Monday, May 31, 2010

Monday Morning Mariner: Medical Requirements


On October 13, 2003, the Staten Island Ferry Andrew J. Barberi crashed into a concrete maintenance pier near its dock, killing eleven people and injuring 71 others. Pilot Richard Smith had fallen asleep at the conn as a result of taking prescription medications and, as he was alone in the wheelhouse, the vessel was out of control. In the months and years that followed, the Barberi crash would have many consequences. Smith himself attempted suicide twice and eventually plead guilty to manslaughter. Prosecutors successfully went after ferry management as well. And in April of 2008, the US Coast Guard issued a Navigation and Inspection Vessel Circular (NVIC) called "Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials" that said the Coast Guard was going to get serious about enforcing, among other things, laws governing mariners use of prescription and over-the-counter drugs.

American mariners already have to have a physical every five years when they renew their licenses or MMDs. Like most Americans, mariners are aging as a group, prone to obesity, and more likely to be taking one or even several medications. The NVIC 04-08 guidelines were published to help mariners and the medical professionals who examine them understand what the requirements are according to the Code of Federal Regulations and the STCW '78 convention.

Medications. Mariners must report all prescription medications filled, refilled, or taken with 30 days of the medical exam. Any over-the-counter medications used for more than 30 days within the 90 days leading up to the exam must also be reported. The Coast Guard is especially on the lookout for side effects that "could impact your ability to safely work on your vessel" according to a Coast Guard guide to the guidelines.

Physical Ability. Mariners must, in the opinion of the medical examiner, be able to lift 40 pound, climb a ladder, etc.

Body Mass Index. You may have to provide additional proof of you ability to perform certain tasks (proof obtained at your expense) if your Body Mass Index exceeds 40. For an American man of average height (5' 9.4"), that means a weight of 274 pounds or more. For a woman of average height (5' 4.6"), that means a weight of more than 237 pounds or more. In addition to lifting and other mobility tests, you may be required to be tested for sleep apnea and other conditions related to obesity.

Denial of credentials. The Coast Guard claims that only one in thousand applications are denied for medical reasons. The top five medical reasons for denial are: 1) pacemakers, 2) use of narcotics, amphetamines, or benzodiazepines, 3) uncontrolled diabetes, 4) mental disorders like uncontrolled bipolar disorder, and 5) uncontrolled sleep disorders.

Problems with the requirements. The Coast Guard insists that "this NVIC puts current Coast Guard practices into writing making the policies transparent for all to see..." but there have been several complaints about the application of the guidelines including: 1) the increased wait time that medical reviews are adding to the application process, 2) unfamiliarity with the regulations and government "bureaucrat-ese" on the part of medical professionals, and 3) whether BMI is an accurate measure of obesity since it doesn't measure body fat, but only a ratio between height and weight.

To download a copy of NVIC 04-08 from the National Maritime Center website, click here.

The Coast Guard uses the formula for BMI used by the Centers for Disease Control. For more, including a BMI calculator, click here.

1 comment:

  1. I have been diagnosed with type 2 bypolar disorder and have been taking lamotrigine 50mgs a day and the company I work for is aware of my condition and said that I wouldn't have any problem renewing my license but I have been reading online that the coast guard has not let people renew with a diagnose of bypolar disorder mine is not that bad I'm not manic or suicidal I just get depressed and I have not been depressed since I have started my medication how do I find out what to do about renewing my license

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