Friday, January 31, 2014

BEASTIE'S PICKS OF THE WEEK

http://www.youtube.com/watch?v=QavxSkTITN4

THE BEAST IS BACK!




"Beastie"our large mouth fishing video editor and critic is back having been offline since January 12th due to the space allocations needed to carry all of the news about the China Seas, Russian activity in the High Arctic, and breaking events in the western Mediterranean. Beastie's pick for the week this week is a single video which actually contains a number of short videos from the TV show America's Funniest Home Videos. Click here to watch on YouTube: Beastie's Pick

WHY ITALY HAS A STRONGER NAVAL PRESENCE THAN USUAL FOR HER SIZE

THE ITALIAN NAVY RESCUES 175 ILLEGAL IMMIGRANTS

File:Cavour (550).jpg
The Italian Navy Aircraft Carrier CAVOUR  Photo by Gaetano56 Wikipedia Commons
On Friday January 31, 2014 the MENA news service of Italy reported that the Italian Navy rescued 175 Egyptian economic refugees , including 6 children from a floundering vessel on Thursday January 30, 2014. The Egyptian "passengers" had paid to be smuggled into Italy to seek work. They feel into the hands of human traffickers and probably would have died at sea but for the rescue and interdiction efforts of the Italian Navy. The 15 crew members aboard the boat were arrested. The illegal immigrants received medical attention and their status will be adjudicated in accordance with Italian immigration law. Most of the economic refugees will probably be returned to Egypt.

Hundred of illegal immigrants attempt to cross over to Italy from parts of North Africa every year. This is just the tip of the ice burg of problems that will beset Italy if North Africa and the Middle East become littered with permanently failed states. Southern Europe can't be the lifeboat for the region. Those nations that don't want to swamped must maintain serious naval forces including coast guards. The Italian navy at 62 ships, 82 aircraft, and over 35,000 personnel is about the size of the U.S. Coast Guard but is equipped with an aircraft carrier, and other highly capable combattant vessels. The Italian coast guard titled the "Corps of the Port Captaincies" has another 11,000 uniformed personnel operating 6 large patrol vessels, 9 smaller patrol vessels, 272  6 to 50 ton motor boats, and  212 RIB type fast response boats, and 22 aircraft.


File:CP-902-Aug2008.jpg
Photo courtesy  A. DeligiannisCopyright © 2008
     Italian coast guard cutter and aircraft, everything is up to date and well kept in the Italian navy and coast guard
File:Piaggio P.166 DL 3 Italian Coast Guard.JPG
Photo courtesy "Roberto" via Wikipedia Commons learn more about Roberto at http://commons.wikimedia.org/wiki/User:SCDBob

 Italy has opted to bite the bullet given their situation and maintain first class naval forces a bit out of proportion to her national size and economy. The legislators and people of Italy have weighed their situation and decided that such forces are a good investment. They have held on to that investment against all sorts of recurrent economic pressures to invest the funds elsewhere. Many nations in the region benefit from Italy's investment but few seem willing to match it even when they are not under a formal Italian defensive umbrella agreement. The United States also benefits especially in terms of our mostly notional 6th Fleet.  Italy has put forth the effort and if she ever has to call on NATO for back up she has earned a right to such back up. Italy is carrying her naval weight. We wish we could say the same for everybody.

BLOW BY BLOW ACCOUNT OF FIGHTING A TAR BABY



WHEN FIGHTING TAR-BABIES BE PREPARED TO EMBRACE THE SUCTION .

What follows is a series of e-mails between NMA Mariner 3001 , the U.S. Coast Guard's National Maritime Center, and various medical personnel that our hapless NMA stand in for Brer Rabbit has to deal with to extract the renewal of his occupational credentials from the sticky clutches of the USCG which in this exchange looks very much like Uncle Sam's Confused Group
 Brer Rabbit and the Tar-Baby Illustration by AB Frost 1895 (PD-Old-100)

Editor's note: Below is NMA Mariner No.3001 's reproduction of a string of E-mails that will give the reader a clear understanding of why we characterize dealing with the U.S. Coast Guard's NMC as "fighting a tar-baby". We have redacted names of individuals and the relevant health insurance company and medical personnel involved. If you encountering this series of posts for the first time this is part 2. Click here for Part 1


START E-MAIL SECTION

This section is a collection of the e-mails that I have on file between the Coast Guard NMC, my cardiologist and myself concerning the NMC's demand for further medical information. In between each letter I have added descriptive comments and the cause and effect of that letter. At the end of this document I share my own personal findings via on line research concerning the NMC and my interpretation of those findings that have been shaped by my own experience with the NMC backed by excerpts from online articles.

I went to our union contracted  local clinic that performs our annual union physicals and bi-annual USCG drug screening to have the required document renewal original Coast Guard physical that everyone must take completed. The doctors at this clinic requested clarifying information concerning my cardiac condition and my  cardiologist Dr REDACTED sent me a letter to give them. Here is that correspondence, 
===========================================================================================================================================================
[LETTER START]

From: NMA Mariner 3001 
To: Name Redacted -Medical Doctor providing documentation of past services and medical assessments
Date: 10/29/2013 09:05 PM 
Subject: Need Clarification of current medical status ASAP 

--------------------------------------------------------------------------------

Hello Dr. NAME REDACTED

 I am preparing for a Coast Guard Physical to renew my Merchant Seaman's Documents

In June of 2012 I had two stents placed in my heart and you were assigned to me as an after care physician. At the time of my discharge from  (Name of Hospital Redacted) I was given a 1 year prescription of Plavix and told after the prescription ran out to take one low dose aspirin per day. My discharge papers from Sunset claim that I did not have a heart attack. It claims that I was suffering from angina.

 I would like confirmation of my current status and if I am still required to take the Plavix or am I actually finished with that requirement and to also confirm did I or did I not have an actual heart attack.

 Your assistance in this matter would be greatly appreciated.

Respectfully,

NMA Mariner 3001
 ========================================================================================
Re: Need Clarification of current medical status ASAP‏
DR.XXXX


3:24 PM 

To: NMA Mariner 3001

hello 

you did not have a heart attack 

plavix is used only for 1 year with Drug eluting stents as you had 

aspirin 81 mg life long 


hope this helps 

thanks 



Name of Physician Redcted, M.D., F.A.C.C.
Chief of Cardiology
HOSPITAL IDENTITY REDACTEDr
Address of hospital Redacted

[LETTER END]
===========================================================================================================================================================
 I included a copy of this letter from my cardiologist to the clinic with my Coast Guard application to be mailed in with the MMD renewal packet. Although that letter satisfied the doctors at the clinic it did not satisfy the Coast Guards NMC medical examining staff. I was sent a letter by the NMC requesting further medical information. 
================================================================================================================================================
[LETTER START]




To: NMA Mariner 3001 E-mil address Redacted 

Please do not reply to this e-mail address. This is an unmonitored e-mail account.

Important information concerning your credential "MMC, Reference Number: XXXX and Application ID: XXXXX from the National Maritime Center.

Additional information is required to complete your medical evaluation. A letter detailing the information requested was mailed on 19-Nov-2013 from the National Maritime Center to your address of record. Please review this letter carefully, it contains all of the information you should need to allow us to continue the application process. If after reviewing the letter you still have questions, contact the NMC at E-mail address Redacted.

Please Note: You have 90 days from the date of your official letter from the Coast Guard to submit the required information.


Sincerely,

National Maritime Center

================================================================================================================================================
The NMC will not e-mail these request letters to you. I have signed waivers in the past permitting medical information to be transferred electronically from point to point.  Why doesn't the NMC offer this waiver option as part of the actual renewal package that we are given at the local USCG REC's instead of adding weeks to the process by using land mail?  This detailed letter they sent was hardly detailed. It was a bunch of mumbo jumbo that my cardiologist could make no sense out of and a government guide line ID number that nobody outside of the NMC had ever heard of. As soon as the letter finally arrived I contacted my cardiologist and sent him a copy of the original NMC request for more information.
===========================================================================================================================================================
 [LETTER START]
 Hello Dr. Name Redacted
My (Health Insurance-carrier's name redacted)   card # is, 00-00xxxxxxxxx
I am sorry to bother you again but I am afraid I have no choice in the matter. I am again being required to provide extra medical information this time for the Coast Guard examiners themselves. Your last clarification letter to me got me through the initial physical process to actually submit the paper work to the Coast Guard but now the problem is the Coast Guard itself. I did include a copy of the clarification letter you sent me to the Coast Guard examining center along with all their other required Coast Guard forms confirming I did not have a heart attack and that I am only required to take a daily low dose aspirin. 

Below is what the Coast Guard sent me,

=============================================================================================================================================================

  
LIST OF ITEMS REQUIRED TO COMPLETE THE EVALUATION PROCESS
November 19,2013
• Amplifying Information from Physician -
Please take this letter to your treating provider's) to assist you with submission of the required
medical informationFeel freto havyour provider contact us with anquestionpertaining to
thiletter. It should bnotedall information requested should be within the pastwelv(12)
monthunless otherwise noted. Please understandit ithe applicant's responsibilitto submit all
information requestedIn order to confirm all the requested information is submitted, it is
recommended yosend it as one completpackage. Be advisedfollowing comprehensive
medical evaluation, additional information mabe requested .
• Amplifying InformatiofroPhysician -
Due to your history of angina treated with drug eluting stent in June 2012, additional information
is required. Please havyour treating provider review NVIC 04-08 guidelineregarding
recommended testing and procedures. A Medical Narrative Summarmust be submitted to
adequatelestablish the inordinatrisk posed bthis condition fosuddeincapacitation or
debilitating complication and the ability of the mariner to operate in a safety sensitive position. This
summarshould include a determination regarding the current status of the conditiontreatment
plan and prognositincludcopieof all pertinent diagnostic test results; if detailed report inot
available. The mariner's treatinprovider should alsinclude risstratification foa negativevent
or recurrence within the next twyears and document the capacitto meet thphysical ability
guidelines in enclosure (2) of NVIC 04-08. ***Please note: This is an initial screening of your
cardiacondition. If the above information inot received in its entiretand/or further clarification
is requireaftereview of thinformation submittedadditional letters requesting more
information/clarification mabe sent.
=============================================================================================================================================================
I have no idea what enclosure (2) of NVIC 04-08 actually is. I tried to look it up on line but it is in PDF format and for some reason I cannot open their PDF. It keeps crashing. Seems like crashing is something inherent in Government websites.

I realize you are busy but if there is any way this can be expedited it would be greatly appreciated. I really need to get back to work because finances are becoming a pressing issue. If for some reason I do not medically qualify for the renewal of my documents then I will need some kind of vouching letter or begin a physical procedure to prove I can no longer go to sea and qualify for medical retirement from my union. Without these Coast Guard documents I am finished in my industry.



 Respectfully,

NMA Mariner 3001
[LETTER END]
============================================================================================================================================================
I received the following reply from my doctor and I responded I would try to get a clarification from the NMC.
============================================================================================================================================================
[LETTER START]
HI

not sure what

Please have your treating provider review NVIC 04-08 guidelines regarding

recommended testing and procedures. A Medical Narrative Summary must be submitted to

the above is

I do not due yearly testing unless you are a airline pilot and for the FAA I see patients yearly and my note suffices for the FAA;

not sure as to what the coast guard wants; happy to write a letter as I did before

let me know or if you want can have my nurse set up an appt and that clinic note can be used

thanks


DR. NAME REDACTED M.D., F.A.C.C.
Chief of Cardiology
HOSPITAL IDENTITY AND ADDRESS REDACTED

[End}
=============================================================================================================================================================
I lost the actual e-mail below which is my response to Dr XXX's email above. I perhaps accidentally deleted it from my "hotmail" account. This is the original text of that e-mail I still have on file from my word processor save files
=============================================================================================================================================================

[LETTER START]
[MY RESPONSE TO DOCTOR XXXXX
I am going to e-mail these guys and get a clarification. I found the requirements and they really do not make any sense as to why I would need a cardiologist to check this stuff out. Basically it is can I perform basic physical functions with out falling over dead which is what the physical papers I just sent in to them already cover. It has stuff like can I crawl in a confined space, can I lift my feet to step over a door sill of a water tight door and can I close such a door with out assistance. Can I lift 40 lbs. all kinds of basic mundane stuff.

So let me contact these yam heads and see just what it is they really want and then I will contact you again.
[LETTER END]
================================================================================================================================================
Becoming exasperated with this process I sent the following e-mail to the NMC  in Martinsburg West Virginia
================================================================================================================================================
[LETTER START]

NMA MAriner 3001
To: NMA (E-mail address redacted)

Below is the response I got from my cardiologist when I contacted him concerning the information you requested
concerning "enclosure 2 of NVIC 04-08. Nobody really knows what it is you really want. You did not include any type of form for him to look at or fill out except a bunch of government numbers that mean nothing to anybody outside the coast guard.

Are you looking for a simple fit for duty statement or what? I myself found the requirements on line and looked at the requirements and saw nothing that is not already covered in our annual physicals which I just took a few months back and I have already sent you a copy of that annual physical card with the rest of my paper work.

Can I lift 40 pounds yes climb ladders yes run and man fire hoses yes and I have been doing all this stuff on ships even after my procedure. Is that the kind of information you are looking for? Can I walk run lift???    I have had no surgery, take no medications and have no physical limitations. Stent placement is an outpatient procedure. There is no surgery. Drug eluding simply means that I do not have to take any type of blood thinners. I am under no medications. The "drug eluding" is not a narcotic drug. It simply prevents clotting while the arterial walls grow around the stent.

Tell us what it is you actually want so my doctor can give it to you. He is ready willing and able to provide as am I but needs to know just what it is he supposed to provide. You state in the letter you sent to me that if we do not send a "package" of information you will snail mail more requests. I cannot afford to sit around for months while you snail mail vague letters to us with find it your self government numbers that nobody but you seem to really know what they are.

=============================================================================================================================================================

To: NMA Mariner 3001
Subject: RE: Need Clarification of current medical status ASAP
From: Dr. XXXX
Date: Mon, 2 Dec 2013 10:41:27 -0800

HI 

not sure what 
========================================================================
Please have your treating provider review NVIC 04-08 guidelines regarding 
recommended testing and procedures. A Medical Narrative Summary must be submitted to 
========================================================================
the above is 

I do not due yearly testing unless you are a airline pilot and for the FAA I see patients yearly and my note suffices for the FAA; 

not sure as to what the coast guard wants; happy to write a letter as I did before 

let me know or if you want can have my nurse set up an appt and that clinic note can be used 

thanks 


DR. XXXX M.D., F.A.C.C.
Chief of Cardiology
Hospital identification info redacted
[LETTER END]
=============================================================================================================================================================
After  I wrote the NMC for clarifying information I continued trying to find accurate information on NVIC 04-08. The information from various sites was conflicting. I found another non USCG Maritime site that claimed to have the NVIC information. The list of requirements included pretty much anything and everything just short of an actual autopsy report. I sent this new found information to Dr XXX.
================================================================================================================================================
[LETTER START]

NMA MARINER 3001
12/03/13 

To: DR.XXXX

I finally found some information on Coast Guard testing requirements at the below address

http://www.americanwaterways.com/sites/default/files/legacy/index/Medical_Forms.pdf 


There are 3 sections one dealing with sleep disorders, Cardiac issues and diabetes in that order. The website is PDF and the conditions are in tables by condition. I copied the cardio section from there but of course the tables were not preserved in the copying process. I tried to re organize it all back into a readable format but perhaps the site itself would be much easier to read. It is not really that long of a section by table. I am truly sorry about all this bother but I have no real choice in the matter. I have to comply with all this stuff to pay the bills.
===============================================================================================================================================


AWO has worked with the U.S. Coast Guard’s National Maritime Center (NMC) to
develop at-a-glance guides to the information that must be submitted when a mariner has
one of several common medical conditions that frequently cause delays in the NMC’s
Merchant Mariner Credential (MMC) application process. The NMC has identified
cardiac difficulties; diabetes; psychiatric disorders; and, sleep disorders as the conditions
most likely to cause delays for mariners. During 2009, AWO worked with the NMC to
develop the new documents in order to help mariners and their physicians to provide the
NMC with the required information as soon as possible. The documents are intended to
assist this process, but are not substitutes for the guidance found in the Navigation and
Vessel Inspection Circular 04-08, or in federal regulations

Heart Condition Patient Summary Checklist


(Includes Hypertension)
(To be filled out by Mariner)
Mariner Name: _________________________________________________
Social Security Number (last 4 digits): ______________________
Mariner Identification Number: ____________________________
Type of Credential Seeking to Obtain: _______________________________
Note: Undergoing a heart transplant or having anti-tachycardia devices or
implantable defibrillators are generally not waiverable conditions. Contact the
National Maritime Center for further guidance on these conditions.
------------------------------------------------------------------------------------------------------------
(To be provided by the mariner and filled out by the Examining Physician)


Dear Doctor:
Your patient is applying for issuance or renewal of a U.S. Coast Guard Merchant Mariner
Credential. He/she will be reviewed using guidance from Coast Guard Navigation and
Vessel Inspection Circular (NVIC) 04-08, available at
http://www.americanwaterways.com/index/NVIC-04a.pdf. To help avoid delays, we
seek your help in gathering information from the tests/procedures on subsequent pages.
A heart condition prompts a series of questions that usually can only be answered by the
treating physician. In order for you to get a better sense of the duties that your patient
engages in, please take a few moments to ask him/her what his/her job entails. Please
provide the results from the tests or procedures you performed as an attachment to this
packet. After submission of this document, it is possible that more information on the
mariner’s medical status will be requested of you. Your time is greatly appreciated.

Hypertension,
systolic BP > 160 or diastolic BP > 100, with or without medication. Primary care evaluation confirming greater than 160/100, and
documented treatment plan indicating all medications used to treat the hypertension. ECG, serum chemistries, lipid profile, and UA should be
included if clinically indicated.
Note: An initial reading exceeding 160/100 should be confirmed by three blood pressure readings separated by at least 24 hours each.
Acceptable treatment of applicants includes all Food and Drug Administration-approved diuretics, alpha-adrenergic blocking agents,
beta-adrenergic blocking agents, calcium channel blocking agents, angiotension converting enzyme (ACE inhibitors) agents, and direct
vasodilators. Centrally acting agents (e.g. reserpine, guanethidine, guanadrel, guanabenz, and methyldopa) are usually not acceptable.


Symptomatic Bradycardia
(<50 bpm)
Exercise rhythm strip. If unable to achieve HR >100 BPM or double resting HR then cardiology evaluation to include GXT and 24-hour
Holter monitor is required. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


Left Bundle Branch Block
Cardiology consultation; evaluate underlying heart disease. PA and lateral CXR, GXT, echocardiogram, and exercise radionuclide scan are
required if clinically indicated. Note: GXT should be Bruce Protocol to at least 8 METS with a
functional cardiac stress test. Pharmacologic stress tests are not acceptable.


Acquired Right Bundle Branch
Block New onset RBB requires cardiology consultation. PA and lateral CXR, GXT, echocardiogram, and exercise radionuclide scan required, if
clinically indicated. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.


Implanted Pacemaker
Cardiology consultation to include history of the cardiac condition which prompted pacemaker insertion. GXT is required. Detailed
reports of surgical procedures as well as cerebral and coronary arteriography and other major diagnostic studies are of prime
importance; evaluation of pacemaker function to include description and documentation of underlying rate and rhythm with the pacer
disabled or at its lowest setting, programmed pacemaker parameters, surveillance record, and exclusion of myopotential inhibition and
pacemaker induced hypotension, powerpack data including beginning of life (BOL) and elective replacement indicator/end of life (ERI/EOL).
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.

Premature Atrial Contractions
If PAC frequency of occurrence is > 10 of any 50 beats, 10% of any one hour, or 1% of 24 hours of monitoring, or applicant is symptomatic
cardiology consultation, 24-hour Holter monitor, echocardiogram, and GXT are required. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.


Premature Ventricular Contractions
If PVC frequency of occurrence is > 10 of any 50 beats, 10% of any one hour, or 1% of 24 hours of monitoring, or applicant is symptomatic
cardiology consultation, 24-hour Holter monitor, echocardiogram, and GXT are required. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.


2nd Degree AV Block Mobitz I
Cardiology consultation, PA and lateral CXR, GXT, and exercise radionuclide scan.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.


2nd Degree AV Block Mobitz II
Cardiology consultation, PA and lateral CXR, GXT, and exercise radionuclide scan.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


3rd Degree AV Block
Cardiology consultation, PA and lateral CXR, GXT, and exercise radionuclide scan.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


Preexcitation Syndrome
Cardiology consultation, 24-hour Holter monitor, GXT and echocardiogram.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


History of Radio Frequency Ablation
3-month wait, then cardiology consultation, 24-hour Holter monitor, GXT and echocardiogram.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


History of Supraventricular Tachycardia (3 ormore consecutive non-ventricular ectopic beats)
Cardiology consultation, 24-hour Holter monitor, GXT, TFTs, and echocardiogram. If evidence of abnormalities exercise radionuclide
scan and cardiac catheterization are required and surgical/ablative procedure reports if performed.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


History of syncope, greater than one episode, within the last 5 years
Cardiology consultation, neurology consultation, 24-hour Holter; bilateral carotid US. History of Atrial Fibrillation within
the last 5 years Document previous workup for CAD and structural heart disease, to include cardiology consultation addressing use of anticoagulants and functional capacity, 24-hour Holter monitor, GXT and echocardiogram. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable. Chronic Atrial Fibrillation Cardiology consultation addressing use of anticoagulants and functional capacity, 24-hour Holter monitor (if clinically indicated)
GXT and echocardiogram. Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not acceptable.


Paroxysmal/Lone Atrial Fibrillation
Cardiology consultation addressing use of anticoagulants and functional capacity, 24-hour Holter monitor, GXT and echocardiogram.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


History of Angina Pectoris
Cardiology consultation, hospital admission summaries if applicable, coronary catheterization report, statement of functional capacity, blood
chemistries, including total cholesterol, HDL, LDL, and triglycerides, echocardiogram with Doppler flow study, maximal myocardial
perfusion exercise stress test (Bruce protocol to at least 8 METS) no sooner than 6-months post-event.


History of Myocardial Infarction
Cardiology consultation, hospital admission summaries if applicable, coronary catheterization report, statement of functional capacity, blood
chemistries, including total cholesterol, HDL, LDL, and triglycerides, echocardiogram with Doppler flow study, maximal myocardial
perfusion exercise stress test (Bruce protocol to at least 8 METS) no sooner than 1 month post-event.
Note: Acceptable treatment of applicants includes all Food and Drug Administration-approved diuretics, alpha-adrenergic blocking agents,
beta-adrenergic blocking agents, calcium channel blocking agents, angiotension converting enzyme (ACE inhibitors) agents, and direct
vasodilators. Centrally acting agents (e.g. reserpine, guanethidine, guanadrel, guanabenz, and methyldopa) are usually not acceptable. The
use of flecainide is unacceptable when there is evidence of left ventricular dysfunction or recent myocardial infarction.


History of Atherectomy; CABG; PTCA; Rotoblation; or stent
Cardiology consultation, hospital admission summaries if applicable, coronary catheterization report, statement of functional capacity, blood
chemistries, including total cholesterol, HDL, LDL, and triglycerides, echocardiogram with Doppler flow study, maximal myocardial
perfusion exercise stress test (Bruce protocol to at least 8 METS) no sooner than 1 month post event, 6 months for CABG.



History of Valvular Disease, nonspecified
Cardiology consultation, GXT, 2-D M-mode echocardiogram with Doppler flow study and 24-hour Holter monitor.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


Aortic and Mitral Insufficiency
Cardiology consultation, GXT, 2-D M-mode echocardiogram with Doppler flow study and 24-hour Holter monitor.
Note: GXT should be Bruce Protocol to at least 8 METS with a functional cardiac stress test. Pharmacologic stress tests are not
acceptable.


History of Valve Replacement
Cardiology consultation addressing cardiac function, evidence of embolic phenomena, arrythmias, structural abnormalities, or ischemia.
GXT, 2-D M-mode echocardiogram with Doppler flow study and 24- hour Holter, monitor INR values for 6 months prior to application,
copy of operative report.


History of Valvuloplasty
Cardiology consultation, GXT, 2-D M-mode echocardiogram with Doppler flow study, 24-hour Holter monitor, and copy of operative
report. Cardiac decompensation or cardiomyopathy Cardiology consultation, GXT, 2-D M-mode echocardiogram withDoppler flow study and 24-hour Holter monitor (if clinically
indicated).


Congenital heart disease accompanied by:
1) cardiac enlargement; 2) ECG Abnormality; 3) or, evidence of inadequate oxygenation Cardiology consultation addressing cardiac function, evidence of
embolic phenomena, arrhythmias, structural abnormalities, or ischemia. GXT, 2-D M-mode echocardiogram with Doppler flow study and 24-
hour Holter monitor (if clinically indicated).


CHF, Hypertrophy or dilatation of the heart Cardiology consultation, GXT, 2-D M-mode echocardiogram with
Doppler flow study and 24-hour Holter monitor (if clinically indicated). Pericarditis, endocarditis, or myocarditis
Cardiology consultation addressing cardiac function, GXT, 2-D Mmode echocardiogram with Doppler flow study and 24-hour Holter
monitor, and documentation of resolution or stability of the condition.

Please fill out spaces below


Treating Provider’s Printed Name:


Treating Provider’s Signature:


Treating Provider’s Address:


Treating Provider’s Phone Number:


Treating Provider’s Fax Number:
Date:

[LETTER END]
===============================================================================================================================================
Now everybody is really confused. Which is it they want? Can the person lift 40lbs or does the doctor have to extract, weigh and document every organ in the applicants body to satisfy the NMC requirements?
Here is the NMC reply to my letter asking for clarification.
===============================================================================================================================================
[LETTER START]

From: NMC related E-mail address redacted
 To: NMA Mariner No.3001
 Subject: RE: Need clarification on info required
 Date: Tue, 3 Dec 2013 18:37:17 +0000

Dear Sir,

 If the provider has questions, they are more than welcome to call the National Maritime Center and request to speak with the medical help desk. We are unable to discuss specific medical information via e-mail.

Thank you for contacting the Customer Service Center. If you have additional questions please feel free to contact us. 

Name redacted
Customer Service Center Medical Specialist II 
Advanced Government Solutions
Contractor to the United States Coast Guard 
National Maritime Center 
100 Forbes Drive 
Martinsburg, WV 25404
Ph: REDACTED
Fax: REDACTED
Email: Website: REDACTED
[LETTER END]
================================================================================================================================================
The NMC refuses to talk to me. They said they will talk to my doctor. So I sent the above information to Dr xxxx.
================================================================================================================================================
[LETTER START]
NMA Mariner 3001 12/03/13 

To: Dr. Name Redacted

Hello Dr. Name Redacted

Well, This is what the Coast Guard sent back to me when I asked for information. Nothing like trying to deal with the government.
==============================================================================================================
Dear Sir,

If the provider has questions, they are more than welcome to call the National Maritime Center and request to speak with the medical help desk. We are unable to discuss specific medical information via e-mail.

Thank you for contacting the Customer Service Center. If you have additional questions please feel free to contact us. 

Name Redacted
Customer Service Center Medical Specialist II 
Advanced Government Solutions
Contractor to the United States Coast Guard 
National Maritime Center 
ADDRESS, PHONE, E MAIL REDACtED

[LETTER END]
===============================================================================================================================================
And here I hit the proverbial brick wall. Everybody stopped communicating with me. The Coast Guard, My (Insurance co name redacted) doctor. There I am swinging in the breeze watching the bank account drop day by day. Out of options I went to our union contracted clinic hoping maybe they had some answers because they do a lot of work with seamen and Coast Guard physicals. I explained to them the the lack of cooperation I was getting from the NMC. They had never heard of NVIC 04-08 either. They made a call to (health Insurance carrier's name redacted) requesting a cardiac status letter concerning me. This was before noon and Dr XXXX would not be in until sometime after noon. The clinic staff was talking with Dr XXXX's nurse and she said she would pass along this information to him. I was told this (Insurance Co.) letter would be forwarded to the clinic. I then left the clinic and returned to my motel room.  That same day some time after noon I received a phone call from Dr XXXX's nurse stating that Dr XXXX wanted to see me at 3pm Monday which was 12/9/13. I received this call on Friday.

I went to the appointment and it was then that Dr xxxx informed me verbally that he had been trying to contact the National Maritime Center by both phone and fax but they would not return his calls. So not only have they refused to talk to me now they have refused to talk to my doctor or answer his fax also. Now we have a government organization  that is demanding information but refuses to tell the applicant or his physician just what information it is they really want.

Not only did my doctor not know what these NVIC guide lines were, I asked him what is "risk stratification"? This was part of the original request. ["The mariner's treatinprovider should alsinclude risstratification foa negativevent"]. He had no idea what they meant. It is not a common medical term. Thus it seems that the NMC demands information but will not clarify what the specific information it is they really want, Refuses to communicate with the applicant nor will they communicate with their medical provider, and use medical terminology that is unfamiliar to the providers.

It is at this point that I began to get a sense that all of this is intentionally designed to be this way by the NMC. These delays, The land mailing and week long wait for vague instructions, the refusal to communicate with the applicant or the medical provider and every other step they use to delay the process are not by accident. One or two related events maybe a coincidence. But when you have a chain of related events that all work together to produce a specific effect it is no longer a coincidence. It is a designed strategy.  And I will show actual evidence for this later in the end comments section.

I asked my doctor about the list of tests I had sent to him from the web site I had found concerning the NVIC and his reply to me verbatim was. "
Believe me you do not want to start running long lists of unnecessary tests".

 So here we both are just looking at each other with no real clue as to what the NMC is actually demanding and it has by now become obvious they have no intention of telling either myself or Dr xxxx what it is they actually want. So Dr xxxxgives me a cardio check up and writes up a simple letter and instructs me to send it to the NMC and lets see what they say. As I was leaving the clinic Dr xxxx in my presence instructed his nurse to again try to contact the Martinsburg
 NMC office in the morning and try to get some information. Due to time differences they were already closed at the time on Monday I was in the doctors office. Again no response was ever received from the NMC.

The simple letter Dr xxxx gave me is,
================================================================================================================================================

[LETTER START]
~ Medical Letter Head redacted

To whom it may concern

Mr. (NMA Mariner No.3001 underwent a coronary based intervention of his left anterior
descending artery and Circumflex artery as well in June of 2012 and with normal
Ivef function at the time.

Patient has not had any problems since the initial procedure as noted above
and is currently without any cardiac complaints.

The above patient has no active cardiac issues at this time, and is capable of
performing any physical activity from a cardiac standpoint

DR.XXXX MD FACC
Department of Cardiology
Hospital redacted

[LETTER END]

================================================================================================================================================
Following Dr XXXX's instructions I mailed this in. Eight days after mailing this I received this letter of warning from the NMC
================================================================================================================================================

[LETTER START]


E-Mail address Redacted )


To: NMA Mariner No.3001  12/20/13 E-mail address redacted


Please do not reply to this e-mail address. This is an unmonitored e-mail account.

Important information concerning your credential "MMC, Reference Number: xxxxxx and Application ID: xxxxxx from the National Maritime Center.

This is a reminder that you have outstanding information due to the National Maritime Center, Medical Evaluation Division, physical evaluation section. If the information is not received within 60 days of this email, your application will time-out and be placed on administrative hold. At that point, the application process will be suspended.

If you have any questions regarding this email, you must contact the National Maritime Center at xxxxxx      [LETTER END]
================================================================================================================================================
So now this government sponsored bully that refuses to cooperate with anyone is threatening to make me suffer for my lack of proper cooperation and for the current situation that they themselves have created. Lets victimize the victim. Now I am furious and I sent them the following letter expressing my opinion of their conduct.
================================================================================================================================================
[LETTER START]
 From
NMA MARINER NO.3001

E-Mail  Redacted
Cell# redacted

This is in response to an e mail received 12/19/13 stating  that you are still waiting for further medical information. 

I already sent this information just 1 week ago now and I have not heard anything from you regarding that information as usual. After receiving your original 11/19/13 request for more information per my Cardiologists request I have tried e-mailing you for more information as to what you actually want and you refused to talk to me. 
Here is your response.

=========================================================================================================================================
If the provider has questions, they are more than welcome to call the National Maritime Center and request to speak with the medical help desk. We are unable to discuss specific medical information via e-mail.

  Thank you for contacting the Customer Service Center. If you have additional questions please feel free to contact us. ============================================================================================================================================
 My (redacted) Cardiologist has been trying to contact you for almost a month now. He has tried to Phone and Fax you seeking clarifying information but apparently you won't talk to him either. This has become flat ridiculous the way you handle things. My Cardiologist scheduled me for an appointment for examination on 12/9/13 due to your request for more information and gave me a letter after examining me stating I am under no medical restrictions or limitations regarding my physical condition. I sent this information to this woman, (Name Redacted) at the address below via land mail. This man does the cardio exams for the FAA so if his examinations are qualified to clear pilots to fly jet liners then I think it is a pretty safe bet his examinations are professional enough to certify me to be healthy enough to plug in a 440volt  reefer container on a ship.

Your attitude has been not only do we expect you to provide the information, we also expect you to guess what information it is we actually expect you to provide. I went on line and the NVIC 0408 enclosure 2 you mention that I could actually find is non specific. It is a catch all list of just about all and any conditions that a person may encounter from hang nails to a brain transplant. And not only that, depending on what link you use the requirements are actually different from site to site referencing the very same NVIC. enclosure 2.  Apparently these sites must have been set up by other people who were forced to guess at what it is you actually want. AND even better the links on your own site do not even work. I get a hand with a spark error trying to open any information links from your own "official" website.

=========================================================================================================================================
Name Redacted
  Customer Service Center Medical Specialist II 
 Contractor's name redacted
  Contractor to the United States Coast Guard 
  National Maritime Center 
  
======================================================================================================================================

What I sent her is the original requesting additional letters from your office that were sent to me also a copy of the letter from my visit on 12/9/13 to my Cardiologist. AGAIN LET ME REPEAT!  As per your original letters instructions I mailed back copies of the the original request for information letter sent by you and a copy of my Cardiologists report concerning my examination  on REDACTED head. Here is a copy of that letter from my REDACTED Cardiologist that I sent. My scan copy is PDF so the REDACTED Letter head does not copy properly

~
 LETTER HEAD REDACTED
To whom it may concern
Mr. (NMA Mariner No.3001) underwent a coronary based intervention of his left anterior
descending artery and Circumflex artery as well in June of 2012 and with normal
Ivef function at the time.
Patient has not had any problems since the initial procedure as noted above
and is currently without any cardiac complaints.
The above patient has no active cardiac issues at this time, and is capable of
performing any physical activity from a cardiac standpoint
DR. XXXX MD FACC
Department of Cardiology
Hospital Redacted
2:50 PM 12/9/2013
pager 310-687-7437

From: NMA Mariner 3001
TO: USCG NMA

Your letter of warning that we need to cooperate soon or my application will be null and void is an insult. It is your own refusal to cooperate with myself OR my Cardiologist with the exception of the periodical "We are still waiting" warning letter that has dragged this simple issue out for so long now and is totally unacceptable. Nobody should have to go through the stone walls you people erect. Perhaps because you are a government entity you can laugh and hide behind the can't touch us we are in the government attitude and we can be as dysfunctional as we want and you just have to live with it. On your website you state as a mission goal something like "striving to better serve the merchant mariner".

 You should be aware that the phrase that frightens all Americans the most is " We are from the Government and we are here to help you" and it is because of this kind of treatment and lack of cooperation from government agencies such as yours while demanding that the tax paying citizens they are supposed to be "serving" jump blind folded through burning hoops over vats of gasoline and of course in a timely manner from agencies such as yours we the people have that kind attitude.

And you know what really truly aggravates me? You know as well as I do that if a major conflict were to break out tomorrow all this "need further info" would go right out the window and you people would be combing nursing homes looking for any breathing merchant mariner to crew your phase 4 deep lay up piles of junk and sail them into harms way delivering military equipment to the conflict zone to protect you while sit safely at home thinking up new ways to "serve the merchant mariner" after the war is over. 
[LETTER END]
===============================================================================================================================================
I actually received a response to this letter on Christmas eve morning.
===============================================================================================================================================
[LETTER START]





Dear Mr.NMA Mariner 3001:

We do not send out emails regarding information that was received, unless you have sent us an email requesting a status. Your current status is that your medical review is complete and your waiver has been approved for issuance. Once received, we will need you to please sign this and send it back to us as soon as possible. You may email that letter to Redacted or fax to redacted. Once we receive the waiver letter, your file will move forward to the final process, Professional Qualifications Evaluation. 


Thank you for contacting the National Maritime Center.

If you have any further questions please feel free to contact us.

MS XXXXX
Advanced Government Solutions, Inc.
Customer Service Center Specialist I 
Contractor to U.S. Coast Guard
National Maritime Center


[LETTER END]
===============================================================================================================================================
I find the above response mind boggling. MS XXXX says, "We do not send out emails regarding information that was received," 

But they can send out threatening e-mails claiming they have not received information? Even though they actually have received that information already? But they cannot send out a confirming e-mail that they have actually received the information that they are falsely claiming you did not send? And not only did they actually have the required information all along but she says, "Your current status is that your medical review is complete" Something else they apparently did not tell me until after the nasty gram from them? So one wrinkle is ironed out because Dr XXXX's simple letter was all they required all along. Something else they apparently could not confirm by e-mail. Nor could they confirm it by answering  phone calls or faxes from my doctor either.

But now there is a new wrinkle. "MS XXXX says, your waiver has been approved for issuance. Once received, we will need you to please sign this and send it back to us as soon as possible." A waiver? A waiver for what? By e-mail? No. Another week waiting on the post office.

And this particular line from MS XXXX, "once we receive the waiver letter, your file will move forward to the final process,". Well that was not quite true. After I received the waiver and signed it I scanned it and e-mailed it back. The NMC sent back this letter,
================================================================================================================================================
[LETTER START]



To: NMA Mariner 3001  1/03/14 

Dear Sir,

I have forwarded this information for review. Your submission will be processed in the order it was received, so please allow 5-7 business days after receiving this notification to check on the status of your application. 

Thank you for contacting the Customer Service Center. If you have additional questions please feel free to contact us. 

Name Redacted
Customer Service Center Medical Specialist II 
Redacted
National Maritime Center 


[LETTER END]
================================================================================================================================================
So what Ms XXXX really meant was, Once received, we will need 5 to 7 days to confirm that this really is our own document we sent you and that you really did sign it. So  eventually I do clear all the medical hoops and hurdles and then make it through the Professional Qualifications Evaluation and receive this e-mail
================================================================================================================================================



To: NMA MAriner 3001   1/10/14 


Please do not reply to this e-mail address. This is an unmonitored e-mail account. If you have any questions, contact the NMC at REDACTED or REDACTED.

Important information concerning your credential "MMC, Reference Number: xxxxxxx and Application ID: xxxxxx from the National Maritime Center.

Your application has completed the evaluation process and is approved for issuance. Unless you provided the Coast Guard with a request for delayed issuance, you should receive notification within one business day indicating that the credential was issued.


Sincerely,

National Maritime Center
==============================================================================================================================================

So I say to myself thank God that this is over with. There is finally light at the end of the tunnel. Unfortunately that light turned out to be an on coming train. The above letter was sent to me on 1/10/14. Today is 1/23/14 and the status of my document at this very moment is, 
==============================================================================================================================================

 Status Information for  Redacted Privacy Information 


Mariner Number xxxxxx 
Application ID xxxxxxxx 
Credential Status APPROVED TO PRINT 
Transaction Type RENEWAL 
Status Information Your application for this credential was approved for issuance on January 10, 2014 and will be produced shortly. 
==============================================================================================================================================

For 13 days and counting they have refused to push the final button and print my document. Everything is done. All the I's are dotted and all the T's are crossed. All the hoops have been jumped through  so why the delay now?

Why are they holding back my document now? I have no idea. I have written them twice now and asked them that question and as usual when dealing with the National Maritime Center Martinsburg, WV  I have received no answer to my letter. And no I was not polite.
===============================================================================================================================================
My first letter asking them why are they delaying my document.
===============================================================================================================================================
[LETTER START]


From NMA MAriner 30001 
Redacted

E-Mail  Redacted


Cell# Redacted

Last Friday I received this notification.
=================================================================================================================================

Your application has completed the evaluation process and is approved for issuance. Unless you provided the Coast Guard with a request for delayed issuance, you should receive notification within one business day indicating that the credential was issued. 
=================================================================================================================================

It has been 3 business days now and I have heard nothing. Perhaps you are tied up in meetings discussing new ways to improve your services to the merchant seaman? If so I apologize for interrupting such an important event. I will just sit around for ANOTHER 2 and a half months while you sip coffee at your meetings and figure out how to load the ink cartridge in the printer.
[LETTER END]
===============================================================================================================================================
My second letter asking them why are they delaying my document after they refused to answer my first one.
===============================================================================================================================================

From NMA MAriner 30001
To: NMC E-mail address redactedl


AGAIN.................


Your application has completed the evaluation process and is approved for issuance. Unless you provided the Coast Guard with a request for delayed issuance, you should receive notification within one business day indicating that the credential was issued.


My document was finished and approved for printing on 1/10/14,
===============================================================================================================================================
Status Information for MMC MMLD Privacy Information 




Mariner Number XXXXXXX (NMA MARINER 3001) 
Application ID XXXXXXX 
Credential Status APPROVED TO PRINT 
Transaction Type RENEWAL 
Status Information Your application for this credential was approved for issuance on January 10, 2014 and will be produced shortly 

================================================================================================================================================



and here you are still dragging your feet refusing to print my document and refusing to answer my 1/16/14 letter asking why you will not release it. What is this your version of "Time for some traffic problems".
[END LETTER]
================================================================================================================================================
And yes I do feel that I have been singled out for "special treatment" by the NMC Goon Squad. I have not been quiet. I have complained. I need to be shown my place and who really has the power here. 

If you are not sidelined by the NMC medical evaluation hit squad the entire renewal process takes around three weeks from start to finish. Mine is finished and I have been forced to sit for an 2 additional weeks and still counting waiting for them to get around to pushing the print button. Considering all the obstacles and road blocks they have thrown in front of me already why shouldn't I believe this delay is intentional and is their way of punishing me for not suffering their abuse in silence?
[END E-MAILS SECTION]
================================================================================================================================================

[START COMMENTS SECTION]

This is an extremely dysfunctional broken process administered by people with an agenda and a mean streak. You may think this is "all about me" but its not. Mine is done. They just refuse to release it for some reason. They are going to have to release it someday. I do not know what day but some day they will have to push the print button. Take a look at these case studies from an older letter from a maritime organization in the Gulf. This is a long letter that addresses the dysfunction of the all the various departments at the NMC involved in the credential renewal process. The case studies are down at the bottom. Take a look at what happened to these people. Their lives were turned upside down inside out and ripped to shreds by unseen powerful forces in West Virginia that have never met them. Have no first hand knowledge of these people. For some of these people the night mare continues even today years later because the NMC took away their livelihoods. In some cases the NMC medical evaluators even refused to accept the personal physicians findings results and recommendations believing they were better suited to make the applicants medical diagnoses from their arm chairs in their office. This is to much like playing God with peoples lives.



This is not right. It is beyond wrong and immediate steps need to be taken to correct this.


==============================================================================================================================================
Here is an excerpt from an article from this site concerning the sharp spike in credential denials since the NMC has ramped up its Martinsburg operation
http://www.professionalmariner.com/August-2012/License-denials-soar-as-NMC-scrutinizes-medical-evaluations/ 

Even though the appeals process can be long and arduous, mariners often get the results they’re looking for. McElroy said his clients have found that process to be slow but fair. The Coast Guard ends up siding with the mariner the majority of the time.

“I recently won two appeals — one for a charter boat captain (who had been) denied renewal because he takes over-the-counter Dramamine for motion sickness. I appealed to Coast Guard headquarters on the grounds that they allow their own boat operators to use Scopolamine, which is a very potent prescription-only drug,” McElroy said.
===============================================================================================================================================
The title of this article is, License denials soar as NMC scrutinizes medical evaluations.

The NMC medical unit is not actually operated "by the Coast Guard". It is being operated by a civilian contractor, Contractor's name redacted. The NMC is disqualifying people for taking over the counter sea sickness pills? While the NMC is disqualifying people, The Coast Guard appeals office is later reinstating a majority of those same people. Out of 100% of the denial cases only 34 % of the NMC denials are fully upheld by the appeals board. Here is the the break down of the appeals cases results.

 Office of Commercial Vessel Compliance has sided with the mariner in 54 percent of the appeals, based either on new information or the existing NMC file.
 Eight percent are partially granted, e.g., with an alternative credential. 
Four percent had other outcomes
Thirty-four percent are denied. 

That gives the NMC an error factor of 66%. regarding credential denials . Anybody see anything wrong here? The article states, The Coast Guard ends up siding with the mariner the majority of the time. That obviously means that the NMC is wrong the majority of the time. And as stated in the above section peoples lives have been destroyed by these peoples "mistakes".

But in this same article the NMC says in its own defense,
===============================================================================================================================================
Many of the successful appeals don’t necessarily negate the findings of the NMC reviewers, Gillis said.

“A lot of those appeals have reached that point because we have failed to get the information from the mariner,” Gillis said. In many cases, the information finally arrives during the appeals process.
===============================================================================================================================================

 It is the Mariners fault for not providing the proper information they require. Blame their victims. I can not help but wonder how many of these reinstated mariners ran into the same brick walls I ran into when dealing with the NMC. I believe this statement speaks volumes,  

"Gillis said. In many cases, the information finally arrives during the appeals process" . 

Once you are no longer dealing with the NMC, which refuses to cooperate with you or your doctor, and move to the appeals office which is actually run by the Coast Guard then all of a sudden the necessary information "arrives". Could that be because when you get that far after months of being run around in circles by the NMC and months of lost income the Coast Guard appeals office actually tells the mariner what specific information they actually need and now the mariner can actually provide it?  

So lets take this a step further. In the above situation the NMC errors are not discovered until the actual Coast Guard appeals process because the applicant was fully denied and forced to take their case to a higher authority and this body lying outside of the NMC domain ruled in favor of the applicant 66% of the time. So what about mariners who are not actually denied but forced into the NMC medical waiver program who have to renew their waiver every 2 years? Or anybody else who may not have actually been denied but had some other limitations or may have had their license reduced to a lower level? For example you can't sail Master any more but you can sail 2nd Mate? Or had extra requirements and restrictions placed on them by the NMC and these cases were never reviewed outside of the NMC staff?  How many of those cases are based on error by an over zealous public advocacy group? Yes that's right public advocacy group. Again from the article in the NMC's spokespersons own words,

===============================================================================================================================================
http://www.professionalmariner.com/August-2012/License-denials-soar-as-NMC-scrutinizes-medical-evaluations/  
No longer are you a patient advocate, so to speak,” said Gillis, a specialist in occupational medicine. “You are an advocate for public safety. You are making an evaluation of whether someone is safe to work in a safety-sensitive position
===============================================================================================================================================

They do not see it as their duty to serve the Merchant Mariner. They see it as their duty to protect the public from the Merchant Mariner.  Her words not mine. I didn't tell her to say that. This corporate group could care less about the Merchant Mariners they claim to serve. Merchant Mariners are just a source of personal income and corporate profits for them. Access to taxpayer dollars via the lowest bidder process. 66% error rating? They are public service advocates? All the merchant mariners lives they have turned upside down? I stated above in the e-mail section there comes a time when coincidences stop being coincidences and here is the proof right here. This process is intentionally designed to cause harm to mariners by a group that publicly states they are an advocate for public safety. The delays the lack of cooperation the hoops the hurdles the stone walls the vague instructions so they can later blame the mariner for any lack of information this is all by design. They want you to get tired, fed up, frustrated and go away and they will run you into bankruptcy to accomplish that goal.

This is not the hall mark of a group that serves. This is the hallmark of a group with an elitist attitude. Thus the vague requests for information. The stone wall attitude when requesting information. refusing to cooperate with attending physicians. The attitude that we are better at determining the applicants medical limitations than their own doctors. And like all such corporate elitist groups they are no where near as good as they think they are, They have a publicly documented 66% failure rate. And as I said above, if an outside body could review the cases that never leave the NMC domain and determine the failure rate among the cases that are not actually disqualified but have unnecessary burdens added to their lives I bet that failure rate would be much much higher. 
===============================================================================================================================================
http://www.professionalmariner.com/August-2012/License-denials-soar-as-NMC-scrutinizes-medical-evaluations/  

Hometown physicians have even questioned the need for certain tests. Sometimes it takes a while for the patient to get an appointment to undergo the additional test, and the test may cost money.

[but the NMC directors reply to this is]

“If it is in the standards of care, theoretically it should be covered by health insurance,” Gillis said. “You’re trying not to be a cost burden on the mariner, but you’re still trying to protect public safety
===============================================================================================================================================

When you look at the opinion of the local doctors and look at what my doctor, The chief of cardiology at a major XXXX medical center said to me," Believe me you do not want to start running long lists of unnecessary tests".

Who should we really listen to? The doctors who work directly with the sick and injured on a daily basis and who have to actually discern and treat the ailments by testing and observation and then develop an actual medical treatment plan for the patient to make them well again or some corporate elitist with a known 66% failure rate who has not seen a real patient in how many years? And think about that one for a minute. Has not seen a real patient in years and still has a 66% failure rate in their never even seen the person before arm chair diagnosis? Maybe we are really lucky these folks are tucked safely away in the hills of West Virginia and not actually working in an operating room in a major facility. They would probably have to hire a lot more staff to crew the morgue. Who sitting hundreds or even thousands of miles away and never seeing the applicant second guesses the attending physicians diagnosis and fail in that second guess 66% of the time? Who do you believe? A hands on physician actually practicing their healing craft every day or a paper pusher physician who believes they actually know better and tries to second guess the doctor in the field?

Again look at the NMC directors response to mariner medical providers concerns.
===============================================================================================================================================
“If it is in the standards of care, theoretically it should be covered by health insurance,” Gillis said. “You’re trying not to be a cost burden on the mariner, but you’re still trying to protect public safety
===============================================================================================================================================
I think she could have simplified this response by simply saying "I don't really care what they think". Notice she uses the term "theoretically". Using what theory? Health plans vary from union to union and company to company. Something's may be covered and something's maybe not. What if it is a non union company with no health plan? What if they have drug out the process for so long the applicants insurance has expired? What do you think the NMC directors position on that might be? I think we can safely assume "I don't really care what they think" would be her response.

But that is only half the issue. Even if the tests they are demanding from an applicant really maybe unnecessary the NMC director says,

 'it should be covered by health insurance." 

In this time of run away health costs, over burdened clinic and hospital staff, clogged labs backed up by back orders for thousands of tests let the insurance companies pay for it? There is no STCW rest periods for medical personal and they work massive amounts of hours on rotating shifts over worked under staffed and over burdened with real cases with real issues but the director of the NMC what do you think she would say? I think she would say "I don't really care".

And outside the NMC in the real world of medicine if a doctor is found to be charging insurance companies for unnecessary tests soaking the insurance companies don't they call that fraud? Doesn't the doctor caught at such things loose their license and go to jail even? Aren't there investigation, hearings and debates raging on Capitol Hill right now concerning medical fraud via unnecessary testing and procedures? But the director of the NMC supports charging insurance companies for unnecessary testing and procedures? And who in the end winds up paying for unnecessary test and procedures? All of us by paying higher premiums.
And if the mariner has no insurance? Well so sad to bad go flip burgers or get on welfare and food stamps. Because Dr XXXX and her NMC staff simply do not care.

I believe I have presented enough evidence to show that the people at the NMC are obstructionist, elitist, uncaring, have a well thought out agenda to inflict unnecessary harm on merchant mariners with medical conditions, are anti merchant mariner in general, vindictive based on even though I completed the actual process two weeks ago not only will they not release my document they will  not even tell me why after two e-mail requests from me,  and just over all have a real bonafide sadistic mean streak.

A new interesting development in today's news is a major company called USIS that specializes in vetting potential government employee's and contractors has been charged with 665,000 fake background checks between 2008 and 2012. The allegedly fraudulent background checks included employees seeking security clearances at the Department of Defense, Homeland Security, Justice Department and other federal agencies. Maybe the people manning the NMC need to be run through a new document renewal process themselves? 

If you made it this far through this document then I thank you for your time and patience. I do hope that at least somewhere in this document something gave you food for thought and consideration and if not then I apologize for taking up your time but I am still thankful you took the time to read it. And I hope you never have to deal with the National Maritime Center medical evaluation department. I do not think I could hate somebody enough to wish this process on them.

Respectfully
NMA Mariner No.3001

EDITORS NOTE: You would think this story ends here with all of the comments and Brer Rabbit assured in writing that his occupational credential , without which he can't make a living is on the way. but the Tar-Baby as of today's post has still not yet released Brer Rabbit's credential. Whatever lands in a tar-baby tends to stay in the tar-baby. Stay tuned as the story continues in future posts.