Cruise death prompts warning on ships' medical care

Bernie Hamilton always dreamed of taking a transatlantic cruise, but the Canadian's trip quickly turned into a deadly nightmare.

Hamilton, 66, of St. Catharines, Ont., suffered a heart attack last April while aboard a Holland America Line cruise ship and became brain dead. He died three weeks later on May 5.

"This is a nightmare that probably has no ending for us," said his wife, Heather Hamilton. "It's heartbreaking, really."

Hamilton told CBC's The Fifth Estate she believes her husband would still be alive if not for a series of misdiagnoses and missteps by the cruise ship's doctor and staff.

No requirements currently exist concerning the training and competency of hired medical personnel aboard cruise ships. All regulations are voluntary.

It's a lesson Heather Hamilton learned the hard way.

Series of missteps

Bernie began to feel ill six days after the Holland America Line cruise ship departed from Fort Lauderdale, Fla. Over several days, he visited the ship's doctor three times, complaining of symptoms including shortness of breath and a sore throat.  

Heather, a former emergency nurse, said Bernie's age and medical history — a heart attack 10 years earlier — should have triggered a chest examination or an electrocardiogram.

The doctor's initial diagnosis was a common cold. On the final visit, the doctor diagnosed Bernie with asthma and prescribed Ventolin, a drug known to speed up heart rates.

A day later, Bernie collapsed on their cabin floor.

Heather called 911 and began CPR. The first responders, two young ship employees, soon arrived with an automatic defibrillator, which they didn't know how to use.

"I could hear the girl saying, 'Here, read the instructions,'" said Heather, who continued to conduct CPR. "And I thought, 'Oh, this is not the time to be reading the instructions.' We were wasting precious time."

Once medical staff arrived, they administered a shock, but spent precious time struggling to insert an intravenous line for clotbuster drugs and an intubation tube to help Bernie breathe, Heather said.

'The cruise line does not make its decisions based upon the welfare of the passengers. It's only the 'love boat' up until something bad happens.' —Lawyer Philip Gerson

It took an hour for medical staff to stabilize Bernie, she said, and then the two were ordered off the ship at a port in Spain where Bernie could get treatment at a hospital. He was later declared brain dead at the hospital.

The Fifth Estate has learned that the doctor who treated Bernie, Dr. Brian Kuhn, is Canadian trained but licensed as an emergency doctor in California and Arizona. He has two malpractice settlements in cases involving allegations of misdiagnosis and mistreatment, both resulting in death.

Holland America has refused CBC’s requests for interviews, saying only that they "believe the care provided to Mr. Hamilton was appropriate."

Months ago, Heather wrote a long letter to Holland America laying out in detail her version of the events that led up to her husband’s heart attack. She still has not received a reply from Holland America. The only correspondence from the cruise line has been a $2,000 bill for Bernie's medical care.

'Too many' similar stories

A member of International Cruise Victims Association, a lobby group seeking medical regulations for cruise ships, says Heather Hamilton's story is tragic but not new.

"I've heard far too many stories," said Lori Vaaga, a Seattle woman whose father also died of a heart attack on a cruise ship. "And hearing Heather's, four years later, just validates to me they haven't changed their way of doing business."

Many cruise lines advertise their state-of-the-art medical facilities and high-quality medical care, a necessity since the ship can sometimes be days away from a port of call. But critics warn the quality of the care is sometimes questionable.

"They advertise that they do have a medical clinic on board," said Philip Gerson, a civil lawyer in Miami who specializes in maritime law. "And they actually sell those services to their passengers. But they don't tell them … that they have no legal responsibility for the carelessness of the medical personnel."

Under pressure from U.S. Congress, cruise lines agreed to adopt voluntary guidelines on medical care.

The pressure came after a 1996 study conducted by two Florida doctors that found 54 per cent of cruise ship doctors surveyed had no training in advanced trauma life support and nearly one in four had no specific training in how to deal with heart attacks.

"Passengers on ships, as well as crew members, have an expectation that their health care is going to be the same that they would receive on land," said Dr. Richard Prager, a co-author of the study.

In the last 15 years, the cruise line industry has spent $36 million lobbying U.S. Congress and federal agencies, in part to fight mandatory regulation for medical training. 

It's very difficult to hold cruise ship companies responsible for medical mistakes made on board. According to maritime law, doctors and nurses are independent contractors, not employees, making it difficult to hold the cruise line legally liable for the medical staff's mistakes.

"The cruise line does not make its decisions based upon the welfare of the passengers," Gerson said. "It's only the 'love boat' up until something bad happens."