Medical removal against passenger's wishes

[serendipity1499]

I agree with most of those who said that the HAL Captain in conjunction with the Physicians report did the correct thing..

 

As others have said, I truly believe that many times patients will tell a Dr. that they are fine but the attending Physician knows otherwise..

 

I used to take my dog to our local hospital for visits with patients & so many times they would tell us that they did not want to go to the Hospital but they agreed only because their family was so upset.. Many of them were happy that they did go into the Hospital because they were really seriously ill & had to have emergency surgery..

 

Several years ago, I was feeling a bit sick to my stomach & my regular Dr. made an appointment for me with our gastroenterologist (sp?) because I had a history of esophagus problems.. Later in the afternoon I called his office & asked if I could get in early the next day as I was feeling worse.. The Dr. was in surgery & his nurse told me to go to the ER immediately.. I was undecided but DH insisted I go to the ER.. By the time I got there I was feeling better but again DH insisted I be examined.. Thank goodness for the Dr.'s nurse & my DH.. The ER did tests & said it was my appendix.. I was immediately transferred by ambulance to another hospital for emergency surgery at 1 a.m...My appendix had burst, & I could have died if they had not caught it in time.. I was in the Hospital for 5 days & a nurse had to come in to our home daily, for weeks to change the dressing on my open wound..

 

If it were my Mom I would be happy that she is OK now & would not fault HAL for taking precautions..

 

Betty

Edited March 6, 2014 by serendipity1499

[whogo]

There will come a time in my life when I would rather die on a cruise ship than have my lifespan extended by going to a foreign hospital. I have told my family that if I drop dead tomorrow I have had a good life. Celebrate it. I hope to enjoy many more happy years, but I would rather spare myself and my family years of hospitals, nursing homes, incontinence, and dementia.

[sail7seas]

There will come a time in my life when I would rather die on a cruise ship than have my lifespan extended by going to a foreign hospital. I have told my family that if I drop dead tomorrow I have had a good life. Celebrate it. I hope to enjoy many more happy years, but I would rather spare myself and my family years of hospitals, nursing homes, incontinence, and dementia.

 

 

Wouldn't we all?!!!!

 

Yours is not a unique wish. ;)

We don't all get our wish. I sincerely doubt many of us would wish for the demise you describe.

 

[SarasMommy]

Hmmm… I am not sure why so many people turned my post into a poll as to whether or not the right decision was made to remove my mother from the ship, as I do not believe that is what I asked. :confused:

 

@boone2, please do not assume that I may have written a “different letter” depending on the outcome of the tests. The original post is the letter I wrote and I am looking feedback on THAT, not hypothetical “what if” letters of events that didn’t happen.

 

@cruisin’girl, the point of my post wasn’t to do with insurance either; I am aware of pre-existing condition clauses, and there are already enough posts about that on these boards. But while on the subject, she DID purchase insurance; in fact this is the first time she ever did. She has a credit card that has good insurance coverage, but the travel company for this trip told her that all customers had to purchase separate insurance through this particular insurance company in order to book with them. It was a very expensive policy, more than ten times what I usually pay for travel insurance. So she put the claim through them because she thought that for the price it would be a full, comprehensive policy. All they told her when she bought it was that any pre-existing conditions had to be stable for the past 180 days, which they were. Yet another case of buyer beware. But again, this was NOT the point of my post.

 

@cbr663, as far as receiving medical treatment that she didn’t want, because she was medically removed from a cruise ship in a foreign country the port authority got involved, and between them and the HAL medical department, when they rebooked her flight home it was apparently the airline who insisted on the tests. If she was at home I’m sure she could have left the hospital at any time upon signing an AMA letter.

 

@sail7seas, yes, she was travelling solo on the cruise. I think that may have factored in the decision to remove her. Also, for the record, her throat wasn’t sore due to a virus or infection; it was caused by one of the medications she was on, which has since been replaced. So it wasn’t an issue of spreading a contagion.

 

@Hlitner, I do not “need to understand” the limitations of shipboard medical equipment; I am well aware of that. Perhaps YOU need to understand what I wrote in my original post was not that she had “irregular heart symptoms”, but that she had a cough from a sore throat which got out of control and caused her to have difficulty breathing, although I am sure that when the doctors checked her heart rate and blood pressure that they probably were elevated after such an episode. And she didn’t have a “long hospitalization”. After arriving at hospital she waited ONE FULL WEEK before they got around to doing the tests, and after they were done she was released less than 24 hours later. Had she stayed on board she would have completed her cruise and been home by then. I also realize that the hospital stay had nothing to do with HAL; I never said it did.

 

@IRL_Joanie, please do not assume that I would sue; you do not know me well enough to make that assumption.

 

@whogo, that is an excellent point, and I agree. I would much rather be treated by a shipboard doctor than in a hospital in some of the ports I have visited over the years. That is a prime example in the debate of whether patients are removed from ships due to liability/convenience or out of necessity.

 

Since it seems many people obviously did not understand the main point of my post, I will reiterate it, as I was looking for other people’s personal experiences rather than a lesson on the importance of travel insurance and the limitations of shipboard medical facilities, or a rundown of what could have been. For those who have been removed from a cruise against their wishes for medical reasons (or know someone who has), do you feel that the medical staff was being overly cautious, either out of concern for your health or because of liability fears or a combination of both? The cruising industry is growing year after year, and, let’s face it, a large share of the market consists of retirees who as they age are going to develop health challenges. If they do experience a health challenge on board, are they going to be more reluctant to call for help for fear of cutting their vacation short, even if it turns out they really do need medical care? Just because a cough may be a sign of heart problems does not mean that every cough by a person with a heart condition is a lead-up to a heart attack. Is there some sort of list of conditions set out in the medical department’s policies that result in non-negotiable removal? In the future will cruise lines request a medical clearance before they will even let passengers board? Could it depend on the itinerary, for example ones that include several sea days in a row like a Transatlantic crossing, or to exotic destinations like Antarctica where even shore facilities are limited or non existent?

 

As for welcoming me to the boards, thank you but it is almost seven years late. I joined the boards back in 2007, mainly as a lurker but occasionally posting. Then I stopped because of some of the heated exchanges I read day after day. Cruising is supposed to be fun and relaxing but I found many of the posts downright mean and critical, and went off on tangents not related to the OP’s original topic. It’s a shame when instead of being able to find out the information requested that posts become a target of criticism by people who always feel they are uniquely qualified to supply all the answers to questions that weren’t asked. I decided to give it another try in the hopes that things had changed.

 

Thank you for wishing my mother well, and I am obviously glad that she was okay, in spite of the medical bills. It was an expensive experience, but many lessons were learned and it hasn’t stopped her from travelling.

[cbr663]

@cbr663, as far as receiving medical treatment that she didn’t want, because she was medically removed from a cruise ship in a foreign country the port authority got involved, and between them and the HAL medical department, when they rebooked her flight home it was apparently the airline who insisted on the tests. If she was at home I’m sure she could have left the hospital at any time upon signing an AMA letter.

 

 

Thank-you for sharing this information. I am from Canada also and did not realize that so many parties would be involved in a medical evac from a ship.

[mamaofami]

. As far as coughing goes, there are times when half the ship is coughing. I can't imagine they would all be put off. I'm sorry this happened to your mother and glad she's

OK.

[david,Mississauga]

... Pre existing conditions should have been declared when insurance was taken out.

...

Terry

 

 

Sent from my iPad using Forums mobile app

 

As the OP is Canadian my comments are based on travel insurance policies available in Canada. All the policies that I have checked into - and there have been many - will cover pre-existing conditions if they are declared and the appropriate premiums paid. But there is a requirement for "stability", and the definition of "stable" is an insurance company definition, not a medical definition. (Yes, that can be tricky.) The requirement of stability for a period of 90 days before the incident is as good as it gets. Most policies require six months and some even longer.

 

Note: Sarasmommy's posting #29 was not appearing when I typed my comments. If I had seen it first I might not have posted it, but as my comments were in direct response to another person I will leave it on.

Edited March 7, 2014 by david,Mississauga
A p.s. was required for clarification.

[PROCRUISE]

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

 

Having spent the last 30 years as an ER/Trauma RN, I can assure you that if you had come to our Level One ER Trauma Center there is no way you would have been sent off on a cruise with a few nitro tablets!!! :(

[BeagleOne]

 

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.

 

 

You are very, very lucky that you didn't die.

[happy cruzer]

Op, I think everyone was trying to be helpful. There is always discussion that may be off your topic but it is general information that is being shared for all on the board.

 

Your question is obviously very important to many. It concerns one of the most critical decisions in anyone's life. Thanks for starting the discussion.

[Roz]

When you post questions in a public forum, you are going to get an array of answers and observations. What is it you want us to tell you?

 

Roz

[RuthC]

When you post questions in a public forum, you are going to get an array of answers and observations. What is it you want us to tell you?

This is a thread from a couple of months ago; it got bumped up, Roz. Don't expect OP to answer you.

[donaldsc]

Would you have felt better if the doctors were correct and your mother was really sick? Be thankful that it was a false alarm. By the way, is your mother a doctor who is capable of evaluating her own condition. Even doctors err when they practice self diagnosis and your mother is not a doctor.

 

DON

[Typhoon1]

I would err on the side of caution and yield to those in the know, such as the ship's doctor.

[Roz]

Ruth, thanks for the heads up. I won't hold my breath. :D

 

Roz

[bottomfeeder]

OP, have you asked Holland America what their policies are for medical evacuation? That seems to be the question you are asking in your original post. I would think that HAL would be the best and most accurate source for that info, rather than asking its passengers here on this board.

 

I only mention this since in your second post you complained that the other posters were not answering your question.

[RDC1]

The key point is that the medical professional on the cruise line can and will make a decision to remove a passenger from the cruise line if they feel that there might be a medical condition beyond their capacity to treat successfully on board or if there is any indication that a condition might develop that is beyond their capacity. They will make that decision even if the individual disagrees.

 

They do not control the land based hospital. The patient can certainly refuse to be treated once they are off of the ship. As far as getting removed from the ship they have no choice once the medical staff makes the decision to remove.

[take us away]

Now I fully appreciate that taking acre of your health is very important, we have seen people medevac'd against their wishes and have heard way too often - 'do not go to medical as they will throw you off the ship'. Latest instance was a good friend who had a mild case of congested heart failure and was having a few breathing issues, the ship's MD (he was a heart surgeon) forced the man to be medevac'd to the local hospital. The man did not want to leave as he knew his condition well but the MD actually said to him "do you want to die on the ship". So the man and his wife were sent to a local hospital and then sent home. He immediately went to his own MD who, after a very strenuous exam, gave him a prescription for diuretics and said everything was fine, just some extra fluid in his heart which was probably due to his change in diet to ship's food with more salt (even if a no or low salt diet). His MD was floored that the ship's doc had not given him a diuretic as it is considered 1st line of treatment and told the gentleman that the next time he cruises, he will give him some in case this happens again.

[Mytime2014]

Now I fully appreciate that taking acre of your health is very important, we have seen people medevac'd against their wishes and have heard way too often - 'do not go to medical as they will throw you off the ship'. Latest instance was a good friend who had a mild case of congested heart failure and was having a few breathing issues, the ship's MD (he was a heart surgeon) forced the man to be medevac'd to the local hospital. The man did not want to leave as he knew his condition well but the MD actually said to him "do you want to die on the ship". So the man and his wife were sent to a local hospital and then sent home. He immediately went to his own MD who, after a very strenuous exam, gave him a prescription for diuretics and said everything was fine, just some extra fluid in his heart which was probably due to his change in diet to ship's food with more salt (even if a no or low salt diet). His MD was floored that the ship's doc had not given him a diuretic as it is considered 1st line of treatment and told the gentleman that the next time he cruises, he will give him some in case this happens again.

 

And you have just given the perfect rationale for someone with a known/chronic medical condition to be cleared by their physician and have "just in case" medication available.

 

A person with an unknown degree of congestive heart failure can just die. I mean - anyone can, but if you have to take meds for CHF, why would you not have an emergency plan? BP cuff, diuretics, scale to see if you need the diuretics....

Same for diabetics or heart patients - have an emergency plan - don't leave home without it!

[sail7seas]

The key point is that the medical professional on the cruise line can and will make a decision to remove a passenger from the cruise line if they feel that there might be a medical condition beyond their capacity to treat successfully on board or if there is any indication that a condition might develop that is beyond their capacity. They will make that decision even if the individual disagrees.

 

They do not control the land based hospital. The patient can certainly refuse to be treated once they are off of the ship. As far as getting removed from the ship they have no choice once the medical staff makes the decision to remove.

 

 

While, of course, the Captain relies upon the advice of ship's doctor, isn't it the Captain that makes the final call if the guest will be a medical evac?

 

[Linda&Vern]

While, of course, the Captain relies upon the advice of ship's doctor, isn't it the Captain that makes the final call if the guest will be a medical evac?

That was my thought exactly. The Captain would have final say - based, of course, on the expertise of the ship's Doctor.

[cruisin'girl]

I seriously doubt the Captain would ever overrule the ship's doctor in such a situation. If he did and the pax remained on the ship and then there were serious medical complications that the ship couldn't handle or even a death, it could open up a whole can of worms for the cruiseline and the Captain.

[sail7seas]

I seriously doubt the Captain would ever overrule the ship's doctor in such a situation. If he did and the pax remained on the ship and then there were serious medical complications that the ship couldn't handle or even a death' date=' it could open up a whole can of worms for the cruiseline and the Captain.[/quote']

 

 

Not quite as simple as that......

 

What about weather?

Sea Conditions?

Communication and agreement of Coast Guard being able to attempt the evacuation?

Distance from land?

 

Etc

 

Edited May 30, 2014 by sail7seas

[cruisin'girl]

Not quite as simple as that......

 

What about weather?

Sea Conditions?

Communication and agreement of Coast Guard being able to attempt the evacuation?

Distance from land?

 

Etc

 

Obviously if it wasn't safe to do or not close enough to get to a hospital on land it couldn't and wouldn't be done. That's a given.

[RDC1]

While, of course, the Captain relies upon the advice of ship's doctor, isn't it the Captain that makes the final call if the guest will be a medical evac?

 

 

 

I would expect that the decision to medically remove a passenger is pretty much made by the senior medical officer on board. The Captain is certainly notified and involved, but I doubt that he would ever override the decision of the medical officer. Especially in a case where the person is removed during a normal port stop. To put is simply it would place him at considerable professional risk with little to gain to override the medical officers decision.

 

Clearly if the ship has to change course, schedule, or meet with a helicopter the Captain will be much more involved in the decision and the exact degree of urgency. There is no indication in anything that the OP stated that the removal from the ship was anything other then a normal port stop.

 

To put it another way the Medical Officer determines the what (passenger evacuation needed) the Captain determines the when and how based upon the degree of urgency from the medical officer.

Edited May 30, 2014 by RDC1