| 30 December 2011
At some point in time the old Western gunslinger realized that it was for him to hang up his gun belt and matching Colt 45 single action revolvers because the string of young lions coming to town to challenge him was never ending. He knew that sooner than later one of the ‘young guns’ would out draw him and he would be left face down in the dirt. Father Time takes its toll on the human body and professional boat captains are no exception. I chose not to attempt to renew my license (it would have been the seventh issue) because I recently had four hours of hernia surgery and am on two types of blood pressure medication. There are far to many hoops for me to jump through.
Do you take any prescription medications, or have health issues such as recent surgery? If so, when it comes time to renew your license, plan on filing six months in advance because the National Maritime Center is taking up to three months to advise mariners that they have a medical condition that requires further review and that they must submit various medical tests and detailed medical records. It is taking up to another three months to receive an approval, or denial. If an application is denied for medical reasons the mariner is given 90 days to file an appeal, or request for reconsideration. Expect another three months for a reply for an appeal, or request for reconsideration.
What am I seeing as reasons for denial? Type II diabetes is number one on the list. It requires a recent stress test, (left ventricle abnormality, or enlargement is automatic denial with no grounds for appeal), two A1C readings of less than 8.0 taken 90 days part, a complete eye exam with examination for detection of diabetic retinopathy, plus a detailed history of diagnosis and control, current treatment plan and amplifying letter from the treating physician. Next on the list are glaucoma, and cataract surgery. Both require a complete eye examination and letter from a physician. Skin cancer requires a dermatology consultation documenting staging, histologic diagnosis, Breslow depth, tumor stage and post-operative therapies, plus much more. Don’t forget that a BMI (Body Mass Index) of 40 or more requires a demonstration of physical ability, plus a Sleep Apnea evaluation.Also on the denial list are excessive medications with overlapping side effects. Sometimes I wonder if the physicians prescribing drugs are aware of the combined side effects. Recently I assisted a captain with Type II diabetes, a history of heart attacks, Lyme’s Disease, Congestive Heart Failure, Glaucoma and twelve prescription medications to review his options for renewal. I advised him to hang up his spurs because his chance of approval was ‘zero.’ When I reviewed his prescription drugs I found that he was ordering two diabetes drugs that were taken off the market in the United States because they cause heart attacks and strokes, and a powerful anti-depressant that a doctor prescribed to relieve his symptom of ‘burning feet.’ The medication, Amitriptyline is an anti-depressant used to treat mental illness, is an automatic disqualifier and requires a DSM Panel evaluation by a psychiatrist for consideration by the NMC.
One of my clients checked off ADD (Attention Deficit Disorder) on his physical form because his mother told him she thought he had ADD when he was in grade school twenty years ago because he couldn’t focus on his schoolwork. She never took him to a doctor for diagnosis, but trying to be forthright, he checked it off. The NMC is requiring that he submit a DSM Axis analysis by a psychiatrist to prove that he does not have ADD.
You may feel fine, and your physician may tell you that everything is under control, but that pulls little weight with the NMC’s medical staff that evaluates your ability to safety operate a vessel based on the medical data you submit.
For information on disqualifying medical conditions go to http://homeport.uscg.mil and look for Medical NVIC 04-08. There you will find all 202 disqualifying medical conditions and what must be submitted for review by the NMC Medical Evaluation Group in order to be considered for a medical waiver. It might just be time to consider hanging up those tired Colt 45’s and spurs. I did.
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Captain Paul McElroy has been involved in licensing regulations for almost thirty years. He was a member of a Coast Guard Quality Action Team charged with developing ways to improve the Coast Guard's licensing service. Many of his recommendations were included in the establishment of the National Maritime Center. 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.
