ORLANDO, Fla. -- Physicians participating in a panel discussion
sponsored by the Florida Medical Association here criticized
cruise-ship medical facilities as being unregulated and hidden from
public scrutiny.
The discussion was part of an annual meeting that gives
physicians the opportunity to discuss medical issues being aired in
the media. The topic of this year's panel, "Travel and Cruise Ship
Medicine: Keeping a Dream Vacation From Turning Into a Nightmare,"
focused on cruise medicine for the first time in the meeting's
10-year history.
Dr. Richard Prager, assistant director of intensive and critical
care at Baptist Hospital of Miami, said he could not advise a
patient with a pre-existing condition if there are adequate
facilities aboard any particular ship in the event of a medical
emergency.
"[We don't have] the information that we need," he said. "As a
physician, I'm concerned about the lack of a database."
Prager said there was also a lack of information on cruise line
plans for evacuating seriously ill passengers.
Dr. Bradley Feuer, an osteopathic physician who is director of
medical and academic affairs for Columbia Hospitals in West Palm
Beach, Fla., said shipboard medical facilities are unregulated and
should be overseen by an independent agency. Feuer, the moderator
of the panel, owns Pace Travel of Lake Worth, Fla., which organizes
cruises for physicians and other professional groups.
Dr. Alistair Smith, who is the medical director of
P&O/Princess Cruises, said International Council of Cruise
Lines (ICCL) has set voluntary minimum standards for its 17-member
lines in providing emergency medical care. Smith, who chairs a
division of the American College of Emergency Physicians (ACEP)
that specializes in medicine at sea, said the guidelines are
identical to those adopted by the ACEP. He added that all ICCL
lines "are fully compliant" with the guidelines.
Asked by Feuer how the public could be assured that the claim
was true, Smith replied, "You have to take it on faith that what
they [the cruise lines] are representing is correct. I think that
very few cruise lines are going to say they have specific
(facilities) aboard their ships if they don't."
Feuer commended Princess for going beyond other lines in listing
its ships' medical facilities and services.
Donna Esposito, president of the National Association of Cruise
Oriented Agencies, said that, although she can obtain information
on ship medical facilities from individual cruise lines, she cannot
find information comparing the lines and their ships in any of her
databases.
Feuer praised the industry for adopting voluntary guidelines but
questioned whether some lines would spend the money to implement
them if others did not.
Prager, who cited a report in a medical journal that cruise
ships face a wide variety of medical emergencies (see accompanying
story), said medical facilities should be regulated by a body such
as the Joint Commission on Accreditation of Health Care
Organizations. "The Joint Commission is there to be a patient
advocate," said Prager. "It's there to see that standards are
maintained. That [doesn't] exist [in the cruise industry]. There
are several guidelines, but there is no regulatory body to oversee
them for the passengers' protection."
Charles Lipcon, a Miami-based attorney specializing in
personal-injury lawsuits and a member of the panel, endorsed
Prager's call for regulation. "There's nobody looking over [the
cruise lines'] shoulders except people who file cases in courts in
the U.S. That's the only oversight," he said.
ICCL president Cindy Colenda, however, said, "From our
standpoint, the industry has done an excellent job in putting
facilities on board to focus on public health."
In a statement distributed to meeting participants, the ICCL
said that its guidelines, which were last revised October 1998, are
identical to ASEP. The statement said the ICCL's member lines meet
the "goals" of the guidelines, but it did not certify that all
lines have implemented the guidelines. She didn't identify which
ships have implemented the guidelines.
"Facilities and personnel will vary from ship to ship, based on
several factors, including the size of the vessel, number of
passengers and crew, and length and itinerary of the voyage," the
statement said.
Colenda said the ICCL is a policy-making organization and does
not collect specific data on cruise ships. Noting that the cruise
industry is continuing to update its medical facilities, the
statement pointed to the "widespread availability of thrombolytic
therapy," a treatment for heart attack victims. The ICCL, however,
did not provide information on which cruise ships offer the
service.
Medical journal calls for disclosure
ORLANDO, Fla. -- The January edition of the Annals of Emergency
Medicine, which is published by the American College of Emergency
Physicians, called upon cruise lines to disseminate information on
their medical practices.
"To allow passengers to develop realistic expectations in the
event of a medical emergency," the journal said, "cruise ship
passengers and travel agents who provide information to prospective
passengers should have information available regarding ship-based
medical capabilities and the cruise line's plans for medical
evacuations."
The journal, which published a study on medical services aboard
four ships during one calendar year, reported that a wide variety
of injuries and illnesses occur, adding that, "the spectrum is
similar in many respects to the patients [who come to hospital]
emergency departments."
The study documented cases involving 7,147 of the 196,171
passengers who were treated aboard four ships of Holland America
Line.
There were 786 cases, about 11%, that involved serious or
life-threatening diagnoses, the journal said.
Of all cases, 69.3% involved existing medical conditions, 18.2%
involved injuries and 12.5% were unspecified.
The most common cases involved upper-respiratory tract
infections, gastro-intestinal problems, sprains, contusions,
superficial wounds and seasickness.
Of the seriously ill patients, the most frequent conditions were
asthma, arrhythmia, angina, congestive heart failure and pneumonia.
Most people treated were from 45 to 64 years old.