Are cruise lines “dumping” their sick passengers?

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.

  • mikegun

    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.)

  • Vicki Margolis

    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 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?

  • travelagentman

    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.