A recent story in USA Today illustrates the serious problems that can arise when unprepared clients face medical emergencies when traveling outside the U.S.
I am not going to get into the debate about the cruise line that removed the affected couple from the ship in Mexico, citing grave health risks to the woman that the ship’s medical facilities were not equipped to treat. I will focus instead on this case as a good example of what can go wrong and how travel advisors can help manage the risks involved.
Let’s be clear at the outset that travel advisors: 1) cannot anticipate every medical problem that may arise during foreign travel; 2) are not competent to make medical risk or treatment judgments; 3) cannot be expected to relieve affected clients from consequences the travelers knowingly risked; and 4) face delicate and sensitive situations when raising medical concerns with clients that have been silent or resistant about the risks involved. That said, the travel advisor is in a unique position to help clients make smart decisions about their own medical risk assessments, and should at least try to do that in any case where the signs of potential risks are present.
What really happened?
First, let’s look at the key elements of the reported story, taking them as “true as reported.” The affected traveler was a 79-year-old experienced cruiser traveling with her 82-year-old spouse. The story does not indicate whether a travel advisor was involved in booking the cruise, but the absence of any mention suggests that the travelers booked it on their own.
The woman was diagnosed with internal bleeding from an ulcer that the ship’s medical team concluded was life-threatening and would require treatment in a hospital. The travelers declined the hospital option and were off-loaded at Puerto Costa Maya. The cruise line arranged for a taxi to Cancun and a connecting flight to Miami, at a total cost of $1,713 per person.
According to the report, the trip home consumed 24 hours and the sick woman wrote an “impromptu will” on one of the flights, though she reportedly already had a formal will at home. Since the couple did not speak Spanish, “they didn’t know where to turn.” Their level of unpreparedness and distress was such that they were not aware of, or at least were disinclined to reach out to one of the several U.S. consular offices along their route home. Happily, the medical issue was resolved successfully and the couple has resumed normal living.
Mistakes were made
What “mistakes” were made in this scenario? Quite a few.
First, if the travelers had used a professional travel advisor, they would have had an advocate to help them in making new arrangements and to serve as a point of contact with the cruise line and with friends/family back in New Jersey. That much is obvious and no regular reader of Travel Market Report is likely to disagree. The decision not to engage a travel advisor probably had the greatest impact on the events that ensued.
Second, the couple apparently did not register their trip with the State Department Smart Traveler Enrollment Program (STEP). Doing so would have created an English-speaking contact point. They were also apparently unaware of the State Department’s 24-Hour Consular Emergency Line that can be called from outside the U.S. This meant the travelers did not have access to help that was readily available.
Third, while it is not mentioned in the report, it is apparent that the couple did not have travel insurance. They said they paid the extra trip costs from their own pockets and were fortunate to be able to afford them. Indeed they were. Professional travel advisors should always inform travelers about opportunities to buy travel insurance and get a signed declination if the client refuses. The value proposition for travel insurance is very strong and should be emphasized with clients for whom it is especially important.
Fourth, again the reports are unclear, but it seems likely that this traveler would have been aware that she had an ulcer before leaving on the trip. No reference is made to a pre-trip medical checkup, so I’m going to speculate that none was done. If a health issue is mentioned in the pre-trip discussion, the travel advisor should raise the question of a pre-trip health checkup. This does not mean the advisor should pry into the medical problem or intrusively question the client. But it is possible to make the same point by simply asking the right questions; for example, “You’ve mentioned you have an active ulcer. Are you planning to get a pre-travel clearance from your doctor?” If yes, “would you like to provide me with the doctor’s contact information to keep in your file?”
Pay attention to important lessons
The lessons are clear. First and foremost, especially when dealing with elderly travelers, the advisor must find a way to raise the sensitive question of health-related issues when there is still time to address any that may exist. It is entirely responsible to point out, for example, the limited medical facilities available in the countries being visited and to make clear that a cruise ship is not a fully equipped hospital. Care in language used and questions asked must be used because clients may be sensitive about the “health issue.” The advisor should play off of and reinforce the cruise line’s own warnings about traveling with pre-existing health issues. Bring the health issue into the planning conversation any way you can, but don’t fail to do it.
If it’s true, remind the travelers that English is not the native language of the itinerary countries and urge them to register their trip with the State Department. In some cases, with their consent, you should do it for them. Pre-trip discussion, planning and record-creation must include emergency contact information in the event the unexpected occurs. In the moment of crisis, the advisor should be armed with information to enable quick action and not have to ask for phone and email contact information from a traveler in distress.
The pre-trip steps I am suggesting are even more important in the case of a solo traveler who would have an even more difficult time if felled by sickness on a trip. This is a tricky balancing act because you don’t want to frighten the client into refusing to take the trip.
The professional advisor also needs to be aware, and reassuring, regarding the privacy issues involved in obtained personally identifiable health information about travelers. Office procedures, whether in-home or brick-and-mortar, must enable the advisor to retain the health information securely and to delete it when it is no longer needed or upon request.
The Boy Scouts had it right
The old Boy Scout motto, “Be Prepared,” is the key watchword in these cases. If the traveler discloses known medical conditions, the advisor should be sure to have an accurate and complete record of that information where it can be accessed from the advisor’s home, since these situations often arise at off-hours.
Failure to address possible medical issues in the case of elderly clients can not only create problems for the travelers, as the USA Today story illustrates, but it can also lead to claims against the agency for failure to warn. The outcome would depend on the particular circumstances, but this is a risk that can easily be avoided. If there are multiple agents in the office, you should consider providing them with a script of suggested questions and techniques that can be used to raise the health subject and help both the agency and the client protect themselves.
One final observation: The traveler in the story was so concerned about her health that she hand-wrote a will on the flight home, even though she had a proper will waiting at home. That decision could have had catastrophic consequences if she had died on the return trip. State laws vary regarding the witnessing requirements for holographic wills and the outcome in cases of conflict between the holographic and the prior typed-and-witnessed will. I am not suggesting that the advisor-client discussion of the health question should delve into the state of the clients’ estate planning. The point here is that poor decision-making in high-stress situations can lead to seriously bad outcomes for many reasons.
You will be doing your client a very good service by guiding them to making some sound health-related planning decisions.