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Cruise ship doctors:  roll the dice with your life

Independent Travel Tips for the professional at Leisure

February 2008


I recently found myself injured on a cruise ship, in pain, and forced to delay treatment while I attempted to vet the quality of a graduate of a Macedonian medical school!  In my case, the cruise ship doctors refused to speak by telephone with my own physician or to help me locate a real doctor from the passenger list.  I was forced to make a knee-jerk decision in a potentially life-threatening situation.


People also don't know that cruise ship medical clinics are effectively judgment proof, protected by a maze of deceptive gerrymandering and foreign jurisdictions.  For example, even though a ship doctor wears an officers uniform of the cruise line, they are independent contractors, a deception that protects the cruse lines from taking responsibility for their shoddy ships doctors.


It's a scary feeling, being stuck with needles by dumb looking people who barely speak English, and I wrote this so that other cruise passengers will understand that your treatment may be worse than the problem.


Most cruise passengers don�t realize that the cruise lines provide medical care as a courtesy only, and they are not required to staff their facilities with qualified American doctors or nurses. You must carefully vet their medical training and certifications before consenting to medical treatment, your life might depend on it.

Historically, under maritime and admiralty law, the captain appoints a ship doctor.  They often chose the cook, since they were good with knives.


While the cruise lines say that there medical treatment rooms meet the guidelines of the American College of Emergency Technicians (ACET), yet they say nothing about the quality of the quacks and charlatans who are passed-off to unsuspecting cruisers as qualified physicians.  Here is my arm after my treatment by an African and Macedonian doctor.  Now I ask you, does this look like competent medical care?


A photograph of my IV injection site, 48 hours after treatment


Is there a doctor in the house?


I have many clients through the Caribbean and over the years I�ve learned to always ask for a M.D. when I am in need of any medical assistance. I have experienced horrendous care by �doctors� overseas, including one physician who told my wife that her joint inflammation was due to her unforgiven sins, and prescribed that she bath in the blood of Jesus Christ!


When you need medical care aboard sip, vetting a doctor can be a life-or-death issue.  I've been on ships with board certified U.S. surgeons, but I've also cruised with witchdoctors who I would not allow to treat my dog, much less myself.

I�m a frequent cruiser, and I know that ships doctors vary widely, in training, licensing and experience. In the absence of a global medical certification, a �doctor� might range anywhere from an ABA board certified surgeon to an Amazonian shaman. Who knows?

As I found out, being injured is not the best time to weigh the risks of being treated by a third world physician.


You're not in Kansas anymore, Toto


I recently had a serious injury on a cruise ship, and I knew that I was going to be in trouble when the cruise ships "doctor" reminded me of the dumb-looking guy who works at my local hippie herbal cure store.


When I asked this this man if me was an M. D., he replied �I�m a doctor�, an answer that I found to be deliberately evasive and suspicious. 

Next, I was treated to a round of evasive word-games with the ships medical staff.

Me: �Are you an M.D.?�

Quack: �I�m a doctor�.

Me: �So was my history professor�.

"I'll ask again:  Are you an M.D.?  It's a simple question, you are either an M.D. or you aren't.�

Quack: Shrugs and goes over to my wife. . . .

This "doctor" then approached my wife and asked: �Can you please tell him that I�m an M.D.?�  My wife replied �Well, you don't look like an MD to me. If you really are an MD, tell him yourself.  I'm not going to lie for you.�


I also asked if it was possible to scan the passenger list and see if there were any qualified doctors on board the cruise ship.  Of course, my repeated requests were denied.

Once I was transported to the medical room, a woman approached me and I again asked:

Me:  �Are you and M.D.?


Quack MD: �Yes� she replied.

Me:  �Great! Where did you go to medical school?�

Quack MD: Macedonia�, she said.


Macedonia?  Visions of Borat flashed through my mind. I did not even know that Macedonia was a country, but I�m well aware that many medical schools in developing nations are a joke.

My other option was an African-trained physician, but he spoke English very poorly.

You must also be very careful when answering medical questions, as many of the cruise ships doctors English skills are as poor as their medical training.


Do you speak English?

In the cruise ship medical facility, my wife is trying to reach a "real doctor" while I was bombarded with a bunch of half-English babble.

Quack doctor:  �Do you take Blutiners?"


Me:  �What is Blutiner�? I've never heard of the word.


At that point, the �doctor� got exasperated and said:

Quack doctor:  You speak English�, he replied in an underserved arrogant tone. "You need to be cooper rahtive".


Me:  "Cooper-ah-tive?  What the F**k does cooper rahtive mean"? (The idiot was trying to say "cooperative")


I later figured out that "Blutiners" were �Blood thinners�, and the quack took offense at my inability to understand his �excellent� English. 


Oh, and I was charged over $850 for this shoddy "treatment", which was right out of a Money Python skit.



My wife was able to reach my primary care physician by cell phone, but unfortunately the cruise ships crummy cell service was cut off before he could speak to the cruise ship "doctors" to offer treatment advice.  Our doctor was sarcastic, at first, thinking that I was playing a bad joke:

"Let me get this straight. 


You want to know if you should entrust yourself to a doctor who went to medical school in Africa? 


Are you joking?"

So here I was, in the uncomfortable position of being in shock and having to delay my treatment while I evaluated the training of doctors who told me that they attended medical school in Africa and Macedonia.


This article by Consumer Affairs Cruise Ship medical care spotty, notes that cruise lines are exempt from most U.S. labor standards and medical safeguards, with woefully unqualified quacks posing as MD's:

"The study found that 27 percent of shipboard doctors and nurses lacked advanced training in treating heart attacks, the leading cause of death on ships.


More than half the doctors and 72 percent of the nurses lacked advanced training in dealing with trauma."

But is this our own fault?  Cruise ships have become a very popular largely because of the low cost that accrues from being outside the U.S. labor laws, and sub-standard medical care is one of the areas where the cruise ships keep our costs low.  According to attorney Jason Turchin, many deaths at the hands of an unqualified cruise ship physician are wholly preventable:

"Injury and death aboard a cruise ship is often preventable and foreseeable. Cruise guests expect to enjoy a safe vacation while aboard a cruise, yet many guests are injured or killed as a result of cruise ship negligence."

For a cost less than the cost of one night at an upscale Manhattan Hotel, you can cruise for a whole week, a remarkable bargain, largely possible because of cheap foreign labor.  However, people don't realize that that once you leave US waters, you are at the mercy of the cruise ships Captain, and you loose all American consumer protection, including the right to treatment by a qualified medical doctor who has been certified by the American Medical Association. 


Cruising is now an alternative to nursing homes, and it's cheaper to put Granny on an all-year cruise, and cruising costs far less than assisted living.  According to this article by Columbia University, the rise in geriatric cruise passengers has led to many deaths at sea. 

The independent contractor doctor scam


If you ran a cruise line, how would you make a profit from selling medical care to your passengers without taking any  responsibility for their safety or well-bring?  Simple, just make the ships doctors independent contractors! 


The scam works like this.  The cruise ship medical personnel appear to be employees and proudly wearing senior officers uniforms, but they will disclaim all affiliation with the cruise line when a patient is killed due to their sub-standard medical training. 


Because the ships doctors can be inept and dangerous, most cruise lines are very careful not to be affiliated with the medical staff.  That way, if they kill you, the cruise ship line just says to take it up with the doctor, but that won't happen since the quack doctors will have been returned to the tent village where the cruise line found them in the first place.


If you are killed or injured by a quack cruise ship doctor, don't even bother seeing a malpractice attorney, since anything goes on the high seas:

"Many of the physicians on the ships are foreign born and filing a lawsuit in their home country can be complex and expensive.


Further, when a malpractice case crops up the doctors usually disappear and the cruise companies don�t offer much help in locating them"


Piracy on the high seas


Cruise ships have been widely criticized for a variety of unsavory practices, everything from the questionable art auctions that prey on the elderly to pre-planned mechanical "failures" that interrupt customers ports.  But while these civil torts are not life-threatening, you must realize that your cruise ship "doctor" may be so unqualified that they would be arrested if they attempted to practice medicine in America.


Let's take a closer look so that you understand that your cruise may place you far away from life-saving medical treatment.  I have many clients overseas, and during my travels I've learned the importance of carefully vetting cruise ships doctors, who can range from well-trained experts to complete fools.


Be prepared to make tough decisions

The cruise ship medical office was growing impatient and had no interest in talking to my "American" doctor.  They would not try to find an MD aboard the ship, and they would not talk to my own board certified MD over the phone.  I was then told that the ships captain was contacted and that I had only three choices:

1. Suck up the pain and stop screaming
2. Accept their treatment
3. Be "put off the ship"

At this point I had visions of being sent adrift on a lifeboat, or worse, inconveniencing thousands of passengers with an unplanned delay.  I was under duress and accepted treatment, and I now wish that I hadn't.  These goofs could not even start an IV line properly:


A photograph my IV injection site, 48 hours after treatment



What can you do to improve medical care at sea?


There are growing pressures to enact legislation requiring cruise ships who cater to American tourists to be subject to the same protections that we enjoy in America. Please join me in supporting legislation that would require all cruise lines who dock in America (and carry a majority of American passengers) to fall under the safeguards and protections that all Americans enjoy.


On the other hand, you get what you pay for.  It's the demand of the cruising public for cheap rates that drives this cost-cutting, and I'm told that the quality of cruise ship medical care is directly proportional to the cruise costs.  The more expensive cruise lines like Cunard and Crystal offer amenities at all levels of service, and the moderate cruise lines such as Celebrity and Holland America have been known to staff their medical facilities with genuine M.D. doctors, licensed by the American Medical Association.  Cruise prices are at an all-time low, and there are now specialty cruises that cater to the working class, a market niche that I call redneck cruising.


Reader Comments:

"I was reading through a few articles on the net as i'm coming to the end of the my General Practice training and i'm toying with the idea of being a ship doctor for a while when i came across your article.

It seems like you had some difficult (not to belittle it) experiences on travels. However I don't believe this deserves the subsequent rather myopic view of you have of Doctors from 'Africa' with your nose inhaling from the stratesphere like it's one small city with 4 people in it. not all Doctors that train in 'Africa' are that bad actually and it may be of help to know that a significant proportion of the American Healthcare System (yes, the one that you enjoy) is propped up by 'African' doctors who have successfully passed the M.D. exams. If you're American i'm overcoming some international generalisations to at least hope that even you will be aware of how polarised ones medical experience can be even within a single health system let alone a continent's worth.

please bear this in mind next time you're spouting your opinions (which i grant is all they are) "

Dr Tennyson





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