Are cruise lines “dumping” their sick passengers? By Christopher Elliott | July 21, 2012 Fred and Connie Claussen’s honeymoon cruise on Royal Caribbean’s Serenade of the Seas ended on a tragic note. During the voyage, Fred suffered a massive heart attack. The Serenade’s medical staff treated him and then diverted the ship to St. Kitts, where he was transferred to a hospital. The Claussens are no strangers to tragedy. Fred lost his wife of 51 years to cancer, and Connie’s husband of 48 years died of heart failure. The retired couple, who live in Macon, Ill., met and married last year but postponed their honeymoon until February. What’s different about this latest calamity — which ended their vacation and will most likely shorten Fred’s life — is that it may have been entirely preventable. The ship’s decision to drop the Claussens off in St. Kitts proved to be a bad one, according to Connie. Conditions at Joseph Nathaniel France General Hospital were “nothing short of deplorable,” she says. The floors were covered with dried blood and vomit, and the emergency room frequently ran out of supplies. On several occasions, Connie had to take a cab to a pharmacy to buy medication for her ailing spouse. “Absolutely nothing was done to improve Fred’s condition while we were in St. Kitts,” she says. “The doctor would come in and look at him once a day. She would not communicate with Fred’s doctors in the States.” Fred languished in the hospital for five days without being given a stent, which aggravated his condition and permanently damaged his heart, Connie says. And then came the final insult: The hospital demanded $1,100 for its services before it would release him to an air ambulance that transported him to an American hospital — a payment that Connie calls a “bribe.” Patrick Martin, the chief medical officer for the Federation of St. Kitts and Nevis health ministry, says that Claussen’s allegations are under investigation as a result of my inquiry. He notes that the hospital in question has received emergency referrals from cruise ships for many years, and he says that the goal of such hospitalizations is to provide “the best available medical care locally in order to stabilize such persons and subsequently ensure their successful airlift to their next destination.” Royal Caribbean reviewed the Claussens’ situation and says it handled it by the book. But at least one expert says that the book is wrong: If cruise lines really cared about their passengers, they’d keep them far away from any hospital near a Caribbean port of call. “There are many horror stories like this,” says Jim Walker, a maritime attorney based in Miami who represents passengers who he says are “dumped” in the Caribbean. “The typical complaints we hear are watches, jewelry and cash being stolen by hospital personnel; unsanitary conditions; windows with no screens; flies everywhere; and nurses cleaning the toilets and then changing their IV lines. Hospitals max patients’ credit cards out. And they’re held hostage until all bills are paid.” Walker says that cruise lines have no legal duty to an injured or ill passenger, and that they are working hard to keep it that way. “Cruise lines have spent millions of dollars lobbying against efforts to change the law,” he says. A Royal Caribbean representative denies that the couple was “dumped” in St. Kitts, saying that the Claussens were taken to Joseph Nathaniel France because it was the closest reliable medical facility. “The health and safety of our guests is always our foremost concern,” says Cynthia Martinez, a cruise line spokeswoman. “The guest was taken to a hospital in St. Kitts so that they could receive lifesaving medical care as soon as possible.” I asked Royal Caribbean about its policy on dropping off passengers and whether the Claussens could have done anything differently. It declined to answer. Walker says that cruise lines keep their policies on emergency care confidential. Patrick Deroose, a general manager for assistance operations at International SOS, a company that offers medical evacuation services, says that the Claussens’ situation is not unusual and that the cruise industry’s policies, though not disclosed, are common knowledge. “It is usual practice for a ship to offload a passenger with medical conditions to the nearest island hospital,” he says. “But that choice is not always the best for the passenger.” How do you avoid a similar problem? Deroose says that you need to do your homework before you leave on a trip. If you bought travel insurance, read the fine print to make sure that medical evacuation is covered, and pay close attention to information about preexisting medical problems. If you have a condition that could flare up while you’re away, you might need a different policy or a separate medical evacuation plan, the kind offered by International SOS, Medjet Assist and other companies. Claussen says that it’s too late for her and her husband. His heart is damaged beyond repair, to the point where he can’t even answer a reporter’s questions about his ill-fated honeymoon. His doctor blames the hospital in St. Kitts, according to Connie. Now, she says she wants to warn others. “If the cruise line and insurance company looked into these hospitals and the kind of care available there, hopefully they could prevent this from happening to someone else,” she says. Christopher ElliottChristopher Elliott is an author, journalist and consumer advocate. You can read more about him on his personal website or contact him at firstname.lastname@example.org. Got a question or comment? You can post it on the new forum.More Posts - Website - Twitter - Facebook - LinkedIn - Google PlusFacebookTwitterLinkedInGooglePinterestReddit Related artemisia jones Cruise lines suck – but short of having a mini-hospital on board or establishing better hospitals in the Caribbean, I’m not sure what they should do. Wouldn’t heading back to the States mean dangerous delays in getting help? Honestly, I’d never take a cruise again. You are hostage to the worst sort of profit-hungry company and a crew of ill-paid and not-well-screened employees. I’d be happy to see most of the industry out of business. hooterville_mom Cannot emphasize enough – it is worth the extra $100-200 to buy medical insurance any time you leave the U.S. TonyA_says Not all countries have American caliber hospital facilities. Invest in Med Evac insurance if you are worried. BrianInPVD Agree—unfortunately sending patient’s family members to outside pharmacies to buy medications (with cash) and supplies is standard in many parts of the world. Also, even in the US, not every hospital has cardiac catheterization capabilities. Those that don’t will fly patients to hospitals that do, but if it’s not safe to fly due to weather, then you’re stuck and will get medicine instead of a stent. This is an unfortunate risk you take by traveling. Even if you have insurance, be prepared to pay cash to settle bills and be reimbursed later. technomage1 This is a tough call. On the one hand, the nearest medical facility may not be of the highest quality. On the other, the cruise line cannot reasonably be expected to provide anything beyond basic care on board. What is right for the patient is going to be judged on a case by case basis. As others have noted, international insurance is the answer. But who should pay for it? Should the cruise lines just pay a bulk fee for coverage, raising prices to do so? Should the cruise lines partner with an insurance company, offering their services at the time of booking for a discount, like trip insurance? At a minimum I do believe the cruise lines should mention that insurance is available while the passengers are booking. http://bidontravel.com/mobile/index.html Don Nadeau I have received simply wonderful medical care on Royal Caribbean’s Serenade of the Seas but its facility has not been designed to replace hospital care in very serious situations. I do not expect a full range of hospital services on a ship. Travel especially in the Third World involves certain risks, some of which cannot be avoided if you choose to go. Lets_Be_Serious Agreed. Many insurance policies will move you to a facility of your choice. The cruise lines definitely don’t have the facilities to address every possible medical need, and if the passenger dies onboard the cruise line is then sued for NOT dropping the passenger off at a medical facility. They are damned if they do, and damned if they don’t. Michael__K They DID ultimately leave by air ambulance, which suggests they either had such insurance or the means to pay for it out of pocket. The question I have is why did it take 5 days? Did it take that long to arrange it or did it take several days before they realized this was necessary? I can’t blame the hospital in St. Kitts for their resource limitations but I would expect them to communicate with the patient’s US doctors and to be up front about their capabilities. —– I’ve taken a trip with a tour operator that required a certain amount of medical evacuation insurance as a precondition for travelling with them. This very sad case makes me appreciate that they did so. But it also makes me wonder if even that is necessarily an adequate solution. jsiess we have a medical evacuation policy from Divers Alert Network (DAN) that costs about $50 for the 2 of us per year. you don’t have to be a diver to buy it. Alan Gore Something like this happened to my German aunt. While on a Caribbean cruise her husband died of a totally unexpected heart attack. She and the Uncle H’s body were dumped on the little island of Tortola, where nobody spoke her language and there was no assistance rendered. Apparently “admiralty law” permits them to do this so that a grieving widow does not interfere with the mood of the other passengers. She had to find her own way back to Bremen. MarkieA I’m not sure what insurance could do in this case; maybe I don’t understand all of the intricacies involved. Does the extra medical insurance ensure that you are taken to a “better” facility? Assuming the “better” facility is inland or, perhaps, in an entirely different country, would insurance provide transportation? Who’s to say which facilities rate the best, especially in a foreign country? I’m assuming the patient wasn’t transported earlier – before the “extra” damage was done – because it is unsafe to move a patient in his condition. I just don’t see how extra insurance would work. naoma We travel a lot and always have insurance that covers “evacuation” home if you become very ill. Some of this is covered on an American Express Platinum Card. INSURE against everything. Costly, but worth it!!! $16635417 Just curious, why single out the cruise line? How would it be different had they chose to stay in a resort in the Caribbean or other destination with limited medical care? backprop Everyone from the OP to the SOS representative is discussing how bad Royal Caribbean’s secret unwritten “dumping” policy is, but I don’t see one suggestion as to what they SHOULD Have done. If your airline is approaching St. Kitts on and you have a heart attack and they divert to the island and call ahead for an ambulance, are they “dumping” you there? Goodness, the ship and thousands of passengers went out of their way so this man could get treatment at a land-based hospital and she’s complaining? Is there something we’re not reading? Did RC send her a bill for the extra fuel to divert? Did the passengers try to recover money from the OP for a delay into the next port of call? I can’t imagine it came down to simple convenience for the cruise line considering it went off itinerary for this passenger. Also, calling the hospital bill a demand for a bribe does nothing to bolster her case. I would like to see the OP’s suggestions as to what RC should have done. http://mytimetotravel.wordpress.com/ mytimetotravel You have to read policies carefully, but there are policies that cover transporting you to the best available facility and then getting you home. You need evacuation AND repatriation. (The DAN policy referenced above doesn’t include repatriation, it only gets you to the nearest facility.) I don’t take cruises, but I don’t travel withou a good evacuation and repatriation policy. ClareClare A very sad case. I am wondering, though, what would have been our reaction if the ship had kept the husband on-board, and he had died before they got him to a “good” hospital in a better country? Wouldn’t everybody be criticizing them for not getting him to the nearest ER as soon as they could? Not that I want to defend cruise-lines, mind you. I’m also wondering whether the wife was in contact with the US Embassy there? It isn’t mentioned… In her shoes I would have been IN THEIR FACE, on the phone to them umpteen times a day. They can’t work miracles and they won’t pay the bills for us US citizens; but surely they could have helped arrange for a prompt medivac AND might have been able to intervene with the “bribe” situation? After all, the US Embassy or Consulate there must already have established ways to get to good medical facilities when their own staffers get sick… Rosered7033 So, the only take-away I can see is don’t have a heart attack if you are far from a hospital with a cardiac unit. When neither the ship nor the “local” hospital can adequately care for a patient, what is the answer? Airlift from ship to an adequate hospital? But the article states he was taken off in St. Kitts to “stabilize” his condition prior to transfer to the states. Immediate transfer to the states without stabilizing the patient is irresponsible & could be deadly. JummpinCaribbeanDeal How sad – this is an eye opener.Now I know why I have a phobia for cruises. http://www.facebook.com/people/Roger-Barnett/1352435334 Roger Barnett This happened to me on a Princess cruise; potential blocked artery, put ashore at Cabo San Lucas, Kaiser Senior Advantage patient, kept overnight and flown back to California the following day. The ship’s doctor, a Swedish doctor, said he could not keep me and provide treatment. The Mexican clinic was fine, and Kaiser was excellent in providing the air ambulance. All turned out well, but was a warning – taking a cruise is a risk if this kind thing happens. Result we have not taken a cruise since, and probably never will. TonyA_says Cruise, Fly, Ride, Run, Walk; doesn’t matter. If you are in St. Kitts and Nevis, you are in for a surprise, not unless you read this before leaving. http://barbados.usembassy.gov/emergency-st_kitts_nevis.html By the way, this is where your (our) tax money is going so use it. TonyA_says Get this! Even medical students at St Kitt’s University of Medicine and Health Sciences (UMHS) are required to have medical and evacuation insurance. Speaks volumes of the place. What’s there to investigate. Sounds like empty words to placate CE. jerryatric From airlines to cruise ships, to online travel agencies, & car rental companies the whole industry can be summed up in a word – it SUCKS. From rude or just plain stupid desk or on board staff, to policies done with behind the scenes lobbyists paying off your congresmen in 1 form or another, there is no regard for the PAYING PASSENGER. Customer Service is a misnomer EVERYWHERE! On top of all this grief in the U.S. you have a TSA filled with incompetent, ill trained “security guards” who relish their opportunity to embarass or steal from passengers. As far as on board hospital – had to be better than where they were dumped, at least it was clean & staffed. OR why not medi vac them from on board @St Kitts dock. They could have easily made the call while they were at sea. Easier just to get rid of the problem! As usual they ALL don’t care! sirwired As opposed to what? I’m wondering what the alternative would have been. While the medical facilities on-board aren’t bad, this isn’t what they are prepared for. Asking for payment before discharge (or, in many cases, before treatment) is the norm in many parts of the world. Get good overseas medical insurance, make sure you have a good credit card, and, for goodness sakes, buy medevac coverage. It’s cheap and worth every penny. If you don’t have medevac insurance, and you need to get home to receive needed treatment, you are simply going to die unless you can pay up for the evacuation. Neither the cruise line nor state department nor airline are going to bail you out. jerryatric TO Backprop A simple call to a medi vac service ( with patient consent) from on board to meet the patient at the nearest landing place (St. Kitts in this incident) & it is done! cruisemagic It is not the cruise line’s responsibility to investigate hospitals. It’s responsibility is to get the patient to a facility that is better equipped than the cruise line’s medical facility. Stop blaming the cruise lines for everything!!. I tell my clients to purchase travel insurance that includes medical evacuation. bodega3 Cruise lines do offer a coverage that includes medical. There is also 3rd party insurance. Medicare doesn’t cover people outside of the US, so anyone with Medicare coverage should always make sure they know BEFORE they travel how they handle any medical emergencies. http://upgrd.com/roadmoretraveled MeanMeosh So…what do you suggest that Royal Caribbean should have done, exactly? We don’t know how far away they were from another medical facility, or what other facilities are available in St. Kitts. The ship’s medical facility usually isn’t sophisticated enough to deal with serious emergencies such as this. What would have happened if it would have taken an entire extra day, perhaps days, or even several hours to get him to a “better” hospital? After a massive heart attack, even minutes without proper stabilization and medication can make a big difference. Delaying by going to another port may have been impractical, or potentially even dangerous to the patient. The sad reality is, when you travel in less developed parts of the world, part of the risk you take is that Western-standard medical care may not be readily available (I know – I lived in India for 2+ years, and although acceptable care can be found in larger cities, good luck if you have a medical emergency while traveling through rural areas). This is a truly tragic situation, but I just don’t see what else could have been done here. My real question is, why did it take 5 days to get the OP’s husband from St. Kitts back to the states? That seems like an inordinate delay – especially since if he did eventually get evacuated, I’m assuming they either had medical insurance and/or the means to pay for the evacuation. If they used insurance, I’d like to hear why it took the insurance company so long to authorize the evacuation. Raven_Altosk Yup. Totally not surprised at this. It’s reprehensible, but when you are dealing with corrupt nations with less sanitary conditions, you can’t expect otherwise. Just as an FYI…this in Mexico, too. I had a friend who had to pay $10K US cash to get her daughter out of a Mexican hospital after the girl broke her leg at a resort. The cash was doled out to doctors, nurses, and even a police officer before the patient would be released. My friend always says, “Funny how as soon as the cash came out everyone’s English improved.” Raven_Altosk PADI also offers them, but I think you do have to be certified to buy those. Nigel Appleby A sad situation. Unfortunately medical facilities on cruise ships are not eqipped to deal with sort of situation apart from what might be called first response. Some years ago we were on an Holland America cruise when one of the crew had a heart attack. HA and/or the ship arranged for the crew member to be put ashore by tender to Grand Turk, to be taken to the airport by ambulance and transferred to an air ambulance to be taken to hospital in Florida. The ship waited off the island until the timing fitted with the arrival of the air ambulance before commencing the transfer. This is the way it should be done and I hope that HA would still do this for a passenger or crew member in today’s world. Whoever is travelling with a passenger with the medical emergency might have to make noise about air ambulance from the get go. With our travel/medical insurance the company has to approve air ambulance evacuation so that might hold things up a bit. The other issue with travel/medical insurance is the limitations on pre-existing conditions which get stricter the more one gets past normal retirement age – like a lot of cruise passengers – at least with the companies with which I’m familiar. Bottom line, buy insurance and keep the contact and policy information handy. $16635417 I didn’t blame the cruise line. It appears the handling expectations are different for the cruise line than if they were staying at a resort on the island. I’m curious why. backprop Right – That’s exactly what the OP should have done. Which medi vac service did the patient have on-call? Which did she request? Oh wait, it was another five days before one came to get her husband. The question was, what should RC have done differently? cjr001 I’m not sure there’s really a right answer here. The man had a heart attack, so ANY treatment at the nearest facility probably saved his life. The only other option seems to be he could have stayed on the boat, where the facilities are next to nil, and died before they could get to a port and hospital that they approved of. I’m not sure of their situation with regards to insurance, nor the path of the cruise ship itself, but a flight evacuation from St. Kitts to the US Virgin Islands or Puerto Rico should have been a possibility. http://ladylighttravel.com/ LadyLightTravel Its medical evacuation insurance, which means that they will try to get you to the nearest good facility. Thier standards are usually US standards. My company uses International SOS. In one case a customer’s wife received a severe head injury. She was airlifted over 3000 miles to tne nearest “good” facility. MJonTravel Very sad for both individuals. But I have to ask, what was the cruise line supposed to do? Which island should they have transported to? They are equipped to triage patients on board and then get the patient somewhere with more advanced care. I know it’s shocking for some that medical care outside of the USA may not be exactly the same as it is here. If the couple had been vacationing at a resort in St. Kitts, the outcome would likely have been the same. backprop Also there is a big difference between DIVE insurance (covers what happens in the water) and medical insurance. The DAN platinum plan (I just renewed) is dive insurance and isn’t mean to cover me for, say, getting into a moped crash on an island. http://pulse.yahoo.com/_PIKT7FPO6W5G2OIEIXUWLHVB7E Judi I have 40+ years of medical experience as a critical care/ER RN. I have also cruised extensively since retiring 2 years ago. I have been able to “tour” the hospital facilities on 3 cruise ships. While these hospitals as equipped very well they do not approach what is available to land based facilities. I believe it is in the passengers best interest, in many instances, to be offloaded at the nearest hospital rather than stay in the ship hospital. Cardiac emergencies, strokes, need for urgent or emergent surgery do not belong onboard! Those patients need to be stabilized and transported. This patient needed a stent- no way is this available onboard! If you’re lucky the onboard MD is trained in emergency medicine but he/she still doesn’t have all the resources necessary to deal with this type of patient. Passengers need to plan, purchase a good travel insurance plan if their own health insurance doesn’t cover out of country care. It is incumbent on the passenger, or family, to NOTIFY the insurance carrier to make arrangements for whatever- transport, payment, etc.- after stabilization in the land hospital. It is not the responsibility of the cruise line. Read your contract of carriage. Bruce Burger I was on a cruise that did the opposite once. An elderly man badly hurt his leg swimming on the first day of a cruise on the Galapagos Explorer II. The ship basically spent the entire next day waiting near ports, first planning to transport him to an island hospital and then changing plans and waiting for an air evacuation. As a result, we lost a significant part of our cruise, especially folks like us who were aboard for only 3 days. Of course none of us other passengers knew the details of that patient’s condition or the discussions between the family, the cruise line, and doctors at home and in Ecuador, so we could only guess whether the cruise line was making a good decision. I’m sure if I had been that gentleman I would have wanted the ship to focus entirely on my needs, but is that fair given that we all must accept some risks when we travel to remote parts of developing countries? Anyway, in that case, as in the one Chris writes about here, the cruise line was damned if they did and damned if they didn’t. bodega3 Do you feel better now after that little rant? jerryatric Ah yes sounds like bodega3 is in the business. I am 74 yrs old. Have travelled throughout Europe incl. behind the old “iron curtain”, throughout Asia (some on business) & Africa, etc., etc. What I HAVE noticed is a terrible decline in Customer Service throughout the travel industry From the early 60’s to today it’s gone straight downhill!. This was no rant but a statement of fact. bodega3 Customer service has declined in very way, in every industry. Especially with the internet, so have the people making the complaints. flutiefan if the cruise line had kept him on the ship until finding a suitable medical facility, it may have also caused irreparable damage to Mr. Claussen’s heart and shortened his life. he may have even died waiting. then we’d STILL be getting a letter to Chris, but about how Royal Caribbean killed her husband. flutiefan i love knowing that you feel i’m “stupid”. MarkKelling I am sorry to hear the trip was ruined by the medical emergency and the perceived lack of medical care provided. Something like this is the last thing anyone wants to happen anywhere and especially not when you are miles from home. And this really did ruin the vacation unlike many of the recent gripes we have seen. While I am not a doctor and cannot know all the medical issues the man has, some of the statements made by the OP seem to be overly dramatic. If you have a massive heart attack, irreversible damage is already done to your heart. There are several discussions about how helpful a stent may be after a heart attack, the general consensus is that it doesn’t matter for what happened in the past. It may help prevent other heart attacks in the future but may not depending on the overall condition of the patient. The ship is obviously not equipped to perform this surgery and cannot expect to be. Was he in a condition that would allow the surgery to be done? It may have taken the five days to get him stable enough to even consider doing anything else. I also doubt the ship has a fully stocked pharmacy that would be able to supply the drugs required to treat a heart attack beyond the initial EMT type. Was there another port the ship would reach that was better equipped for these types of situations? Maybe. But the chance of dying or having another heart attack before reaching that port outweighed the benefit of trying to get there. The OP may think that no real medical care was provided, but I would think they did everything they could with what they had to prevent a second heart attack or death. The OP didn’t say what drugs she had to run to the pharmacy to buy. Was it the daily prescriptions her husband may have already been on? If so, she probably paid a lot less than hospital prices for those. And $1,100 for a five day hospital stay is not expensive compared to prices in the US. You can be charged more that that for a single day. In this particular case, the cruise line “dumping” the passengers probably saved the man’s life. However, I don’t believe that any and all medical condition requires the afflicted passengers to be dumped. And deciding where the line is on who gets dumped and who doesn’t is really the question that needs to be answered. flutiefan that’s not what mikegun said. read it again. jerryatric To the Flutie guy. I feel it’s more appropriate to call them Stupid or uncaring rather than thiefs or liars. If you like I can send you a summary of my last trip involving, Alamo, United Airlines etc., but I know you could not care less. Work in any of these industries? It wasn’t always like this. By the way flying in & out of Russia FAR WORSE than in the U.S. & Amsterdam airport just as bad or worse than anything in any U.S. airport. MrsFlutterby Had a tough time answering this question. We don’t know the cruise line’s policies, they are confidential. To say that disembarking passengers in any port is irresponsible is wrong, given this passengers obvious need for a higher level of care. He may have been medically unstable to travel for five days, we just don’t know. Most likely, it was the hospital not having the skills or facilities to properly stabilize that were the core of the problem. I was medically evacuated out of Venice, Italy. I had a great travel plan that came to my rescue, we had to front the $15,000 (thank you Air France) to get home but we had a check in less than 2 weeks. Never, I repeat, never travel internationally without a full fledged comprehensive medical insurance plan. In Italy, the doctors mimed to me that they could not help me and to go home, the ship’s doctors agreed. Fortunately I only needed a wheelchair. This man was in severe cardiac distress and probably needed a full air life flight to get him to a facility with full cath labs and coronary care units. All in all, I feel terrible for the couple who were lucky enough to go on a second honeymoon but am saddened they were placed/fell into such dire circumstances. A bit more research, perhaps a good travel agent, could have helped avoid this awful scenario. As Americans, we may complain about our healthcare system but which would you choose? I doubt any island nation would beat it. scapel The ship doctor should stabilize the patient and then transfer them by air or air ambulance as the case dictates back to their home hospital. I think the patient should have some imput as to where they wish to be sent and it should not be entirely up to the doctor as to where and how they go. The patient should be in agreement as to where and when they should go. Many times the doctor on board the ship and the observations hospital onboard is better than the local hospital. If the on board doctor feels that and angiogram and possible stent are indicated than they should be evacuated to a hospital that they the patient feels comfortable with and one that is able to treat the patient. How much communication is done between the on board doctor and the hospital doctor that the patient is being transferred to is questionable. I had a DIL sustain a fracture dislocation of her ankle on the first night of a Caribbean cruise and we got her to an airport and back home to Germany for her surgery later. Sadie_Cee There is no U.S. Embassy on St. Kitts. The closest embassy and the one designated to handle the affairs of the U.S. and its citizens on St. Kitts is located in Bridgetown, Barbados. Sadie_Cee Someone has written here that it is not the cruise line’s responsibility to know about the conditions in local hospitals. I strongly disagree. This should be an essential part of their logistics. We cannot blame St. Kitts for its limited medical facilities, it is what it is. On some of the islands, when faced with hospital stays local people have to prearrange their own support group to keep them provisioned with cooked meals, clean bed linen, and medicines, etc. It is also not unknown for surgeons and other medical specialists to demand payment in advance. All hospital expenses, including diagnostic tests, have to be paid before discharge. In this very sad case, there was probably no alternative but to transfer the OP’s husband to the hospital on St. Kitts, but RC could have prepared the OP by letting her know what to expect. The culture shock, in the midst of all her other troubles, was severe. From previous postings on this blog, we know that cruise lines are not equipped to deal with serious illnesses and this is unlikely to change soon, but surely they can be more solicitous in caring for people who find themselves in the OP’s position. $16635417 I still can’t understand why the clerks at WalMart know less about the items they stock than the guy who owns and runs an independent hardware store up the street. An why are his prices more than WalMart? Must be a scam. ;) <<< (Note my tongue in my cheek.) Ronay Cruise Lines are not hospital ships, but they should be responsible enough to see a seriously ill passenger transported (by medi-vac or ambulance) to a QUALIFIED medical facility…not just the nearest. The cost of that transportation should be borne by the patient and/or the patient’s insurance. If the cruise lines had to maintain an onboard ER (qualified team of physicians, and/or sophisticated advance life support equipment), most of the public wouldn’t be able to afford the cruise. It’s not fair to expect the cruise line to safeguard everyone against ANY health issue or accident that arises, unless it is a direct result of negligence on the part of the cruise line. Both parties need to own up to their fair responsibility in these cases. cjr001 And if you want to be safe, you go with a 3rd party insurance instead of what the cruise line offers. After all, those terms are to the cruise line’s advantage, not yours. FreshGinger This isn’t only a problem for guests. A friend of mine was working for a major cruise line, when she fell ill. On board they assumed she had the Norwalk virus and just quarantined her when she was complaining of severe pain accompanying her nausea. She finally was taken to a hospital in the Bahamas – where the only drugs they had were morphine based and would have caused an allergic reaction. How does a hospital only have one type of drug? It took days of wrangling thru insurance for her to be airlifted back to the US for major surgery to solve the problem. backprop I don’t think it’s the cruise line’s responsibility at all. If you are traveling to the Caribbean (or any foreign country), you need to prepare, and the way you do that is medical evacuation coverage. I can’t imagine how a scenario would play out where the cruise line demands a patient board a helicopter, only to, what, bill the patient later? And if the medevac was insured, why didn’t the OP call earlier? http://pulse.yahoo.com/_HMW3OTJSBDWWRKIEKEKWWM7BEA bc I find this entire article rather inflammatory. How can you expect a cruise ship to continue to transport a sick person? Really, so the cruise ship should have had the passenger stay in their stateroom until they arrived in america several days later. Last time I checked a cruise ship does not have medical personnel equipped to handle a customer in this state. Or do you expect the ship to return to America immediately and screw up everyone’s vacation for one elderly passenger? Disembarking is the only responsible thing to do. Also, as for referring the payment for the hospital services rendered as a “bribe” really? When you have a service at a hospital you usually have to pay for it? Do you expect to be treated for free? Finally, this is exactly why we buy travel insurance. It is not the cruise line’s responsibility to make sure it has the facilities to handle every kind of medical emergency that can occur on a boat. that’s plain ridiculous. If you voted yes, that disembarking passengers is wrong you’re nothing more than a bleeding heart with the right intention but little logic. http://pulse.yahoo.com/_HMW3OTJSBDWWRKIEKEKWWM7BEA bc I completely agree. What were they expecting the boat to turn around and give them all a ride back to America while her husband lay dying? disembarking to a land based hospital is the only right and logical thing to do. http://www.facebook.com/profile.php?id=731550660 Mayra Perez-Wiggins Holland America almost leave us in Aruba. My husband blood pressure was low and one of the ship nurses called the port paramedics. She was giving all the orders because “she don’t wanted a sick person on the ship”. The doctor never mentioned that we needed to leave the ship, while he was still taking care of my husband, she was still pushing for us to stay on the island. We refused to go to the hospital in Aruba, because their plan was to leave us with our two children on the island. We were charged more than $2800 for a a blood test and the use of the ship enfermery for 2 Hrs. until his blood presure was back to normal. Those were the longest 10 days of our life. Last day, one of the cruise engines blowed up and we were late for almost 6 or 7 hours. People missed their flights, transportation arragements, etc. Big mess… Our cruise #14 was the cruise from HELL!!! Tip: Next cruise will include an insurance to cover for any possible medical or travel problems. Byron Cooper I am a doctor. In the USA, an ambulance will bring a patient to the closest hospital, period. It is far too subjective for a cruise line to rate hospitals and weigh the risk of delaying treatment against going to the “best” hospital. The optimal thing would have been to stabilize the patient at the local hospital and transport him to a hospital with advance cardiac care ASAP. Michael__K RC should have alerted this family about this hospital’s limitations, as reported by the US State Dept, and suggested or at least brought up the medi vac option and offered to place the proper calls. IMO, it’s a lot more reasonable to expect the ship operator to have this awareness about hospitals along its route than to expect 2,000 passengers to individually research the medical facilities of dozens of islands that might be in the vicinity of their ship’s course. Don’t get me wrong, the hospital itself certainly should have been clearer from the beginning about it’s limitations too, and communicated with the patient’s US doctor. Before travel, RC could do a better job of alerting it’s passengers to this type of possibility. Do they refrain from doing so because it might scare off passengers? I’ve taken a trip with a tour operator that required a certain threshold of medical evacuation insurance as a precondition for being accepted on their tours. . Michael__K This makes sense for places one knows they will be visiting. St. Kitt’s might have been an unscheduled stop. I don’t think it’s reasonable to expect someone taking a Caribbean cruise to exhaustively research the medical facilities throughout the region. TonyA_says Why No sense? Isn’t that what the OP is complaining about. The lack of good hospital and staff [near where they were cruising]. Ever been to a third world country? The thought always crosses my mind. Michael__K When you fly to Asia, do you think it’s reasonable to research the medical facilities near every single airport on the planet where a plane might end up if it has to make emergency landing (for a medical or other type of emergency)? TonyA_says Enough to know what I have to do in case of an emergency. In fact during my last visit, I went to one such hospital. If you have a medical condition you might as well be ready. Fit_to_be_tied I believe the cruise ship SHOULD know which are the better hospitals for the types of conditions like cardiac care. How much effort would it take? Put an intern on it and get some preliminary lists, then turn it over to a medical professional consultant to rate the hospitals. Cardia care for the elderly is a no brainer. Michael__K You went to a hospital in a country that you had no plans whatsoever of visiting? And yet you specifically sought out State Department reports on that hospital before your trip just in case? If so, that would be super-impressive, but I still don’t think it’s reasonable to expect that of tourists. I hope everything turned out okay for you or your travel companion. TonyA_says If you have a medical condition, you would do research. I hope. Michael__K The question at hand is the scope of the research. (And people w/ no medical conditions have emergencies too… perhaps the OP was even in that category). backprop Wow, absolutely not, anymore than an airline should inform a passenger in cardiac arrest about the hospital they may wind up at. And that assumes that RC even knew which facility the passenger would be taken too. And to warn ahead of time isn’t the cruise line’s responsibility any more than it’s an airline’s responsibility to give crime reports of the city they’re about to land in (and in this case, RC wasn’t even scheduled to go to St. Kitts!!!!). judyserienagy What a tragic story, but the blame does not lie with the cruiseline. Third parties cannot be relied on to take care of you when you travel. Even if a cruiseline made the obvious effort to ascertain the best medical care at each of its ports, someone would sue them for something. Travellers MUST make arrangements for themselves. I subscribe to MedJet Assist which will take care of this kind of problem whether it be finding the best care in the Caribbean or evacuating me from Somalia. It’s not very expensive, I hope I never need it, but I certainly would not expect a cruiseship, a hotel or an airline to find the best care for me. I want experts doing that and I have to find them myself before I need them. sirwired As opposed to what? I’m wondering what the alternative would have been. While the medical facilities on-board aren’t bad, this isn’t what they are prepared for. Asking for payment before discharge (or, in many cases, before treatment) is the norm in many parts of the world. Get good overseas medical insurance, make sure you have a good credit card, and, for goodness sakes, buy medevac coverage. It’s cheap and worth every penny. If you don’t have medevac insurance, and you need to get home to receive needed treatment, you are simply going to die unless you can pay up for the evacuation. Neither the cruise line nor state department nor airline are going to bail you out. sirwired This is standard for any transportation method… air, ship, bus, whatever. I believe it may even be a legal requirement to discharge the body at the next port of call, so all the appropriate legal paperwork on the death can be issued. This can happen no matter what method of travel you use. Most trip insurance covers repatriation of remains, and most embassies will at least help make arrangements even if they don’t pay. sirwired Consulates do not arrange emergency medevac. Making a pest of yourself will not make that any better. At best they can provide contacts to medevac companies. (Just like they also don’t provide legal counsel, translation services, or doctors… just contacts to local providers, if any.) As far as the “bribe” goes… I don’t see how this was a bribe at all. They were requesting payment for services rendered. Operating on a cash-n-carry business is standard for hospitals in developing nations. After all, what could they possibly do if the bill was never paid? $1,100 is big money for a hospital like that. In fact, asking for payment AFTER services are rendered puts them a step above most such facilities; many require payment BEFORE treatment. TonyA_says Don’t you have any responsibility to take care of yourself? TonyA_says Can you imagine what 3,000 drunken folks on a cruise ship would do if the ship turned around for one sick guy? TonyA_says Good post. I also wondered about the responsibility of the ship for the rest of the 2000-3000 folks who paid good money to have fun. The show must go on. Michael__K Yes, and the captain of a ship has a responsibility to look after the well-being of his passengers like he would his own well-being. Michael__K So if you don’t think RC needs to know which facility the sick passenger would be taken to, then I suppose it’s okay with you if they deposit the passenger on an island with no hospital at all, right? IGoEverywhere After dozens of cruises in 30+ years, you could not give me, then pay me extra to take one. They are money grabbing insensitive corporations that will dump you with three sneezes. Mrs Classen should establish a class action suit against RCCL and get the laws changed to rectify this problem. They are not safe! Lindabator What solution would you prefer? Keep them on the ship, with no hospital services at all? Unfortunatley, we understand that these hospitals are not up to US standards, but they are the only ones available – so without med-evac insurance, you find yourself in this situation and without alternatives. Had the cruise line kept him on board, without any medical services available, we would hear how it was their fault he suffered this way. No winning in this case – that is why I ALWAYS sell the proper insurance for my clients – and I’ve had a client who had his legs crushed in an accident in Morocco, who was airlifted back to his hospital of choice here in the US. Of course, he was stabilized first at a local hospital, as would be expected. Lindabator The insurance includes med-evac to facilities in the US – a much better choice once the client has been stabilized. And since the insurance company pays the hospital, they get “stabilized” pretty quickly, in my opinion. Lindabator You are correct – the body must be certified by the first port of call. And then re-patriated from there. Another good reason for insurance – repatriation and all paperwork is handled by them for you. Lindabator Agreed – if you go to your hospital, and have to pay your out-of-pocket portion, would you consider that a “bribe” too? Lindabator Or a long-distance flight, or a stay in a foreign country, etc etc etc. That’s why med-eac insurance is so important when you travel. Lindabator There IS NO onboard HOSPITAL – there is a small clinic that can manage small injuries and sea-sickness — your rant makes absolutely no sense – its not a matter of customer service, its a matter of making the best possible decision for a clients’ well-being – taking them to the first available hospital is better than letting them die onboard because there ARE NO facilities! Lindabator True – but it sounds as if they didn’t bother to take out the insurance – probably had to arrange for a med-evac on their own dime, and frankly, I’d hate to see that bill! Lindabator Don’t bother, Tony – he just likes to hear the sound of his own voice calling everyone BUT himself responsibile. Lindabator And a friend’s husband died in China – had to pay to get the body back – it’s everywhere – when they know you are foreign, they require the money immediately – knowing full well that once you leave, so does any money they are waiting on. Lindabator But this isn’t a matter of customer service – it was a medical emergency a ship CANNOT handle, so they moved him to the first available medical facility – they did the only thing possible. But, they are NOT responsible for you taking the proper med-evac insurance, nor are they resposnible to pay such an expense out of their pocket. Sometimes the CLIENT needs to take responsibility – the customer service isn’t the only thing that’s declined – our ability to assume risk and live with the consequences of our actions seems to be nill nowadays as well! TonyA_says Why are they NOT SAFE? The cruise ship did not cause his heart attack or stroke. Aren’t we expecting too much from a carrier? They have to be practical since they also have hundreds, perhaps thousands, of other passengers on board. Lindabator Are you out of your mind???? They have a clinic, NOT a hospital onboard — and if you went into a clinic here, they would call an ambulance to transfer you to a HOSPITAL. And since when does a patient know when/where the best choice is? they have no clue how long a cruise time it would take – the cruise did their best – and for all we know, he was in such bad shape it TOOK 5 days to stabilize him for transport! Lindabator In ANY med-evac case, the patient needs to be STABLE before being flown out – that is WHY they put him in the hospital – it is NOT something they can do onboard. Lindabator It may have actually TAKEN 5 days to stabilize him – we just don’t know. Lindabator Not even a matter of screwing up the cruise for everyone else – the journey time might have put him in further jeopardy – and then we would be hearing it was their fault the man died. Lindabator THANK YOU! My point here, exactly. Lindabator And what then? Sail for 3 days to find that best hospital? Then you could really say it was their fault he died. TonyA_says Linda, a fellow TA of ours here in NYC who specialized in [Catholic] religious tours often took her husband (as a second TC) to help out with the old [and handicapped] peoples’ luggage and logistics. On one trip he had a massive heart attack and died in Medjugorje (if I remember correctly). She not only had to take care of him and repatriate his body back here, but she also had to help the rest of the tour participants finish the tour. We all never want to be in this situation. But it makes a lot of sense if we buy some kind of insurance to help us if it happens. Lindabator People today are just NUTS! The cruise line took them to the closest facilty (as an ambulance here would) – and you want to complain? They did nothing wrong – in fact, did everything they could to ensure he was cared for at the soonest possible moment. Lindabator Yes it does! We had a client killed by a drunk driver, and 1 call by his travelmate had the re-patriation taken care of within a half-hour. What a relief for an already grief-stricken family! TonyA_says I wonder it they are suing the cruise line. Michael__K Is the captain of a ship responsible for anything? Or is it every passenger for him/herself? ngbmd We were on Princess cruising to Hawaii when a passenger started having massive bleeding from the stomach ..there was a 2 am ship wide call for blood donors with Red Cross ID..2days later we arrived at the first Hawaiian island–he was transferred.. The doctors (South African) and medical facility are state of the art! The patient survived to be transferred under very difficult conditions (required many blood transufsions )- only surgery could have corrected the bleeding) Afte the event, the ship doctor gave us a tour of the facility (my husband & I are MD’s)–amazing what they are capable of doing short of invasive interventions like PTCA/surgeries… One other item that was mentioned, altho I am sure this rarely impacts on care on board: It is thought that Americans are medical malpractice suit prone…the ship doctor mentioned that Princess has been sued many times for malpracice…mostly by Americans…the suit is dropped when the medical bills are “forgiven”. In her experience, only a very small minority of passengers ( all nationalities) carry trip insurance. Michael__K Even if you have medical evacuation coverage, if either: (a) you aren’t aware that the nearest hospital isn’t qualified to treat your condition or (b) your are travelling alone or you and your travel companion both have incapacitating medical emergencies and your tour operator doesn’t capture passenger insurance information … then you can’t take advantage of that coverage. jerryatric I say it again. Coming to port, confirm people have the coverage, & call in Air Ambulance. Even if they are not covered the Cruise line could probably make arrangements. It’s true re entitlement, but as an old geezer I’m also FED UP with the lack of service, rudeness & just plain stupidity of some people in the service industry. Not to mention thieves ! I can regale you with personal horror stories. Fit_to_be_tied What would you want that boat to do if the sick person were you or your father? At least having an understanding of where the better hospitals are is better than dropping someone off at an island where maybe they have horrible care. There should be a plan in place for emergencies in areas where care is bad. You don’t just drop a sick person off and leave them with no recourse. Sorry, but if you’re going to be in the cruise business you need to have this stuff mapped out. Daves Feel better? DavidZ Daves http://www.elliott.org/blog/are-cruise-lines-dumping-their-sick-passengers/#comment-594644222 Rosered7033 Thank you for your knowledgeable information, Lindabator, here and in answer to other posts. You do a service for everyone who reads them! Don Spilky 74% would have kept the patient onboard? Any policy that doesn’t quickly get an emergent patient to a HIGHER LEVEL of care would be the irresponsible course. Don’t agree? Consider the case of any patient who is kept onboard, then crashes while 3 hours out at sea. These cruise line “sick bays” are simply not set up to do anything more than triage, bandage, medicate and release. Yes, I am an EMT. Interestingly enough, while the poll seems lopsided the only comments are from the minority vote. Chris – Is the poll reporting correctly? Sting D’Ding While I do feel for the couple involved, travel – especially to what are considered less developed countries – involve inherent risks. Medical care is one of them. I do think we also need to consider the hospital in St. Kitts. As far as they are concerned, they received a patient and treated him to the best of their abilities and charged him a mere (compared with US medical rates) $1,100 for that. I think it is a little culturally insensitive to be hesitant to pay that bill when they received a service just because it wasn’t what you would expect in the US. boboadobo TAKING A CRUISE IS JUST NOT WORTH IT! you are on a big nice ship, but they really can not do anything to help you! and just because you are on vacation does not make you immune to LIFE. if you survive long enough you will get dumped in a third world backwards joke of a “hospital” you want fun in the sun? go to fort lauderdale ,marco island or palm beach for a week ! nobody ever thinks they will be the one wishing they had not gone on the cruise. stay out of the third world. travelers diarrhea, mosquito born illness and other goodies aside.