Ships' Doctors and Is It True?

Seems to me I have heard two things that have stuck in my head and I wonder if they are accurate............

A cruise ship cannot sail without a doctor aboard

and

If a ship's doctor tells the captain a guest/crew person has to be medically evacuated, can captain overrule him or her or is that one exception where captain does not have last word unless a case of possible injury to ship or souls aboard?

I am sure the Captain has the last word. The Captain will be looking at the big picture- distance from help, weather, capabilities of the ship and rescuers, etc. The doctor will be focused on patient care. I am sure the doctor would say "this patient needs a higher level of care ASAP" and the Captain will do what it takes, considering the variables I mentioned, and many more. I doubt a Captain would say no to a doctor, or say "I don't think the patient needs it at this time" as that is not the Captain's specialty. But the Captain would say, "OK, we will make it happen", but be in total control of how it happens.

Can't cite sources, but my understanding is that any ship carrying over a given number of passengers (a small number like 10 or so) must have medical staff. Freighters which carry less than the given number and have no medical staff require medical certification for passengers over a certain age.

Also, I think nothing and nobody limits the authority of the captain of a ship normally, but there is the Cain Mutiny based on real events.

Seems to me I have heard two things that have stuck in my head and I wonder if they are accurate............

 

A cruise ship cannot sail without a doctor aboard

 

and

 

If a ship's doctor tells the captain a guest/crew person has to be medically evacuated, can captain overrule him or her or is that one exception where captain does not have last word unless a case of possible injury to ship or souls aboard?

 

1. Star Clippers run smaller ships 171 passengers and sail with a nurse as far as I know but then for "Ocean Crossings" have a doctor on board.

2. If the ship's doctor said a passenger needed emergency evacuation on medical grounds. How will doctor organise this without the captain's assistance? Realistically it will be discussed and a sensible outcome will ensue.

I think it likely that once a certain number of passengers are being transported it simply becomes prudent to have a doctor on board. Similarly with litigation in mind it would be foolhardy for the captain to say no to a medical evacuation if the doctor insisted it was a life or death situation.

Regards John

Can't cite sources, but my understanding is that any ship carrying over a given number of passengers (a small number like 10 or so) must have medical staff. Freighters which carry less than the given number and have no medical staff require medical certification for passengers over a certain age.

 

Also, I think nothing and nobody limits the authority of the captain of a ship normally, but there is the Cain Mutiny based on real events.

I'm pretty sure the number of passengers is 13 (13 passengers and over requires medical staff). Here's the info from a travel site: "Most ships carry a maximum of twelve passengers. This is the magic number, as ships carrying twelve or fewer passengers are not required to employ a physician."

I'm pretty sure the number of passengers is 13 (13 passengers and over requires medical staff). Here's the info from a travel site: "Most ships carry a maximum of twelve passengers. This is the magic number, as ships carrying twelve or fewer passengers are not required to employ a physician."

 

 

Interesting topic! I'd doubt the travel site statement, as this would seem to indicate that ferry boats or tour boats (such as whale watching or snorkeling excursions) which often carry a hundred or more passengers would require a doctor, yet I've never known that to happen. We've been on one where we know there was NOT a doctor onboard, as a passenger had a heart attack onboard and we had to quickly head towards shore to meet an emergency response team. I also doubt the statement "Most ships carry a maximum of twelve passengers..." - that just isn't a true statement. There must be much more to the rules than just the number of passengers.

Calliope is correct, with the distinction that another poster mentioned: An ocean-going vessel that carries more than 12 passengers requires a physician. Therefore, ferry boats and excursion boats do not require the physician.

As far as who's call it is, it will be decided by not only the doctor and the Captain, but by the "Designated Person Ashore" who is the Captain's contact with corporate in any emergency. This person will contact the authorities in the nearest countries to determine whether evacuation is possible. The DPA will make the decision to divert, but the Captain will have final say as the person on sight whether or not the diversion will risk the safety of passengers, crew, or vessel.

This may come as a shock to many, who believe that the Captain is personally directing things in an emergency, but in fact one of his first responsibilities is to contact the DPA, who will mobilize the corporate resources and will activate the command center and be the point of contact for all outside agencies. This is actually about the one thing that incompetent idiot Schettino did during the Concordia disaster, however, he then failed to communicate the severity of the incident to the DPA. The Captain is the coordinator onboard, and the emergency bill will delegate the actual handling of emergency situations to others, who will report to the Captain so he can make the informed judgements.

Ultimately, the captain has the last word. If the captain says the ship can't be turned round because the waves are too big, then the ship doesn't turn round and the passenger doesn't get the treatment required.

Not everything is so black and white. The Captain is the "Master" of his/her vessel and has complete authority (and responsibility) in all decision making. If the ship's physician tell the Captain they need to evacuate a passenger the responsibility is then with the Captain how to best achieve this goal. It is just that simple and no reason to read more into a basic issue. And we would add that the Captain's total and complete authority are derived from International and Maritime Law.

Hank

Not everything is so black and white. The Captain is the "Master" of his/her vessel and has complete authority (and responsibility) in all decision making. If the ship's physician tell the Captain they need to evacuate a passenger the responsibility is then with the Captain how to best achieve this goal. It is just that simple and no reason to read more into a basic issue. And we would add that the Captain's total and complete authority are derived from International and Maritime Law.

 

Hank

Hank, I'm going to have to disagree with you on this thread as well. As you say, things are not black and white. While the Captain's responsibility and authority onboard is absolute, he is still the company's representative. International and Maritime Law, under the International Safety Management System (ISM) required for all ships by the IMO, created the DPA who is the company's person in charge during any emergency situation. The Captain has the ultimate authority to disregard the DPA's decision, but he must be prepared to defend his choice, and not just use the "I'm the Captain and in charge" statement.

From our recent experience, I do know that the captain can refuse a patient's return to the ship once they have been medically disembarked. We left the ship in Colon, went to hospital in Panama City and were medically cleared and prepared to rejoin the next day at Costa Rica, but the captain said the following "Due to the fact that we will have 60 hours at sea, I do not feel comfortable having this passenger onboard in the event that another medical event occurs."

His ship, his rules; we understood completely, so that was the end of our cruise.

Smooth Sailing! :) :) :)

Hank, I'm going to have to disagree with you on this thread as well. As you say, things are not black and white. While the Captain's responsibility and authority onboard is absolute, he is still the company's representative. International and Maritime Law, under the International Safety Management System (ISM) required for all ships by the IMO, created the DPA who is the company's person in charge during any emergency situation. The Captain has the ultimate authority to disregard the DPA's decision, but he must be prepared to defend his choice, and not just use the "I'm the Captain and in charge" statement.

This introduces the economics of company structure which complicates the basic issue. The orders of the captain of the vessel are final in any event, and the same applies to the aircraft commander of air vessels. Yes, they may be called to task for their decisions, but on the sea and in the air, they are totally in charge.

Calliope is correct, with the distinction that another poster mentioned: An ocean-going vessel that carries more than 12 passengers requires a physician. Therefore, ferry boats and excursion boats do not require the physician.

 

As far as who's call it is, it will be decided by not only the doctor and the Captain, but by the "Designated Person Ashore" who is the Captain's contact with corporate in any emergency. This person will contact the authorities in the nearest countries to determine whether evacuation is possible. The DPA will make the decision to divert, but the Captain will have final say as the person on sight whether or not the diversion will risk the safety of passengers, crew, or vessel.

 

This may come as a shock to many, who believe that the Captain is personally directing things in an emergency, but in fact one of his first responsibilities is to contact the DPA, who will mobilize the corporate resources and will activate the command center and be the point of contact for all outside agencies. This is actually about the one thing that incompetent idiot Schettino did during the Concordia disaster, however, he then failed to communicate the severity of the incident to the DPA. The Captain is the coordinator onboard, and the emergency bill will delegate the actual handling of emergency situations to others, who will report to the Captain so he can make the informed judgements.

What is the definition of "ocean going?" Are the Med, Adriatic and Aegean "oceans" in this context?

What is the definition of "ocean going?" Are the Med, Adriatic and Aegean "oceans" in this context?

Ocean going vessels are defined by tonnage and voyage length, not where they sail. Ferry boats, excursion boats, and charter fishing boats generally fall short of the tonnage definitions (these vary by organization) and those larger ferries like the Alaska Maritime Highway have voyages that are too short of duration or are considered "coastwise" traffic (going from one port in a country to another port in the same country).

Thanks, everyone.

Interesting responses.

Seems to me I have heard two things that have stuck in my head and I wonder if they are accurate............

 

A cruise ship cannot sail without a doctor aboard

 

and

 

If a ship's doctor tells the captain a guest/crew person has to be medically evacuated, can captain overrule him or her or is that one exception where captain does not have last word unless a case of possible injury to ship or souls aboard?

 

By international law, the ship's doctor is the only person onboard who can legally over-rule the Captain - but only on medical matters.

By international law, the ship's doctor is the only person onboard who can legally over-rule the Captain - but only on medical matters.

Presumably the most important provision (though not often needed) is that the doctor can certify the captain to be mad, and have him replaced by the first mate.

Anyone been on a cruise where that happened? :)

.....is that the doctor can certify the captain to be mad, and have him replaced by the first mate.

 

I saw that episode of Star Trek!

By international law, the ship's doctor is the only person onboard who can legally over-rule the Captain - but only on medical matters.

BruceMuzz, thank you for verifying I really had heard that. :)

I seriously doubt it is often the Captain would quibble the matter with the doctor but I suppose there might be a rare occasion.

Our other expert poster here, Chengkp, mentioned about the Designated Person Ashore who gets into the logistics.

Between the two of you, great information.

Ocean going vessels are defined by tonnage and voyage length, not where they sail. Ferry boats, excursion boats, and charter fishing boats generally fall short of the tonnage definitions (these vary by organization) and those larger ferries like the Alaska Maritime Highway have voyages that are too short of duration or are considered "coastwise" traffic (going from one port in a country to another port in the same country).

I asked because we cruised that area in a 50 pax, 1200 ton, MV and there was no doctor on board.

I asked because we cruised that area in a 50 pax, 1200 ton, MV and there was no doctor on board.

Interesting point. May I ask what flag the ship was, and what countries were called at, and whether or not all these countries were EU members? As I said, strictly "coastwise" trade (for example up and down the West Coast from LA to Seattle) would not require a doctor, hence the exemptions for ferries and the like, and I know that the EU has similar cabotage laws that restrict coastwise traffic to only EU members flag shipping, so this could have fallen into that category. I confess that I'm not as conversant with EU regulations.

Another question. Were passengers constantly getting on and off? I know that Hurtigruten operates kind of a combined cruise/ferry operation in Norway, and I believe they are also exempt, so this could be another factor, that the trip from one port to the next is an individual voyage, so the voyage length may be the factor.

Interesting point. May I ask what flag the ship was, and what countries were called at, and whether or not all these countries were EU members? As I said, strictly "coastwise" trade (for example up and down the West Coast from LA to Seattle) would not require a doctor, hence the exemptions for ferries and the like, and I know that the EU has similar cabotage laws that restrict coastwise traffic to only EU members flag shipping, so this could have fallen into that category. I confess that I'm not as conversant with EU regulations.

 

Another question. Were passengers constantly getting on and off? I know that Hurtigruten operates kind of a combined cruise/ferry operation in Norway, and I believe they are also exempt, so this could be another factor, that the trip from one port to the next is an individual voyage, so the voyage length may be the factor.

Maltese flagged - Pireus, Itea, Corfu, Saranda, Kotor, Dubrovnik, Korkula, Hvar, Split. Same pax the whole way.

Maltese flagged - Pireus, Itea, Corfu, Saranda, Kotor, Dubrovnik, Korkula, Hvar, Split. Same pax the whole way.

My next question would be, when was this, as some further research into the MCL 2006 international labor convention (which only went into effect in 2012, I think, now states that ships carrying 100 passengers or more, on voyages over 3 days are required to have a doctor. So, there has been a change.

super short answer to this

the CAPTAIN/MASTER decides whether or not to ask for outside help .... and I'm sure disagreeing with the doctor or the home office is a significant factor . . .

BUT a ship does not just pick up the phone and call say USCG and say "send a helo for an evacuation" ..... That's NOT how it works . . .

Yes I'm only talking about US (and Carib') waters ..... but for a USCG response the ship doctor and the USCG (usually a flight surgeon) talk and decide on a plan .... AND THEN the Operations guys come into play ... is there an ASSET that can perform the mission . . . the Dr can be over ridden many steps along the way ... and CG may not agree with the need for an immediate move ... sometimes the stress of the helo lift is a negative factor (I was On Scene Commander for more than one of these, with the helo on my ship back side)

I would NOT say that some ship doctors say, "get 'em off .... get 'em off" because that would be inappropriate . . . . .

**************

trivia

did you know that RCCL MONARCH nearly sank because of a return to port for a medical emergency .... (super simplification) .. Captain ran the ship aground to avoid sinking . . . 1998

http://marinecasualty.com/documents/monarch.pdf

My next question would be, when was this, as some further research into the MCL 2006 international labor convention (which only went into effect in 2012, I think, now states that ships carrying 100 passengers or more, on voyages over 3 days are required to have a doctor. So, there has been a change.

It was Nov '13 . . .