Coast Guards says new medical rules will simplify medical evaluations but not boost rejections

A new 52-page document posted by the Coast Guard offers mariners a checklist of items they must submit if they have any one of 202 ailments. Instead of processing mariners’ medical paperwork at several Regional Examination Centers around the country, all such reviews will now be done by professional staff at the National Maritime Center.

If adopted, the reforms won’t result in higher rejection rates, Coast Guard officials said.
Although the Coast Guard and mariner license applicants are already using the document as a guideline, the new regulations won’t become official until they are given final approval by the Department of Homeland Security and the Office of Management and Budget.

The new guidelines are included in the latest Navigation and Vessel Inspection Circular, commonly referred to as NVIC, pronounced NAVV-ick. It was written in consultation with the Merchant Marine Personnel Advisory Committee.

MERPAC’s chairman, Capt. Andrew McGovern, said the new NVIC should clear up a lot of confusion for licensees.

“We just want to make sure it’s fair to the mariner,” said McGovern, who is also the New Jersey president of the Sandy Hook Pilots Association. The problem “has been delays. It has been inconsistencies — the not knowing what is needed in order to get approval. This is something that the new NVIC will strive to fix. At least it will be laid out, and you’ll know what you need.”

Capt. Andrew McGovern chaired the committee that helped rewrite the rules.

The NVIC details the medical data and test results that a mariner must send to the Coast Guard if he or she has certain conditions ranging from stuttering or glaucoma to cirrhosis or a history of tumors or heart problems. The document also provides a list of potentially disqualifying medications.

The detailed instructions should finally give mariners confidence that medical evaluations are being conducted consistently and efficiently, said Capt. Arthur French, a physician who was chief of the medical evaluation branch at the NMC until his retirement from the Coast Guard in May.

“It really makes the process more transparent,” French told Professional Mariner in an interview on his last day of active duty. “We’re being more thorough in saying, if you have one of these (medical conditions), this is what you need to submit.”

Over the years, the RECs processed the medical waivers without having medical professionals in-house.

“There was a lack of consistency, and those people changed quite frequently,” French said.
Now the NMC medical branch employs a staff of nine experienced health care staffers, including a nurse, a physician assistant and medical coders.

“That has made a world of difference,” French said. “These are all medical professionals who have worked in physicians’ offices and are used to a medical environment. They understand how people expect to be treated. They’re not bureaucrats.”

While mariners have clamored for streamlined approvals from the Coast Guard’s medical evaluation process, the opposite problem revealed itself during an April hearing before the National Transportation Safety Board investigating the Cosco Busan oil spill.

Investigators revealed that the San Francisco bar pilot involved in the November 2007 bridge collision was taking at least four medications to treat sleep apnea and other ailments. An expert physician testified that the drugs cause delayed reaction time and impaired judgment, and the pilot’s license should not have been renewed in early 2007.

“What happened there was his application and physical were reviewed by the local REC,” French told Professional Mariner. “This was one that came under the old system, and this is why we’re changing it.”

Mariners were often frustrated that they would submit a test result from their physician, only to receive a letter from the Coast Guard months later stating that they needed further testing. An applicant’s head was spinning as he shuffled paperwork between his own doctor and the REC, which also relayed documents to the NMC and back.

MERPAC urged the Coast Guard to allow direct communication between the Coast Guard medical staff and the mariner’s physician. Now that the RECs are out of the picture, another step is eliminated.

“That hopefully will solve this ‘playing post office’ and it should speed things up,” McGovern said.

Although the new NVIC is clearly helpful, mariners may continue to be intimidated by complicated medical terms in the guidelines, said Paul McElroy, a Stuart, Fla., consultant who helps license applicants fill out their paperwork.

The NVIC “scared the (expletive) out of me,” McElroy said. “It is a massive document — very difficult to read and understand. But I made an investment in a medical dictionary and now I am able to ascertain the meaning of the medical terms that apply to my clients. Now I am prepared to inform my clients of what will be expected of them if wish to pursue a medical waiver.”
McGovern said MERPAC wants more plain English.

“One of the things we recommended is that the forms be made very clear,” McGovern said. “These are not lawyers filling out these forms. These are mariners. We want to make sure this is not to the detriment of the mariner, and the mariner is still able to work, and there aren’t these gotcha questions that could get him in trouble later.”

The health status of a mariner has been a factor in several major maritime casualties in recent years, including the 2003 accident involving the Staten Island Ferry Andrew J. Barberi. Eleven people died after the assistant captain lost consciousness and crashed the vessel into a dock. Investigators determined that he was taking medications that cause sleepiness and had knowingly withheld information about his various health problems on a previous 719K statement to the Coast Guard.

McElroy said it is sometimes difficult for very experienced licensees to swallow the fact that aging mariners eventually can pose a safety threat to the public and to each other. At the same time, maritime employers place a premium on older, highly qualified mariners to fill positions in a rapidly growing industry.

McGovern said some employers feared that the new NVIC would result in stricter evaluation of medical conditions — perhaps not formally, but in practice at the NMC.

French said that will not happen. The medical disqualification rate was less than 1 percent before the new NVIC, and he expects that rate to remain the same.

“We don’t want a mariner not seeking medical treatment because of this,” McGovern said. “We don’t want people to retire rather than go through this.”

French’s replacement as chief of medical evaluations will be Coast Guard Capt. Matt Hall, a physician specializing in occupational medicine. Hall takes office in July at the NMC, located in Martinsburg, W.V.

The NVIC can be found on the Coast Guard’s Homeport Web site. Mariners may contact the NMC medical staff with questions by sending an email to marinermedical@uscg.mil.