By Dorie Cox
Several yacht captains were busy with medical appointments (one was in a doctor’s waiting room) when we connected with attendees to this month’s Triton From the Bridge lunch. So we took a captain’s suggestion to find out how healthcare is handled in yachting.
Captains hope to avoid medical check-ups in foreign ports, but the travel itinerary of many yachts makes it a hard to visit the family doctor. Most do their best to get checkups on stops in their home port.
“Now that I’m getting older, I think, ‘Well, before we head to the Caribbean, let me get a physical, let me get that tooth looked at,” a captain at this month’s lunch said. “Because the last thing I want is to be in St. Maarten and have some local sort me out.”
“I agree,” another captain said. “I’m actually going to the doctor after this lunch.”
Individual comments are not attributed to any particular person in order to encourage frank and open discussion. The attending captains are identified in an accompanying photograph.
Most captains are required to pass a physical such as an ENG 1 for Maritime and Coastguard Agency (MCA) to maintain their credentials.
“If you do not pass those, you could possibly lose your license, which would jeopardize your job,” a captain said. “So it behooves you to maintain some type of health care system for yourself so you can continue to work.”
“Without being healthy and stable, you can’t keep your position,” another captain said.
“It’s our responsibility to cover those things; it’s part of our job,” said a third.
This captain said the same goes for crew.
“I say that to the crew, ‘Did you get everything done? Did you check your teeth?’ ” this captain said. “Because we’re going someplace where they don’t have that. And we’re not stopping.”
Another captain agreed.
“Every crew gets that talk,” the captain said. “Sort out your health, sort out your finances, your car, your family.”
“As soon as we get there, don’t tell me you need something,” another captain said. “We’re leaving in five days, get your things in order.”
“I pound Murphy’s Law into them all,” a third captain said.
Aim for prevention, plan for problems
No matter how much captains prepare, there are reasons captains and crew find themselves in doctor’s offices, hospitals and emergency rooms around the world.
“I had to go to the dentist in Cozumel; it’s going to happen,” a captain said. “Somebody’s always going to get hurt and you have to network when you get there. Talk with friends down the dock, talk with the dockmaster, talk to your agent, talk to the locals and talk to the cab driver, and then go and get taken care of.”
Everywhere they go, they have to be prepared for emergencies, another captain said.
“You have to know where the hospital is, where the doctor is and how to get in touch with people,” this captain said. “It’s part of a passage plan for the area you’re cruising. It’s always something you have in your mind.”
Captains understand emergencies, but have less tolerance when an illness or condition could have been prevented.
“It’s cause and effect, when you knew something was wrong with you before you left and you didn’t take care of if,” a captain said. “That’s your responsibility. It’s your responsibility to take care of yourself. Not mine.”
But several captains said they understand why younger crew aren’t concerned about their health and don’t plan ahead.
“You’re young, you’re invincible,” a captain said. “I mean, I was like them.”
“Previously, we had people that came into yachting from other careers and were independently functioning adults,” he said. “Increasingly we have people come in straight from mother’s apron strings. They’re the ones that come from an all-encompassing support structure and expect the yacht to be that support for their medical, their finances and other things.”
“You become daddy,” another captain said.
“My parents always set up my regular visit to this thing or that, why haven’t you?” the first captain said.
But the obligation still falls to the master of the vessel, another captain said.
“Unfortunately, it will be your responsibility,” this captain said. “And you’ll be running around in the jungle looking for the witch doctor.”
Kinks in the plan
Although all the captains at the table aim to handle issues at their home dock, the task is not without challenges. For example, some prescription drugs need to be monitored and the patient retested, which is not so easy when away for a season.
Several captains said they have a way around that.
“You have a relationship with your doctor, he gives you a six-month supply even though it’s only supposed to be a 60-day supply,” a captain said.
“But there are certain prescriptions that have restrictions, so you can do that up to a certain level,” another captain said. “Theoretically, the doctor should not be signing you off as fit for service.”
That conversation lead into pre-existing conditions and other medical situations the captains have seen.
“Cholesterol is one thing thing, but I’ve had people come onboard that have lied to the doctor about things like epilepsy,” a captain said. “And then, there they are in a coma in the crew mess.”
Several captains have had similar experiences.
“We had a crew go to the Bahamas, she had narcolepsy,” another captain said. “She was sitting in the wheelhouse and then boom, her head hit the table and she was snoring.”
“I had friend with diabetes, she would not pass the ENG 1,” a third captain said. “Finally, she said, ‘I’m going to take myself out of yachting’. She had to walk away.”
A captain brought up another angle of medical health.
“We’ve been talking about the physical in order to work in this industry, with an ENG1 or a mandate that shows you are physically able to do it, but the thing that I’ve had an issue with is the mental aspect,” this captain said. “I had an issue with a crew who was bipolar and it caused really big problems.”
“They’re holding the proper certificates and meet the proper medical requirements,” another captain said. “So how do you determine this? It doesn’t flag them on any tests.”
“This comes back to lying at the time of the examination,” a third captain said. “It’s in the form that you get that asks if you have any history of this, do you have any symptoms of this.”
There is no escaping medical emergencies, even when it is on the boat next to yours or the tourist walking by, a captain said.
“We feel obligated to help,” a captain said of an incident with a neighboring boat in the Bahamas. “Kid took his finger off, we prepared him for transport, got the finger on ice and got him on a boat.”
Another captain described a potentially dangerous scenario while at anchor in St. Maarten.
“A tender rolled up that I had never seen before and the kid said,’ do you have a defib onboard?
We have someone with chest pains’,” the captain said. “I said, ‘My best advice is turn around, go back to your boat and get that guy ashore. I’m not giving you my defib kit just to force you to take him to shore.”
The issue of who is responsible
The topic of health care often veers to medical insurance. The captains said they have worked on yachts that paid for crew insurance and yachts that did not.
“We have insurance covered by our boat,” a captain said. “If you fall off the boat you’re covered, if someone is sick on the boat or has a funky toe, we just take them to the doctor to get checked out and the boat pays for the visit. Every crew has their own card. It works really well, but that’s not every boat.”
But that is changing, according to several at the table.
“With MLC [Maritime Labor Convention], you have to have health insurance; this is becoming across the board,” a captain said.
“If you get hurt on a yacht and they kick you off the boat, you can go back to flag state and say we got kicked off,” a captain said. “And there are all these repercussions the yacht will incur for not taking care of you.”
Every boat has to have protection and indemnity insurance, a captain said.
“P&I and the requirements to repatriate covers you if you’re on the boat, but not necessarily if you’re off,” another captain said.
It depends on the country and state you’re in, this captain said.
“For example, with a boat that dovetails on nationalized medicine, we have a separate policy for those who are non-European nationals,” this captain said. “If we have an accident, we invoke that policy. Now with MLC, and even before MLC, it was becoming a standard, particularly with boats that travel a lot, to have full medical insurance over and above P&I because P&I is quite basic.”
The captain recollected when insurance was uncommon, and owners and captains were learning how to navigate coverage.
“At that time, a lot of owners were crossing over from the amateur-sailboat-type to a point where they saw it as having employees onboard,” this captain said. “Now under the UK and all the flags associated, it’s a requirement that once you have four people onboard you must have P&I and you must provide coverage.”
P&I doesn’t always cover medical issues, another captain said. And it doesn’t cover accidents on motorcycles or while water skiing, diving or similar activities crew may participate in.
“But that’s off the boat,” another captain said.
“In that case, you have to let them know this is covered under your insurance,” a captain said. “If you get messed up, you’ll have to meet the deductible. Don’t come back to me.”
Medical issues and yacht jobs
With sickness and unforeseen emergencies, we wondered how medical issues affect captains and crew at work. We asked the captains if crew take work or personal time for their health and if owners are involved.
“I tell the crew we’re coming into the dock and anyone who needs to get stuff done, do it while the owner’s not onboard,” a captain said.
“As captains, we have no conversation whatsoever about it with the owner,” another captain said.
“Owners don’t want to know,” a third captain said. “They don’t want to know what it costs or what is broken. They want happy, smiling faces.”
So we asked what happens when crew are unable to work because of illness or injury.
“Can you stay on the job?” one captain began. “Only until you can be replaced, because technically you’re not fit.”
A captain told of a friend on a big boat who broke his leg.
“He went back and they said, ‘You can’t work, we don’t want you’,” the captain said.
“I think it depends on things like how long you’ve been onboard and what the owner’s like,” another captain said.
“If you have an owner with longevity, he may say, ‘Yeah, we can work around that’,” a third captain said.
One captain was confident the owner would support recovery after an injury and medical treatment in the Bahamas.
“I banged my head and got it sorted out,” this captain said. “You just keep working through, because what else are you going to do?”
“As captain, you try to find a work around,” another captain said.
Sometimes captains sacrifice their health to work and keep their job, according to another captain. He knew a captain who fell down the stairs onboard and broke his collarbone.
“He worked for about another month with the fractures, he worked through the pain,” the captain said. “Finally the owner saw him lurching around and asked if he was ok. He said he fell down and the owner said go see a doctor and get fixed.”
The surgeon said surgery was required and the owner said to do what needed to be done, the captain said.
“Then it went from being five weeks to being five months and the owner said, ‘Look, we’re not doing this anymore.’ And just stopped paying him,” this captain said.
This triggered more tales from captains about injuries at work.
“I had a buddy who lost his leg, it went through the windshield of the tender and he didn’t get paid for years and lost his job,” a captain said.
“I had a friend with similar thing, big boat captain, very knowledgeable, fell down the stairs in a terrible accident,” another captain said. “And he’s fighting.”
A captain said the yacht’s contracts have disability coverage in them and that most P&I policies also do.
“But there’s a limit,” a captain said. “It’s 180 days the boat will pay you, but after that if you’re unable to do your job, the boat’s still going to float and go on. So after that they’re going to say, ‘Sorry the charterer is here and we’ve got to ride’.”
“That’s what we signed on to,” this captain said. “If you have something terminal or something really bad, you’ve got 180 days to get sorted out before you’re off.”
“In the crew agreements there’s usually something in there,” another captain said. “Hopefully you’ve got a good crew agreement.”
The conversation circled back to responsibility. Although there are always small injuries onboard, most are prevented with training and procedures, a captain said.
“We have systems in place, were you educated in going aloft, in this diving aspect, with this machinery, did you know to keep your hands out of that?” a captain said. “Or are you just stupid that you stuck your hand in there?”
“Theoretically, things don’t happen,” another captain said. “But when crew don’t follow the briefing, you better have that in writing.”
After discussing prevention, as well as unforeseen emergencies, this group agreed that the topic of medical care is best handled directly and immediately.
“I think people need to understand what they’re signing on to, what medical coverage they’ve got and it should be all mapped out,” a captain said.
It is important to clarify responsibility and expectations, said another captain who illustrated with his memory of a photo of someone jumping off a yacht’s high deck.
“Someone commented on Twitter that it didn’t look like he would clear the boat,” the captain said. “Yes, there’s Darwin’s Theory [the theory of natural selection], but we are the ones who have to do the paperwork.”
Dorie Cox is editor of The Triton. Comments on this story are welcome at firstname.lastname@example.org. Captains who make their living running someone else’s yacht are welcome to join in the conversation. Email us for an invitation to our monthly From the Bridge lunch.