The Medical Center on a cruise ship is one of those things that are taken for granted until the need arises. Like most things we take for granted, we hear little about it unless we have a negative experience. We expect high standards in our medical care, after all it is one of the most regulated professions in the world- except on cruise ships.
The International Maritime Organization (IMO), the UN agency that is responsible for safety at sea has a set of guidelines for medical services at sea. Most countries in the world are members of the IMO and have adapted the standards into their own laws. After you go through the pages of legal boilerplate, you find all the IMO says is that adequate care should be provided given the limitation of the vessel. That really does not help codify what is needed and also remember that IMO is mostly cargo orientated.
Land based hospitals and clinics have many government agencies looking over them. Surprisingly, ship medical centers have little government supervision. If fact, you will be horrified to learn that there is basically no supervision. The U.S. Coast Guard inspects ships regularly on a range of safety issues, as does the Center for Disease Control (CDC). While the CDC inspection includes the medical center, the inspection is about sanitary issues and does not address medical equipment, supplies, or staff. The 2010 U.S. law, Cruise Vessel Security and Safety Act (CVSSA), is touted as being a major improvement in protection of cruise clients. However, its requirements for onboard medical care to be enforced by the Coast Guard has only one focus. While it is an important concern, it is very narrow in scope. The law requires each ship to have what is called a “rape exam kit” onboard and a U.S. certified medical staff to administer a sexual assault exam. That member of the medical staff can be a RN. There are no other mandated government requirements concerning cruise ship medical facilities.
Cruise lines who are members of CLIA, which is most cruise lines, have voluntarily aligned themselves with American College of Emergency Physicians. This is one of the largest medical organizations in the world and sets the standards for emergency care in the United States. They are the board that certifies Emergency Physicians. Their standards are generally applied in other countries as well, with local modification. The college has designated a committee that works in cooperation with cruise lines to create standards of care that will apply on cruise ships.
Minimum staffing levels, required certifications, and pharmacy stocks are also included. The cruise lines voluntarily follow these guidelines and coordinate with the committee any recommendations for changes and reports of the clinics performances. The majority of the CLIA members use only U.S. or Canadian board certified doctors. A few have European doctors on their staff. In some lines, such as Holland America lines, a doctor designated at the crew doctor will be licensed in the Philippines. The college provides no inspections of the facilities, that is an internal function of a cruise line. In summary, the matter of medical care is solely in the hands of the cruise line.