Cruise Ship Medical Malpractice Claims

162017_132140396847214_292624_nIn a federal appellate case decided on November 10, 2014, the United States Court of Appeals for the Eleventh Circuit (“Appellate Court”) declined to adopt the “Barbetta rule” that immunizes a shipowner from respondeat superior liability whenever a ship’s employees render negligent medical care to its passengers. The Barbetta rule confers broad immunity no matter how clear the shipowner’s control over its medical staff or how egregious the claimed acts of negligence.

The Appellate Court had to decide whether a passenger could invoke the principles of actual agency or apparent agency to impute to a cruise line liability for the medical negligence of its onboard nurse and doctor. The Appellate Court ruled that actual agency and apparent agency were viable theories available to the plaintiff in this case. The Appellate Court stated: “We have repeatedly emphasized that vicarious liability raises fact-bound questions, and we can discern no sound reason in law to carve out a special exemption for all acts of onboard medical negligence.”

The Underlying Facts

On July 23, 2011, a passenger, along with his wife and family, were aboard the “Explorer of the Seas” cruise ship owned and operated by Royal Caribbean that had sailed to Bermuda. When in port in Bermuda, the passenger fell while boarding a trolley at or near the dock, thereby suffering a severe blow to his head. The passenger was allegedly required to go to the ship’s medical center to be seen for his injuries and was taken in a wheelchair to the ship’s infirmary.

A nurse allegedly employed by Royal Caribbean evaluated the passenger and observed a lump and an abrasion on his head. The nurse did not administer or recommend any diagnostic scans and advised the passenger and his wife that he was fine to return to his cabin, but cautioned the man’s wife to keep an eye on her husband’s condition because he might have a concussion.

An hour and a half after returning to his cabin, the man’s son and daughter-in-law noted a deterioration in the man’s condition. The daughter-in-law called the ship’s emergency number but it took twenty minutes for someone to arrive to transport the man by wheelchair back to the infirmary. Once he arrived at the infirmary, medical staff refused to examine him until the ship’s personnel could obtain his credit card information.

Nearly four hours after his first visit to the ship’s infirmary, the man was evaluated by the ship’s physician, who was an employee of Royal Caribbean. The physician had the man transferred to King Edward Memorial Hospital in Bermuda; the man arrived at the hospital two and a half hours after being evaluated by the onboard physician, by which time his life could not be saved. He was airlifted the following day to Winthrop-University Hospital in Mineola, New York, where he was in the intensive care unit until he died one week later.

The Cruise Ship Malpractice Claim

A lawsuit was filed against Royal Caribbean only, under 28 U.S.C. § 1333 and the general maritime laws of the United States, alleging various negligent actions by Royal Caribbean’s onboard medical personnel. The trial court dismissed the plaintiff’s claims pursuant to the Barbetta rule.

The Appellate Court held that it was obliged to exercise its broad discretion in admiralty and maritime to develop law in this area of the law. Under general maritime law, a shipowner traditionally has owed no duty to practice medicine or to carry a physician on board. Therefore, the shipowner is only liable to its passengers for medical negligence if its conduct breaches the carrier’s more general duty to exercise reasonable care under the circumstances.

The plaintiff did not argue that Royal Caribbean violated its duty to exercise reasonable care under the circumstances but rather sought to hold Royal Caribbean vicariously liable under the doctrine of respondeat superior because the ship’s medical employees allegedly failed to treat her father with appropriate care. The Appellate Court held that it would be manifestly just to hold principals responsible for the conduct they command from their employees (“We can see nothing inherent in onboard medical negligence, when committed by full-time employees acting within the course and scope of their employment, that justifies suspending the accepted principles of agency”).

The Appellate Court stated that absent any statutory mandate to the contrary, the existence of an agency relationship is a question of fact under general maritime law. The Appellate Court held that the plaintiff’s complaint unambiguously alleges an agency relationship between the employer, Royal Caribbean Cruises, Ltd., and its full-time employees, the onboard nurse and physician, and nothing in the complaint suggests that these medical professionals somehow acted outside the scope and course of their employment or that the requisite control was missing. Thus, applying the standard principles of agency, it held that the plaintiff’s complaint sets out a plausible basis for imputing to Royal Caribbean the allegedly negligent conduct of its onboard medical employees.

The Appellate Court held that it did not find that the arguments set forth in Barbetta justify its broad grant of immunity from vicarious liability in all claims of medical malpractice. The Appellate Court stated that it was obliged to follow its own maritime precedent, which demands fact-intensive treatment of agency questions: “We cannot accept a legal principle that would erect a categorical exception from this settled practice, and we see no reason to follow an outdated rule that serves no useful purpose in modern maritime law. Thus, we hold that [the plaintiff’s] allegations established a plausible agency relationship between the employer, Royal Caribbean Cruise Lines, Ltd., and its employees, [the nurse and the physician onboard], and that the district court improvidently granted the Rule 12(b)(6) motion to dismiss.”

The Appellate Court also concluded that a passenger may sue a shipowner for medical negligence if he can properly plead and prove detrimental, justifiable reliance on the apparent agency of a ship’s medical staff-member (respondeat superior derives from a principal’s right to control the conduct of its agents – liability under apparent agency flows from equitable concerns when a principal’s conduct could equitably prevent it from denying the existence of an agency relationship). Under apparent agency, three elements must be satisfied: a representation by the principal to the plaintiff, which causes the plaintiff reasonably to believe that the alleged agent is authorized to act for the principal’s benefit, and which induces the plaintiff’s detrimental, justifiable reliance upon the appearance of agency.

Lastly, the Appellate Court held that in order to plead negligence in a maritime case, a plaintiff must allege that (1) the defendant had a duty to protect the plaintiff from a particular injury; (2) the defendant breached that duty; (3) the breach actually and proximately caused the plaintiff’s injury; and (4) the plaintiff suffered actual harm. In the case it was deciding, the Appellate Court stated that the precise contours of Royal Caribbean’s duty depend on questions of fact that need not and cannot be answered at the pleading stage; the plaintiff’s specific allegations sufficed.

Source Patricia Franza, as Personal Representative of the Estate of Pasquale F. Vaglio, Plaintiff – Appellant versus Royal Caribbean Cruises, Ltd., a Liberian corporation, Defendant – Appellee. No. 13-13067.

If you or a family member may have a claim of medical negligence against a cruise line, you should promptly consult with a maritime medical malpractice lawyer who may investigate your cruise ship medical malpractice claim for you and represent you in a claim of medical malpractice against a cruise line, if appropriate.

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This entry was posted on Tuesday, November 11th, 2014 at 6:29 am. Both comments and pings are currently closed.

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