In our articles over the past 6 months, we have spoken about several important health and safety aspects at sea. We have covered subject of home country case management as well as ports of call case management challenges. Today we are going to talk about Pre-employment and re-employment medical examinations.
Unfortunately the importance of these tests is under estimated, left for the responsibility of the crew member, treated as a formal requirement, which eventually might lead to very costly claims onboard and/or even direct threat to the crew member’s life.
A simple example from our recent experience is below (please note that all personal data has been modified for data protection purpose).
Antonis Balodis is a very experienced seafarer, first engineer, he has over 20 years experience of working on different ships. When he was offered a new position, he had to go through Pre Employment Medical Examination. The new employer was only asking for the complete Fit for Duty certificate in a standard form.
Mr. Balodis is overweight, has diabetes type 2, several cardio vascular episodes in his medical background. Antonius always went to the same doctor he new for many-many years to do his pre-employment, and the Doctor would never reject the Fit for Duty certificate, so the appointment reminded more of “old friends meeting” rather than proper medical evaluation of health status. The Doctor knows, that all Antonius’s family depends on him, and yes, there are some evident health problems, he should keep an eye on, but it’s ok, he has been having them for quite many years, and nothing ever happened…
But it’s always like that: nothing ever happens, until it does. One of the days, after about 2 weeks since Antonius joined the new employer’s Vessel, he was especially tired and stressed, it has been a difficult month overall, he was on a new position, and he was trying to do everything in best possible way, in order to earn his reputation on a new ship. Antonis suddenly felt unwell, and that was not a minor thing, he could not remain standing, and fell down. It was a diabetic coma. Antonis needed an urgent evacuation. The ship was in the Gulf of Maine, and the nearest port, Port of Portland, was not far, but Antonis could not wait, he needed urgent help, so the emergency evacuation plan was activated. Evacuation was conducted with the help of helicopter from local rescue service and within 3 hours Antonius was delivered to emergency hospital in Portland, hospitalized and fortunately, survived this accident. Although he needed to stay in ICU for over 2 weeks and needed medical escort to get back home upon discharge from the hospital. The cost of this medical case for the ship owner, was 532.000 USD (including cost of helicopter evacuation, hospitalization, medical escort evacuation back to Antonis home country – Letonia). Just to compare the costs: the range of professional independent reliable Pre Employment Medical Examination, may vary from 80 to 120 USD per seafarer. So just one medical case of this nature, clearly illustrates a very high risk to which ship owners expose themselves by not controlling pre-employment examinations closely. At the end of the day it’s not only about the costs (which have to be taken in charge by the ship owner), but it’s very often about crew member’s life.
The Pre-Employment Medical Examination (PEME) Program has been established as a Loss
Prevention measure in 1996 to assist in detecting pre-existing medical problems prior to the crew member joining a vessel. Since the beginning of the program, more than 250.000 have undergone the evaluation.
Some statistics according to UK P&I Club.
The graph details illnesses diagnosed in potential crew members since the schemes inception in 1996. All of these cases could have easily turned into expensive repatriation claims as the case described above, should these crew members be allowed onboard. According to MLC 2006, it is ship owner’s responsibility to provide the same level of medical help to the crew member, as if he was ashore.
Being a seafarer onboard a Vessel immediately imposes high risks to the person’s health due to: working a lot of hours in a high noise and a high stress environment, in most of the cases it is physical work, that requires a very good health condition. For the moment, the majority of the ship owners delegate the PEME to the Crew Member and in may cases it brings significant problems. Not all the seafarers hold sufficient funds for a reliable facility. And not all the seafarers are keen to get truthful and objective medical examination, as they might be declared not fit for duty and would be refused a job based on this fact. The objective of the seafarer, at the end of the day, is not the evaluation itself, he is not interested in finding out the actual state of his health, the main objective is Fit for duty certificate. Therefore, in many cases the certificates are obtained in a doubtful way from a non-specialized clinic, or just “bought”.
Often, seafarers’ or doctors’ personal considerations, that the seafarer and his family might really need this job, that he has been working in this industry for the whole life and does not imagine his life ashore and other very human reasons, end up with a Fit Certificate, that can ruin the ship owner because of a huge medical case, and even kill the seafarer, if his actual state of health does not allow him to perform his functions on board and finally he has a stroke, heart attack, diabetes coma, or any other serious condition.
In addition, the manning agent and the ship owner are also pressing for the Fit Certificate, as they need the highly qualified and experienced specialist on board as soon as possible. As a result of all these factors, the seafarer ends up in doubtful facilities, not familiar with maritime industry requirements, in many cases, just ready to provide any kind of document.
What can be done to mitigate this risk?
It’s highly recommended that ship owners should pay more attention to this important subject matter and preferable have a very clear and strict guidelines on how, who and when should perform PEME and REME examinations for their seafarers. This function can be delegated to relevant professionals: P&I clubs or specialized companies or just to limited number of checked and reliable medical providers in each location.
AP Companies has been facilitating high quality medical check ups for seafarers in different parts of the world since 2012. There are several key aspects which we consider in order to help our Clients to have high quality check ups:
- Check up facilities are carefully selected and checked by AP medical team.
- Ensure continuity of sampling
- Objective evaluation of test results
- Double control where by Fit for Duty certificate is evaluated by AP staff doctor. All the original tests results are double checked to make sure that the Fit/not Fit status corresponds to objective findings during those tests.
- Clear Management of Expectations of all parties involved. Manning agency, the ship owner and the seafarer, would normally need the certificate ASAP, would sometime request to bypass some tests in order to save time, but this is not allowed and proper time allocation has to be made to undergo required testing and evaluation.
Pre employment medical examination from first glance might seem an insignificant formal paper, but at the end of the day it is the foundation of the crew member’s wellbeing and safety on board, the guarantee for his family and vital cost containment tool for the ship owner.
The views presented hereabove are only those of the author and not necessarily those of SAFETY4SEA and are for information sharing and discussion purposes only.
About Elena Donina Glukhman, Project Manager, Development & Cooperation Worldwide
Elena Donina Glukhman is Project Manager of AP Companies Global Solutions, the international leading health care management, cost containment, and emergency medical assistance company. AP Companies has the largest direct medical provider network in 185 countries. AP’s Cost Containment team consistently achieves significant savings worldwide in all kind of different medical facilities. Elena has been working in the field of International Medicine since 2009 having previously worked in Bupa Global, dealing with insurance market development for expats and crew members and has a wide experience of cooperation in terms of medical care for the crew members with global cruise line companies and Marine Insurance companies.