Some Ships’ Doctors May Need to Be Examined : Health: Cruise lines may stress that they have a doctor on board, but in some cases these doctors are improperly trained, improperly licensed and improperly supervised.

How serious is the problem of obtaining competent, qualified medical care aboard cruise ships?

“Actually, it’s quite scary,” claimed Charles Lipcon, a Miami-based personal injury lawyer specializing in admiralty law. “Most of the cruise lines boast that they have a doctor and an on-board clinic. 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.

“Cruise passengers are misled. They think they’re going to get good medical care on board, and they don’t. Personally, I love cruising; I think it’s a great vacation. I just don’t ever want to get sick on board a ship.”

Lipcon is one of a number of Florida lawyers who specialize in handling wrongful death and injury cases involving cruise lines. He represents both passengers and crew members.

Invariably, Lipcon’s cases are settled out of court. Why? Some legal observers believe that the cruise lines settle these cases not just to avoid the undue publicity of a trial but to avoid setting legal precedent.

Under current law, shipping companies are not liable for the conduct of the ship’s doctor relative to the ship’s passengers. The shipping company can be held liable for the crew, however.

“This is where the cruise lines are misleading the public,” Lipcon said. “In their brochures they boast of their doctors, put them in ship’s uniforms, like the ‘Love Boat,’ but when something goes wrong, the cruise line claims that the doctor is an independent contractor and not an employee of the line.”

In recent court cases, investigators have discovered that some cruise ship doctors are improperly licensed, improperly trained and improperly supervised. These same doctors have been charged with improper record-keeping, misdiagnoses, prescribing the wrong medications and, in some cases with contributing to the deaths of passengers and crew members, deaths that might have been avoided.

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,” said 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 lines with a reputation for maintaining high medical standards for its ships’ doctors. All Holland America doctors must be licensed in North America and trained in emergency medicine and family practice. A majority of them must be in active practice when not serving on the ship.

Additionally, each Holland America ship has three nurses (most ships have one). And, while there is no U.S. regulation 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.

“We’ve had instances where a doctor was late getting to a ship,” Hill said. “The ship waited.”

“Providing proper medical care has not been a problem for us,” said Roderick McLeod, executive vice president of Royal Caribbean Cruises. “Traditionally, 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. On-board medical care is an area we pay strict attention to because it’s the one area you can’t afford to compromise. Our doctors are not only properly certificated but well-equipped for emergency medicine and trauma care.

“Passengers need to be responsible, too. Some need to be reminded 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.”

Most cruise ship doctors are hired as independent contractors. With the exception of dispensing seasickness tablets, which is usually free, passengers pay the doctor--not the cruise line--for treatment.

Understandably, cruise lines try to protect themselves and limit their liability. Virtually every cruise ship brochure explicitly states that passengers with pre-existing medical problems or those requiring special medical treatment must disclose these conditions to the cruise line before boarding. The line then can refuse to accept these passengers, or require a liability waiver.

Still, Royal Caribbean’s McLeod argues that care “goes beyond the issue of a waiver or the facilities of any one ship. After all, no cruise ship is equipped with the resources of a hospital intensive care unit and most cruise ship doctors are usually at a disadvantage.

“In an emergency, they don’t know the patient or his/her medical history,” McLeod said. “They have to make a diagnosis based on the situation they’re presented.

“We strongly encourage each of our passengers to always travel with the name and telephone number of his or her personal physician, and also to carry a clear written record of any needed prescriptions or drug allergies.

“In an emergency the ship’s doctor can phone that physician over the marine satellite phone. It often makes a big difference in diagnosis and treatment.”

Holland America’s Hill agreed.

“We don’t do the proper job in encouraging travel agents to tell passengers how important this is,” he said. “A lot of them don’t discuss medical preparedness with their clients because they don’t want to bring the subject up.”

“We always encourage travel agents to tell their clients about travel medical insurance,” said Carnival Cruise Lines spokesman Tim Gallagher, “but most travel agents don’t sell it. People just don’t anticipate a medical problem on board cruise ships, and that’s understandable. Statistically, very few people do get sick on board.

“But passengers also need to know that the minute they leave the borders of the United States and sail into international waters, they are not covered by most insurance plans, including Medicare. We do recommend the extra insurance, especially the policies that cover medical evacuations.”

Such evacuations can be costly, ranging up from $5,000, a charge that is levied against the passenger.

Carnival, like most cruise lines, offers a Cruise Vacation Protection Plan, which is described in its brochures. The insurance policy covers everything from trip cancellation and delay to medical expense and medical transportation.