I only needed a blood transfusion! Why did my cruise leave me behind?

He needed a blood transfusion so NCL left him behind in St. Kitts.

During his recent NCL cruise, Andrew Goldstein suffered a sudden medical emergency that required a blood transfusion. Unable to provide such a service onboard, the cruise left him behind in St. Kitts to seek treatment. Now he wants a refund for his missed cruise and reimbursement for his additional travel and medical expenses. But is this reasonable?

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

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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. The medical staff advised him that he needed to have 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, the staff did a lot more without my consent.”

“I needed a blood transfusion”

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

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

The next morning, an NCL crew member escorted him 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. Then he took a taxi back to the ship.

At that time, the ship’s medical team informed Goldstein that he could not complete his cruise. Neither the local hospital nor the medical personnel on the ship would clear him for further travel.

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

Goldstein believes that NCL improperly denied him reboarding. Since that time,  he has been attempting to receive reimbursement from the cruise line for all of his expenses.

Could NCL have provided a blood transfusion?

When I read Goldstein’s complaint, his lofty expectation of how the medical center on The Breakaway should have handled his self-described “serious medical condition” surprised me. He told me:

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 a consumer advocate, I’m always ready to go to bat for a consumer (For example: This is how a consultant’s mistake made them miss their cruise). But in this situation, I could not. Expecting the NCL 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 wasn’t reasonable.

Goldstein’s complaint letters 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 our publisher Christopher Elliott points out in his article on the topic, this type of aggressive strategy rarely ends in a consumer victory. And it wasn’t successful for Goldstein either.

If Goldstein had purchased a good travel insurance policy, it could have covered all of his expenses, including his missed cruise and his evacuation from St. Kitts. The travel insurance company could have made all of his return travel arrangements for him — alleviating much of his anxiety.

But Goldstein did not purchase any travel insurance for this trip.

NCL’s response

In its response letter to Goldstein, NCL explained 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.

I reviewed the terms and conditions that NCL is referencing. In the section entitled “Refusal of Passage” I 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.

Unhappy with our advocacy team’s position, Goldstein took his plight to Elliott Advocacy’s help forums. He 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.

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 real medical emergency.

Norwegian Cruise Line’s final word

NCL pointed out to Goldstein:

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.

Our advocacy team receives many letters from consumers who want to 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.

Hopefully, his story will serve as a reminder to future travelers. Even if you think you are healthy and strong, you may want to consider travel insurance. A good policy will protect you against life’s unanticipated calamities. And that’s exactly what it’s designed to do.

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

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75 thoughts on “I only needed a blood transfusion! Why did my cruise leave me behind?

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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?

  8. 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.

  9. 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.

  10. 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?

  11. 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.

  12. 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.

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

  14. 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.

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

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

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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.

  22. 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.

  23. 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.

  24. 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.

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

  26. 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.

  27. 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.

  28. 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.

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

  30. 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!

  31. 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.

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

  33. 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.

  34. 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.

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

  36. 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.

  37. 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.

  38. 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.

  39. If you have travel insurance and are in an inadequate facility your travel insurance will make arrangements to move you to an adequate facility.
    You don’t decide the facility is inadequate because it is filled with non-English speaking people or you don’t like the food or there is no tv.
    Remember to always get travel insurance, it could save your life, save you a ton of money and get you home.

  40. This is one of the more astonishing attitudes I have ever encountered. He didn’t feel well, saw the ship’s doctor, refused the advice, went back the next day, didn’t like the local medical facilities, tried to sneak back on the ship … and now maintains that he should have been left to relax in his cabin??? Is he totally oblivious to the fact that cruise ships tend to resist having dead bodies in their cabins? You can’t make this stuff up, Michelle!

  41. Wow… Just, wow…. And if he had worsened, then he would be suing NCL for letting him back on board.

    One additional option for those who haven’t purchased travel insurance is your credit card may provide some relief in these circumstances with some of their travel emergency benefits.

  42. I think he was expecting to find a willing donor among the passengers and crew. Quite presumptuous, in addition to being naive about the risks involved.

  43. Having recently been through a medical problem that caused my hemoglobin count to fall to 6.2, I can attest that a shipboard clinic is no place to treat such a condition. After my Primary Care Physician saw my Hgb number, he immediately contacted a Hematologist who agreed to see me the following morning. The Hematologist ran some test and then arranged for me to received a transfusion at a nearby hospital. Until my problem was correctly diagnosed and treatment could be started, several more transfusions were required. During this time, I was very weak and couldn’t walk more than 100 feet without becoming totally out of breath or collapsing. NCL did the right thing by refusing to re-board Mr. Goldstein. He belonged in a hospital, not on a cruise ship.

  44. I am sorry but if NCL denied him boarding for ANY reason they owe a refund IMHO. They took money for something they didn’t provide.

    Quit winning about “should have bought travel insurance.” Yiu give the impression that you own a lot of travel insurance stock. Other times when the person actually has the insurance you point out how none of the situations cover the reasons. You should advocate for your readers. Most of the time what you do is advocate for the industries.

    As for the other issues, it seems he should have been denied reboarding as the medical issue not likely couldn’t have been handled on board the ship. As far as the travel home, that would have been on the passenger. However, NCL owes reimbursement for the services not delivered due to THEIR refusal to allow boarding.

  45. While I think NCL did the correct thing and I do think he was wrong for not buying the insurance, I am wondering about a clause noted in the article.

    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.

    As far as the article denoted, he seems to have left the ship voluntarily to seek help at the hospital. If he did not pack his bags and disembark, would he have been entitled to a refund?

  46. Why are we seeing something that was answered nine months ago? I thought Chris and company have been overwhelmed with requests for help.

  47. Because not every reader catches every story the first time around, we do re-share popular articles from time to time. To avoid any confusion, these will always be identified above the title with the tag “Encore Presentation.” :)

  48. That’s not exactly what I was asking. If he did not disembark (pack his bags and go) to go to the hospital, if he came back to the boat and was denied entry, would he get a refund. At this point, they are denying him re-entry on to the ship. The ship’s doc had not declared him unfit to travel, they advised him to just to seek medical help off ship. If he would have returned and said the hospital gave him a clean bill of health and they denied him passage, would he get a refund?

  49. For all those making recommendations on Iron supplements, it is not so easy as it sounds, especially with blood issues. There is such a condition as overdosing that can complicate and frustrate emergency efforts! Iron is something that must be taken in moderation which is why I take a Multivitamin without Iron so I can add it in the doses I need, even when my jock side wants to double up with the multivitamin!

  50. Why cant all cruise lines do blood transfusions?? & other routine Medical care beyond sunburns, rashes & botes ALL cruise ships,NO exceptions esp RCCL Mega ships

  51. they are within their rights to not allow somone checked into a hospital who decides to check himself out against medical advice onboard — it is a medical reason

  52. Again, I am not questioning that and in fact I agree with the medical personnel to deny him passage. What I am asking is, according to the story, the onboard medical people told him to consult a hospital on shore. From this second hand account, they did not mention he was kicked off the ship because of the onboard medical assessment. If he went to the hospital and the doctors there gave him the transfusion and said it was ok for him to go back on his cruise and the boat denied him boarding based on the ship’s medical evaluation and not the hospital’s, should he have been given a partial refund?

    Note that I am not talking about his actual actions. I am asking about a hypothetical case where the hospital and the ship’s doctor disagree.

  53. Cruise ship sick bay can do a fair bit, BUT they are not full hospitals with labs, full pharmacies, surgical theatres, specialists etc. If you remember the show MASH, it’s more like Battalion Aid, get them patched up and sent to the MASH unit for surgery and other treatment. Given the choice between treating an unstable patient (medical sense, not mental sense) on board or evac-ing them to a land based hospital with all the equipment, they will send you to the land hospital, this is basic medical ethics.

    Here is the analogy I would use. Let’s say you walked into your family physician’s office with the classic symptoms of an active stroke. Would she do all the treatments herself in the clinic, or call the ambulance and get you to the hospital for treatment (while doing what she can until the EMTs arrive)?

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