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"Immediately after 9/11 it was very difficult (to get medical parole for injured crew members) because of security," Blackwell says. "Then things kind of eased up a little. Recently, it's gotten more difficult again."
Blackwell says that medical parole in the U.S. is determined by immigration officials based on a doctor's evaluation. He also says the company can be fined up to $50,000 for violating immigration laws. He refused to comment on specific cases, but when pressed by New Times about his e-mail alerting INS that Doran McDonald had been "intercepted by an attorney" at Miami International Airport, Blackwell offered this hypothetical situation: "Our obligation as a company is, if a crew member is in transit and in the process they arrive in Miami to change planes and they do not make the flight, we have an obligation as a company to let INS know that a crew member has jumped ship, essentially."
Rivkind admits that, post-9/11, more stringent adherence to U.S. immigration laws makes it harder for cruise lines to keep injured crew members for treatment in the U.S. "But I think they're using that, as well. They used to have an ability to keep these guys on medical parole if they wanted to. With immigration changes, I believe it is more difficult, but I think the cruise lines also take advantage of that."
While Blackwell was willing to speak to New Times -- though not about any specific cases -- weeks of back-and-forth with South Florida's other cruise line giant, Carnival Cruise Lines, resulted in an anemic e-mail response. Spokesperson Jennifer De La Cruz wrote that no information on the number of crew members the company employs was available, nor was there any available information on the number of crew members receiving medical treatment, in the U.S. or elsewhere.
ITF's Brady says that the cruise industry is notorious for pressuring employees to avoid making waves, even when their health is at stake. "I can't prove it because all I get is word of mouth," he says. "Every once in a while someone gets a lawyer, but they always include nondisclosure agreements in their settlements. And if word gets back to a cruise line that an employee is speaking with a union representative about these kinds of issues, they'd be fired from their jobs and probably blacklisted."
There is no shortage of anecdotal evidence of medical malfeasance by cruise lines. Brady has stories, and Walker and Rivkind each have had several clients with similar tales of woe. One of them, 28-year-old Azumi Sagara, is actually a U.S. citizen who says Royal Caribbean employees tried to delay her access to an emergency room until the ship she was on traveled to Nassau, and then refused to pay for her medical care. Sagara was an ice skater on Royal Caribbean's Mariner of the Seas. As the ship lumbered toward Port Canaveral on March 27, Sagara found herself doubled over in pain. "Something in my abdomen really hurt -- I didn't know what it was, but I knew I needed to see a doctor." She was told she was probably pregnant. When a quick test proved otherwise, the ship's medic said she probably had an infection. "The doctor gave me some pills and told me to come back in a week," Sagara says.
By 9:00 p.m. the pain was so severe, she knew she'd have to go to the emergency room when the ship docked in Port Canaveral the next day. That night she called a nurse, asking for a referral from the doctor to seek medical treatment in Port Canaveral the next day. "She said, öI can't call the doctor for that, you'll have to wait until tomorrow.'"
Sagara knew that would likely mean she couldn't get treatment in the U.S. Crew members only had two opportunities to get off the ship in Port Canaveral: before the passengers started leaving at 7:30 a.m., and after all passengers had disembarked, at noon. Sagara knew that a trip to the doctor would mean she'd have to wait until noon to get off the ship, and she was in too much pain to do that. "And at that point, I thought maybe I could get back onboard that day, but we had to be back by 3:45 p.m., so waiting until noon would pretty much put that out of reach," Sagara says. She decided to get off the ship and to the emergency room by any means necessary. "The ship's security officer wouldn't let me off," she says. "I said, 'I'm in a lot of pain, I need to go to the ER.' While I was signing off, he told me to wait until we got to Nassau." Eventually, she made a break for it. "I ran past the security officer and got to the immigration guy. The security officer was saying,'She's not cleared, she's not cleared.' I said, öI need medical attention.' The immigration guy said, 'I can't stop you from going to your own country.'"
Doctors in the ER told Sagara she had pelvic inflammatory disease, and ruptured ovarian cysts with some internal bleeding. "They said I had to see a specialist immediately," she says. Sagara flew home to California, received a week's worth of medical care, and returned to the Mariner on April 4 after missing one week of work. She worked for Royal Caribbean for the duration of her contract, until May 2.