Cruising for a bruising?
May 13, 1999
Web posted at: 10:21 a.m. EDT (1421 GMT)
(CNN) -- Last year, more than five million North American vacationers boarded cruise ships, many expecting floating utopias.
But Consumer Reports Travel Letter says that instead of paradise, some of the estimated five percent of cruise passengers who sought medical attention may have had a nasty shot in the arm.
Consumer Reports is a nonprofit, independent consumer information organization. Its Travel Letter is a monthly magazine of evaluative material specialized for the travel market.
The April edition reports that in many cases, medical facilities aboard cruise ships simply don't measure up to passenger expectations. And the data gathered by Consumer Reports is compelling enough that the organization is calling for regulation of such factors on ships sailing from U.S. ports.
What are the rules? There are few...
According to Consumer Reports, there are no international standards governing medical care on cruise ships -- no regulations even saying that a passenger vessel must have specific infirmary facilities or equipment.
Ships aren't even required to have physicians on board, although the five biggest North American cruise lines -- Carnival, Holland America, Norwegian, Princess and Royal Caribbean -- sail with at least one doctor and one nurse on each ship, according to a survey by Consumer Reports.
HEALTHY CRUISING
Consumer Reports Travel Letter recommends cruise passengers take the following health precautions:
- Check with your doctor to make sure your health permits travel
- Ask cruise lines about their medical facilities
- Alert the cruise line about any specific medical needs
- Check the ship's most recent sanitation rating, as ranked by the Centers for Disease Control and Prevention (CDC)
- Bring extra medicine
- Bring a medical information sheet, and an EKG if you have a heart condition
- Provide emergency contact phone numbers, including your doctor's
FLOATING A PROPOSAL
Some of the standards the American College of Emergency Physicians recommends for cruise ships:
- Physicians with three years of post-medical school clinical practice and board certification in emergency medicine, family practice, internal medicine or general practice with emergency medicine experience
- Shipboard capabilities for isolating infectious passengers
- Supplies and medications for common medical emergencies, including enough advanced life-support medications to handle two complex cardiac arrests
- Basic X-ray and lab facilities; two cardiac monitors, two portable defibrillators, an external pacemaker, an electrocardiograph (EKG), trauma-cart supplies and cervical-spine immobilization capability
"We're not trying to alarm anyone," says Laurie Berger, editor of the Travel Letter, "but we are saying be smart about it. Don't assume the level of medical care is the same as what you receive in the U.S., because many ships lacks the proper facilities and the doctors aboard often don't have medical training comparable to doctors in the U.S."
While passengers can't expect National Institutes of Health, Consumer Reports' position is that cruise ships should have at least infirmaries, similar to small emergency rooms.
'A floating biological island'
"People have the sense they're going to New York for the weekend, or next door, when really they're on a floating biological island," says Emory University's Dr. Phyllis Kozarsky. She's a specialist in infectious diseases and travel medicine.
"People are in close contact with one another for longer periods of time than they're used to," she says, "and they need to exercise common sense and be prepared."
Kozarsky says preparedness includes making sure that immunizations are up to date and that passengers know how to treat themselves for any illnesses they know they have, such as diabetes.
The Travel Letter checked the five largest lines, each of which said it meets or exceeds the medical guidelines of the International Council of Cruise Lines (ICCL). The letter reports that doctors aboard Carnival, Holland America and Norwegian lines ships are licensed in the U.S. and Canada. Princess and Carnival doctors are licensed in the United Kingdom. Norwegian lines doctors may also be licensed in South Africa. Royal Caribbean says its doctors are licensed primarily in Scandinavian countries.
Nevertheless, Consumer Reports quotes a 1996 survey of the medical facilities and staff qualifications of 11 cruise lines that found 27 percent of shipboard nurses and doctors not certified in advanced cardiac life support; 54 percent of doctors not certified in trauma life support; and 45 percent of doctors weren't board-certified in their areas of practice.
In terms of medical equipment, the same study indicates that of ships surveyed, 72 percent had no floor-mounted X-ray machines; 45 percent had no mechanical ventilators or external pacemakers; and 63 percent had no labs to do blood tests used to diagnose heart attacks.
"Inadequate medical care on cruise ships is an overwhelming threat," Berger says, "an accident waiting to happen, especially when it comes to seniors and children. You have lots of opportunity for harm and injury, and cruise lines are not prepared to deal with them."
That survey was conducted by two Florida physicians, Richard Prager, M.D., and Bradley Feuer, D.O. It was published in the Journal of Critical Care Medicine and its findings were presented to the Florida Medical Association. That association's resolution on the matter was adopted by the American Medical Association in 1996. The ICCL then used recommendations of the American College of Emergency Physicians (ACEP) to help it generate medical guidelines for its 17 member cruise-ship lines.
But Consumer Reports points out that neither ICCL nor ACEP enforce those guidelines or inspect ships that are on record as having adopted them. In a phrase: no oversight.
Case in contention
The Travel Letter tells the story of Darcy and Kristopher Carlisle. They're suing Carnival cruise lines, alleging the company failed to provide their 14-year-old daughter with proper medical care and a competent physician aboard the "Ecstasy" on a 1997 cruise to Mexico.
Consumer Reports says the Carlisles' suit states that they visited the ship's infirmary twice with their sick daughter. Each time, the suit charges, the ship's physician misdiagnosed their daughter's appendicitis as influenza. The court complaint says that today the teenager suffers from lingering health problems.
A Carnival representative is quoted by Consumer Reports as saying the company disputes the Carlisles' account of the incident and going on to say, "We are confident that our ship's medical staff will be exonerated."
The issue -- as viewed from which deck?
Cruise-industry attorney Jeffrey Maltzman -- who's handling the Carlisle case -- tells Consumer Reports, "The whole problem in cruise-ship medicine depends on what you consider the benchmark. Compared to major metropolitan hospitals, it comes up short. But compared to (the care available) in a remote area, it's excellent."
Maltzman's client list includes Carnival, Princess, Royal Caribbean and other lines. He tells Consumer Reports that while it's true most cruise lines don't hire a lot of U.S.-licensed doctors, the physicians they do hire have equivalent qualifications.
Emory University's Kozarsky says that unrealistic passenger expectations or inadequate preparation can cause problems on board.
"Cruise lines are paying more attention to passenger health," she says, "because they have to. But you cannot expect to find a specialist on board. A cruise ship is not a floating hospital. The facilities are not the same as people would find at home."
To ward off potential problems, Consumer Reports advises that cruise passengers check with their doctors to make sure their health permits travel; ask cruise lines about their medical facilities and make sure staff members speak English; alert the cruise line about any specific medical needs; and check out the ship's most recent sanitation rating, as ranked by the Centers for Disease Control and Prevention (CDC).
Consumer Reports' call for a response
Consumer Reports is looking for wider action -- with teeth. The organization, its report reads, "believes the health-care guidelines already proposed for cruise ships by the American College of Emergency Physicians (ACEP) are a good start. But we believe the guidelines should have the force of law. An enforceable, international standard of care may be years away -- but health-care services on cruise ships routinely sailing from U.S. ports should be regulated by American law."
Some of the ACEP recommendations: physicians on ships with three years of post-medical school clinical practice and board certification in emergency medicine, family practice, internal medicine or general practice with emergency medicine experience; shipboard capabilities for isolating infectious passengers; supplies and medications for common medical emergencies, including enough advanced life-support medications to handle two complex cardiac arrests; basic X-ray and lab facilities; two cardiac monitors, two portable defibrillators, an external pacemaker, an electrocardiograph (EKG), trauma-cart supplies and cervical-spine immobilization capability.
While such recommendations and demands for action remain unfulfilled, Kozarsky says passenger foresight is the key.
"Don't assume anything," she says. "Make sure your immunizations are up to date. Bring an extra stock of medication that you normally take. Before you leave on the cruise, walk through your pharmacy and stock up on over-the-counter items that you take at home for minor illnesses.
"Learn to self-treat minor ailments yourself. And if you have an underlying illness such as diabetes, you need to make sure you're self-educated and prepared."
