Report faults medical reviews of pilot killed in fall from ladder

Nov 24, 2008 12:00 AM

A Boston pilot who died in a fall from a Jacob's ladder in 2006 had three serious medical conditions, and the U.S. Coast Guard Regional Examination Center failed to analyze the ailments adequately while renewing his license earlier that year, according to a Coast Guard investigative report.

Capt. Robert G. Cordes had nearly reached the top of the Jacob's ladder that rose 28 feet up the side of the bulk carrier Baldock when he fell to his death onto a construction barge tied up alongside the ship.
The Massachusetts Pilot Commission also failed to review results of the pilot's annual physicals to ensure that he was fit for duty, the report said.

Capt. Robert G. Cordes, of the Boston Harbor Pilot Association, was killed Oct. 24, 2006, when he fell more than 20 feet from a 28-foot rope ladder. He was attempting to board the moored 803-foot bulk carrier Baldock at a Chelsea, Mass., salt terminal.

Cordes fell onto a steel barge to his death. He had been a pilot with the association for 30 years.

Witnesses said the pilot had climbed, unsteadily, almost to the top when he stopped, "appeared to grab his chest•bCrLf and let go of the ladder, according to the Coast Guard's report, which Professional Mariner obtained through a Freedom of Information Act request.

"The witnesses noted that Mr. Cordes had been climbing very slowly, apparently laboring, and just prior to the fall, Mr. Cordes appeared to have taken a step back from the ladder, in a gesture that suggested to witnesses that he was suffering a heart related episode,•bCrLf the report said.

Cordes weighed 264 pounds and was 5 feet, 11 inches tall.

A closeup view of the rope ladder. (Photos courtesy U.S. Coast Guard)
The Coast Guard report did not specify Cordes' medical conditions, which were known to the Coast Guard since 2001. Each of the three conditions was determined to be a "latent unsafe condition.•bCrLf

Later in the report, the investigators highlighted Coast Guard rules for documenting cardiovascular, diabetes and vision problems. Cordes had undergone stress tests and was taking unspecified medication.

The Massachusetts Pilots Commission stated that all licensed pilots must submit the results of their annual physical to the commission. The organization collected Cordes' results, but never reviewed them, so the commission wasn't aware of his medical conditions.

As a result of that statement, the Coast Guard recommended that the Commonwealth of Massachusetts adopt rules requiring the commission to review pilots' medical records.

"The absolute ability to leap, grasp and climb is essential to ensure safe performance of duty, often in extreme weather conditions consisting of rough seas, strong wind, and hot and freezing temperatures,•bCrLf the Coast Guard investigators wrote. "An annual review of the status of the physical condition of each pilot should be of eminent concern to the governing authority and a requirement for continued employment.•bCrLf

Massachusetts Pilot Commissioner Capt. George Landrigan disagreed with the Coast Guard's recommendation and said state officials are not planning to change their policies.

"We do not have the medical expertise. I see no way that you can improve on the structure by making us, in essence, the final word as to whether a man goes to sea or not,•bCrLf Landrigan told Professional Mariner. "If the (pilot's) doctor says he's OK and passes him, who are we to say we don't think he is?•bCrLf

The Coast Guard also said its own Regional Examination Center in Boston should not have renewed Cordes' license in 2006 without more medical data.

"Mr. Cordes should have been asked to produce further documentation from his physician in regards to his diagnosis ... to determine whether or not a physical waiver would be applicable or appropriate,•bCrLf the investigative report said.

The Coast Guard said current efforts to standardize the medical waiver process in the Navigation and Vessel Inspection Circular should prevent such problems.

"We believe this issue will be adequately addressed through the current initiative to restructure and centralize many licensing functions at the National Maritime Center•bCrLf and through the new NVIC and medical forms, the Coast Guard wrote.

Earlier news reports said that perhaps the Bahamas-flagged Baldock had unlawfully failed to provide an accommodation ladder for Cordes' embarkation. Documents in the Coast Guard report noted instead that federal Occupational Health and Safety Administration rules allow a Jacob's ladder to be used when the accommodation ladder cannot be.

Baldock's master could have moored his vessel farther forward of the barge to allow use of the accommodation ladder, which is located amidships, but declined to do so, the report said.

"While Mr. Cordes seemed displeased with not having the availability of the accommodation ladder, he did not refuse to use the Jacob's ladder,•bCrLf the investigators said, citing witnesses.

-Dom Yanchunas

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