Cruise Ship Medical Malpractice Results in Severe and Permanent Brain Injury

Today we blog about the tragic case of Richard Burgess, who suffered severe and permanent brain injuries due to Royal Caribbean Cruise Line’s medical negligence. Burgess suffered a medical emergency while sailing aboard the Harmony of the Seas, and his injuries were exacerbated by the negligence of the RCCL medical staff aboard the ship. Below is an excerpt from the complaint.


Burgess and Henze attended a comedy club onboard the ship on the evening of February 17, 2019, which was the first night of their cruise. In the early-morning hours of February 18, 2019, Burgess fell inside his cabin, hitting his head. Burgess awoke later on February 18, 2019, and discovered a 10-centimeter laceration (approximately 4 inches) across the back of his head. 

Burgess went to the ship’s medical center, where he was evaluated and treated by RCCL medical personnel, including Dr. Etsebeth and registered nurse Lilibeth Rivera. Dr. Etsebeth stitched the wound shut and discharged Burgess. Despite the severity of the head injury, Dr. Etsebeth did not prescribe that Burgess undergo any radiological studies (such as a CT scan or MRI) to determine whether Burgess was suffering from any subdural injury, such as bleeding on or around the brain. Despite the limitations of the ship’s medical center, Dr. Etsebeth did not take steps to arrange for Burgess to be medically evacuated off the ship to a shoreside medical facility where Burgess could undergo additional radiological studies and receive advanced treatment that was not available aboard the ship.


The RCCL Harmony of the Seas docked in San Juan, Puerto Rico on the morning of February 21, 2019. 28. Early that morning, after the ship was already in port, Burgess began to suffer symptoms of a stroke, including the inability to move the fingers on his right hand, an unsteady gait, weakness in his right leg, and vision changes in his right eye. Burgess called his family and sought assistance from an RCCL crew member, who summoned medical personnel. Burgess described his symptoms to responding RCCL personnel and told them he thought he was having a stroke. RCCL’s medical personnel brought Burgess to the ship’s medical center in a wheelchair.  RCCL’s Nurse Mary Bremner electronically entered Mr. Burgess’s triage notes at 9:25 a.m. RCCL’s medical records document that Burgess’s condition was “urgent” and that he was “to be seen by Dr in ICU” [intensive care unit], for “? CVA”, which is an abbreviation for cerebrovascular accident or stroke. RCCL’s shipboard doctor, Joao Pereira, diagnosed Burgess with acute cerebrovascular insufficiency priority level 4. Dr. Pereira knew or should have known from the ship’s own records that Burgess had been treated for the head trauma three days before.

At approximately 9:55 a.m., Dr. Pereira prepared a medical shoreside referral that recommended Burgess be taken ashore in Puerto Rico for an evaluation “(including CT-scan if you see fit) and treat accordingly.” The shoreside referral form did not indicate that Burgess was suffering from a medical emergency, did not request a medical evacuation, and did not provide a diagnosis. Despite, Burgess’s emergent and critical condition, RCCL failed to immediately disembark and/or medically evacuate him. Instead, Burgess was forced to remain onboard for several hours despite showing obvious signs of a stroke and/or other cerebrovascular emergency. While Burgess’s condition continued to deteriorate, RCCL personnel refused to medically evacuate him from the ship until after Henze tended to several trivial matters. Specifically, RCCL demanded that Henze go to his cabin and retrieve Burgess’s insurance card and passport. Next, RCCL informed Henze that he would need to personally pack his and Burgess’s luggage and take them along when they disembarked for the ambulance ride to the hospital in Puerto Rico. Finally, RCCL refused to allow Burgess and Henze off the ship until after Henze went to guest services to settle outstanding charges from the cruise. This despite the fact that RCCL already had their credit card information on file.

At approximately 1 p.m. on February 21, 2019—about 3½ hours after Burgess first arrived at the ship’s medical center suffering from a stroke—RCCL finally allowed Burgess and Henze to disembark the ship, where they were met by an ambulance arranged for by RCCL. Burgess finally arrived at HIMA San Pablo Caguas at approximately 1:50 p.m., or about 4½ hours after Burgess first told RCCL and its medical personnel at the ship’s medical center he thought he was suffering a stroke. At HIMA San Pablo Caguas, the medical staff immediately noted Burgess’s history of head trauma three days before, and the fact Burgess was outside the window for doctors to administer medications and interventional procedures that would have materially improved Burgess’s condition and prognosis. The hospital’s medical team was playing “catch up” due to the misdiagnosis and significant delays in providing the emergency care and treatment Burgess needed to prevent and/or minimize damage to his brain.

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