| 01 December 2011
Over the past months I have written about problems captains are having with the National Maritime Center. I haven’t been very nice to the NMC and even considered rounding up the villagers and passing out torches and pitchforks. However, the NMC is charged with protecting maritime and public safety and they must be very careful. Captains complain that they were denied the renewal of their license over a medical condition, or prescription medication, that was approved every one of their past four renewals. Times have changed, and so has the laxity in approving just about anyone who could walk, talk and sign his, or her, name on a license application form.
What’s happened in the past five years? The accident involving the New York ferry that crashed into a pier killing several people and injuring dozens more after the captain passed out at the helm! The Transportation Safety Board ordered the Coast Guard to tighten up their physical standards and many sportfishing captains have lost their licenses as a result. Were they all a “risk to maritime and public safety” because of their medical condition? Maybe, but often the potential side effects of their prescription medications caused denial. If you were diagnosed with “Anxiety” or “Depression” your doctor may have prescribed an Anti-Psychotic (mood altering) medication such as: Ativan, Diazapam, Klonopin, Lexapro, Librium, Paxil, Valium, Wellbutrin, Xanax, or Zoloft. The medication makes you feel better, but consider the potential side effects: suicidal thoughts/behavior, impulsive/dangerous behavior, impaired judgment, amnesia, dizziness, respiratory depression, sedation and a host of others. Consult a PDR (Physicians’ Desk Reference) for all of the possible negative side effects. The NMC properly pays attention to the potential danger of those side effects on maritime and public safety.
If you have a medical condition, and take one or more prescription medications, the NMC will request “amplified information” from your physician and will give you 90 days to provide it. This will include a 12-month history of prescription refills, any restrictions on your activity, and record of treatment. If you had surgery they will ask for a surgeon’s report and prognosis. If you have a heart condition, high blood pressure, or diabetes they may request a Bruce Protocol stress test with a minimum of 7.5 minutes on the treadmill, reach 85% of predicted Maximum Heart Rate (220 minus your age times .85), 8.0 METS, plus an echocardiogram with a left ventricle ejection fraction of not less than 51%.
If you are denied for a medical reason you will have 30 days to respond by filing a “request for reconsideration.” After filing a “request for reconsideration” you can expect a second denial letter with an option to “appeal” also with a 30-day window to respond. The appeal must contain appropriate citations from Coast Guard regulations, physician’s statements, and recommendations from your employer, clients and peers. Unfortunately, very few appeals are granted and the time frame from initial denial to final resolution can be six months, or in many cases even more.
The NMC looks at the possible side effects and interactions for each medication you take. Most doctors are good about noting on the physical form that you have no side effects, or drug interactions. These medications are commonly prescribed for high blood pressure, high cholesterol and/or triglyceride levels and have possible serious side effects.
Ezetimbide (Zetia) – Liver damage, diarrhea, joint/muscle pain, back/chest pain, dizziness and tiredness.
Hydrochlorotiazide – Do not drive! Dizziness, diarrhea and irregular heartbeat.
Lisinopril (Zestril) – Low blood pressure, dizziness, diarrhea and chest pain.
Metopolol tartrate (Lopressor) – May mask diabetes, avoid driving, possible heart failure, depression,
confusion, nightmares, dizziness, heart block, hallucinations and
emotional instability.
Nifedipine (Procardia) – Low blood pressure, lightheadedness, fainting, nausea, swelling of arms, legs,
hands and feet, giddiness, mood changes and tremors.
Ramipril (Altace) – Dizziness, fainting, low blood pressure and nausea.
Slo Niacin (Niaspan) – Do not drive! Dizziness, fainting, rapid heartbeat, nausea, and skipped heart beat.
Put yourself in the Coast Guard’s shoes. Would you issue a license to someone whose medications risk hallucinations, emotional instability, possible heart failure, heart block, or fainting? After reviewing your own medications, and possible side effects, you might find that your chance for renewal is very low and may not be worth the time and expense to make the attempt. However, it’s your option.
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Captain Paul McElroy has been involved in licensing regulations for thirty years. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or (772) 288-1066.
