In a decision that could open cruises lines to damage payments when medical malpractice is alleged, a federal appeals court panel has rejected a defense that the cruise industry has used for a quarter century to avoid liability for mistakes made by medical staff on ships.

The decision by the U.S. Court of Appeals for the 11th Circuit could result in cruise lines defending themselves in more lawsuits, lawyers said last week.

The case in question involved a man who was treated for a head injury while ashore in Bermuda on an Explorer of the Seas cruise in 2011. The man later died, and his daughter, Patricia Franza, sued Royal Caribbean Cruises Ltd., seeking to hold it liable for alleged negligence on the part of the ship’s doctor and nurse.

The plaintiff alleged that the nurse failed to assess the man’s cranial trauma or do any diagnostic scans and left him without treatment, while the doctor took more than four hours to see him.

Initially filed in U.S. District Court for the Southern District of Florida, the suit was dismissed in a summary judgment by District Court Judge Joan Lenard, based on a long-standing precedent.

But writing for a three-judge panel, Circuit Judge Stanley Marcus said the suit plausibly established a claim against Royal Caribbean, and he sent it back to the trial court for “further proceedings consistent with this opinion.”

For more than 25 years, courts have relied for precedent on a 1988 case that found cruise lines could not be held liable for the actions of doctors on their ships because the doctors were independent agents, not employees.

That case, Barbetta v. Bermuda Star, has meant that injured cruise passengers have been limited to suing the medical providers on the ships.

Marcus wrote that much has changed since Barbetta was decided, including the rise of a complex cruise industry and the progression of modern technology, which have “erased whatever utility Barbetta once may have had.”

Robert Kritzman, a lawyer at Fowler & White in Miami and a former general counsel at Norwegian Cruise Line, said it was the first time Barbetta had been rejected as a precedent.

“It has been challenged before, but it hasn’t been overturned at the Circuit Court of Appeals level before,” Kritzman said.

Formerly, the courts had adopted the cruise industry’s position that because cruise lines were not in a position to supervise doctors and question their medical judgments, medical practitioners could not be considered employees.

Marcus said that other courts have abandoned this logic in other contexts, most notably involving railroad engineers, airplane pilots and chemists. He also said that medical professionals now routinely work for corporations, universities and other large organizations.

“As a matter of law, we are hard-pressed to see why the principal-agent relationship between a shipowner and a medical provider should be treated any differently,” Marcus wrote.

He said the roots of the Barbetta rule go back to “a wholly different world” of the 19th century, when doctors worked on steamships out of communication with land for weeks at a time.

“We now confront state-of-the-art cruise ships that house thousands of people and operate as floating cities complete with well-stocked modern infirmaries and urgent-care centers,” Marcus wrote. “In place of independent doctors and nurses, we must now acknowledge that medical professionals routinely work for corporate masters. And whereas ships historically went ‘off the grid’ when they set sail, modern technology enables distant ships to communicate instantaneously with the mainland in meaningful ways.”

Cruise lines themselves have asserted recently through CLIA’s “bill of passenger rights” that guests have a right to full-time professional emergency medical attention at sea.

Kritzman said the ruling did not automatically mean that doctors would henceforth be treated as cruise employees, but it did mean that courts will have to consider their employment status on a case-by-case basis.

“It stands to reason there will be more lawsuits,” Kritzman said, because it will enable lawyers to now try to attach liability to the deep-pocket cruise lines.

However, he added, “I don’t know ultimately whether or not there will be any greater level of success in those lawsuits.”

Cruise lines make attractive targets for lawsuits seeking monetary damages because ship’s doctors have fewer resources and are often foreign nationals who, after being sued, return to their home countries where collecting judgments following civil actions under U.S. laws are problematic.

Kritzman also said that decisions by the 11th Circuit Court have particular relevance for the cruise industry because it has authority over Florida. Most cruise ticket contracts specify that lawsuits against the cruise lines must be filed in Florida courts.

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