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MERPAC recommends extensive overhaul of Coast Guard's proposed NVIC on medical conditions, medications

The Merchant Marine Personnel Advisory Committee (MERPAC) has submitted its report on the Coast Guard's proposed navigation and vessel inspection circular (NVIC) on medical conditions and prescription medications. The MERPAC report included sixteen recommendations, several of them calling for sweeping changes to the Coast Guard's proposed NVIC.

MERPAC met April 9 and 10 in RTM STAR Center at American Maritime Officers headquarters in Dania Beach, Fla., to, among other things, review and vote upon the MERPAC working group recommendations formulated during nearly three years of research and work. American Maritime Officers Director of Government Relations Mike Murphy participated in the working group that reviewed the Coast Guard's proposed NVIC.

AMO submitted its comments and objections to the proposed medical NVIC more than a year ago. It was remarked at the MERPAC meeting April 10 that the Coast Guard had made the approval of its proposed medical NVIC a priority following the Cosco Busan casualty in San Francisco Bay.

In April, a federal grand jury returned an indictment charging John Cota, the pilot onboard at the time the Cosco Busan allided with the Bay Bridge, with allegedly providing the Coast Guard in 2006 and 2007 with information that was not complete or true regarding his current medications, the dosage, possible side effects and medical conditions for which the medications were taken.

The Coast Guard is seeking final approval of its proposed NVIC from the Department of Homeland Security. The proposed medical NVIC could have a significant impact on American mariners in all sectors. It has the potential to prevent some mariners from receiving Coast Guard documentation, and to require many mariners to obtain medical waivers for any number of medical conditions or medications before receiving or renewing Coast Guard documentation.

The proposed medical NVIC is a complete revision of the entire NVIC 02-98 and medical evaluation form CG-719K. The changes to existing Coast Guard policy are vast and would have a wide range of implications for American mariners.

MERPAC opened its report by stating: "the development of the draft NVIC and the accompanying draft 719K has not used good principles of risk-based decision making. MERPAC recommends that the Coast Guard use all data available to them and reconsider the information contained in the NVIC. Any requested information or medical conditions that are currently listed as a medical condition on the current draft that could prevent a mariner from receiving their credential, that is not specifically required by statutory or regulatory language and that is not supported by the casualty data or root cause analysis that the Coast Guard has in its database of accidents, should be removed from the criteria listed in the NVIC."

As stated by MERPAC: "We continue to be concerned that the list of medical conditions exceeds the defined goal of task statement 61, which was to 'provide recommendations on medical waivers, functional tests for mariners and identify risks of sudden incapacitation.' MERPAC believes that many conditions listed in the draft NVIC continue to exceed the above described standard, and should be removed from the document."

MERPAC also recommended the Coast Guard conduct "a comprehensive risk based study to determine the causes of and contributing factors to marine casualties. The study should identify data requirements and collection procedures, reports, and other measures that will improve the Coast Guard's ability to evaluate future marine casualties, to monitor trends to identify causes and contributing factors, and to develop effective safety improvement policies, including: workload, manning and medical review provisions and programs."

Murphy identified several specific elements of the Coast Guard's proposed NVIC that have the potential to significantly impact U.S. mariners and noted the MERPAC recommendations that applied. Among them were:

  • All medical evaluations and waivers will be done at the National Maritime Center (NMC). The health care provider who conducts the physical examination will only gather the data required by the NVIC for submission to the NMC. MERPAC recommended designating certain medical practitioners as "trusted agents" and giving their physical examinations more weight when processing them.

  • The NVIC now lists 201 medical conditions requiring further review. The NVIC directs detailed documentation of tests and evaluations for each condition and these will have to be submitted with the physical to NMC in order to be considered for a waiver. MERPAC expressed their concerns that the list of medical conditions "exceeds the defined goal."

  • The NVIC has a revised section on medications, including prescribed, over-the-counter and herbal supplements. Medications are classed as: "Non-Waiverable," "Waiverable" or a time of abstention prior to operating under the authority of a credential. All medications, whether prescribed, over-the-counter or herbal supplements must be disclosed on the Medical Evaluation Form CK-719K. MERPAC recommended that the look back period be limited to the 30 days prior to the physical examination.

  • Hearing standards have been significantly tightened. The unaided threshold in four frequency ranges is 30 db and the threshold with a hearing aid was proposed at 20 db. MERPAC has recommended that the hearing aid threshold be lowered to 30 db.

  • The CK-719K Medical Evaluation Form now incorporates a comprehensive health questionnaire. This 89 question survey delves into every aspect of a mariner's health and requires a "yes" answer if the mariner currently has the condition, "or has ever suffered from" the condition. MERPAC and the medical working group had a vigorous debate over this questionnaire because it puts the mariner at risk of prosecution under 18 USC 1001 if there is inconsistent information between physicals. MERPAC ultimately recommended that this section, along with the medication declaration, is made detachable and not submitted with the physical.

  • The CG-719K Medical Evaluation Form has a Body Mass Index (BMI) rating. A BMI of 40 will automatically trigger a Demonstration of Physical Ability Test. MERPAC recommended removing all references to Body Mass Index in the NVIC and the Medical Evaluation Form.

    When the complete MERPAC report and attachments become available, a link to the documents will be posted on the AMO Web site.