Last May, Capt. Renee Hobart sent in her Merchant Mariner Credential Medical Evaluation Report to renew her U.S. license. In her application, she missed something.
“I had accidentally left a blank, a square on the medical condition list,” she said.
The application came back with a cover letter requesting more information. It was the beginning of a six-month process.
Hobart started her career 26 years ago with a 100-ton ticket. Now on her sixth issue, she decided to start her renewal in May, seven months early, to be sure to have her new license in time for a scheduled yacht delivery.
“It used to be much easier,” Hobart said of her previous renewals. “There were about 33 items on the list last time.”
Now the list includes 88 medical conditions that must be attested to. That increase, in effect since September 2009, gives mariners at least 50 more items to clarify about their health status.
Hobart identified that she takes blood pressure medications, previously had a small heart murmur and has had neck pain due to mild migraines. She said she manages her blood pressure and minor headaches and it was questioned if she even had a heart issue.
“I wrote a letter explaining everything and the migraines I’ve managed since I was 10,” she said.
In August came a letter from the coast guard requesting “amplifying information” to complete the evaluation process.
Hobart set out to fulfill the request by revisiting her doctor. By now her personal insurance co-payments had increased from $40 to $75 for each visit.
“I am happy to know about my health, but it adds up,” Hobart said.
The Coast Guard requested she take a $1,200 cardiac test. Her doctor said it was unnecessary and requested she wear a monitor for 24 hours to prove she had no heart concerns.
Her doctor addressed the other requests.In late October, another letter arrived with four more “amplification” requests. This time the list referenced a drug she was prescribed but was not taking.
So, Hobart wrote another letter explaining she does not take the drug and supplied a history of prescriptions from her pharmacist. Next, the coast guard requested the doctor correct the error, which entailed a five-page fax for correct medical records, and a copy of his correction letter.
With barely a month to go before her license expired, Hobart finally received notice that her application had cleared the medical screening/evaluation process.
To hold a mariner’s license, every captain and crew must fulfill the medical requirements. Occasionally, a condition such as arthritis, high blood pressure, back pain, hearing loss, diabetes or heart disease can prevent, delay or restrict their approval for a license.
The process is regulated by more than 75 pages detailing hundreds of medical conditions that may require review. They are found in the document titled Navigation and Vessel Inspection NVIC No. 04-08 on the USCG Web site.
This is where applicants with heart conditions can find how many beats their heart should beat per minute, learn if they are classified as overweight and clarify how big a space they must be able to crawl through (24 by 24 inches).
This increase in scrutiny is to ensure mariners are fit to perform their duties. The USCG recognizes “service on vessels may be arduous and impose unique physical and medical demands on mariners.” And in an emergency, the vessel’s crew may be the only help, so crew must be medically and physically fit.
“Today there are a lot of conditions that previously would have gone through,” First Officer Karen Anderson said of the current procedures.
Anderson got her first license in 1982 in St. Thomas, USVI. Back then, she said, the doctor basically asked if she could see and hear. Now on her seventh renewal, she said the process is definitely more complicated.
The USCG Web site explains that the current levels of specificity of medical conditions are necessary to reduce subjectivity. The intention is to promote more consistent evaluations across the board.
The Coast Guard expects the process to be fairer and less subjective, and its Web site states that officers “anticipate application processing time to be reduced because all parties will know precisely what information is needed at the outset of the application process.”
At 70 years old, Capt. Bill Tinker has seen the process change as he’s renewed his license through the years. It used to be that the report from the mariner’s doctor defined the applicant’s medical status.
“Now when you give it to the Coast Guard, it goes before their doctors,” Tinker said by phone from Vancouver.
The actual review is conducted by a team of doctors and medical personnel employed by the USCG at the National Maritime Center.
“Now, doctors that specialize in each area are the ones that say yes or no,” Tinker said.
Those with physical limitations who do not meet the guidelines may be issued a credential with waivers or restrictions. This renewal, Tinker wears a hearing aid so he had to pass a speech recognition test.
“This time I got a waiver on my license,” he said. Now he’s required to carry spare batteries when he works on off-shore supply vessels.
Applicants don’t automatically get their new credentials when they clear their medical requirements.
“That just means you can go on with the next steps,” Hobart said. “It has to go in this order. You have to get medical clearance before they evaluate your sea time.”
This has caused some mariners to be pressed for time to complete all their requirements before their licenses expire. Occasionally, it’s only after the medical clearance that crew find out they must show more sea time, re-certify STCW or take another course.
“The Coast Guard does one line at a time,” Hobart said. “I told them I need to know it all now.”
The USCG Web site states that recent revisions to the requirements should reduce the time required to process credential applications by helping eliminate the uncertainty that mariners may encounter as to the specific physical and medical information needed to be submitted to process their applications.
Extra work aside, several captains said they are now in better health because of increased awareness.
Capt. Randy Boatright learned of his tonsil cancer right before renewal time two years ago. He resigned his position to undergo radiation treatments and to recover.
“Then I got the OK from the doctor,” Boatright said. “I’m healthy to run boats.”
Boatright now submits an annual health report for the USCG.
“I think I’m even better,” he said. “I have learned the value of health. You do see guys who can’t even get up the stairs. Bad health doesn’t set a good example, anyway.”