Doctors on the Docks : Medicine: Hospitals competing for business in the era of health-care reform are targeting seafarers who come from many lands and may be in port for only a few hours.

When the stately Viking Serenade glides into Los Angeles Harbor two mornings each week, it is greeted by a van dispatched by a local clinic to fetch the cruise ship’s ailing crew members.

The van whisks them to the hospital-run clinic in San Pedro where, last Friday, 16 crew members were treated for such ills as back injuries and a sprained shoulder. A ship’s pianist received physical therapy for his hands. A casino employee underwent tests for abdominal pain.

Then the crew members were rushed back to the docks before the ship set sail for Mexico later that day.

Such port traffic is the lifeblood of so-called “maritime medicine,” the seafarers’ version of industrial medicine. In this relatively small and overlooked field, doctors treat workers from cruise lines, cargo ships, tugboats, oil companies and onshore concerns catering to the marine trade.

These days on the Los Angeles waterfront, it seems as if every hospital and clinic is scrambling for a piece of the maritime pie.

The market has been shaken up this year with the shutdown of a respected, decades-old maritime clinic in San Pedro, as well as the launching of several new, hospital-run clinics in San Pedro and Long Beach.

This sharpened focus on such a narrow medical field, some experts say, illustrates how hungry hospitals are seeking out new niches in their communities--areas where they can foster specialties and loyal clients--as they position themselves for the new world of health-care reform.

Yet some wonder if all these maritime clinics will survive.

“They’re going to have to steal (patients) from one another. There’s only a certain amount of business,” said Janet Woods, administrator of the CareStation Industrial and Maritime Center launched in July by San Pedro Peninsula Hospital.

“A lot of these entities are going to end up losing lots and lots of money,” predicted Dr. David Smith, who has an independent office that treats seafarers.

“We’re not running (the clinic) at a loss,” said Blair Contratto, vice president of corporate development at Little Company of Mary Health Services, which includes San Pedro Peninsula Hospital. “It’s not a big moneymaker, but it’s a way of serving local employers.”

Potential clients for these new clinics include the ships using the Port of Los Angeles, which recorded more than 3,000 vessel arrivals over the past year.

While the big cruise ships have doctors aboard who handle most passenger and crew complaints, many cargo ships do not.

And the cruise ships have such large crews--the Viking Serenade has a complement of more than 600--that they are an attractive market for doctors on shore.

Today, San Pedro is home to three hospital-run clinics that offer maritime and industrial medicine. Each is operated by a different hospital: San Pedro Peninsula Hospital, which recently affiliated with Torrance’s Little Company of Mary Hospital; Torrance Memorial Medical Center, and Long Beach Memorial Medical Center.

What distinguishes the maritime field from most workplace medicine is that part of the market is made up of seafarers who work aboard vessels many miles offshore, far from ambulances and hospitals.

“They can’t just call 911 and have the paramedics come,” Long Beach maritime specialist Dr. Brian Tang said.

So when a ship pulls into port, the onus falls on the onshore physician, who must quickly assess patients since a ship may be in port only for a few days or even a few hours--and not necessarily during normal business hours.

Just hours after the Viking Serenade docked last Friday, for instance, the CareStation was filling up with crew members such as the man who lay on a stack of hot pads in the physical therapy room, nursing a strained lower back.

And the ship’s musical director, David Udolf, 29, grimaced as he gingerly lowered his left hand into a bowl of hot paraffin, a technique intended to soothe his hands after daily piano playing.

Only a few doors up West 6th Street from the CareStation stands a competing clinic operated by Long Beach Memorial.

There, last Friday morning, Memorial Maritime clinic manager Lois Winkelman was gathering supplies and rushing out the door to pay a “ship call” to a cargo vessel to provide 10 crew members with cholera immunizations. She then escorted two crew members ashore, one to a dentist for a toothache and another to her clinic to be treated for a skin rash.

With crew members coming from many countries, familiarity with foreign cultures comes in handy. The ability to quickly shuttle patients to specialists off hours is also important.

The immediate catalyst for some of the recent clinic growth was the closure of Anderson Medical Group, which for decades dominated maritime medicine in San Pedro.

The clinic was acquired several years ago by the parent company of Bay Harbor Hospital, which decided to close it this year.

In response, San Pedro Peninsula Hospital rented the Anderson clinic building and reopened it as the CareStation.

Meanwhile, some of Anderson’s longtime seafaring clients were scattering to other clinics and doctors in San Pedro and Long Beach.

Some health experts suggest that by offering specialized services such as maritime medicine, the hospitals are making themselves more attractive to health-care networks, such as health maintenance organizations, or HMOs, which choose hospitals to use. Since those networks are to be the linchpins of health-care reform, hospitals want to be plugged into as many networks as possible.

On Los Angeles’ waterfront, meanwhile, the clinics are busy monitoring the port business and one other.

“Everyone is trying to gain a market share,” said Dr. Maurice DeCuir of Memorial Maritime Clinic, who adds: “It’s a very finite market. There’s only so many ships.”