UK Club's Crew Med Program To Expand

The UK P&I Club's Pre-Employment Medical Examination Program, which promotes higher health standards among seafarers, is set to expand. Designed to protect ship owners from claims arising from medical conditions existing prior to employment, the program aims to build on an eight-year history of considerable savings.

Since August 1996, over 73,000 crew have been examined and around 3,600 rejected as unfit. Today, the needs of 31 owners of tankers, bulkers, passenger ships and other vessels are catered for by 25 accredited clinics around the world. Six members and two clinics have joined the program in recent months as owners seek to avoid the disruption, extra costs and higher protection & indemnity premiums stemming from crew claims.

Examinations, which amount to a free health check for crew, are running at around 1,500 a month. Over half the examinees are Filipino with significant contingents from Thailand, India, South Africa, Croatia and the UK. While program members seek to fill posts involving a full range of seafaring duties, an increasing number are for cruise ship functions.

Program Director Sophia Grant of UK Club managers Thomas Miller has recently returned from the Philippines, which still supplies over 20 per cent of the world's seafarers; and the Ukraine and Hungary, who are supplying an increasing number of people. Discussions with shipping firms and clinics have convinced her of a growing demand for higher standards of pre-employment medicals.

"There is a growing perception among ship owners and operators that healthy crews are more viable commercially. Many on board tasks, some backed by legislation and regulation, cannot be carried out properly or perhaps at all if crew members are not fit enough. "Further, while most of our activities are concentrated in Asia Pacific and India, there has been a noticeable rise in enquiries about Eastern European crews. Factors like these have acted as a green light for us to expand our activities."

Accordingly, the Club has launched a new brochure to promote the program. Of the 25 clinics, seven are in the Philippines, five in India, two each in Australia, the UK and South Africa, and one each in Indonesia, Croatia, Hungary, Ireland, Spain, Thailand and the USA. Locations are Manila, Bangkok, Jakarta, Brisbane, Melbourne, New Delhi, Mumbai, Johannesburg, Capetown, Las Vegas, Dublin, Leeds, London, Barcelona, Budapest and Zagreb. Operations are being expanded in the Philippines, India, Spain and Croatia while another clinic is under development in the Ukraine.

Compensation and medical benefits under employment contracts are considerable. Undiscovered or undeclared pre-existing defects do not generally affect shipowners' liabilities towards seafarers who become ill on board ship. Obligations generally include immediate treatment, medical care at the port of disembarkation and the seafarer's own port, repatriation, sick wages and disability compensation. Under P&I cover, direct costs can usually be recovered but owners and operators face additional expenses from deductibles, crew replacement, disruption to operations and time loss. Further, an unfit crew member may compromise safety and efficiency by contributing to accidents and colleagues' workloads.

The UK Club's Pre-Employment Medical Examination program utilizes a comprehensive range of tests provided by the ILO's C73 Medical Examination (Seafarers) 1946 Convention and the UK DTI's Merchant Shipping Notice 1765 (M). These assess whether a crew candidate is suffering from any disease likely to be aggravated by or render him or her unfit for service at sea or endanger the health of others on the ship.

The PEME initiative is very much in the spirit of STCW '95 which requires each crew member to have a valid certificate of fitness but it is significantly more inclusive than the great majority of national standards. The main reasons for rejecting around 3,600 applicants have been hepatitis B (just over 20 per cent), followed by abnormal liver function and hearing problems (both over 16 per cent), hypertension (11 per cent) and pulmonary tuberculosis (10 per cent). Gall bladder, kidney, heart and venereal disease, diabetes, kidney complaints, cardiac arrhythmias, drug test failures, sight defects, HIV, and blood and ear, nose and throat disorders have also contributed to the rejections total.

However, the rate has been declining. It was 10 percent in 1997, falling to six per cent by 1999 and just 4.8 per cent this year. Only three repatriation cases emanating from program members are known to have been related to pre-existing medical conditions.

While it is difficult to be specific about the monetary benefits yielded by the program, the managers have no doubt the savings are considerable. They maintain that if a well controlled system rejects 4.8 per cent as unfit for duty because of pre-existing conditions, an uncontrolled environment would undoubtedly produce a significantly higher incidence of defects. This would then mean repatriation, operational disruption and safety problems, impacting on owners' P&I records and eventually leading to higher insurance premiums.

At an average cost per examination of $82, total outlay is running at just under $6 million. If all 3,600 rejected candidates had incurred average claims costs of nearly $7,000, the bill would have been around $25 million. Clearly, a substantial proportion would have made claims, some at a much higher level than average. "There is, therefore, no doubt that the savings have been and will continue to be substantial," claims Ms. Grant.

"The program has resulted in fewer claims, safer ships, less disruption and fitter and healthier crew. We feel the percentage fall in rejections and the limited number of repatriations are testimony to the program achieving its primary aim of screening out a significantly higher proportion of pre-existing medical defects. The very existence of a more rigorous regime has almost certainly discouraged some crew applicants aware of their unfitness from being examined at all. "We confidently expect more owners, operators and managers to join the PEME program. We plan to expand steadily in terms of members and clinics while maintaining tight quality control."