Medical Malpractice on Cruise Ship

Medical MalpracticeIn a prior article we discussed some common injuries that can occur on cruise ships, and some of the liability and compensation issues that arise.  In this article we are going to talk about a brand new case that addresses the issue of the cruise line’s liability for medical malpractice which occurs at the hands of the medical staff on board the ship.

The Eleventh Circuit court just recently published a 63 page opinion on the matter of liability for medical malpractice that occurs on cruise ships.  Franza  v. Royal Caribbean is a departure from prior case law on this particular matter, and could have quite an impact on the cruise industry.

Factual Background

The passenger in this case was an elderly man on a cruise with his family.  The ship was docked in Bermuda.  He fell and hit his head on land and was taken back to the ship and was required to go to the medical center on the ship.  There he was treated by a nurse, who failed to properly assess the extent of his head trauma and sent him back to his cabin with an instruction to his wife to “keep an eye on him.”   They complied, but after about two and a half hours, the family noticed his condition was deteriorating and they took him back to the medical center.  The onboard doctor did not see him until over four hours after the accident (and, interestingly enough, not until they had his credit card information!), and the patient was immediately transported to a hospital on Bermuda.  He was flown back to a U.S. hospital the next day, where he died a week later.  The lawsuit was brought by his daughter on behalf of his estate.

Respondeat Superior         

There is a concept in the law known as respondeat superior.  This concept determines who is really at fault (and who will pay for damages) when an employee or agent of a company is negligent in the performance of their duty.  For instance, if a pizza delivery driver hits your car as they are running delivery errands, you would be able to sue the pizza place on this theory.  The driver was acting in the course and scope of his employment (and as an agent of the employer) when the negligence occurred.

Similarly, the daughter of the elderly cruise passenger brought suit under the theory that the cruise line was liable for the death of her father because the nurse and doctor who gave the negligent medical care were agents and employees of the cruise line, and had the apparent authority to act on behalf of the cruise line.  She did not sue them directly, only the cruise line.

Lower Court Ruling

The trial court dismissed the case upon the cruise line’s petition, stating that Franza had failed to state a cause of action upon which relief could be granted.  In doing so it relied on long-standing rule of law from a 1969 appellate case.  The reasoning was that, under a case known as Barbetta, the cruise line was not liable.   The court stated   “the so-called “Barbetta rule” immunizes a shipowner from respondeat superior liability whenever a ship’s employees render negligent medical care to its passengers. The rule confers this broad immunity no matter how clear the shipowner’s control over its medical staff or how egregious the claimed acts of negligence.”

Franza, the daughter, appealed the lower court ruling.

Ruling On Appeal

The United States Court of Appeals for the Eleventh Circuit found differently.  They maintained that the lower court should not have  dismissed the case because the plaintiff did state a sufficient cause of action.

Most importantly, they found the Barbetta rule did not apply in this case.  The court invoked a long line of precedents where the concepts of agency and respondeat superior in maritime law were applied to assign tort liability to the ship’s owners.  The key, they said, was the principal’s control over the agent.

In assessing the facts to determine whether respondeat superior should apply to the cruise line the opinion stated:  “According to our unambiguous precedent, an agency relationship requires: ‘(1) the principal to acknowledge that the agent will act for it; (2) the agent to manifest an acceptance of the undertaking; and (3) control by the principal over the actions of the agent.’”

To determine whether the nurse and doctor were actual agents of the cruise line, or apparent agents upon which the deceased relied to his detriment, the appellate court looked at a number of facts:

  1.  The nurse and doctor were employees of the cruise line and were “at all times material acting within the course and scope of their employment.”
  2. The cruise line directly paid them for their services in the medical center.
  3. The medical facility was created, owned and operated by the cruise line
  4. The doctor and nurse wore uniforms provided by the cruise line with its name on them.
  5. The cruise line represented to immigration officials that the nurse and doctor were members of the ship’s crew.

Taking all these factors into account, the appellate court found there was sufficient “indicia of control” by the cruise line of the medical personnel, and these factors were enough for Franza to plead the agency and apparent agency theories.

Take special note that this does not mean Franza won her case for damages due to her father’s death from the medical malpractice.  It only means that the appellate court believed she did sufficiently plead the basic elements of her case, and that a trial should occur.  The case was remanded to the lower court for a trial on the merits in accordance with the appellate court’s findings.  It remains to be seen what the outcome of the trial will be, but the door is open to find the cruise ship liable for the actions of its agents, the doctor and nurse.

Why Does This Matter?

In the decision, the court speaks to how ships and technology have evolved.  The cruise ships these days are fully equipped floating cities.  No longer does a ship go off the grid when it sets sail – modern technology ensures that the ship can stay in touch anywhere in the world (and some cruise line medical centers have partnered with on-shore hospitals for additional  support).  These advancements necessarily change the availability of medical services and communication.

In recent years, cruise lines have touted their state of the art medical centers and fully staffed infirmaries.  This supposedly gives the passengers peace of mind that any medical emergencies can be treated, and thus serves as an enticement to cruise.  The Franza decision means that the cruise line will no longer be able to glorify their medical centers and expertise on one hand, then hide behind the Barbetta immunity defense on the other hand when someone has been injured or dies as a result of the professional negligence of their medical staff.

Seek Experienced Counsel

While this particular case must be re-tried, the basis of the case can be viewed as a victory for those who have suffered medical malpractice in a ship’s medical center.  If you or a loved one has been injured on a cruise ship, or as a result of the negligent actions of medical personnel on a cruise ship, you should obtain the services of an attorney experienced in these types of cases.