Most people on most cruises are middle aged and older. Any time you get a thousand or more middle aged and elderly people together for a week or so, simple unavoidable statistics dictate the likelihood of at least one person becoming critically unwell, or even of dying.
So cruise lines are no strangers to issues to do with passengers needing critical care during a cruise. No-one is disputing that, not even the cruise lines. But what is in dispute is the adequacy of the care arrangements the cruise lines make.
Unsurprisingly, if a passenger has a serious medical emergency, the cruise ship offloads the passenger at a shore hospital with more sophisticated facilities for patient treatment and care. But depending on where the cruise ship is at the time the emergency occurs, the closest hospital may not always be the best hospital – and, more to the point, it may not be a suitable choice of location at all.
That of course is something that we as passengers understand. If we, for example, go on a world cruise that involves sometimes multiple days at sea far from any port at all, and weeks at a time touring around the horn of Africa or other places where medical care is much less advanced than we are privileged to enjoy at home, we of course accept the implied risks inherent in our choice of cruise itinerary.
But there’s surely an obligation on the cruise lines to make the best choice they possibly can when it comes to deciding what hospital, in what port, to offload a passenger. We as passengers can’t be expected to research the health care services at every hospital in every port on our itinerary, and to have a type of ‘living will’ list of where we wish to be taken in the event of incapacitation. The cruise lines, with their many ships going around the same itineraries all the time, surely can be expected to build up a database of the best hospital facilities.
The cruise lines can also be expected to add further value by creating a ‘concierge’ type relationship with their preferred hospitals. Just like concierges have special relationships with restaurants and theaters that can enable the concierge to get preferential treatment for their guests, surely the cruise lines can ensure that their passengers are given full fair treatment when hospitalized. It is a simple concept – ‘We will designate you our preferred hospital on this island if you in turn agree to follow best medical practices in caring for our passengers’. The hospitals get a steady flow of patients, who they can charge western rates of health care services to, and the patients get the western standards of healthcare they expect and hope for. Everyone wins.
So in a perfect world, that is what would happen. But in the real world? Read this horror story about an unfortunate passenger’s experiences after being disembarked from Royal Caribbean’s Serenade of the Seas and transferred to a hospital on the Caribbean island of St Kitts.
Not to downplay the terrible tragedy of what unfolded for the passenger, but the thing that horrifies me the most is the denial and non-responsive response from Royal Caribbean. Where is there any indication of any interest at all in the cruise line seeking to add any value at all to this key part of managing their passengers’ experiences?
Royal Caribbean’s spokeswoman says
The health and safety of our guests is always our foremost concern
without seeming to notice or care that simply saying this doesn’t make it so, and indeed, their actions seem to colossally contradict their claim of the health and safety of their guests being their foremost concern at all.
Shame on Royal Caribbean.
David, this artcile does not tell the whole story, neither from the passenger’s side nor that of RCCL. Check out Chris Elliott for the details, which tell a somewhat different story.
Hi, Joel
The linked article is Chris Elliott’s article. What in particular do you feel is unfairly misstated?
Although I find that Chris Elliott is often biased in his views, he hit the nail squarely on the head when he offered advice about travel insurance.
No one should leave home without it. I would also ask the question whether it might be better to be put ashore and taken to a medical facility that might save your live, or to be carried around from island to island for who knows how many days aboard a cruise ship that has minimal medical facilities and little chance of receiving anything but first aid? I’ll take my chances on shore.
My travel insurance provider will come to my aid and get me to the proper facility or back home very quickly. I know this from experience.
Hi, Bob
Your question about the lesser of two evils – staying on the ship or getting off at the nearest hospital – is a very relevant question, for sure.
My sense is that the larger ships (and in this case, Serenade of the Seas is a very large ship, with 2500 pax and 900 crew) have reasonably extensive medical facilities on board, and, as best they can, have the ability to provide a western level of hygiene and care. And probably within the 2500 passengers at any given moment, there are at least a dozen nurses and half a dozen physicians who could be called upon to supplement the medical staff on board, too.
Clearly, in the case written about here, the person was not advantaged by being put ashore, and while it seems he did have health/travel insurance of some sort, what use is this when the hospital is filthy, the staff neglectful, and the medicines in short supply?
I don’t know the first thing about medicine and medical best practices, but I’d wager the key issues are to stabilize a patient and then to arrange for a medevac flight operated by a plane with a full suite of care equipment and staffed by at least one doctor and one nurse for the duration of the flight. Assuming a patient can be stabilized on board the ship, it would seem ideal to me never to set foot into a ‘foreign’ hospital ashore; but merely to be transferred by ambulance from the dock to the airport and taken straight into the waiting jet and then flown at 550mph from there either back to the US or to the nearest ‘western standard’ hospital, wherever that may be.
David,
Even the largest cruise ships do not have the type of medical facility that you envision.
They cannot perform surgery. They cannot even set broken bones. Many, if not most, have no x-ray equipment. The doctors are not schooled in trauma management, only general medicine or maybe internal medicine. So, if you break an arm or a leg, you will be dumped in the first port. This man had a massive heart attack that required specialized skills and equipment of the sort that no ships, and not even many hospitals in the US, have. So which is worse – being kept on the ship for possibly several days eating aspirin, or going ashore and hoping for the best and getting transported to a suitable locale? Neither option is good.
And, if there are medical personnel on board, what can they do without the right drugs, equipment, and facilities? Not much. Further, would they be willing to accept the liability? Most would not since there would not be much that they could do for the patient.
If the man in question had the “correct” medical insurance with evacuation coverage and 24-hour help, then the situation should have been resolved in good time. It sounds to me like his “insurance” was not adequate. But I don’t know since I have not spoken to him or his wife to learn about it.
I have had travelers in similar situations where the insurance company arranged for a transfer from the original medical facility to one better equipped to handle the situation as soon as the patient was stable enough, then fly him and his wife home (from Norway to San Francisco) by private jet as soon as the doctor said he could travel. They oversaw all of his medical treatments while abroad and for the first 48 hours after being admitted to UCSF Medical Center. It was all paid for 100% – $85,000 or more. I was his travel agent and I was in touch with the insurance company and the medical facilities in Norway for the entire time he was there to make sure he was getting the best possible care. Did this man’s agent do this – or did he book his trip and buy the insurance on-line? I don’t know.
But I do know about medicine and best medical practices having been an Army corpsman for six years, worked in military hospitals and several civilian hospitals around the country, and now I am a fulltime caregiver. As I have already said, the best course of action is to first stabilize the patient, then transport to a location that can give better care, then, if necessary, transport to the location that can offer a cure. Only the first option can be offered on a cruise ship.
The one thing that I will not comment on is the condition of the cleanliness of the hospital in St. Kitts, their pharmacy stock, or the quality of the care since I did not observe it. I have been a patient in and worked in hospitals in this country that I would be ashamed of for the same reasons as given by the man’s wife. I do know that there are many fine and reputable “Western standard” medical facilities in the Caribbean. I have even been treated in some. So I would not assume that just because it is in a tropical setting that the level of care will not be good.
As for the cruise line vetting the various medical facilities on all the islands, to me is a bit much to expect. What are they to do? Sail 1,000 miles to one that they feel is the best, or go to the one that is 100 miles away to get help for the traveller as quickly as possible? I would opt for the latter. And I would not even start to talk about the liability that the cruise line would take on. What if the patient dies while they are sailing the 1,000 miles to a “good” facility. What if the patient dies at that “good” facility that the cruise line recommended?
When we travel, or do just about anything in life, we assume the risks, whatever they might be. If we are smart, we anticipate that something could go wrong and provide for the eventuality. Hopefully, we will seek out people with the knowledge and experience to help us in making the correct decisions. But we still have to understand that there are no guarantees in life except for death. With that in mind, I go off and travel the world knowing that someone has my back, but that I still might not get home in the same condition in which I left it.
Bob Ensten
Windsor, CA
Hello again Bob
Thanks for your detailed further response.
I’ll happily concede the details to you, but may I return back to a top-level concept, which is simply this : I believe the cruise lines owe a duty of care to their passengers that is greater than that which they are currently discharging.
If you set yourself up in the business of taking elderly people on one week and longer journeys away from excellent medical care facilities, you need to be able to provide an adequate level of on-board care, and you also have some obligation to assist/ensure that when you offload your unwell passengers, they go somewhere that is suitable for their care needs.
Clearly Royal Caribbean clearly failed to do this.
This is not about insurance, although I completely agree with you that, while not cheap, good travel and medical insurance cover literally can be a life-saver and is not something one should skimp on. This is about the ‘first responder’ – which necessarily is the cruise line, and the inadequacy of their current level of response, and their stonewalling non-replies when asked to publicly explain/justify their actions.
David, we could debate this forever as I don’t think that we will ever agree. But I will ask you if a safari camp in a remote part of Kenya or South Africa should have a full medical clinic with an operating room and a large blood supply in case you are mauled by a lion? Should airlines go back to having only RNs as flight attendants in case someone has a heart attack at 39,000 feet? I’ve been called upon in the air to try to resuscitate someone. My point is that the cruise line offers transportation ONLY and NOT health facilities. And why do you think it is only elderly people who cruise or have medical situations on ships? I was on a cruise where a 30-something man fell and broke his arm while playing basketball. He was put ashore at the next port in order to receive medical treatment.
The medical staff on a cruise ship is similar to the EMTs in your local town/city. They are, as you call them, the first responders and will provide immediate care to stabilize in order to transport. Nothing more. I don’t believe that you would expect an EMT to perform heart surgery to insert a stent, or to set broken bones. Why do you expect that on a cruise ship?
I agree with you that a reply of some sort of reply from RCI might be nice, but I would never expect them to state publicly their policy on care and treatment of sick or injured passengers. Again, it would leave them wide open for all sorts of law suits from those who thought that they received “inadequate” treatment under the “policy” of the cruise line. We already have way too many frivolous law suits in this country, and others.