Coast Guard taking steps to cut delays in processing medical evaluations

Capt. Matthew Hall, a physician, directs the Coast Guard’s medical evaluations branch. He is expanding the staff to address serious backlogs and delays in issuing waivers. (Dom Yanchunas)

The U.S. Coast Guard needed its own version of a troop surge to correct severe delays in processing mariner medical evaluations at the National Maritime Center (NMC) this year.

An unexpectedly high workload caused the NMC to fall behind in the health-review aspect of the mariner licensing process. The average processing time for medical-fitness evaluations soared to over 90 days in February. The Coast Guard’s announced goal is six days.

Maritime labor groups including the International Organization of Masters, Mates & Pilots and the National Mariners Association decried the delays as excessive and disruptive to their members’ livelihoods. The Coast Guard agrees and has increased staffing to address the backlog.

In 2008, all mariners’ medical files were gradually centralized at the NMC in Martinsburg, W.Va., for review by a medically trained professional. Previously, the Coast Guard’s regional examination centers — with no medically trained staff — would forward a mariner’s health file to the NMC only if it was crystal clear the applicant needed a waiver.

Based on historic volumes, the NMC in early 2008 forecast about 1,000 cases per month and hired two medical professionals, said Capt. Matthew Hall, a physician who has been chief of the NMC’s medical evaluation branch since July 2008. At first, the duration of the medical reviews generally was less than two months. By December, when the NMC was handling all of the medical reviews, the actual volume turned out to be between 3,000 and 5,000 cases per month.

“It was way above what was predicted and way above what our manning load was able to handle,” Hall said. “Now we have a pretty good idea about how many people need evaluation and how many people need waivers.”

NMC commanding officer Capt. David Stalfort said the Coast Guard couldn’t reliably predict what the workload would be for the medical evaluation branch. It seems clear that, under the old system, mariners with serious medical conditions were improperly approved for licenses without being sent through a waiver process. In addition, first-class pilots on vessels over 1,600 gross tons now need to have their annual physical reviewed at the NMC.

The volume overwhelmed the NMC’s staff. At first, Stalfort and Hall hired a few temporary reviewers and created a triage system to identify high-risk health problems that would need close scrutiny. It wasn’t enough.

By February, with the backlog spiking, Coast Guard Commandant Adm. Thad Allen approved a plan that Stalfort and Hall call “the surge.” A corps of Coast Guard flight surgeons, retired Public Health Service physicians and medically trained Coast Guard Auxiliary volunteers rotated in to Martinsburg for a week or two at a time.

By April, the delays had eased tremendously. The average processing time was down to 19 days.

Despite the Coast Guard’s efforts to improve the processing of medical reviews, some mariners are still experiencing problems.

National Mariners Association President Capt. Joe Dady said follow-up medical tests are causing undue bureaucratic problems and confusion.

“I am getting reports from mariners who have put in their application and have waited three months before being asked for more information from the medical reviewer,” Dady said. “That’s a huge delay. So there’s still things getting messed up.”

Even worse, Dady was contacted by an applicant who heard nothing for four months, and then the Coast Guard asked for additional information and gave him 90 days to submit it. Shortly thereafter, before the mariner had a chance to send in the new data, a medical reviewer rejected the application.

“This mariner sat around for four months waiting for a response, and they just went ahead and denied him without letting him submit the additional information,” Dady said. “They didn’t give him the 90 days they said they would.”

In another odd case, a mate on Maersk Alabama learned of an NMC follow-up request only because the ship was attacked by pirates off Africa, said Mike Rodriguez, executive assistant to the president of Masters, Mates & Pilots.

“He wouldn’t have gotten that notice if the ship hadn’t been pirated and he was sent home,” Rodriguez said. “If he didn’t respond in 30 days, his application was going to fall off the table.”

Another mariner, who has sleep apnea, needed several months to get an appointment at a busy sleep clinic, so he missed a Coast Guard-imposed deadline for the results, Rodriguez said.

The NMC plans to add 10 permanent positions to the medical branch this summer to stay on top of the job.

Unfortunately, Stalfort doesn’t expect to attain the goal of a six-day average processing time for a while. A new Navigation and Vessel Inspection Circular (NVIC) provides more detail on what tests and diagnostic information are required. Most hometown physicians are not yet familiar with the new NVIC, and the NMC returns about half of the applications to the mariner for additional information, Stalfort said.

“The ‘Additional Information’ is our new backlog,” Stalfort said.

Hall encourages mariners, when it’s time for a physical, to bring to the doctor’s office the portion of the new NVIC that pertains to their particular ailments.

“Don’t try to figure out the NVIC on your own,” Hall said.

Hall said medical waivers are being reviewed with a keener eye toward maritime safety. That’s because politicians and the public have demanded more scrutiny as a result of the Cosco Busan oil spill in San Francisco Bay.

One additional barrier is the paperwork that the hometown doctor completes. It is still the old form from the previous NVIC. Stalfort said a new form corresponding to the new NVIC may be approved by the U.S. Office of Management and Budget by this summer.

Dom Yanchunas

By Professional Mariner Staff