Australia Investigates Death of Passenger on Sun Princess

The Courier Mail newspaper reports today on a case involving the death of a 72 year old passenger aboard the Sun Princess cruise ship. The circumstances surrounding the passenger's medical treatment on the ship have led the Attorney General of Queensland to order an inquest into the death.

Australian cruise passenger Betty Virgo was sailing on the Princess cruise ship from Brisbane to New Zealand in November 2012 on a two week cruise.  

Ms. Virgo became ill at dinner on the fifth day of the cruise while the cruise ship was in port in Napier.

Betty VirgoMs. Virgo's daughter, Gayle, was sailing with her. 

Her daughter observed that although all four medical bay beds were empty, the ship's medical staff refused her requests to keep her mother there under observation that night.

The following morning Ms. Virgo's condition continued to deteriorate.

Gayle remained with her mother throughout the day in their cabin, leaving only briefly to eat because she is diabetic. When Gayle returned to the cabin, her mother was gasping for breath. Ms. Virgo was taken by stretcher to the medical center that evening and died soon afterwards as the ship sailed.

The ship doctors diagnosed "angina" as the cause of death. Gayle disputes the diagnosis.  

When Ms. Virgo's body was returned several days later, it had been embalmed without a post mortem examination being conducted or Gayle being consulted. 

To add insult to injury, Carnival Australia, which owns the Sun Princess, offered Gayle a credit of $1,100 towards another cruise. 

Carnival denies that its medical staff neglected Ms. Virgo or provided bad medical care.

We will report on the medical inquest when it become public.

Bad medical care and a lack of responsibility of the cruise lines are issues which we discuss often here on Cruise Law News.  A case involving issues of medical malpractice and a cruise ship doctor evading jurisdiction made our list of the top ten most outrageous cruise ship stories last month.

 

Photo Credit: Adam Head / News Limited via Courier Mail

 

Shell Game: No Justice for Cruise Passenger Who Suffered Sepsis, Multiple Organ Failure & Cerebral Hemorrhage Due to Alleged Misdiagnosis by Royal Caribbean Ship Doctor

The Florida Third District Court of Appeal published a ruling today which is, in a word, shameful.

The case involved allegations by a passenger who sailed on a cruise that she suffered sepsis, multiple organ failure, and a cerebral hemorrhage due to medical malpractice and misrepresentations by a doctor on a Royal Caribbean ship.

According to the allegations in the lawsuit filed in Miami, Ms. Gutierrez and her husband sailed on Royal Caribbean's Oasis of the Seas cruise ship in May 2010 from Port Everglades, Florida for a week long cruise through the Western Caribbean. Ms. Gutierrez experienced intense abdominal pain as the Royal Caribbean - Oasis of the Seas - Ship Doctor Chris Taylorcruise ship approached Labadee, Haiti. She was taken by wheelchair to the ship's medical facility. The ship doctor, Dr. Chris Taylor, diagnosed and treated her for gastritis. However, Ms. Gutierrez was actually suffering from a far more serious abdominal infection.

The lawsuit papers further alleged that Dr. Taylor and the cruise line told Ms. Gutierrez and her husband that they could not be evacuated from the vessel and taken to an on-shore hospital. In truth, emergency evacuation services could have been arranged. Ms. Gutierrez sought emergency medical assistance at the ship’s next port in Mexico where she underwent abdominal surgery. Ultimately, she suffered abdominal sepsis, multiple organ failure, and a cerebral hemorrhage.

Cruise lines like Royal Caribbean have insulated themselves from lawsuits when ship doctors maim cruise passengers by characterizing the doctors as "independent contractors" for whom they are not liable.

Most cruise passengers don't understand that the doctors wearing officer stripes and cruise line uniforms and hats who treat them in the ship infirmary are somehow not ship doctors for legal purposes. Passengers usually don't read the fine print buries in the cruise ticket and are tricked into thinking that big, beautiful cruise ships like the Oasis costing over a billion dollars must hire highly trained, educated and experienced ship employees in the infirmaries and the cruise lines must be responsible for the doctors when they make errors. We have written about this issue many times before. Read: If the Ship Doctor Kills You, Too Bad

So as matters now stand, when passengers are injured or killed due to malpractice of the doctors in the cruise ship infirmary, they can't sue the cruise line in most cases. They are left to try and seek the recovery of medical bills and other compensation from the doctors who are usually not U.S. citizens.  

In Ms. Gutierrez's case, Dr. Taylor was born in the U.K. but for the last nine years he worked on cruise ships sailing from Florida. When Dr. Taylor was sued, the cruise lines hired its usual defense lawyers to defend him. They moved to avoid the lawsuit arguing that Ms. Gutierrez could not establish that Dr. Taylor was subject to personal jurisdiction here. However, Ms. Gutierrez's lawyers did a thorough job establishing a strong connection between Dr. Taylor and the state of Florida:

  • Dr. Taylor entered into employment agreements in Florida with Florida-based cruise lines (Carnival Cruise Lines and Royal Caribbean Cruise Lines) over the course of nine years;
  • Dr. Taylor's employment agreements specified Florida as the required jurisdiction to resolve any disputes with the cruise lines; 
  • Dr. Taylor attended annual medical conferences in Florida;
  • Dr. Taylor received advanced cardiac life support certification in Florida;
  • Dr. Taylor vacationed from time to time in Florida;
  • Dr. Taylor made presentations at medical conferences in Florida;
  • Dr. Taylor maintained two bank accounts in Florida;
  • Dr. Taylor worked aboard cruise ships that embarked/disembarked at a Florida port one day a week;
  • Dr. Taylor was on duty and treated passengers and crew members while the cruise ships were in Florida waters and returning to Miami, docked in Miami, and leaving Miami, weekly, over a course of nine years; and
  • For all intents and purposes, Dr. Taylor worked and resided exclusively on a cruise ship.      

Based on these undisputed facts, the trial court ruled that the ship doctor was clearly subject to jurisdiction in Florida and could be sued in the courts in Florida.  The judge ruled that Dr. Taylor not only Oasis of the Seasintentionally played a “shell game" to thwart jurisdiction in Florida, but he engaged in a "nefarious scheme" to avoid being sued in any court. 

On appeal, in a 2-1 decision the Third District Court of Appeal reversed the trial court holding that the factors discussed above were insufficient to establish jurisdiction over Dr. Taylor.  In my view, the appellate court nitpicked the lower court's findings and ignored the continuous and substantial relationship between the ship doctor and the state of Florida.    

You can read the order here.

The result of this decision is cruise passengers' rights are further limited. This is exactly how the cruise industry wants it.

Ms. Gurierrez, a mother of young children, is left with permanent brain injury, huge medical bills and no compensation. 

Royal Caribbean may boast that its 1.2 billion dollar mega-ship Oasis of the Seas is the largest and most technologically advanced cruise ship in the world. But as far as the treatment of gravely ill guests is concerned, the cruise line is sailing in Medieval times.     

Have a thought? Leave a comment below or join the discussion on our Facebook page.

 

Coincidence or a sign of mischief to come? The Wall Street Journal published an article in March 2010 about the Oasis of the Seas which mentioned Dr. Taylor talking about rarely medevacing passengers back to the U.S. This was two months before Ms. Gutierrez sailed on the Oasis:

The ship has three doctors on board. It also has its own intensive care unit and can keep one person at a time on life support. Every few weeks a passenger has a heart attack so thrombolytic drugs are kept on-hand, says Chris Taylor, the ship's senior doctor.

If there's a serious illness, the ship's doctors and captain can decide to divert to a port early, but rarely is anyone airlifted back to the U.S., says Dr. Taylor, who has been a doctor on cruise ships for seven years. "Many people have the belief that the U.S. coast guard is always going to come to the rescue if there is any emergency at sea. The actual truth of the matter is that most of the time the ship is well out of range of the coast guard," he says.
  

Photo credit: Dr. Chris Taylor - LinkedIn;  Oasis of the Seas - Wikipedia / Baldwin 040. 

Crew Medical Care: 3 Recommendations to the Cruise Lines

Here's another great guest bog by one of our attorneys here at Cruise Law, Charles Gourlis, who takes a look at cruise line medical care for ship employees: 

Not all cruise lines are made equal. Some provide adequate medical treatment to their injured crew members, but there are several cruise lines that just won’t get “on board” (pun intended).

I try to live up to the saying, “Don’t Just Complain, Do Something About It!” So, in that spirit, I have a few recommendations for our friends at the cruise lines. My recommendations:

1. Invest in Quality Shipboard Physicians

Most shipboard doctors either were not qualified to attend medical school in the U.S. and are not licensed in the U.S. Most cruise lines hire non-U.S. doctors because it’s cheaper than hiring U.S. Cruise Ship Medical Caredoctors. If shipowners paid their doctors salaries that were competitive with U.S. salaries, they would attract better-trained physicians. The quality of care would improve, diagnoses would become more accurate, and more serious injuries & illnesses would be prevented.

2. Bring Your Crew Members to Miami for Treatment

Most injured crew members are repatriated to their home country to receive medical treatment from doctors in their home country. This presents the same problem as problem number one. By bringing ill or injured crew to Miami for immediate treatment, all examinations, tests, and doctor’s visits are conducted by U.S. physicians here in Miami. Again, the quality of care would improve, the amount of care needed would decrease as American physicians more precisely diagnose conditions and deliver timely treatment, the need for drawn-out care would decrease.

3. Pay Your Crew Members, Not Your Defense Lawyers

As I outlined in my first guest bog post, most crew members sue only after the cruise line stops paying maintenance & cure and the crew member becomes destitute. The cruise line could prevent problems by coordinating with its local agents to ensure that all injured crew members receive maintenance payments on a timely basis every month and are promptly scheduled for medical appointments. As a result, thousands of crew members don’t languish at home while the defense lawyers for the cruise line earn their holiday bonus defending the cruise line.

Following these recommendations, the cruise lines could actually save the cruise line millions of dollars a year in needless medical and legal expenses. If the human factor wan’t a compelling enough reason to change the business practices, dozen’t saving money make a strong business case for pro-active medical treatment?

 

Photo credit: Pullmantur.es

Medical Malpractice on the High Seas: Do Cruise Passengers Have Any Rights?

CBC News in Canada published a story this week about cruise passenger Bernie Hamilton, age 66, who died following a Holland America Line ("HAL") cruise due to what sounds like a series of errors by the ship's medical personnel.  The article is entitled "Cruise Death Prompts Warning on Ships' Medical Care."  

I have heard these stories time after time over the years.   A couple excited about a dream vacation.  The husband experiences medical issues during the cruise which a competent doctor ashore would easily handle.  But due to blunders by the cruise ship medical team, the wife returns home alone to face the cruise line's denials of responsibility for the suffering and death.

In Bernie Hamilton's case, you can read about the ship doctor's misdiagnosis by concluding that Mr. Hamilton had just a common cold or perhaps asthma which led to a prescription of Ventolin which accelerates a patient's heart rate.  You can read that after Mr. Hamilton collapsed on Holland America Line - Cruise Ship Medical Carethe floor of the cabin, his wife Heather had to witness the spectacle of the medical personnel trying to decipher the instructions for the automatic defibrillator as precious minutes ticked away on her husband's life.  

After the ship medical team struggled to insert an intravenous line and intubation tube and finally "stabilized" Mr. Hamilton, the ship put Mr. Hamilton ashore in Spain where the shore-side doctors declared him brain dead.

Ms. Hamilton received no apologies from HAL.  The cruise line is quoted in the article saying that they "believe the care provided to Mr. Hamilton was appropriate."  All that Ms. Hamilton received from HAL was a bill for $2,000.

Last year, I wrote an article "If the Ship Doctor Kills You, Too Bad" which explains the dangers provided by the limited nature of cruise ship medical care and the difficulty seeking compensation when malpractice of the ship doctor or nurses harms your family. 

Yes, doctors and nurses make mistakes, but a cruise ship is about the only place where a doctor can negligently kill your loved one and there is no accountability. 

As I mentioned last year, as long as cruise lines are not liable for bad medical care, there is no financial incentive for the ships to invest in training and hiring more qualified and experienced doctors and nurses.

There is no economic or moral justification for such an inequitable situation. The cruise industry collects over $35 billion dollars a year and pays no Federal income taxes by registering their cruise ships in foreign countries.  As long as travel agents, cruise fans and the public are indifferent to these type of stories, in the future other families will experience the horror of dream vacations going terribly wrong.

 

Photo credit:   CBC News / Heather Hamilton

Reason No. 6 Not To Cruise: If The Ship Doctor Kills You, Too Bad

This is reason no. 6 in the series: Top 10 Reasons Not To Cruise

The last place you want to become ill or injured is on a cruise ship far away from a U.S. port.

Cruise ship medical care is limited.  Ship doctors are usually from foreign medical schools.  The shipboard facilities are often inadequate and the medical care is sub-standard.  Consider reading "Cruise Ship Medical Care Spotty" (Consumer Affairs) and "Ocean Liners' Medical Care May Not Be Shipshape." (CNN)

Cruise Ship Doctor - Cruise Line MalpracticeMost disturbing is the fact that cruise lines are not legally responsible when their ship doctors commit malpractice.

In Carnival v. Carlisle, a family took a vacation cruise aboard Carnival's Ecstasy.  During the cruise, the family's 14 year old daughter developed abdominal pain and was seen several times by the cruise ship doctor.  The doctor assured the concerned family that it was not a case of appendicitis, but was just the flu.  When the family returned home to Michigan, a U.S. doctor correctly diagnosed a ruptured appendix.  Due to the rupture, infection and delay in treatment, the daughter was rendered sterile.

The family sued Carnival for damages caused by the Carnival ship doctor's negligence.  The Florida Supreme Court ruled, however, that cruise lines like Carnival are not legally responsible when the ship doctor commits malpractice.  The Court held that because the ship doctors are "independent contractors," cruise lines cannot be held vicariously liable for the doctor's wrongdoing.

If a passenger is injured or killed due to malpractice by the ship doctor, the passenger is forced to try and sue the doctor.  This is problematic for several reasons.   The doctor inevitably does not live in the U.S.  It is very difficult to serve a ship doctor with a lawsuit or obtain personal jurisdiction.  Also, many doctors do not have liability insurance and have few assets.   

This presents a "double whammy" to passengers.  The chance of receiving bad medical care is greater on a foreign flagged cruise ship than in a passenger's home town.  And if there is malpractice, the cruise line can avoid responsibility because of the "independent contractor" defense.  

This leaves an injured passenger, or the family's surviving family members, forced to try and chase the foreign ship doctors around the world to obtain accountability.

Cruise Ship Doctor - Independent Contractor? Over one-half of the passengers who seek medical treatment during cruises are over age 65.  Many passengers have pre-existing medical conditions including heart conditions.  Elderly passengers are at risk for complications on cruise ships with noro-virus and are then at the mercy of incompetent or inattentive ship doctors.  For an example of cruise ship medical negligence, consider reading:

Cruise Ship Doctors: Roll The Dice With Your Life

As long as cruise lines are not liable for bad medical care, there is no financial incentive for the ships to hire more qualified and experienced doctors and nurses. 

There is no economic or moral justification for such an inequitable situation.  The cruise industry collects over $35 billion dollars a year and pays no Federal income taxes by registering their cruise ships in foreign countries.       

Most passengers do not understand that the "Carnival" ship doctor, wearing a uniform with a "Carnival" badge, is not considered by the cruise line to be a "Carnival" employee. 

If the ship doctor's negligence kills your parent or maims your child, what are you going to do?

This lack of accountability by the cruise industry is another reason why Americans should think twice about taking a family cruise. 

 

Tomorrow, we will discuss Reason No. 7 Not to Cruise: Cruise Lines Exploit Foreign Crew Members, Like You'd Never Believe.

 

Credits:

Photographs       TBO.com News Channel 8 (Jim Hockett) "Cruise Ship's Doctor Puts Elderly Man Ashore"