WorkBoat Focus Mariner Medical Manual

Fit for Duty

Proposed rule aims to speed mariner medical reviews.

By Dale K. DuPont, Correspondent

The Coast Guard says it expects mariner medical evaluations to be ‘less subjective and more efficient.’

BARGE

The Coast Guard’s recently released Merchant Mariner Medical Manual is an attempt to clarify and explain often frustrating rules that can put mariners in a bind over health issues and jeopardize their license. The 292-page proposed rule consolidates guidance previously scattered in a variety of documents. As a result, the Coast Guard says it expects medical evaluations will be “less subjective and more efficient.”

Nice try, said mariners, trade groups and others who weighed in, but they still have questions and concerns about issues such as certificate cancellation policies, responsibility for bad decisions, the frequency of exams, and fitness for credentials versus fitness for duty.

The draft manual drew favorable comments on the Designated Medical Examiner (DME) pilot program, though many want a widespread rollout sooner rather than later. Long under discussion

as a way to speed medical reviews, the DME program would allow Coast Guard-certified local doctors to determine mariners’ fitness. Mariners could still choose to use their personal doctor whose report would be reviewed by the Coast Guard.

Among the manual’s major changes: the Coast Guard will no longer require medical certificates for entry level mariners on vessels not subject to STCW who do not serve as food handlers; and the addition of a specific procedure for cancelling a certificate when the agency receives “credible information” a mariner is no longer fit.

“This manual’s process for removing restrictions or waivers, or restoring medical certificate eligibility, seems uncomfortably weighted toward taking away one’s ability to sail, without considering that many conditions — even very serious ones — are temporary in nature,” commented one person identified as “a licensed unlimited tonnage

deck officer.” Making it too difficult for mariners to prove their fitness for duty encourages them to hide their medical history or leave conditions untreated “to avoid potentially negative entries in their records and an unclimbable hill to gain back eligibility to work.”

The Coast Guard’s goal was to clear things up. Putting everything into one document “means that the regulated community will not have to consult multiple sources to find necessary information,” said Dr. Adrienne Buggs, the Coast Guard’s medical officer. The detailed discussion “provides transparency and reduces confusion for mariners and their medical practitioners and promotes consistency in the Coast Guard’s medical evaluation processes.” The agency said it welcomed suggestions on how the manual could be improved. And it got them.

CANCELLATION

The Passenger Vessel Association (PVA) wants the Coast Guard to clarify what would trigger an investigation of a mariner’s fitness, the definition of “credible information” that could lead to cancellation, and how employees can protect themselves from false reports. (Mariners can lose their medical certification and still retain their credential.) And PVA members are concerned, for example, that someone could be wrongly labeled as having sleep apnea if they have a personal history of obesity or a neck circumference of more than 16" for a woman and 17" for a man. Sleep apnea, diabetes and coronary artery disease affect many mariners, the draft notes.

PVA suggests that medical professionals doing the exams be familiar with a mariner’s duties. They also want to know how often medical conditions in the manual will be re-evaluated. “Medical advancements, improved treatment methods, and technology within the industry have allowed mariners with conditions once immediately disqualifying to continue to work and be valuable members of the crew,” PVA said.

The American Waterways Operators (AWO) raised the cancellation issue as well. The draft doesn’t specify how the Coast Guard expects to get information on a mariner’s health. “Any requirement of employers to report must be tempered against privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), that prevent the disclosure of protected health information,” AWO said. The manual needs to spell out employers’ obligations, if any.

The American Pilots’ Association (APA), which represents almost all state-licensed pilots in the U.S., wants cancellation procedures established through a formal rulemaking.

By making it too difficult for mariners to prove their fitness for duty, it encourages them to hide medical histories or leave conditions untreated.

Kirk Moore

“There is simply too much at stake for the mariner — his or her career and livelihood — for the Coast Guard to use an informally established process that is not ‘legally binding’ to cancel a mariner’s medical certificate,” APA said.

The American College of Occupational and Environmental Medicine, whose members do mariner physicals, challenged a statement in the proposal that said mariners could rely on Coast Guard decisions, but “the government is not bound by the mistakes of its employees, especially in a situation where public safety is at issue.”

The wording, the medical group said, “seems to remove any blame on the Coast Guard for erroneous certification decisions which may lead to mishaps or untoward medical situations at sea. If the Coast Guard will not be responsible for the decisions made by its employees regarding medical certification, then who shall be?”

ACOEM wants more clarification on waivers and restrictions. “Our members have seen mariners with similar conditions and medications inconsistently given waivers and limitations on their certificates,” they said. “A waiver should be rare and not a common occurrence if the Coast Guard is to keep up with typical transportation medicine practice.”

Some who commented want physical exams every five years to coincide with the credential instead of every two. Others suggested random exams similar to drug testing or exams given only past a certain age.

Several people raised concerns about fitness for a credential versus fitness for duty. The occupational medicine group wants the manual to give a “clear mandate for owners, operators, and unions to assume full responsibility for determining the fitness of their own mariners based on operational requirements.”

Fitness for medical certification “is necessarily a snapshot of the mariner’s medical and physical condition at a single point in time,” Dr. Buggs said via e-mail. “Fitness-for-duty status can change suddenly due to an acute illness, injury or incident” and is determined by an employer.

Standards in the law are the minimum acceptable ones. Employers can establish medical and physical ability

standards that are more stringent than the Coast Guard’s “based on factors such as specific duty requirements, austere work environments, and operational tempo,” she said.

Dr. Brian Bourgeois, owner of West Jefferson Industrial Medicine LLC, New Orleans, and a member of the Coast Guard’s Merchant Mariner Medical Advisory Committee (MEDMAC), said the main problem he sees is overuse of prescribed opioids. And mariners’ biggest health challenge is “proper care of medical conditions.”

As for when the final manual would be out, Dr. Buggs said the Coast Guard first has to review the comments and make any necessary revisions. The comment period closed Jan. 14.

Editor’s Note: To view the manual and all comments, go to www.regulations.gov and enter USCG-2018-0041.