Ingangsdatum: 08-01-2005
General
This regulation serves to implement the recent changes in
the Ships Manning Order for merchant ships and sailing vessels and the Ships
Manning Order for fishing vessels and is an elaboration of the completely
integrated medical examination for seafarers, as already detailed in both
orders. The changes with respect to the decree "Medical examinations for
seafarers 2002" are explained below.
The experiment in
which a number of examining physicians performed the six-yearly examination
of the eyes and ears for was successfully completed. No notable problems
were reported with regard to general physicians' carrying out these
examinations, providing that they had the necessary equipment and were
sufficiently competent. In case of doubt or if indicated in the directions
and standards, an additional examination by a specialist must be carried
out.
The integration of the three medical certificates
into a single document increases the efficiency. In addition to this, the
period of validity has been adjusted, and has now been set at a maximum of
two years, instead of the period of one year adopted up to now. This is in
accordance with the international regulations from ILO Convention no. 73,
concerning the medical examination of seafarers.1 international regulations
of the International Labour Organisation (ILO) of the United Nations. Up
until now, the specific function of the seafarer was always stated on the
medical certificate. This gave the impression that there were also many
different function-specific medical requirements: an officer could not be
declared fit for the position of captain and vice versa. In order to remove
this apparent precision, the duty category for which a declaration of
fitness has been issued will be stated from now on.
The
Decree "Medical examinations for seafarers 2002"was already geared to this
and no adjustment was needed with respect to the medical standards.
The Examination Form for the anamnesis and physical
examination was previously made available to examining physicians on a
voluntary basis. Their use has now become compulsory. The underlying
intention is to realise a greater uniformity in the medical examination
whilst at the same time standardising the recording of the data. If further
tests are necessary, data can easily be exchanged.
The
examination results have always been recorded by the examining physician in
the register designated for this purpose. An electronic register is now
available as well, and the Medical Adviser of the Netherlands Shipping
Inspectorate will soon make the use of this compulsory by enforcing article
10 of the Decree "Medical examinations of seafarers 2005". This will prevent
delays due to the manual transfer of the examinations in the database. The
phenomenon of "doctor shopping" can be detected at an early stage and
eventually it will be possible to analyse trends in the numbers and types of
rejections.
The examination card has been a valuable
instrument for detecting doctor shopping, but places an extra administrative
burden on the examining physician. With the introduction of the compulsory
use of the electronic register, this card will become obsolete. The Medical
Adviser of the Netherlands Shipping Inspectorate will receive a warning as
soon as the database detects a declaration of fitness following a previous
rejection.
With the present medical standards, Table
B-I/9-2 of Code B (Guidance on assessment of minimum entrylevel and
in-service physical abilities for maritime personnel) has also been
implemented. This Code is part of the International Convention on Standards
of Training, Certification and Watchkeeping for Seafarers that was amended
in London on 7 July 1995 (Trb. 1996, 249).
Administrative burdens
This regulation is part of a project aimed at considerably
reducing the administrative burdens involved in the medical examination of
seafarers.
The reduction is quantified and further
explained in the explanatory notes of the Decree of 13 December 2004
(Bulletin of Acts and Decrees 2004, 711), concerning amendments to the Ships
Manning Order for merchant ships and sailing vessels [Besluit
zeevaartbemanning handelsvaart en zeilvaart] as well as the Ships Manning
Order for fishing vessels [Besluit zeevisvaartbemannin]) (revision of the
system of medical certificates for seafarers and several other amendments).
Medical examination procedure
The periodic examinations will be carried out by
physicians, who in accordance with article 40, subsection 1, of the Ships
Manning Act [Zeevaartbemanningswet] (hereafter referred to as: the act) have
been appointed for this purpose by the Minister of Transport, Public Works
and Water Management.
Prior to the actual examination, the
person who subjects himself to the - legally required - examination hands
over a number of documents which will be checked by the examining physician.
The fitness examination will then take place, including a complete
examination of the eyes and ears. In the case of doubt or if required in the
medical standards, the examining physician will request information from the
attending physician or will refer the candidate for an additional
examination. The examination can be completed once the respective reports
have been received.
Article 1
The World Health Organisation (WHO) periodically publishes
information about the prevalence of tuberculosis. The basic premise of the
current regulation is that countries where the prevalence of tuberculosis is
higher than 50 cases per 100,000 residents should be viewed as risk areas.
The risk of infection here is greater than that for the Dutch population in
general.
Article 2
Prior to the medical examination, the examining physician
should verify the identity of the candidate and establish whether the
additional tests have been performed.
Article 3
The examining physician carries out the examination on the
basis of the examination directions and medical standards, and records and
enters the data in accordance with the Examination Form. The medical
examination data are archived and retained for the applicable periods. The
medical examination should be completed in full before a judgement is made.
Article 4
If the examining physician does not have sufficient
information to reach his judgement then he can, with the candidate's
consent, request information from the attending physician. Should this
information not be available or transpire to be insufficient, the examining
physician will refer the candidate for an additional examination by a
specialist. This will also happen if the regulation specifically requires
this. For the examination, the examining physician can refer the candidate
to a specialist of choice. When all of the information is available, the
medical examination can be completed.
Article 5
After the seafarer is declared fit, he receives the
Seafarers' Medical Certificate.
Article 6
If the examining physician is of the opinion that the
candidate cannot be declared fit, he gives the candidate a so-called Notice
of Rejection. The examining physician is expected to state the reasons for
rejection and to draw the candidate's attention to his right to a
re-examination. The Notice of Rejection states how the candidate can request
a re-examination.
Article 7
After a period of temporary unfitness, a candidate can be
re-examined by the same examining physician who rejected him. If the
examining physician is of the opinion that the original objections are no
longer present, the candidate will be declared fit. The re-examination will
be performed by the referee if the candidate does not want to be re-examined
by the first physician or in the case of permanent unfitness.
Article 43, subsection 1, of the act states that a
declaration of fitness issued by a physician other than one of the approved
physicians, is not valid.
Article
8
The refereer follows the same procedures and standards,
with the understanding that elements for which the candidate has already
been declared fit, do not need to be repeated. Furthermore, for a
reexamination it is not always necessary to perform a physical examination
on the candidate. The assessment of medical data can be sufficient to allow
the referee to reach a result.
The re-examination by the
referee is organised along the same lines as the first examination. A
general referee takes the advice from additional examinations by specialists
and then decides whether to declare fit, reject or issue a dispensation.
In cases concerning the vision and hearing, advice will be
requested from a professor in ophthalmology or otolaryngology.
Article 9
The decree of 2002 already offered the possibility of
exemption or dispensation from this examination for crew members on sea
fishing vessels with sailing area II, crew on sailing ships with sailing
area IIIa and crew on seagoing vessels travelling near the coast from a
named Dutch working harbour. For this, copies of the certificate of
seaworthiness, accompanied by the employment contract or the partnership
contract, a declaration from the Vereniging Beroepschartervaart BBZ or a
declaration from the Head of the Netherlands Shipping Inspectorate had to be
submitted to the examining physician.
Allowing seafarers
who do not stay in a risk area to choose whether or not they want to undergo
a test for tuberculosis, with the consequence that -if they decide not to-
the permitted sailing area will be geographically limited, has led to a
number of administrative duties being scrapped.
Article 10
After a transition period the examining physicians will
supply the examination results electronically. This will enable "Doctor
shopping" to be monitored efficiently and as a consequence of this the
examination card will be withdrawn.
Article 11
With the new regulation the quantity of forms has been
more than halved. Examining physicians should make use of the models of the
Seafarers' Medical Certificate, the Notice of Rejection and the Examination
Form supplied by the Medical Adviser (of the Netherlands Shipping
Inspectorate in order to prevent fraud and abuse.
The
Seafarers' Medical Certificate is presently available on paper with a
watermark.
Annex II Medical
standards
In general, small modifications have improved the text of
the medical standards. Sections for which an explanation was frequently
requested from the Medical Adviser of the Netherlands Shipping Inspectorate
have been explained in greater detail. The examining physicians have been
given greater responsibilities, as a result of which the time-consuming
re-examinations for seafarers can be limited. Where possible, the
requirements have been adjusted to take into account new medical
developments and changed insights.
General physical condition and physical skills
Up until now the general physical requirements were
overlooked, due to the focus on detecting diseases and conditions. Yet these
also form an essential part of being able to function safely onboard ship.
This issue was tackled by a workgroup in 2000, and
following their deliberations a supplement to the STCW Code was published:
Chapter B-I-9 with Table B-I/9-2. Being able to negotiate stairs without any
problems and the ability to move around on a swaying ship are important in
terms of safety, as is the physical ability to be able to stand and walk
during a full watch. The regulation about being able to move through an
opening of 60x60 cm relates to the requirement with respect to obesity,
which has been effective since 1 July 2000.
Element VIII.2 Conditions of the nervous system
Epilepsy has long been a reason for rejection. For the
re-examination by a referee an internal policy has developed over the years
for making exceptions based on an individual consideration of the risks.
Discussions with experts and literature research has made
it possible to realise a differentiation in this as well. The conditions
under which the general medical examiner can issue a declaration of fitness
are specified.
Element XIII.3
Cardiovascular complaints
Wearing a pacemaker has also long been a reason for
rejection. Modern developments have opened up the possibility of introducing
a distinction with respect to these medical devices. If the candidate wears
a pacemaker which cannot be deregulated by electromagnetic radiation and if
the condition is satisfied that a life-threatening situation does not
immediately arise should the pacemaker fail, a declaration of fitness can be
issued by the general medical examiner.
Element XXIII Eye and vision
The requirements for visual acuity had already been
adjusted in line with the international guidelines of the ILO and WHO. The
use of these has led to few problems.
The inability to
distinguish colours remains a reason for rejection in about 8-10% of cases,
which is in line with the expected prevalence of colour blindness amongst
men in general. Under the present criteria a mild form of colour blindness
can be accepted. However with the tests currently used, the problem remains
that seafarers do not see the relationship between the coloured numbers in
the textbooks and, for example, the red and green lights which they must be
able to observe at sea. They therefore experience difficulties in accepting
the rejection. Yet at present no better test methods can be recommended.
The number of seafarers that undergo refraction correction
is increasing. Also students at nautical college are increasingly deciding
to undergo the operation in order to make it possible to start a career at
sea. This operation does not form a reason for rejection, as long as all of
the criteria for visual acuity are satisfied and there are no negative side
effects.
Element XXIV Ear and
hearing
There are no changes with respect to the Decree "Medical
examinations of seafarers 2002".