The Sun Sentinel recently reported on a lawsuit filed against Holland America Line arising out of a stroke suffered by a 65 year old woman while aboard the M/S Zuiderdam in March of 2018.

Lila Graciela Kohn Gale reportedly suffered a hemorrhagic stroke shortly after the HAL cruise ship left Ft. Lauderdale at the start of a seven day Caribbean cruise. Although the medical emergency occurred less than five hours after the ship left Port Everglades, when the cruise ship was likely less than 100 miles from the South Florida coast, the ship did not contact the U.S. Coast Guard in order to request an emergency medical evacuation.

Mr. and Ms. Gales reportedly enjoyed traveling together on cruises.  Mr. Gale described his wife, prior to the cruise, as a vibrant, fun loving, bilingual therapist and counselor.

Ms. Gale lost consciousness around 8:30 p.m. on the first evening of the cruise; the ship’s doctor, Socrates Lopez, assessed Ms. Gale and quickly determined that she required a CT scan of her brain and an emergency consult with a neurologist or neurosurgeon. However, instead of calling the Coast Guard and requesting a medevac, the ship’s medical staff reportedly left Ms. Gales untreated despite her worsening condition. It then sent her via a tugboat to a hospital in Freeport, Bahamas, Rand Memorial Hospital, around 11:00 p.m., after giving her husband a medical bill for $3,500.  Ms. Gales arrived at the hospital in Freeport shortly after midnight, but the public hospital did not have a neurosurgeon, neurologist, or even a functioning CT scan.

According to the lawsuit (which you can read here), a doctor in the Bahamas made the decision to transfer Ms. Gale to Broward Health Medical Center, a comprehensive stroke center in Ft. Lauderdale, but the airport was also closed for the night.  The next morning, Ms. Gale arranged for an air ambulance (at an expenses to him of $15,000 which HAL refused to pay) to fly his wife from the Bahamas to Broward Health where she finally arrived more than 15 hours after her stroke on the cruise ship.  Ms. Gale required emergency surgery to relieve the pressure on her brain in order to try and minimize the extent of her cerebral injuries

The lawsuit alleges that the delay in treatment cause an excessive amount of Ms. Gale’s brain tissue to die, leaving her with “devastating physical, cognitive and neurological deficits which require extensive medical care and treatment around the clock.”  Her lawyer, Tom Scolaro of Leesfield Scolaro P.A. in Miami, (as quoted in the Sun Sentinel article) states that Ms. Gale is now  “severely disabled” requiring  “24-hour round-the-clock nursing care.” The Chicago Tribune, which also covered the tragic story in an article titled ‘I Want Justice’: Suburban Family Sues Cruise Ship Operator For Not Airlifting Woman Who Had Stroke On Board, further explained that Ms. Gale “cannot walk and struggles with language while her memory, perception and concentration skills have been impaired.” She now lives in pain at a nursing home and is not expected to recover enough to return home.

The irony of this sad case is is that HAL claims that it is an “industry leader in cruise medicine.” It advertises to its mostly elderly cruise customers that it can disembark them “via Coast Guard helicopter if medically appropriate and logistically possible in relation to the ship’s distance from land.”

Medically Appropriate?

Based on the facts presented, there appears to be no dispute that it was “medically appropriate,” if not absolutely necessary, to have arranged for Ms. Gale to receive comprehensive treatment at a stroke center as soon as possible.  The facts alleged are that her brain was “slowly dying;” sending her via a tugboat to an ill-equipped hospital in the Bahamas without qualified and experienced specialists appears to be an undeniably ill-conceived and callous decision under the circumstances.

Logistically Possible?

And there appears to be little dispute that it was “logistically possible” (in relation to the ship’s distance from land) for the U.S. Coast Guard to dispatch a helicopter to fly 100 miles to medevac Ms. Gale from the cruise ship.

We have written about over 150 medevacs of passengers and crew members by the Coast Guard from cruise ships since 2011 (our list is admittedly not complete).  In the last four years alone, there have been at least twenty  medevacs via helicopter where the Coast Guard flew in excess of 100 miles to the cruise ships to hoist ill passengers aboard and then fly them an equal distance to a land-based hospital in the U.S. with appropriate medical facilities and experts.

The last reported medevac, just five days ago, from a cruise ship involved a Coast Guard helicopter which flew 200 miles to the Norwegian Star west of San Diego in order to medically evacuate a passenger with a heart condition.

Shorty before Christmas last year, the Coast Guard flew a distance of 402 miles to rescue a passenger suffering from kidney failure from the Anthem of the Seas in the Atlantic so that he could receive emergency medical treatment in North Carolina.

Coast Guard Helicopters Fly Thousands of Miles a Year to Rescue Sick Passengers During Cruises

The Coast Guard also conducted the following medevacs in the last four years, each in excess of 100 miles:

• 230 miles – Norwegian Breakaway, abdominal pain, November 2018;
• 150 miles – Adventure of the Seas, stroke, July 2018;
• 160 miles – Anthem of the Seas, renal failure, May 2018;
• 160 miles – Carnival Dream, seizure, December 2017;
• 100 miles – Vision of the Seas, internal bleeding, December 2017;
• 500 miles – Grandeur of the Seas, appendicitis, November 2017 (medevac performed by the U.S. Air Force);
• 300 miles – Norwegian Breakaway, appendicitis, June 2017;
• 150 miles – Carnival Ecstasy, chest pain, April 2017;
• 100 miles – Carnival Magic, chest pain, April 2017;
• 150 miles – Grandeur of the Seas, abdominal pain, March 2017;
• 230 miles – Norwegian Breakaway, abdominal pain, July 2016;
• 260 miles – Norwegian Breakaway, abdominal pain, June, 2016;
• 165 miles – Norwegian Breakaway, abdominal pain, October 2015;
• 115 miles – Carnival Triumph, heart attack, October 2015;
• 300 miles – Carnival Miracle, abdominal pain, August 2015;
• 185 miles – Carnival Magic, respiratory problems, February 2015;
• 220 miles – Norwegian Gem, diabetes complications, January 2015;
• 230 miles – Carnival Triumph, seizure, January 2015.

These distances are to the cruise ship; the Coast Guard helicopters obviously have to fly an equal distance back to land. (There may be other emergency medical rescues via helicopter; this list is not exhaustive).

In addition to these medevacs by the U.S. Coast Guard, we have written about long distance emergency medical evacuations conducted by navy and air forces in Europe involving distances of several hundred miles, such as this case in 2017 involving the P&O Aurora where a Portuguese Air Force helicopter flew nearly 600 kilometers (photo above right) from the coast of Portugal to rescue an ill cruise passenger at sea.

Strokes Require FAST Medical Treatment – Not A Slow Boat to the Bahamas

All first year medical or nursing students know the “FAST” acronym regarding a stroke:  Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services. It is universally recognized there is a limited time period in which to treat a stroke before a patient suffers irreversible, serious neurological deficits. Failures of the type alleged in this sad case typically appear to involve incompetent shipboard medical staff.

The Delayed Care of Christina Marie Ricci

We are aware of at least one other recent instance of delayed and substandard shipboard care and a refusal to request a Coast Guard medevac involving a young woman who sustained a stroke on a Carnival cruise ship.

In 2015, 24 year-old Christina Marie Ricci was a passenger aboard the Carnival Victory when she suffered a stroke just eight hours after the cruise left Miami. According to her mother’s account, instead of requesting a Coast Guard medevac, the Carnival cruise ship, which was off the coast of Florida, sailed on to Key West as her medical condition worsened. Once there, about six hours after her stroke, Christina was taken to a non-trauma care facility unit, where she was assessed and then eventually flown to Miami’s trauma hospital, Jackson Memorial. Her treating doctors at Jackson informed her family that they could have managed her medical care if the cruise line had timely requested a Coast Guard medevac from the ship.

Christina died 19 days later, without regaining consciousness.

That’s why most competent ship physicians will not hesitate to contact the nearest Coast Guard station and discuss a passenger’s symptoms with a Coast Guard flight surgeon in order to request a medevac.

I have never heard of the Coast Guard refusing to dispatch a helicopter to a cruise ship involving a victim of a stroke, heart attack or other serious medical emergency, particularly where the ship was less than 100 miles from a state-of-the-art stroke center in the U.S.

The Coast Guard Does Not Charge Cruise Passengers or Cruise Lines for Emergency Medical Care

The expenses of a Coast Guard medevac are never charged to the ill cruise passenger and are paid for 100% by the federal government. Cruise passengers do not have to have medical insurance in order to reimburse the Coast Guard. The Coast Guard also do not charge the cruise line for the medevac of their ill guests who require emergency care ashore, which makes the alleged failure of the medical staff aboard the M/S Zuiderdam even more inexplicable and troubling.

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Story credits: Sun Sentinel, Chicago Tribune, CBS 4 Miami (video).

Photo of M/S Zuiderdam – Copyright © 2008 K. Krallis, SV1XV – CC BY-SA 3.0, commons / wikimedia.

Photos of Ms. Gale – via Chicago Tribune, CBS 4 Miami.

Photo of Christina Marie Ricci – Lisa Ricci.

Medevac Photo Top – U.S. Coast Guard via Defense Visual Information Distribution Service (DVIDS).

Medevac Photo Bottom – Esquadra 751.