I only needed a blood transfusion! Why did Norwegian Cruise Line leave me in St. Kitts?

By | April 8th, 2017

When Andrew Goldstein suffers a sudden medical condition that requires a blood transfusion while on a Caribbean cruise, he is left behind in St. Kitts to seek treatment. Now he wants our advocates to help him get a refund for his cruise and reimbursement for his additional travel and medical expenses. But from whom?

If you are one of our regular readers, you probably know where this is going. This story is yet another unfortunate tale that shines a light on the importance of travel insurance — even if you don’t think you will need it.

Goldstein was on a 14-day cruise on Norwegian Cruise Line’s (NCL) The Breakaway when he began feeling unwell. He visited the ship’s medical center and was advised to have two tests: an EKG and a blood test. He refused both and returned to his cabin.

Still feeling ill the next day, he revisited the medical center.

“I agreed to have the tests that I opted not to have done the prior evening,” he told us. “But in addition to these two tests, a lot more was done without my consent.”

Later that evening, Goldstein received his blood test results and it became clear that further treatment was indicated.

“The doctor told me that my hemoglobin was very low (less than 6), and that I needed a blood transfusion, and that it should be done in a St. Kitts hospital the following day,” Goldstein remembers.

The next morning, Goldstein was escorted off the ship and to the hospital in St. Kitts. Here he was told that it would take two days for the correct blood to arrive for his transfusion. Unwilling to wait for this treatment, and not pleased with the quality of the medical facility, he checked himself out and took a taxi back to the ship.

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At that time, Goldstein was informed that he would not be permitted to complete his cruise. The ship’s medical team was not willing to clear him for further travel.

Left with no other option, Goldstein made airfare arrangements and flew home from St. Kitts.

Believing that he was improperly denied reboarding, he has been attempting to receive reimbursement from the cruise line for all of his expenses.

When we read Goldstein’s complaint we were struck by his elevated expectation as to how the medical center on board The Breakaway should have handled his self-described “serious medical condition.” He told us:

Clearly, the best and safest option would have been for me to be allowed to stay in my cabin. A blood donor(s) for A+ blood could have easily been found on The Breakaway, and the transfusion could have been done in the Medical Center. I could have also been given iron supplements, eaten iron-rich foods, and rested a lot. I would have then been in stable condition when I arrived in New York City.

As consumer advocates we are always ready to go to bat for a consumer, but in this situation we could not. Expecting the crew to search for a suitable blood donor, do all the required laboratory testing of the blood and perform a transfusion aboard the cruise ship in a nonemergency situation is not reasonable.

Goldstein’s letter to NCL accused the doctor and captain of The Breakaway of making “very bad decisions” that put his life in danger by leaving him in St. Kitts. He demanded that they send him his refund and reimbursements by overnight mail within one week.


The hostile nature of Goldstein’s letters to NCL likely alienated him from any executive who may have read his complaint. As we have frequently pointed out, this type of aggressive strategy rarely ends in a consumer victory. And it wasn’t successful for Goldstein either.

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If Goldstein had purchased a good travel insurance policy, he would have been covered for all of his expenses, including his missed cruise and his evacuation from St. Kitts. The anxiety he experienced trying to find his way back home would have been alleviated because the travel insurance company would have made the arrangements for him.

As you have probably guessed, Goldstein did not purchase any travel insurance for this trip.

In their response letter to Goldstein, NCL explains that:

Please understand that guests who leave the ship early for personal or medical reasons are not entitled to a cruise refund, as stated in our brochure and contract of passage.
Although our records show you did not purchase the passenger protection program offered by Norwegian Cruise Line, if you purchased travel insurance through an independent agency you may wish to file a claim with your insurance carrier for the days you were ill, and also for your out of pocket expenses.

We carefully reviewed the terms and conditions that NCL is referencing. In the section entitled “Refusal of Passage” we found the pertinent information for Goldstein’s case:

NCL reserves the right to decline to accept or retain any person as a passenger on the cruise at any time. NCL shall not be required to refund any portion of the fare paid by any passenger who must leave the ship prematurely, nor shall it be responsible for lodging, medical care expenses, meals, return transportation or other expenses incurred by the passenger.

Goldstein took his plight to our forums and wasn’t pleased with what he heard there either. He reiterated that if NCL had just left him in his cabin to relax he would have been fine.

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Perhaps — but what if his condition had worsened at sea? There is no way anyone, not even Goldstein, could have predicted the course that his illness would take. And a cruise ship medical center is not the place you want to find yourself in a true medical emergency.

As NCL pointed out to him:

“Please note that the shipboard medical facility is equipped to provide basic medical care; we cannot offer care for conditions requiring specialized expertise or equipment.”

…Like a blood transfusion.

We receive many letters from consumers who want to retroactively invoke the benefits of a good travel insurance policy even though they did not purchase one. We can’t help in these cases. What we can do is to continue to stress how beneficial travel insurance can be when faced with unexpected illnesses and accidents — before and during your travels.

We are happy to hear that Goldstein has recovered. While we wish we could provide him some additional assistance, it isn’t possible. He is not entitled to a refund of his cruise or a reimbursement of his expenses. The terms of his contract with NCL spell this out.

But we hope that his story serves as a reminder to future travelers that even if you think you are healthy and strong you may want to consider travel insurance to protect against life’s unanticipated calamities — because that is what it is designed for.

Should NCL have provided an on-board blood transfusion for Goldstein?

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  • Kristiana Lee

    With hindsight, it’s easy for Mr. Goldstein to say that iron supplements and protein-rich foods would have done the trick (I won’t even touch the blood transfusion expectations). However, the cruise line had to make the call with limited information knowing it didn’t have the necessary equipment or expertise to deal with a medical emergency. Norwegian was in a tough spot. They knew they’d be dealing with an angry Mr. Goldstein but I’m sure they’d prefer that to an emergency evacuation and/or lawsuit. Given that one of the complications of severely low hemoglobin is heart failure, I don’t blame Norwegian at all for being conservative.

  • Jim Zakany

    Iron pills may have helped somewhat (if the obstinate Mr. Goldstein were to actually take them) but a blood transfusion would have made him feel much better.

    Still, I don’t think I would have enjoyed staying at some janky St. Kitts hospital waiting two days for blood to arrive. That’s silliness, too.

    I have to smile at the idea of using another passenger, as a Mad Max style blood bag, to perform a transfusion in an examination office.

  • Carrie Livingston

    That has been done in rare instances on a cruise ship.

  • sirwired

    NCL did everything right here. They made an accurate diagnosis and arranged for appropriate treatment at a facility that could provide it. Without knowing why his red count crashed, having him complete the cruise would have been a horrible idea. (For reference, his hemoglobin was less than HALF the normal level; he was not just a touch anemic here… “relaxing in his cabin” was definitely not a good idea.) And given some of the causes of a count that low, an extensive blood workup was appropriate; he wouldn’t be alive to write this letter if he was suffering acute organ failure.

    A field transfusion was a non-starter. A ship is not equipped to perform any tests on donor blood besides maybe typing (making the blood quite dangerous) and would only be able to perform a whole blood transfusion, even though it appears all he needed was red cells. (Blood is rarely transfused whole.)

    And yes, no refund was appropriate. They offer insurance, he didn’t buy it, end of story. (And insurance would have gotten him home, quite possibly with nursing care in transit.)

    I wonder what treatment he did receive at home. I’m fairly certain it was a bit more involved than bed rest.

  • Jeff W.

    NCL is in the right. Mr. Goldstein when to the medical office when the symptoms first occurred and he refused treatment. Went back the next day because the situation did not get better and a visit to a hospital was required. Mr. Goldstein refused treatment there as well.

    NCL did not want the liability of the passenger condition getting worse while at sea. He had two chances, NCL was giving him a third.

  • Pat

    In late February, I was was admitted to a hospital with sepsis. My hemoglobin, iron, and red blood count are still low and have not recovered to normal. Mr. Goldstein needed to have have a full evaluation by doctors for the cause instead of playing doctor with what was needed (especially since he did not stay at a Holiday Inn Express the previous night). I do not blame NCL from not letting him board. If he needed a blood transfusion, that is serious and a cruise skip is not where Mr. Goldstein needed to be.

  • Joseph

    As a physician (not involved in this case), NCL was in the right.

  • Dutchess

    One “Yes” vote to the survey? My only guess is Goldstein showed up to vote.

    NCL owes him nothing. He had a self described “serious” medical condition. A cruise ship is in no way prepared to deal with his failing health or any of the multitude of things that could go wrong. File this under entitled consumer.

  • finance_tony

    NCL is a physician?

  • Annie M

    This guy is in la-la land believing a cruise line has blood on board for transfusions. I remember reading his complaint on the forums and he even wanted the ship employees to provide blood for the transfusion if I recall correctly.

    And this story is a LOT different than the story on the forum, where he didn’t mention that he was told it would take 2 days to get blood and he walked out and refused treatment. This is even more reason for the cruise line to not allow him back on the ship. What if something happened and his condition worsened during sailing?

  • Rebecca

    How much do you want to bet that if NCL allowed him to reboard the ship and he became even more ill, requiring a medical evacuation, he’d be screaming up and down about how NCL should have never let him get back on the ship and he wanted them to pay his medical expenses, pain and suffering and emotional distress?

    Seeing as the OP is so obviously outside of reality (they should have found a donor on the ship, really?), I’ll go ahead and say it. I’d also be willing to bet money here that he contacted not just this site, but several personal injury attorneys that told him to pound sand.

    Just wow.

  • Rebecca

    For the life of me, I simply can’t understand how some people live so far outside of reality. Most times I can at least see the other side, even if I don’t necessarily agree. This guy is living in an alternate universe.

  • JewelEyed

    There is no possible way they have the equipment to, beyond performing a type and screen, collect for donation and screen donor blood for infectious diseases on board the ship. If they had accommodated him without that, guess who he’d be suing for contracting Hepatitis C or worse?

  • sirwired

    Is this a record for survey unanimity? Currently running at 297 to 2.

  • LeeAnneClark

    And you KNOW who the two yes votes came from! ;-)

  • Chris_In_NC

    Is the OP serious? A hemoglobin of 6 is more than a serious medical condition. It is a medical emergency. A hemoglobin of 6 puts a patient at imminent threat of death. Completely delusional.

  • PsyGuy

    What kind of nutter PAX is the LW? I think the best outcome might have been a credit for the difference of the cruise time he lost. I wouldn’t have allowed the LW to reboard, you don’t want to be doing something at sea, when you have a perfectly good hospital. This is really a case of the cruise line performing appropriate CYA. Next time by cruise insurance, or don’t complain to the ship’s medical center.

  • PsyGuy

    I can take a guess.

  • PsyGuy

    Absolutely agree.

  • PsyGuy

    No, because in an alternate universe, the LW would be wrong to.

  • PsyGuy

    What does Holiday Inn have anything to do with the story?

  • PsyGuy

    NCL could have gotten the blood, already typed and screened and infused it. It’s just putting in an IV line.

  • Pat

    The old Holiday Inn Express commercials used a tag line the I am not a ( insert occupation) but I stayed at a Holiday Inn Express last night. It was a bit of sarcasm on my part in the fact he was not being smart in his actions.

  • PsyGuy

    Oh, never seen this advertising, though I Google searched it, and saw some video’s on You Tube, cute.

  • Rebecca

    I think he’s the only one actually in that universe. So at least it wouldn’t matter. He’s complaining to himself.

  • michael anthony

    If one was in the hospital and had a hemoglobin come back at 6.0, they’d be hooked up to a transfusion within a few hours. And he’did probably get a few pints. It’s that serious. And no, rest and iron supplements aren’t going to do a thing.

  • michael anthony

    And what would they have done had he had a reaction to the blood? Even with typing and cross matching, reactions can occur and they can be deadly. It’s one reason you are pre-medicated before a transfusion, meds that the cruise line may not have in stock.

    It’s one thing to do it in a life or death situation, as the law usually looks at it as a good Samaritan act. This was not and had something gonew wrong, the liability would have been huge.

  • MarieTD

    I had a long career as a trauma nurse. I disagree that infusing blood is just like putting in an IV line. We had to watch closely for any sign of an adverse reaction and then follow emergency procedures to protect the patient. Transfusing blood is a lot more risky than a simple IV. I wouldn’t want a basic med unit to carry that out under all but the most emergent of circumstances.

  • jah6

    I am a retired ICU nurse. No way! Who on a cruise line would have been qualified to type blood and perform a blood transfusion? One task needs a qualified Lab Tech and the other an RN. They are not a Medical Center. This man is out of touch with reality.

  • cscasi

    i wonder just where NCL would have gotten the blood, already typed and screened when it was at sea? I am sure they do not carry whole blood on board as a normal course of business. Also, when it put Mr. Goldstein ashore at ST Kitts, the hospital there said it would take two days for the blood to arrive.

  • cscasi

    ??

  • disqus_00YDCZxqDV

    He wanted an on board blood transfusion? Now I really have heard everything !

  • Bob Curtis

    I am a doctor. This OP is an idiot.

  • gpx21dlr

    Sorry, Andy, you expected too much from a cruise ship medical facility. Only a hospital could provide what you wrongly expect from medical personnel on a tourist ship. I voted a HUGE NO.

  • sirwired

    Where would NCL have gotten the blood? It’s dangerous to get it from passengers without full testing (and the ship would not have a centrifuge to separate it), it would have cost a fortune to have some air-couriered in from the US, and still wouldn’t address the WHY he was dangerously anemic.

    In a life or death trauma emergency, yes, you can wing it, but no doctor would do that if there were any other choice.

  • PsyGuy

    Not from passengers, the same blood bank or resource the hospital was going to use to get the blood. The actual procedure for the infusion once you have the blood is just putting in an IV line, which the ship’s medical facility could easily do.

  • PsyGuy

    The same place or resource the hospital was going to use to get the blood. Probably the Red Cross or another type of organization.

  • PsyGuy

    True you have a higher risk of rejection and of an adverse reaction, but the procedure is still putting in an IV line, and monitoring the patient.

  • PsyGuy

    They would have treated the patient. There can be a bad reaction, but you’d get the same reaction in a hospital and the treatment is the same. You’d stop infusing, and treat for anaphylaxis (most common reaction). This isnt brain surgery. They were transfusing whole blood first in 1665 and have been since.

  • Byron Cooper

    A hemoglobin of 6 is less than half of normal. The OP needed a work up for the cause of anemia in addition to a transfusion. No physician would have agreed to do this on a cruise ship. We don’t know pertinent details including cardiac or pulmonary status that informed the cruise ship doctor. We also do not know the OP’s vital signs. If the passenger did not trust the advice from the cruise ship, he could have called his regular physician in the US for advice.

  • PsyGuy

    His alternative universe self would say he was wrong too. The LW isn’t right in ANY universe.

  • AgentSteve

    OK, so when I read this, I noticed that 1,200 votes were for NO and 23 votes were for YES. Question: what in the world do those 23 voters know, that the rest of us don’t know? NCL did the right thing and bear absolutely NO responsibility to the passenger. As a travel agent, I make sure clients understand the perils of declining insurance and I make them document their refusal. Further, the ship’s medical staff and facility is limited. If a traveler feels that they need to be close to a hospital, then I strongly suggest they forget about traveling on a cruise ship. The OP needs to go back and read the gazillion pages of passenger agreement/contract that he signed. The ship’s doctor, in coordination with the ship’s captain, have total discretion; end of conversation!

  • sirwired

    There’s also the matter of whatever it was that caused his red count to crash; which the ship is not equipped to diagnose or treat. Even if he had immediately obtained a transfusion on-shore, I doubt the ship would have let him re-board.

    And if they had done an on-board transfusion, they would not be equipped to treat any complications.

  • Fishplate

    But it takes two days to get the blood, if the hospital isn’t moving. Probably longer if it has to chase the ship.

  • Lindabator

    duh – Joseph is

  • Tigger57

    I wonder who the 25 people are that voted yes on this one! Why people think that cruise lines should be able to offer medical services such as blood transfusion is beyond me. We have several great hospitals in our area but often times it is the best decision to have patients life flighted to Boston. Mr. Goldstein made the best decision in my opinion. If he didn’t like the hospital in St Kitts – fly home.

  • PsyGuy

    Was going to take two days anyway no matter where you are. If this had happened at sea, they would have ordered blood by air courier to be dropped off. I bet the ship and its parent corporation has better access to blood than this hospital did.

  • PsyGuy

    Maybe depends on the complications, the majority of them would be anaphylaxis, which is easily treatable.

  • sirwired

    Again, you are ignoring whatever caused his count to crash.

    And “depends on the complications”? And if the complication WASN’T anaphalaxis? Then what?

    This is something that could be done in an emergency, but not if there was any other choice, which there was.

  • DChamp56

    I will be a smart traveler and purchase trip insurance
    Repeat 100 times.

  • PsyGuy

    No idea why his count crashed.

  • sirwired

    And there’s no indication the Dr. on the ship knew either, which is why treatment ashore (or, better yet, home) was the best option.

  • PsyGuy

    I’m not disagreeing with you, i wouldn’t want that PAX on my ship either. What I am saying is that IF the issue regardless of what it is entirely within the realm of treatment vie transfusion, then once one has appropriate screened and typed blood, the procedure of infusing it is no more than that of putting in an IV and monitoring the patient.

  • finance_tony

    duh – not the way it was written

    “As a psychologist, you’re crazy.” :)

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