The Coast Guard is now moving its proposed Medical Navigation and Vessel Inspection Circular (NVIC) toward final approval within the Department of Homeland Security. The Medical NVIC could have a significant impact on American mariners in all sectors, and has to the potential to prevent some mariners from receiving Coast Guard documentation, and to require many mariners to seek medical waivers for any number of medical conditions or medications before receiving or renewing Coast Guard documentation.
The Merchant Marine Personnel Advisory Committee (MERPAC) submitted its final report on the Coast Guard’s Proposed Medical NVIC with 16 recommendations. The committee met April 9-10, 2008, in RTM STAR Center at American Maritime Officers headquarters in Dania Beach, Florida, to review and vote on the medical working group recommendations that had been formulated over nearly three years of research and work.
The Proposed Medical NVIC is a complete rewrite of both NVIC 02-98 and the Medical Evaluation Form CG-719K. The changes are sweeping and have many implications for today’s mariner. Some of the most significant changes are:
• All medical evaluations and waivers will be done at the National Maritime Center. The health care provider who conducts the physical examination will only gather the data required by the NVIC for submission to the NMC. MERPAC recommended designating certain medical practitioners as “trusted agents” and giving their physical examinations more weight when processing them.
• The NVIC now lists 201 medical conditions requiring further review. The NVIC directs detailed documentation of tests and evaluations for each condition and these will have to be submitted with the physical to NMC in order to be considered for a waiver. MERPAC expressed their concerns that the list of medical conditions “exceeds the defined goal”.
• The NVIC has a revised section on medications, including prescribed, over-the-counter and herbal supplements. Medications are classed as: Non-Waiverable, Waiverable, or a time of abstention prior to operating under the authority of a credential. All medications, whether prescribed, over-the-counter or herbal supplements must be disclosed on the Medical Evaluation Form CK-719K. MERPAC recommended that the look back period be limited to the 30 days prior to the physical examination.
• Hearing standards have been significantly tightened. The unaided threshold in four frequency ranges is 30 db and the threshold with a hearing aid was proposed at 20 db. MERPAC has recommended that the hearing aid threshold be lowered to 30 db.
• The CK-719K Medical Evaluation Form now incorporates a comprehensive health questionnaire. This 89 question survey delves into every aspect of a mariner’s health and requires a “yes” answer if the mariner currently has the condition, “or has ever suffered from” the condition. MERPAC and the medical working group had a vigorous debate over this questionnaire because it puts the mariner at risk of prosecution under 18 USC 1001 if there is inconsistent information between physicals. MERPAC ultimately recommended that this section, along with the medication declaration, is made detachable and not submitted with the physical.
• The CG-719K Medical Evaluation Form has a Body Mass Index (BMI) rating. A BMI of 40 will automatically trigger a Demonstration of Physical Ability Test. MERPAC recommended removing all references to Body Mass Index in the NVIC and the Medical Evaluation Form.
The Coast Guard is now moving the NVIC toward final approval through the Department of Homeland Security. MERPAC’s recommendations have not received a formal reply as of this date, but the sense of the Committee can be summed up in the first two sentences of recommendation #1: “MERPAC believes the development of the Draft NVIC and the accompanying draft 719K has not used good principles of risk-based decision making. MERPAC recommends that the Coast Guard use all data available to them and reconsider the information contained in the NVIC.”
Captain J.M. Murphy is the Director of Government Relations for American Maritime Officers