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:

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.

A cruise passenger on board Holland America Line’s Maasdam was killed on November 7th when she slipped and fell between a tender and the HAL cruise ship. At the time of the incident, the ship was in Rarotonga in the Cook Islands.

The source of the information is a passenger, wishing to remain anonymous, who stated that: . . . the seas were very rough and it was debatable whether we should have been tendering at all. She was traveling by herself. It would appear that this incident is being covered up. The safety on this ship is rather haphazard.”

The passenger later stated that “the tender service was definitely operated by HAL. The staff members were offered counseling by phone.  I am particularly surprised how unsafe it is on their tenders . . . This particular day was the roughest I have ever seen at sea.  It was definitely not safe and that poor lady paid the ultimate price.”

The Maasdam is currently sailing on a 28 night “Polynesian & South Seas Sampler” cruise.

Cruise lines have a legal duty to exercise a minimum of reasonable care while transferring passengers to and from their cruise ships. A passenger was killed three and one-half years ago when she fell between the tender and the Cunard Line’s Queen Elizabeth. Eight years ago, a passenger was seriously injured when she fell trying to exit from a tender ferrying passengers to Grand Cayman from a Carnival cruise ship. Seven and one-half years ago, a woman died when she was dropped during a transfer from the Ocean Countess operated by  Cruise and Maritime Voyages.

The case is likely to be governed by the Death on the High Seas Act (“DOHSA”), which limits the recovery only to “pecuniary” (i.e., financial) damages.  Any surviving family members, such as a spouse or children, are not entitled under the terms of DOHSA to recover emotional damages such as grief, bereavement and emotional distress. If the woman is retired and not a wage earner, her family will be limited to just burial expenses.

DOHSA is one of the most antiquated, cruelest and completely callous laws imaginable.

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November 12, 2018 update: A passenger on the cruise left the following comment on our Facebook page: “We were on that cruise and witnessed how unsafe the tendering operation were conducted.The tragedy of this event is that the captain did cover the fatal accident from the passengers and did not properly informed us about what had happened. This gives people reason to gossip and speculate about the real cause of the accident. On that day in Rarotonga the sea was very rough and there were no extra activities from the crew to make sure that tendering operations went safer. The state of tenders on HAL was below criticism.”

November 13, 2018 a.m. update: Newsweek is reporting on the fatality.

November 13, 2018 p.m. update: The Maasdam returned to Rarotonga today, but the master announced that due to rough conditions the ship is unable to tender ashore. A passenger stated “funny, it’s a lot calmer than the other day” (when the passenger died). A photo of the weather conditions today:

The local newspaper (Cook Islands News) reported on the incident.

November 14, 2018 Update: HAL touts itself today in a press release for winning the best cruise line for  shore excursions in a reader’s choice award from Porthole magazine, just a week after a guest was killed during a shore excursion.

Photo credit: Top -M/S/ Maasdam via Holland America Line

Middle and bottom – Maasdam tender – anonymous.

A crew member is reported missing from a Holland America Line cruise ship in Alaskan waters, according to the Alaska Anchorage News.

 

The 35-year-old crew member went overboard from the Holland America Line’s Amsterdam yesterday evening.

The male crew member was reportedly last seen on the cruise ship around 6 P.M. on Thursday.  The ship’s master was eventually notified after the crew member did not show up for a work shift.

The Coast Guard stated that “the Amsterdam crew made extensive searches of the vessel, and turned the vessel around toward its last known position to search the water . . ”

Ship officials did not notify the Coast Guard of the missing  crew member until  9 P.M. and the Coast Guard did not deploy a helicopter until 1 A.M. The helicopter crew began searching in the Sitka Sound early this morning.

The Coast Guard suspended its search this afternoon (Friday), according to Coast Guard press release.  The Amsterdam has since continued its voyage toward Victoria, British Columbia,” according to a Coast Guard press release.

According to cruise expert Professor Ross Klein, there have been 319 people who have gone overboard from cruise ships since 2000.

The last person who went overboard from a HAL cruise ship was a passenger who went overboard from the Westerdam two and one-half weeks ago.

There is no indication that the Amsterdam was equipped with an automatic man overboard system, nor is there any indication that any closed circuit television cameras (CCTV) on the ship captured images of the man going into the water.

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August 7, 2018 Update:  The crew member is Rezan Monteroso. He had been on the Amsterdam for just five days, and left behind a wife and children in the Philippines. Rest in Peace Mr. Monterosa.

Photo credit: 663highland – CC BY 2.5, commons / wikimedia.

The Centers for Disease Control (CDC) reports that there was a gastrointestinal outbreak on the Crown Princess during its recent cruise, from October 25th to November 8, 2017. The Princess cruise ship departed Quebec, Canada on October 25th for a two-week cruise to Canadian and U.S. ports. The cruise ship arrived in Fort Lauderdale, Florida on November 8th and will begin its Caribbean season.

According to the CDC report, 184 passengers and 12 crew members became ill with gastro-like symptoms which included diarrhea.  

During the period from 2010 to the current date, Princess Cruises experienced the most outbreaks on iCrown Princess Princess Cruises Norovirusts cruise ships calling on U.S. ports, according to the CDC. Princess reported twenty-one (21) cases to the CDC during this time period.

The Crown Princess alone has suffered through six (6) norovirus outbreaks since 2010 to the present. Before the current GI outbreak, the last norovirus outbreak on the Crown Princess was from January 3 – 18, 2016 and, before that, from October 18 to November 16, 2014. Earlier, there was a norovirus and e-coli outbreak from February 5 to 12, 2014. It also experienced back-to-back norovirus outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012 (photo right).

The cruise line with the second most outbreaks is Holland America Line with 18 cases of GI sicknesses reported to the CDC since 2010. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam this year.  

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example? The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Are guests of HAL the second most unhygienic cruisers? Do they wash their hands the least of any cruisers? This seems like absurd arguments to make.

Is there a correlation between the age of the cruise ships and gastrointestinal outbreaks? Are different food sources and food handling techniques a more reasonable explanation? How about different sanitation procedures? 

The CDC doesn’t have time to determine the source of the norovirus outbreak (sick food handlers versus contaminated food or water or a sick passenger) so it is of no help. The CDC has not even determined the type of virus involved in the most recent outbreak on the Crown Princess.  

But blaming the passengers when one cruise line (and one cruise ship in particular) has far more gastrointestinal outbreaks than its competitors is certainly not the answer.

Whoever is to blame, the crew members, of course, always pay the price, by having to wipe and scrub and spray everything in sight for long 16+ hour days to try to disinfect a ship longer than three football fields.

Irrespective of the blame-game, don’t call us if you get sick on a cruise. Proving where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out whether the outbreak is due to norovirus, e-coli or something as exotic as shigella sonnei or cyclospora cayetanensis

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Read: Why Do the Cruise Lines Always Blame the Passengers When Norovirus Breaks Out?

Oceania Crew Members Pay the Price When Norovirus Hits.

Photo credit: WPTV (2012 noro outbreak); Royal Caribbean crew members (anonymous crew member).

HAL's OosterdamPassengers aboard a Holland America Line (HAL) cruise ship have fallen ill with symptoms consistent with norovirus on an approximately two week trans-Atlantic cruise that departed from Civitevecchia, Italy on November 3rd and arrived today in Tampa, Florida.  

According to the Centers for Disease Control and Prevention (CDC), the November 3 – 18 cruise aboard the Oosterdam sickened 86 of 1,843 passengers (4.67%) and 18 of 796 crew members (2.26%) who exhibited symptoms of vomiting and diarrhea. 

The link to the CDC about this outbreak is here. There has been no official determination of the cause of the outbreak although norovirus is suspected.

According to the CDC and the FDA, the most common cause of norovirus is contaminated food or water. Of course, like land-based restaurants, ill food handlers often transmit the virus. Passengers can also obviously bring the disease aboard which can spread due to unhygienic conditions caused either by the passengers and/or the cruise line.

Before there can be a scientific determination as to the actual cause of the outbreak, there must first be a serious epidemiology assessment of the ship which the CDC rarely performs due to the quick turn-around of the cruise ship. Unfortunately, in this case HAL immediately argued that norovirus is allegedly "circulating throughout North America and can be easily transmitted if personal hygiene is not maintained," according to a statement that it released to the Tampa Bay Times.

The CDC says that there have been 13 GI outbreaks this year, mostly involving norovirus with two e-coli outbreaks. 

The cruise ship says that it performed enhanced cleaning and left today for the Caribbean.

Photo credit: Sebastian Wessels wikipedia / commons, CC BY 2.5.

The U.S. Coast Guard medevaced a 63-year-old woman from a Holland America Line (HAL) cruise ship approximately 60 miles east of Virginia Beach yesterday morning.

The HAL Rotterdam was sailing from Boston to Fort Lauderdale, Florida when it requested the Coast Guard to medically evacuation a passenger who was reportedly suffering from stroke-like symptoms.

At about 8:30 a.m. yesterday, a MH-60 Jayhawk helicopter launched from the Coast Guard station in Elizabeth City, North Carolina. The aircrew arrived at the cruise ship around 9 A.M  and hoisted the ill woman and her husband to the helicopter. 

The Coast Guard flew the woman and her husband to Sentara Norfolk General Hospital. 

Video credit: Defense Video Imagery Distribution System

 

A couple on a cruise spent a little extra for the proverbial room-with-a-view only to find that HAL had a little surprise – it didn’t tell them beforehand about a crew member using a grinding tool outside their cabin’s window. 

The YouTube caption says: "Thanks for telling us when you upcharged us $600 extra for the window guys."

There are over a thousand comments to the video on Nate Zemanek’s YouTube page. 

Video Credit: Nate Zemanek

Hat Tip: Nine News Australia 

July 18 2016 Upgrade:  Seems that the couple were on their honeymoon.  According to UPROXX, when they complained, HAL didn’t seem to care and told them that the maintenance work on the lifeboats would continue, from 9-5 daily, for the rest of the cruise.  Later, after the issue went viral on Reddit and on YouTube, HAL refunded the $600 and gave them a free dinner.

 

https://youtube.com/watch?v=lA-9Y5L8NpI%3Frel%3D0

Yesterday, a jury in Seattle awarded $21,000,000 to a cruise passenger hit in the head by an automatic glass door on Holland America’s MS Amsterdam in 2011.

KIRO Channel 7 reports that the passenger suffered a traumatic brain injury which included debilitating headaches, problems with his balance and fatigue.

His lawyers at the Friedman Rubin Law Firm showed the jury that sliding doors injured 30 others across Holland America’s fleet of cruise ships in the three year period before the accident. 

Holland America Line said in a statement that it is "committed to the safety and security" of passengers, and that it will appeal the verdict. 

 

 

The Alaska Department of Environmental Conservation contends that cruise lines have violated Alaska air pollution regulations for the past five years. 

Tradewinds, a shipping trade organization, and the Juneau Empire report that Norwegian Cruise Lines (NCL) and Royal Caribbean Cruises disclosed in recent SEC earnings reports that they violated Alaskan Marine Vessel Visible Emission Standards.

KRBD reports that the alleged violation of the Alaskan air pollution law is widespread in the cruise industry. The community radio program interviewed a specialist at the Alaskan environmental program who identified other cruise lines who are accused of violating Alaskan law. In addition to NCL and Vision of the Seas Alaska PollutionRoyal Caribbean, Carnival, Holland America, Princess, Celebrity and Silverseas violated the emission standards according to the environmental specialist. 

Alaska issued 18 notices of violation involving 48 instances of excessive air emissions since 2010, according to KRBD. Each violation of law carries a fine of approximately $37,500. 

The cruise line are contesting the violations and are in negotiation with Alaska. 

The cruise industry, which largely burns cheap filthy bunker fuel, is installing scrubbers to reduce air emissions.

Have a thought? Please leave a comment below or join our discussion on our Facebook page.

 

Photo Credit: Royal Caribbean’s Vision of the Seas cruise ship – AlaskanLibrarian’s Flickr photostream

KHON 2 reports that two Norwegian Cruise Line (NCL) crew members were injured and hospitalized yesterday in an accident on the Pride of America. 

The accident occurred when the NCL cruise ship was docked in Hilo.

The crew members, in their 30s, were reportedly lowering a lifeboat from the cruise ship when the cables broke. The video below says that the men ended up falling into the lifeboat which fell into the water. 

July 30 2015 Update: A crew member contacted us and said that "they were raising one of the rescue boats after doing some routine maintenance on the boat. it was not a life boat. As the boat was going up it somehow detached and fell from deck 6 to the water(4 deck fall)."

 

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