Medical removal against passenger's wishes

[SarasMommy]

Has anyone been medevacked from a HAL cruise against their wishes? While on a cruise last year my mom went into a coughing fit due to her throat being sore, which made her cough and have difficulty breathing. She called 911 and had oxygen administered and then felt much better. She told the doctor that she felt better, but when the medical staff found out her medical history included heart problems they insisted she be removed from the cruise and sent to the hospital. She repeated several times that she felt fine, but they had made their decision.

 

Upon arrival at the hospital she had to wait a week until they would release her pending the outcome of tests they insisted on doing, even though the entire time she insisted she felt fine. The tests came back clear and she was released less than 24 hours later, but not before being presented with a bill for several thousand dollars which her insurance company is refusing to pay because of the “pre-existing condition” clause.

 

This troubles me greatly, because I think these types of cases will make people think twice about making that call to the ship's medical department for fear of being removed from the ship. Just because someone has a less than ideal medical history, does that mean HAL doesn't want the responsibility of having them as a guest? Is anyone familiar with their policies and guidelines for medical evacuation, or is the decision strictly up to the discretion of the attending physician?

[Krazy Kruizers]

Sorry about what happened to your mother.

Ships have limited medical equipment and can handle problems to a certain extent. The ship you were on may have felt that the cough your mother had may have led to further problems which they felt they could not handle being as your mother had other medical problems. Thus they made the decision to have your mother leave the ship and go to a hospital with more equipment.

[boone2]

Has anyone been medevacked from a HAL cruise against their wishes? While on a cruise last year my mom went into a coughing fit due to her throat being sore, which made her cough and have difficulty breathing. She called 911 and had oxygen administered and then felt much better. She told the doctor that she felt better, but when the medical staff found out her medical history included heart problems they insisted she be removed from the cruise and sent to the hospital. She repeated several times that she felt fine, but they had made their decision.

 

 

 

Upon arrival at the hospital she had to wait a week until they would release her pending the outcome of tests they insisted on doing, even though the entire time she insisted she felt fine. The tests came back clear and she was released less than 24 hours later, but not before being presented with a bill for several thousand dollars which her insurance company is refusing to pay because of the “pre-existing condition” clause.

 

 

 

This troubles me greatly, because I think these types of cases will make people think twice about making that call to the ship's medical department for fear of being removed from the ship. Just because someone has a less than ideal medical history, does that mean HAL doesn't want the responsibility of having them as a guest? Is anyone familiar with their policies and guidelines for medical evacuation, or is the decision strictly up to the discretion of the attending physician?

 

 

If the tests had shown up that something was wrong wouldn't you be happy she was disembarked and thoroughly tested. As has been said there is a certain limit to what can be done on board. If the ship had got out to sea and her condition had worsened I'm sure you would be writing a different letter. Pre existing conditions should have been declared when insurance was taken out. I'm so glad your mom is well now and it had a good outcome

Terry

 

 

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[sail7seas]

Ship's Doctor makes recommendation to the Captain and the decision is made.

It is for the safety of the guest and in case of contagion, all guests and crew.

 

And the protection of the cruise line.

 

[sail7seas]

OP....

 

Do you mind my asking if your Mom was traveling solo when this happened?

I wonder if that made any difference if she was a solo traveler?

 

[cbr663]

I don't know if this will help or not: http://www.hollandamerica.com/assets/news/PR_Medical.pdf

 

My understanding is that cruise lines will err on the side of caution and want to reduce the liability of any medical emergencies while on board. That is most likely why they removed your Mom from the ship, as persistent coughing is often a sign of heart problems.

 

I am surprised that your Mom received medical treatment at a hospital when she did not want it. I do understand though that medical staff sometimes find it difficult to accept the word "No". I was once told that I had to remain in a hospital in order to see the doctor and I replied that I had to do no such thing. I advised them to quickly get whatever paperwork they needed me to sign as I was leaving in 15 minutes. The medical staff started to pay attention then.

 

Yours is a great reminder to us all that we all need to be our own advocates for our own health care. I am glad to hear that your Mom is feeling better and I certainly understand your anger at having her subject to medical treatment that she did not want.

[cruisin'girl]

This is a perfect example of why everyone with any preexisting conditions at all, especially serious ones, should be sure to purchase insurance coverage and in time for it to cover preexisting conditions. No matter how good your Mom was feeling when she booked the cruise she did have "previous heart problems and a less than ideal medical history", so you never know when health issues can reoccur. Her bills would have been paid.

[luxurysailer]

It isn't uncommon for patients to make very unwise decisions. It is the obligation of the medical staff to advise of their best medical opinion and against leaving the hospital. However, if the patient insists on leaving they should sign out "against medical advice" thereby relieving the medical staff and hospital of liability.

 

You can bet your bottom dollar if the medical staff doesn't argue strongly against leaving and something disastrous happens that they'll be sued.

[RuthC]

Two hours after my heart attack I felt fine, and wanted to use the theatre tickets I had for that afternoon. I was told to lie down, and stay quiet; I was in a dangerous period.

 

Just because your mother felt fine didn't mean she was. The doctor didn't want to take a chance with her life.

[doublebzz]

I understand the doctors on HAL ships have to board certified in emergency medicine in either Canada or U.S. I would give a lot of weight to medical advice provided by these physicians.

[legalslave]

I can certainly understand your mother being upset when she felt fine and did not want to leave the ship. However, what if they decided to let her stay on the ship and the worse case scenario occured? She would have very possibly been upset that they were not cautious enough to make her seek medical help off of the ship, had she survived.

 

I went to the doctor for my check up. I had an irregular EKG. I felt fine and told them the EKG was irregular because I had to carry my dog up a hill just before rushing to my appointment. My doctor scheduled a stress test for the next day. I was emphatic that I was not going to have it done. She was emphatic that she would not keep me for a patient if I didn't have it.

 

I had aorta femoral bypass surgery shortly after the stress test. If I hadn't had the test, I would have most likely died within 6 months. The doctor's want to be sure there isn't anything wrong and can't just go by what a patient tells them.

 

Diane

[elevario]

I agree. Don't gamble with your health. I leave for my cruise in under two weeks and found myself in the ER last week. I was trying to put it off because I didn't want to miss my cruise. After being in pain for 15 hours and multiple tests later I found out I was fine. Unknown abdominal pains, gallbladder is ok, pancreas ok and appendix has already been removed. The best part no heat attack either. Now I can go on my cruise and feel good I am in good health. Better to be safe than sorry. Also if your mom would have died on the cruise the cost of returning her body home may have been more than the medical and Medivac services. Just saying

 

 

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[dadroy]

I was scheduled to leave on a cruise on a Saturday. Going out of Tampa to New Orleans for Monday and Tuesday of Mardi Gras. Woke up with a wierd feeling in my neck and called my HMO. They said, don't call 911 but ger here as soon as you can.

 

They did a treadmill walking test EKG which was supposed to take about 30 minutes. After about 3 minutes they told me to stop and said I would be needing heart bypass surgery on Saturday. I told them I was going on a cruise and enjoying Fat Tuesday. They advised against it but gave me nitro glycerine to use on the cruise. On the Monday I came back, quad bypass.

 

So I cruised against medical advice but had I gone to the ship doctor, I am sure they would have put me ashore since they are not set up on the ship for bypass surgery.

 

Great time in New Orleans though, wish they would do that itinerary again.:D

[COLLEYBERRY]

I was scheduled to leave on a cruise on a Saturday. Going out of Tampa to New Orleans for Monday and Tuesday of Mardi Gras. Woke up with a wierd feeling in my neck and called my HMO. They said, don't call 911 but ger here as soon as you can.

 

They did a treadmill walking test EKG which was supposed to take about 30 minutes. After about 3 minutes they told me to stop and said I would be needing heart bypass surgery on Saturday. I told them I was going on a cruise and enjoying Fat Tuesday. They advised against it but gave me nitro glycerine to use on the cruise. On the Monday I came back, quad bypass.

 

So I cruised against medical advice but had I gone to the ship doctor, I am sure they would have put me ashore since they are not set up on the ship for bypass surgery.

 

 

 

 

 

 

 

 

 

 

 

 

Great time in New Orleans though, wish they would do that itinerary again.:D

 

 

 

Wow I am incredulous ...I am glad you are well ,but seriously, what a silly, selfish, decision.It could have turned out much differently and impacted many more people then yourself.

 

Wishing you continued good health.

 

The medical community and much of the general public know denial is one of the first symptoms of a cardiac event

[boone2]

I was scheduled to leave on a cruise on a Saturday. Going out of Tampa to New Orleans for Monday and Tuesday of Mardi Gras. Woke up with a wierd feeling in my neck and called my HMO. They said, don't call 911 but ger here as soon as you can.

 

 

 

They did a treadmill walking test EKG which was supposed to take about 30 minutes. After about 3 minutes they told me to stop and said I would be needing heart bypass surgery on Saturday. I told them I was going on a cruise and enjoying Fat Tuesday. They advised against it but gave me nitro glycerine to use on the cruise. On the Monday I came back, quad bypass.

 

 

 

So I cruised against medical advice but had I gone to the ship doctor, I am sure they would have put me ashore since they are not set up on the ship for bypass surgery.

 

 

 

Great time in New Orleans though, wish they would do that itinerary again.:D

 

 

Well done. And what sort of post would you have been making if you had a cardiac event at sea that couldn't be treated. The mind boggles

 

 

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[Hlitner]

We did note that the OP is making their first (and only) post here on CC so we welcome them to the boards. When I was a lot younger I was fortunate to have worked as a Paramedic for several years which included handling field calls (ambulance emergencies) and working in various hospital ERs. We also have a friend (a board certified ER physician who works in FL) who works on HAL a few months a year. This topic has come up in several dinner conversations with our physician friend (while onboard HAL cruises).

 

The OP needs to understand that the shipboard physician has to function with decent, but minimal, facilities/equipment. Ships can handle most emergencies and are usually capable of stabilizing a case. But they are not equipped for longer 24/7 care and lack the sophisticated lab and other diagnostic equipment necessary to handle all but the most simple and easily monitored cases for any length of time. The physican's primary responsibility is for the safety and well being of his/her patient and all the folks on the ship.

 

Removing from the ship, a passenger with irregular heart symptoms (especially with a prior history of heart issues) is a no-brainer and would happen on any cruise ship. Difficulty breathing is a major emergency and often needs sophisticated tests and monitoring to avoid further problems. The ship just does not have the facilities to properly monitor (or even diagnose) such a case with the reliability of a properly equipped shoreside hospital. So if one wants to criticize a physician for doing what is best for his/her patients well-being...then so be it!

 

As to the issues with the hospital, that is beyond the control of HAL. And the fact that the shoreside medical staff saw a need for a long hospitalization (with tests) just seems to support the original decision of the onboard physician to evacuate the patient from the vessel.

 

Regarding the cost and lack of good insurance, this is the responsibility of the patient! There are trip policies that do cover pre-existing conditions and the cruiser should have considered her history when buying insurance and purchased a policy that covered such pre-existing conditions (most of these policies must be purchased within a few days of booking the cruise).

 

Rather then criticizing HAL (or any line) the patient should be grateful that there was a nearby physician able to act in the best interests of the patient.

 

Hank

[kpgibbs]

It's CYA. BUT, I can understand why. If something was truely wrong with the patient and the ships Dr's ignored it, then they would have a law suit on their hands. It's sad but it's the world we live in now.

[IRL_Joanie]

We did note that the OP is making their first (and only) post here on CC so we welcome them to the boards. When I was a lot younger I was fortunate to have worked as a Paramedic for several years which included handling field calls (ambulance emergencies) and working in various hospital ERs. We also have a friend (a board certified ER physician who works in FL) who works on HAL a few months a year. This topic has come up in several dinner conversations with our physician friend (while onboard HAL cruises).

 

The OP needs to understand that the shipboard physician has to function with decent, but minimal, facilities/equipment. Ships can handle most emergencies and are usually capable of stabilizing a case. But they are not equipped for longer 24/7 care and lack the sophisticated lab and other diagnostic equipment necessary to handle all but the most simple and easily monitored cases for any length of time. The physican's primary responsibility is for the safety and well being of his/her patient and all the folks on the ship.

 

Removing from the ship, a passenger with irregular heart symptoms (especially with a prior history of heart issues) is a no-brainer and would happen on any cruise ship. Difficulty breathing is a major emergency and often needs sophisticated tests and monitoring to avoid further problems. The ship just does not have the facilities to properly monitor (or even diagnose) such a case with the reliability of a properly equipped shoreside hospital. So if one wants to criticize a physician for doing what is best for his/her patients well-being...then so be it!

 

As to the issues with the hospital, that is beyond the control of HAL. And the fact that the shoreside medical staff saw a need for a long hospitalization (with tests) just seems to support the original decision of the onboard physician to evacuate the patient from the vessel.

 

Regarding the cost and lack of good insurance, this is the responsibility of the patient! There are trip policies that do cover pre-existing conditions and the cruiser should have considered her history when buying insurance and purchased a policy that covered such pre-existing conditions (most of these policies must be purchased within a few days of booking the cruise).

 

Rather then criticizing HAL (or any line) the patient should be grateful that there was a nearby physician able to act in the best interests of the patient.

 

Hank

 

To back up the statements/comments by Hank, I cannot count on both hands how many patients, I as a former EMT/Firefighter, in the field, that have signed AMA (Against Medical Advice) releases by those that we knew needed immediate medical attention. Whether from a car accident, a fal or breathing problems. They thought they knew better than those with even the most minimum of medical knowledge. They felt fine at that time, but so many times we ended up being dispatched back to those same patients homes or offices an hour or so later only to be unable to provide any care for them then as they had passed away from the original problems.

 

When your adrenaline is hyped up for any reason, even people with broken bones can not feel or see the injury(injuries), some for many hours and even days later..

 

Your mother is alive, she might not have been if the shiop Medical Officer had not sent her to the hospital instead of letting her sign a medical waiver or as I said earlier Against Medical Advice. If they had, you might now be complaining or suing them for not doing what they did.

 

I wanted to also welcome you to Cruise Critic and to say I am so glad to hear that your mom is still with you and doing well:)

 

Joanie

Edited March 6, 2014 by IRL_Joanie

[iancal]

HAL is a business.

 

Their first priority is liability. They acted accordingly in order to minimize their liability.

 

If it was your business, you would probably do the same.

[mamaofami]

Three weeks prior to our scheduled cruise this January, my husband had a medical emergency involving heart surgery. If it had happened while we were cruising through the Caribbean, they would surely have put us off the ship, thinking he was having a heart attack.

 

We were lucky enough to be close to home and the ER of a very fine hospital where they made the correct diagnosis and he had emergency surgery that night.

 

It still haunts me to think this could have happened in the Caribbean where I know he wouldn't have received the care he needed and would not have made it home.

 

Scary, but that's the risk you take when you travel. The HAL doctors can only do so much on the ship and they put you off hoping they won't have any liability and that you will get the needed care.

 

Happy to say he is well on the road to recovery.

[whogo]

I fear that some cruisers have been transferred to hospitals that are less capable of providing care for their condition. I would feel better in the care of a US/Canada trained emergency room doctor on an ill equipped cruise ship than in a hospital in a foreign port with staff that don't speak my language and have been trained gods know where. Caracas? Tirana? Port-au-Prince?

 

I wonder if doctors sometimes transfer patients from ships for their own convenience rather than for the health of the patients.

[sapper1]

I fear that some cruisers have been transferred to hospitals that are less capable of providing care for their condition. I would feel better in the care of a US/Canada trained emergency room doctor on an ill equipped cruise ship than in a hospital in a foreign port with staff that don't speak my language and have been trained gods know where. Caracas? Tirana? Port-au-Prince?

 

I wonder if doctors sometimes transfer patients from ships for their own convenience rather than for the health of the patients.

 

I agree with you. I would sooner take my chances on the ship.

[SJSULIBRARIAN]

I agree with you. I would sooner take my chances on the ship.

 

I agree. We had a non-emergency medical issue on a Princess ship which was overnighting in San Francisco and the MD asked us if we would rather go to a San Francisco hospital ER to have the few tests run. We immediately said NO. I knew we would be waiting hours in an ER to be seen and the tests were done within half an hour on the ship. I think the MD thought we might be concerned about the cost we would pay aboard ship vs being covered by Medicare on land. Since it was non emergency time was more important than cost which was eventually covered by our travel insurance anyway.

 

If it had been an emergency, that would be another story.

 

The few times we have used a ship's medical facility, I have found the services of doctors and nurses excellent both on HAL and Princess.

[sherilyn70]

I think they probably made the right decision. When you are focused on wanting to do something else you are more likely to make poor choices. No one wants to spend time at the hospital instead of being on their vacation but I have learned to take nothing for granted anymore. If I hadn't made poor choices about medical decisions in 2012 I very well could have been cured of cancer, but I was to focused on not taking time of for suggested scans in order to have lots of pto left for fun vacations.

 

The other week I found myself actually frustrated that everyone kept giving me choices when I almost passed out at work and the paramedics were called. Even the emt asked me If I wanted to be taken to a hospital, knowing that I had health issues. I told them yes and we did discover I had a bad case of pneumonia, so I'm glad I let them take me even though my head had cleared.

 

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[Mary Ellen]

The few times we have used a ship's medical facility, I have found the services of doctors and nurses excellent both on HAL and Princess.

I share your experiences. The time on Princess when I needed to see the Dr., I was traveling with a friend, who is in the medical profession. She had never needed to visit the on board medical facilities before. While she hopes that she will never need to avail herself of them, she was quite impressed with both the facilities and the treatment I received.

 

For the OP - hindsight is (usually) 20/20. Several years ago my parental units were in a severe car accident. My step-mom was obviously critically injured, but Dad kept insisting that he was 'fine' - until he went into respiratory failure, 6 or more hours later. Thankfully, he was still at the hospital with my step-mom when that happened. Dad ended up in the Medical ICU on a respirator for over 3-weeks (just down the hall from the Trauma ICU where step-mom was). As others have said, just because the patient 'knows' they feel fine....