Medical negligence at sea: can the cruise line be held liable?

Franza v. Royal Caribbean Cruises, Ltd., No. 13-13067 (11th Cir. Nov. 10, 2014).

An elderly man fell and injured his head while on a cruise. The nurse and doctor on the cruise ship delayed treatment until the man was beyond saving, and he died a week after his fall. The man’s estate sued the Royal Caribbean, the cruise company, for medical negligence. The estate’s complaint asserted that Royal Caribbean was liable for the negligence of the nurse and doctor, who, the complaint alleged, were either employees of the cruise line (the cruise line’s “actual agents”) or were held out by the cruise line as employees (“apparent agents”). The district court dismissed the claim, ruling that federal maritime time did not make Royal Caribbean legally responsible for the actions of the nurse or doctor. 

So the question here is whether, under federal maritime law, Royal Caribbean may be held liable for the medical negligence of its actual or apparent agents. Congress has not legislated on this issue, the Eleventh Circuit observes, so the field is open for the federal courts to pronounce on it. 

The Eleventh Circuit begins by noting that maritime law has generally accepted respondeat superior, the rule that principals answer for the torts of their agents. But a few circuit courts—most notably the Fifth Circuit in a 1988 decision called Barbetta—have declined to apply respondeat superior to medical negligence.

The Eleventh Circuit declines to follow those other courts. It rejects the notion that doctors are off-limits from respondeat superior. Sure, doctors exercise independent judgment, but that doesn’t mean that doctors’ bosses can’t “powerfully influence the medical judgment and conduct of their employees” through hiring or training policies, policies and guidelines, peer review, discipline, and so on. Nor (the Eleventh Circuit continues) is a patient rather than the employer somehow responsible for the medical treatment—particularly since, on a cruise, the patient has nowhere else to go. The court also says that Royal Caribbean can’t shield itself from liability merely by pointing out that a ship isn’t a hospital. That may be true, the court admits, but providing medical care for patients is a part of a cruise line’s business, and a respondeat superior applies to all parts of a business. (I would add that if medical care weren’t a part of a cruise line’s business, cruise lines would probably see a lot fewer elderly people buying tickets.) 

So the Eleventh Circuit rules that cruise lines can be liable for the medical negligence of their agents. And, because the deceased man’s estate adequately alleged medical negligence and an principal-agent relationship between Royal Caribbean and the doctor and nurse, the district court’s dismissal must be reversed. The claims may proceed to discovery.