Department of Homeland Security
U.S. Coast Guard
Docket No. USCG–2013–0089
Comments of
International Organization of Masters, Mates and Pilots
and
American Maritime Officers
and
Marine Engineers Beneficial Association
Regarding
The Merchant Mariner Medical Evaluation Program
May 2, 2013
Department of Homeland Security, U.S. Coast Guard, Docket: USCG‐2013‐0089 Comments on Coast Guard Assessment of Medical Evaluation Programs
Our organizations, the International Organization of Masters, Mates and Pilots (MM&P),
the American Maritime Officers (AMO), and the Marine Engineers Beneficial Association
(MEBA) represent substantially all the navigating and engineering officers on U.S.-flag
commercial vessels in international trade, in addition to mariners on civilian-crewed ships in the
government fleet, on towing vessels and ferries in domestic trade, harbor pilots and maritime
industry shore side clerical and service workers.
We have been on record with the Coast Guard and in testimony before Congress
objecting to the present Coast Guard medical evaluation program since its inception. And, we
welcome this long overdue assessment and opportunity to participate through public comments
for change that would better align mariners medical evaluation of fitness for duty with the norms
in other transportation modes in the U.S. and internationally.
The current medical review program is based on a flawed concept that has a number of
major problems. First, it attempts to evaluate and monitor for changes the medical condition of
over 200,000 mariners with a small staff of medical evaluators at a central office who have never
seen or spoken to the mariner. The evaluation is based solely on a stream of paper work between
the National Maritime Center (NMC), the mariner and their doctors that can require multiple
medical specialty consultations, imaging procedures, laboratory tests and time-consuming and
often irrelevant evaluations to satisfy an unknown and distant medical evaluator with no direct
contact with the mariner or his doctor. Mariners with more than one medical condition, which is
a common occurrence, will be subjected to multiple time consuming and often unnecessary
medical evaluations.
Of major concern to mariners who are employed in international trades where
assignments are four months aboard ship out of contact with the NMC followed by four months
off duty is that the indefinite time lines, delays in the process and scheduling of multiple
appointments for doctors, testing and evaluations when combined can result in the medical
evaluation not being completed in time to meet their reassignment date. This can potentially
result in the loss of four months of employment and eight months loss of income and benefits.
This is an unacceptable and highly stressful consequence of the present program that is based on
the premise that mariners are continually available to interface with the system and that all
necessary appointments can be scheduled in a timely manner. The present medical evaluation
process is not compatible with the long duration of shipboard assignments of many mariners. It is
not sensitive to these time and scheduling issues and does not match the real world time
limitations on the availability of mariners and medical resources.
A mariner without insurance coverage may be subject to many thousands of dollars in
expenses as a result of these burdensome and medically questionable procedures. In some
instances these costs will be shifted to insurance carriers and ultimately to maritime employers
and health plans. But more likely these tests will be deemed to be “medically unnecessary” by
most insurance carriers, with the costs borne directly by the mariner. These costs have become a
significant barrier to employment to both existing mariners and new entrants to the industry.
1 Department of Homeland Security, U.S. Coast Guard, Docket: USCG‐2013‐0089 Maritime labor and industry members of the USCG Merchant Marine Personnel
Advisory Committee (MERPAC) have consistently advised the USCG during its initial
discussion phase that such a proposed process was time consuming, expensive, and difficult for
the mariner and the mariner's doctors who have to interface with a faceless and cumbersome
bureaucracy at a remote location. It was reasonably foreseeable from the start that the current
program was impractical and would lead to problems.
A second flaw in the present medical evaluation program is that the guidelines for
evaluating the physical and medical conditions of mariners contained in the Coast Guard
Medical NVIC are not applied in a consistent manner by NMC medical evaluators. There is a
need for clear guidance and transparency on what medical standards are to be applied in
determining medical fitness for specific ship board duties. Hopefully this issue may be resolved
by the Merchant Mariner Medical Advisory Committee developing clear guidance on medical
standards and there application by independent medical examiners who understand the duties
involved for different categories of mariner’s and actually physically examine the mariners.
A third flaw in the concept is that it does not provide for a separate medical certificate. It
links a medical evaluation to determine fitness for duty to a credential that is a certificate of
professional competency with a five year term. Medical conditions and professional competency
are two distinct and separate issues that should be covered under separate certificates that may
have separate periods of validity. Linking the medical review to the five year term of the
mariner’s professional credential creates the sticky problem of issuing waivers to track changes
in medical conditions. Requiring the mariners to then notify the Coast Guard of changes in
medical condition places them in the untenable position of self determining what degree of
change triggers a requirement to notify the Coast Guard and place them at risk of the loss of their
professional credentials and their career. Lamentably, the mariner may be prosecuted for
allegedly making the wrong determination if he is involved in an accident where there is any
possibility that his medical condition may be an issue.
The problem of linking medical fitness to a certificate of competency, rather than a
separate medical certificate may be solved by the new requirements of the ILO Maritime Labor
Convention (ILO MLC 2006) that will apply to U.S. mariners working in international trades.
The Coast Guard has indicated it is likely to apply the international ILO MLC 2006 provisions to
mariners working in both the international and domestic trades. The international standard
separates the medical certificate from the professional credential. The medical certificate is valid
for a maximum period of two years. This solves the problem of waivers and continuing
monitoring of mariners medical conditions. If there is a medical condition that may deteriorate
with time the medical certificate can be issued for an appropriate period that allows for
reexamination by a recognized and qualified medical practitioner without going through the
cumbersome, expensive and time consuming current Coast Guard medical review process. It
should also be recognized that compliance with the international two year maximum period for
medical examinations would increase the workload of the present five year cycle for centralized
medical evaluation by the NMC by 250%. This alone is a compelling reason for decentralizing
the medical examination process to one of designated and qualified medical practitioners.
2 Department of Homeland Security, U.S. Coast Guard, Docket: USCG‐2013‐0089 We strongly support the ILO MLC 2006 provisions on medical evaluation of a mariner’s
fitness for duty. They are based on a system that requires a medical certificate issued by a
qualified medical practitioner recognized, i.e. "trusted", by the competent authority (USCG) as
qualified to issue such a certificate. The medical practitioner has full professional independence
in exercising their medical judgment in undertaking medical examinations. In such a system a
registry of qualified medical examiners would conduct medical examinations and issue medical
certificates as trusted agents of the Coast Guard.
The assessment of the current Coast Guard medical evaluation program directed by
Congress must specifically include an analysis of how a system similar to the Federal Motor
Carrier Safety Administration’s (FMCSA) National Registry of Certified Medical Examiners
program and the Federal Aviation Administration’s (FAA) Designated Aviation Medical
Examiners program could be applied by the Coast Guard in making medical fitness
determinations. We believe that the national FMCSA, FAA and international ILO MLC 2006
programs all follow the same general concept. Fitness for duty is determined by independent
medical examiners on a national registry that are qualified to issue medical certificates based on
established guidelines after an actual medical examination. This is a recognized normal method
applied in the other modes of transportation both in the U.S. and internationally. We fail to
understand why the Coast Guard has adopted a cumbersome, bureaucratic, time consuming,
expensive and stress filled medical evaluation program that is outside national and international
norms for U.S. mariners.
In addition, the Coast Guard has asked for comments on a hybrid system whereby the
designated medical examiner would issue medical certificates when mariners meet certain preestablished criteria, and the Coast Guard would only be involved in reviewing those mariners
who have certain conditions. We can understand where this system would be of benefit to the
Coast Guard, but see no benefit to mariners. Mariners in perfect medical condition that may
reasonably be expected to meet the pre-established medical criteria would still be required to use
designated medical examiners rather than using their own doctor. The many mariners, generally
older with age related conditions, that do not meet the pre-established criteria would still be
engaged with the bureaucratic NMC review process that we find objectionable for the reasons
stated above.
We believe the Coast Guard should adopt a medical evaluation program that follows the
general concept of the FMCA, FAA and ILO MLC 2006 model. But the medical standards and
guidelines to be applied should be tailored to the specific tasks and the working environment of
specific categories of mariner’s developed by the Merchant Mariner Medical Advisory
Committee. We believe such a program would improve the quality of medical evaluations and be
far more efficient in speeding up the process by eliminating the time consuming delays involved
in the exchange of paper work and dialogue with the NMC that is of great concern to mariners
who have time constraints on their availability between shipboard assignments.
We also recognize that there is a concern among some mariners that a registry of
designated medical examiners may create a burden of finding a medical examiner and traveling
an excessive distance with lost time from work to obtain a medical certificate. There is a clear
need for a transition period where dual programs are in place, the present program and a
3 Department of Homeland Security, U.S. Coast Guard, Docket: USCG‐2013‐0089 designated medical examiner program, to permit time for the registry to grow to the size that
Coast Guard designated medical examiners would be readily available throughout the entire U.S.
This could be accomplished within a reasonable period of time by incorporating many of the
thousands of medical examiners on the FMCA and FAA registries into the Coast Guard
designated medical examiner registry.
Donald Marcus, President
IOMM&P
Mike Jewell, President
MEBA
4 Tom Bethel, President
AMO