doctor, who now is medical director with an air ambulance based in Brooksville.

A cruise ship infirmary can handle bumps and bruises, cuts and scrapes, sea sickness and headaches. It's ill equipped, however, to treat life-threatening aneurisms or heart attacks.

"If push comes to shove," Malbin said, "they maybe can do appendectomies."

Emergency treatment for a heart attack can often be done but only to stabilize a patient before removal from the ship.

Typically, ships have EKG machines and a laboratory that can do basic work. Doctors can run IVs and they have basic cardiac drugs. Some may have X-ray machines and can do suturing and put splints on broken bones. Infirmaries typically don't have blood banks for transfusions and can't do procedures inside the body, he said.

In the 1990s, Malbin worked as a doctor aboard the Regents Sun cruise ship out of Miami and New York City. He sent ashore one passenger a week, on average, when the infirmary couldn't do the job.

"It was a lot more work than I thought it would be," Malbin said. "You get a lot of people with different ailments."

The cruise and the medical profile of passengers vary widely, he said - young people and families on summer cruises in the Caribbean, for example, or older people taking the more expensive cruises to Alaska and Canada.

But one thing is common to all: People with heart disease, high blood pressure and diabetes still have those ailments when they board a vessel, he noted. Yet they might do a lot of drinking, eating rich and fat-filled foods, and generally failing to take good care of themselves.

Sometimes, those ailments catch up while at sea.

Insurance Can Help

Jack Clevenger was no cruise novice when he sailed with his family from Tampa last week on his sixth
birthday cruise in a row. At sea aboard Carnival's Legend, he noticed blood in his stool. He sought help at the infirmary, and was put off the ship with his son at the island of Roatan in Honduras.

That was unnecessary, he said, because the symptoms quickly subsided. He never even sought care at the Roatan hospital. Two days, three flights and $2,500 later, they landed in Tampa.

One lesson he learned, he said, is to buy travel insurance every time - a move strongly encouraged by Malbin and the cruise lines, too. Some travel insurers contract with air ambulances and pay for transportation from anywhere in the world, Malbin said.

Travel insurance might also have helped Georgene Wells, 65, Shirley Smith, 64, and Virginia Harley, 91, all of New Port Richey, who embarked on the Inspiration for Grand Cayman and Cozumel.

During the trip, Harley became disoriented and got lost on the ship, Wells said. She was found safe and sound, but the next day, Wells and Smith brought their traveling companion to the ship's doctor.
"We felt it was our responsibility to bring her down to the infirmary," Wells said.

Harley was diagnosed with high blood pressure, Wells said. The doctor said they had to leave the vessel in Cozumel.

The three women found themselves in a foreign port trying to figure out how to get home. It took 16 hours to get back to Tampa, she said, and cost them about $1,000.

"People should be aware that this can happen," she said.

They won't learn about it from the flashy ads or commercials that beckon passengers with promises of romance, fine food and snorkeling. But it's there in the fine print on the ticket contracts they sign.

There might not even be a doctor or nurse onboard, one contract reads, but it also says the cruise line might front the money for onshore medical care.

"The Vessel may or may not carry a ship's physician or other medical personnel at the election of Carnival," one of the cruise line's contracts reads. "While at sea or in port the availability of medical care may be limited or delayed. Guest acknowledges that all or part of their voyage may be in areas where medical care and evacuation may not be available. Guest agrees to indemnify and reimburse Carnival in the event Carnival elects to advance the cost of emergency medical care."

Putting Sailing Over Safety

Malbin said two stories from his service aboard a cruise line illustrate how passengers need to take responsibility for their own health.

Once, while docked in a New York City port, Malbin saw paramedics treating a passed-out man in the cruise ship's terminal. That night, he saw the same man in the ship's infirmary and asked what happened.

The man said he was taken to a hospital emergency room in the city, but the wait was long and he didn't want to miss the boat. He didn't much care about Malbin's explanation that medical care on the boat is limited. He was allowed to remain on the vessel.

Another time, Malbin's cruise ship was docked in Quebec City and he was called to a cabin to treat an emergency heart problem. Since they were in port, he called for emergency help ashore and the passenger was taken by ambulance to a nearby hospital.

Later that day, Malbin was called back to the same cabin to treat the same man. Malbin said the patient told him the Canadian doctors wanted to put a pacemaker in him, but he didn't want to miss his trip, so he returned to the ship. He was not allowed to sail.

"The bottom line is that there are limited capabilities on cruise ships," he said. "If you are out at sea, there is only so much you can do."


Reporter Keith Morelli can be reached at (813) 259-7760 or kmorelli@tampatrib.com.

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