The document discusses the responsibilities and procedures of Approved Doctors in conducting medical examinations of seafarers under new Norwegian regulations. It outlines that while the regulations introduce some changes, the doctors' main obligations remain the same - to follow administrative law, conduct thorough evidence-based medical assessments according to best practices, and justify their decisions. The document provides guidance on collecting relevant medical information, performing risk assessments based on the job and vessel, applying ethical standards, and explaining the rationale for certification decisions in writing.

1. Department of Occupational Medicine

2. The Approved Doctor’s responsibilities and the procedures of medical examination
Alf Magne Horneland
Head Appelate Body NMA
Director NCMM

3. Department of Occupational Medicine
Some abbreviations used here
•AB Appelate Body
•ASD Approved Seafarer’s Doctor
•NMA Norwegian Maritime Authority
•NCMM Norwegian Centre for Maritime Medicine
•PAA Public Administration Act
•HR Health Regulations

4. Department of Occupational Medicine
New regulations – new responsibilities?
•Yes – and No.
•YES:
–No absolute contraindications
–Does not indicate easier terms – rather an increased authorization of the ASD – More decisions can be taken by the ASD
–Ex.: Absolute contraindications for medicines with restricted prescriptions (analgesics, stimulants, anxiolytics etc) – does not mean they are not a safety risk – rather that the classification used earlier was inappropriate to identify harmful medicines. Many other medicines (antiepileptic drugs, antihistamines, antidepressants etc) could be a safety risk. They should all be judged thoroughly.

5. Department of Occupational Medicine
New regulations – new responsibilities?
•NO:
–No changes in the Public Administration Act
–Increased responsibility and authority under the new HR emphasizes the importance of following the PAA requirements
–Ex.: The really difficult cases, which earlier were decided by the Appelate Body, now will be decided by the ASD. They will not be judged by the Appelate Body unless an appeal is filed.
•This emphasizes the importance of thorough, fair and sound assessment by the ASD, in accordance with best medical practice, evidence-based risk assessment and the HR – following the PAA requirements.

6. Department of Occupational Medicine
What are the obligations of the ASD?
Administrative procedures
•Public Administration Act
•Health Regulations
Medical procedures
•Collect medical information
•Evidence based risk assessment
•Best medical practice
•Evidence based
•Ethical aspects
•Justification of decision

7. Department of Occupational Medicine
Collect medical information
•PAA: …the case is clarified as thoroughly as possible…
–Anamnesis
–Medical examination
–Supplementary information
•Laboratory tests
•Hospital and specialist reports
•Statements from employers
•NOT: ALL POSSIBLE information
•BUT: ALL RELEVANT information

8. Department of Occupational Medicine
Evidence based risk assessment
•NOT ONLY: Likelihood for a medical incident to occur
•BUT: Risk to
•Ship
•Crew
•Self
As a product of
•Likelihood for a medical incident and
•Consequences
Which depends on
•Medical condition
•Job position
•Manning
•Type of ship
•Trade area
•Cargo they carry – etc.

9. Department of Occupational Medicine
Best medical practice
•Guidelines for investigation and examination
•Standards
•Algorithms, flow charts, decision trees
•Expert consensus
•The ASD must him-/herself decide what is needed
•In cases of complaint, the Appelate Body will review the ASDs decision and approach
•The audits from the NMA will focus on the process of sound medical assessment

10. Department of Occupational Medicine
Ethical aspects
•PAA:
–Impartiality!
•Not running errand for a third-party
•Not being too strict, not being too lenient
–Duty to consider possible disqualification
–Duty to inform
–Duty to provide guidance
–Pledge of secrecy
–Fair, just and sound practice.
–The seafarer has the right to get a medical certificate if standards are met
–The seafarer has the right to appeal

11. Department of Occupational Medicine
Justification of decision
•Important aspects
–Justification shall be in writing.
–The seafarer shall receive the written decision.
–The seafarer has the right to see all documents of the case.
–Grounds for the decision shall be given
•Legislative justification
•Medical justification
•The justification should be written in a way that the seafarer can understand
•Bear in mind that the justification could be reviewed by the Appelate Body in cases of appeal

12. Department of Occupational Medicine
How to order a specialist report
•You cannot presume that the specialist
–Knows much bout seafaring
–Knows much the shipping industry
–Is familiar with the medical standards or the legislation
–Knows the purpose of the medical examination
–Understands the limited time perspective
•Hence – you have to ask specific questions
•It is calle “competency to order”

13. Department of Occupational Medicine
You will be given advice
•Guidelines to the Regulations will come soon

14. Department of Occupational Medicine
You can ask for advice
•Call or e-mail the NMA regarding administrative or legislative questions:
•+47 52745000
•post@sdir.no
•Call or e-mail the NCMM regarding medical questions:
–From Norway: 05300
–From abroad: +47 55975000
•And ask for Hege Imsen
–hege.sofie.imsen@helse-bergen.no
•Or Alf Magne Horneland
–alf.magne.Horneland@helse-bergen.no

15. Department of Occupational Medicine

16. Department of Occupational Medicine