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Questions raised about cruise ships' medical care

The man in his 40s was thrilled when he hit a big jackpot at one of a cruise ship's slot machines. Ten minutes later, his jubilation was abruptly ended by chest pains.

Dr. John Bradberry performed an electrocardiogram and quickly determined the Carnival Cruise Lines passenger was having a heart attack. Bradberry gave him a thrombolytic, a clot-busting drug that increases the survival chances for heart attack victims.

"We treated him with all the basic treatments he would have in an emergency department on land," Bradberry said. "He subsequently did well."

Cruise companies point to such stories as examples of the high-quality medical care they provide at sea, on ships that carry nearly 5,000 people. But critics say that despite recent improvements in care, passengers are still at risk if they become seriously ill.

Some doctors say onboard care has a long way to go, pointing out that most ships only have one or two physicians and that most infirmaries don't have surgical equipment. "The facilities are as good as they can be for a ship but it's not an emergency department," said Marshall Silk, a former cruise doctor for two decades.

The majority of the more than 9-million people who take cruises each year don't need medical care onboard.

But the three biggest cruise companies _ Carnival Corp. and PLC, Royal Caribbean Cruises Ltd. and Star Cruises PLC _ have all been sued over alleged shoddy care on ships that led to passenger deaths or permanent health problems.

Dr. Arthur Diskin, medical director of Carnival Cruise Lines, said many of the passengers who have sued either came aboard already sick or did not inform ship doctors of their health problems. "The majority of the cases I've seen have resulted from unrealistic expectations of the passengers," he said.

Critics say the industry needs government oversight.

"I wouldn't want to get sick on a ship," said Charles Lipcon, a Miami lawyer who has represented passengers in lawsuits against cruise companies and doctors. "I've just seen too many horror stories, although I do think it's improving."