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Our Mission Statement:

Access to an entire range of women’s wellness health care is becoming unavailable because of southern states brutal attitudes, policies & laws, endangering the health & even the lives of women in the entire Gulf region.  Our goal is to facilitate that access  via  an offshore clinic on a classic  cruise ship…& do so confidentially and at rates lower than land-based clinics. Won’t you be part of the plan?

 

 

 

       AUDIO INTRO by AVA*                                                                                            AUDIO INTRO by AVA*

Click Picture or Scan QR Code for 9 minute audio summary of the project

To listio to the asdio & read the script, click the audio control & then click HERE  (or HERE for PDF version)

 

To view an extensive project summary flipbook, please register by email.
Then click https://heyzine.com/flip-book/0acb9d4b52.html or the pictures below

 

 

SUMMARY POLICIES & CRITERIA FOR SUCCESS:

Accepting that there is a definite need for an offshore women’s health facility, because of (particularly Southern US states’) restrictions on women’s care, the following summarizes the major mandates that MUST be met to establish the facility; to remedy the multitude of issues hindering its establishment; & to assure its success & ensure its security from outside intervention. Here are just the major critieria itemsthat must  be met to secure the best chances for initial & continuing enterprise success:

·      The $20MM cost & 1 year lead time to establish an offshore women’s clinic quoted by other promoters was determined to be unacceptable and yet, to meet the host-vessel mandates, was actually likely to be inadequate if the target vessel is a new, or the total reconfigured non-passenger, US-built vessel;**  It  turns out that the suggested  host vessel is the ONLY existing  US-built passenger vessel that  meets all requirements  for cost & compliance.

·       A 3 nautical mile buffer is inadequate for various reasons (ie: relatively easy access for patients also means easy access to anti-abortion fanatics or states that could attack or seize the vessel; Federal limitations remaining that would limit sources of affordable drug & equipment & subject the vessel to Federal Court jurisdiction, etc) Plus, the state jurisdiction of TX & FL, in the Gulf of Mexico, extends to 9NM, not 3NM; and those states might not hesitate to lie about the location of the vessel, there not being “mile markers” on the water! Thepromoter ofthese operation has already secured import sources for the clinic FF&E & supplies that halve the US cost of same (...a saving of close to $1MM).

        The only feasible service area is the relatively calm Gulf of Mexico, because servicing the anti-abortion Atlantic Coastal states would make egress & embarkation to the vessel dangerous. It would also require a very large, unaffordable vessel to provide the range, stability & safety needed  to handle the large service ares.

·      **Because of US laws limiting access to serial US ports by foreign vessels, the ship must be US-built, flagged & crewed, even if it never docks within the US; and even if it does not venture closer to shore than the 12-24NM “Contiguous Zone”.** At the same time, the wages paid to US-based medical & maritime crew, and retail cruise fares need to be competitive, while also keeping clinic charges competitive with land-based clinic services.

·      The vessel must meet international safety & environmental laws; must be able to adapt to changing “green” laws that will tend to raise its operating costs; and it must have an extended range to minimize the frequency of refueling/reprovisionings, as it will be forced to refuel outside of the US (because anti-abortion states that will not hesitate to seize the vessel if it ventures within their jurisdiction, even if the clinic closes (like casino ships) when docked. The ship cannot hope to be secure from illegal “police powers” attempted while on state  waters. 

·      The size of the vessel required to provide a reasonable level of staff and service will make it subject to a huge web of US & international safety & environmental regulations, even if operating only in international waters. These will mandate a maritime & hospitality crew at more than twice the size & cost of the clinic staff. It is inconceivable that a medical group & staff could affordably or quickly master the multitude of maritime regulations and management skills necessary for safe, certified, clean and efficient operation of this vessel.

·      Thus, to be able to cover costs & provide security to patients & passengers, the vessel must host both maritime & clinic operators, which must be entirely separate entities (…w/ the clinic, leasing space & hospitality services from the ship-owner.)

·      As an additional security measure,  the clinic needs to offer full women’s health services (vs being solely an abortion clinic) & must be price competitive w/ land-based service and travel. In fact, the ostensible reason for everyone boarding the vessel must be for a full Wellness Exam or as (daily or extended) cruise guests. It should be obvious that the Women on Waves operation of docking to pick up patients, for whom only medication abortion services are available, is an unworkable concept for the US. Complete confidentiality is a must, as it  cannot be cetain that the sourthen states will not institute a reporting & rewards systems (as TX has done) to turn in women who have had, or traveled for, medical services their states forbid. Boarding passes or receipts for the ferry transit should only refer to the day pass on the ship &/or, at most, the medical exam. 

         It is almost  certain that structuring the operation as a charity,will doom it to fail...and, in fact, such a path is unnecessary if the clinic rates beat those of land-based clinics, & provide extra & exemplary service for a lower cost. The reasoning being that, if structured properly, the fair profits  & incentives for all parties will bring in the startup capital needed. As a charity, not only must the initial required capital be raised, but millions will have to be begged for every year. It is an impossible situation, especialy since there's no reason to presume that third party non-profits (ie: planned Parenhood, etc) will be unwilling to pay for fair-priced services.

·      To estimate demand for services, it was assumed that potential patients will travel as much as 2 hours to their ferry port, plus a half-hour ferry to the clinic vessel, versus traveling as much as 1,000 miles to a liberal state. So the populations in thosee areas was estimated....& based only actual  abortion figures (ignoring the general  scarcity  of women's clinics) the demand forservices points to a  figure of 10-20 times the capacity of theproposed host ship.

·      To assure the most itinerary service points with a full day of clinic service, it is assumed that each must be within a 12 hour (overnight) sail of the previous anchorage. (Because the likely daily demand for banned services is over 10 times the daily capacity of the clinic, overlaps of these coverage areas overlap is OK.)

·      Special pains must be taken, including superlative service, unique excursions & inclusive pricing must be taken in order to satisfy the retail cruise passengers who will be transiting on a cruise ship that is perpetually at sea.

 

  

PRO FORMA, PROPOSED SCHEDULE & CONCEPTUAL FLOORPLAN

(Please note:  SIX-month pro forma shown, matching proposed crew/staff contracts)

 

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Mariner Medical FAQ:  Frequently Asked Questions About this Project

 

Target for the services:: The intent is to provide, affordable, confidential, comprehensive, health services topatients from within a two-hour drive and half-hour ferry ride of nearly the entire US gulf coast, from Fort  Myers, FL to Brownsville, TX.

Where will the actual services be provided: Service will be accomplished via the clinic-ship transiting between 9-10 approximately equally spaced venues that are within international waters, approximately 12 miles offshore, with patients transiting  to& from the ship by a company-owned ferry.

What services will be available:  Complete wellness health to women (&, upon request, men) that will  always include a  full health & reproductive examination, Pap test, mammography, STD & other  blood & urine tests; with sonograms, contraceptive services, inoculations & other drug dispensing, medication/surgical reproductive services & more.

Clinic/Ship Components: In addition to addition to staff quarters & some patient rooms, this complete clinic will include: multiple exam & surgical rooms, a lab, offices, store & break rooms. The retail operation will serve over 70 guests, with cabins, lounge, restaurant, sun deck, etc. When previously operating as a cruise ship, it was rate over 3.5 stars, etc.

Why make this proposal, when others have done so? While well-intentioned, the other proposals, more or less “knee-jerk” reactions to the dismembering of Roe v Wade, failed to conceive a plan that was actually “doable”: Valuable but affordable, confidential, operationally practical, safe & secure for patients & operators, as well as able to be quickly implemented.

What about operating between 9 & 12 miles out? Operating within the 12-mile Federal limit leaves the ship vulnerable to lawsuits brought in Federal court, as well as potential search & seizure. Plus, transit time to the ship would be over an hour, in a boat unlikely to have proper navigation equipment, which is impractical & dangerous. The clinic equipment & medications would also have to be from US sources, at 2-10 times the cost of imports. 

Sadly, that other proposals have not been implemented more the 2.5 years after they were proposed is evidence of their weaknesses and the clinic would be limited to government imposed specifications, etc.

In fact, in deriving the Mariner Medical plan, scores of project solutions (some noted herein) conflicted with each other and, as noted, resolving those conflicts was like a game of “whack-a-mole” that took over a  year. In the end a comprehensive plan was conceived that meets the above requirements, including a 60-day implementation and a cost less than half others anticipated..

.What are some of the issues we think other planners failed to anticipate?

It is presumed that  the Women on Waves operation in Europe was the idea source for other proposals. But that operation provides nothing but “abortion pills”, almost certainly to less than 10% of Mariner Medicals presumed capacity. WoW also enters ports to pick up & drop off patients which, as noted below, would be extremely to accomplish in the US.

To avoid the risk of a state seizing the ship, or other risk from the neighboring states, a Gulf coast clinic ship must operate beyond the state’s maritime limit. But, the normal 3-mile Gulf state limit is 9 miles for TX & FL. Plus, the numerous Federal regulations, that would still apply up to 12 miles offshore would impose crippling costs & liabilities including the potential for lawsuits brought in Federal Courts. Hence, operations must be confined  to international waters.

Terrorist Danger: Plus, if a non-mariner could reach the ship in a small boat, it would be ulnerable to attack by fanatics opposed to the ship’s operations, especially if it is advertised specifically as an abortion clinic.

Patient Transit Danger: It would be dangerous for the average desperate patient to rent a boat & motor to transit to 9-12 miles back & forth in the Gulf.

And, the potential for 80 boats to be transferring patients to and from it on a daily basis, than anchoring in deep water while the patient is receiving service is among the most dangerous of maritime activities.

Even if operated in international waters, a ship capacity of over 12 requires compliance with multiple IMO, SOLAS & environmental regulations, plus maritime training for all crew  members even if having no patient contact. The practical & technical skills required are far beyond those possessed by a bunch of doctors & nurses. And, the cost to maintain the maritime & hospitality crew, and feed the staff, will double the operational costs.

Operating in the manner of a gambling ship that merely locks up the casino when in port where gambling is not legal, would not  work. No-one could guarantee that the ship is not seized, & medical staffers arrested, when in port even if the clinic was closed then. Hence, the ship must be fueled or provisioned beyond the risky states…which means outside of the US, because no US state without abortion bans is within range. And that means having a range much greater than the average ship candidate. In addition, provisioning must be  facilitated, since the ship can’t dock to pick up supplies either.

Why not operate as a non-profit: If operated like Mercy Ships, it becomes very hard to hire crews/staffers that work for free, in competition with paid maritime or clinic employers. Plus, doctors can’t be expecte to know how to run a charity. Plus, the inability to access southern health services has more to do with availability than cost, so affordable clinic ship’s services will not be a barrier, especially since, for patients that qualify, there are already multiple third-party sources of funds for medical services.

Operations: By operating an affordable, but for-profit clinic (as a foreign registered tenant on the ship), as a tenant on a ship with a separate US–registered maritime & retail cruise operation, not only are the maritime, legal & hospitality responsibilities covered for the clinic, there is further isolation from state & Federal authorities, but still full compliance with the US-PSVA.  As noted above, It is inconceivable that a clinic could comply, by itself, with the multiple maritime regulations that apply even international waters, nor could it afford to do so.

Staffing: Staffing on any vessel is difficult, because of competition with hundreds of other passenger vessels seeking crews, the usual long work hours of staff, and the generally low pay. If structured like WoW or Mercy Ships, whose crews mostly work for nothing, it is even harder to staff up a vessel. [For that reason, Mariner Medical is structured to pay competitive wages & other incentives, including not forcing staff to work 11-14 hous/day, & 7 days a week for 6 months straight.]

Funding & Incentives: As structured, there are incentives for promoters, operators, substantial rates for, lenders/investors; while still setting clinic rates significantly below land-based clinics, even including patient meals & transits. By requiring engagement fees from the clinic & maritime operators, but loaning back most of it as operating reserves, such reserves are ensured to be in place…with profits still expected to exceed the engagement fees in under a year.

The Passenger Vessels Services Act (often incorrectly referred to as The Jones Act) prohibits passenger vessels from servicing serial US ports unless they were built & registering in the US & manned by a US crew. Foreign vessels are only exempt if a stop in a foreign port is included in every itinerary & the passengers must travel to that port on the subject ship.

The cost to build a large enough ship (ie: a yacht) in the US is prohibitive, as is the cost to convert a ferry or cargo ship. The proposed host ship, in contrast, is both US-built & large enough for the intended use, as it is certified to transit up to 20 miles offshore. In checking, the subject ship is the ONLY US-built ship currently available that is practical and affordable for joint clinic & passenger service, as well as either currently, compliant with international & US environmental standards, & compliant with International Maritime & SOLAS (Safety of Life At Sea) current standards, or quickly, & affordably able to be made compliant.

Together with importing the clinic’s FF&E & medications  from governments certified, but non-US sources, Mariner Medical’s startup budget is less than half of the $20MM others have proposed…and that budget includes over $1.5MM in operating reserves.]

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Hello! This is Ava. . I hope you will allow me about 9 minutes to introduce you to the Mariner Medical plan, to launch a maritime clinic that will provide affordable, women’s reproductive and other health care that will be as comprehensive as that provided by comparable land-based clinics. This is a response to the restrictions of US Gulf State governments, including policies that extend well beyond outright abortion bans, and remain even after state constitutional amendments. The result is that the health, and the very lives, of women in these states is endangered, as is the well-being of their entire families. .

With the proposed host ship’s 5000-mile cruise range, and with the transport of provisions and people to and from it to be only via high-speed ferry, the offshore operations are ensured to be safe and secure, by confining operations to the international waters of the US Gulf, except for refueling and some reprovisioning and periodic down-time in Tampico Mexico. Comprehensive service is expected to be convenient to almost the entire gulf population, from Fort Myers Florida to Brownsville Texas, that is within 2 hours of the coast. This scenario is based on a presumption that an option of a maximum 2-hour drive & half-hour ferry-ride to a modern clinic, for affordable, comprehensive & confidential health care, together with a relaxing day on a classic cruise ship, is preferable to a costly, multiday trip to a distant state’s clinic, for more expensive, more limited and not fully confidential care. .

Careful planning included locating ten approximately evenly spaced offshore service venues along the coast, that are each about 12 miles offshore of a ferry-capable port. This will facilitate access to the ship, which will transit overnight, from most of those venues to an adjacent one, so as to be ready for services there, early the next day, while also facilitating day excursions to the coast, by the retail cruise guests. It will also facilitate 2 visits to almost all venues, during each repeating 21-day itinerary of 2200 miles. With the clinic being merely a ship tenant, registered as an independent entity in corporate secrecy Bermuda, operations restricted to international waters and records encrypted to secure them from theft or seizure, the operations, staff and patients will be beyond US & State government or third-party control, except for international safety mandates that apply to all ships, in all waters, that have more than 11 persons onboard. .

Furthermore, the proposed host ship already is, or can affordably be made to be, both environmentally and IMO compliant. And, it is US-built, registered and owned, and will have an American maritime crew. That makes it virtually the only available, affordable and appropriate-size vessel in America, that complies for exemption from the Jones-Act and other regulations that prohibit foreign vessels from servicing serial US ports, even if they never actually enter the ports. .

Resembling a large yacht, the clinic’s proposed host is an existing but fully rehabbed small classic cruise-ship, with 100% exterior cabins. The clinic will be adjacent to this ship’s sparkling restaurant, with a super-comfortable, multi-purpose ship lounge one deck higher, and a spacious top sun-deck with a bar, lounge chairs, fishing-equipment, kayaks and other water-sports gear available. A separate onboard operation, serving up to about 80 retail cruise guests and with its own crew of 45, will handle all hospitality and technically-complex maritime obligations for the clinic, saving it extreme effort and expense. This will leave basic S T C W maritime certifications, internationally mandated even for non-maritime shipboard workers, as the clinic’s only non-medical obligation. .

Patients and guests will enjoy meals prepared by talented, culinary graduates and patients will have access to all ship amenities during their day on-board. Patient day-fees will be inclusive of the full exam, pap & other tests, mammogram and outside lab consultations, in addition to those meals and amenities. Excluding other services, the only other cost will be $60, for the high-speed-ferry round-trip, snacks & beverages, charged because the ferry is a completely separate entity from the clinic operation. .  

The clinic staff of 18, will include an equal number of 6 doctors and nurses, plus lab and other workers. The clinic facilities will consist of seven exam, surgical procedure and recovery rooms; plus a lab, office, pharmacy, mammography, waiting, staff-break and store-rooms, plus staff quarters. At least 6 patients at once will be able to be accommodated on board, for up to a one week stay, if their post-procedure condition or other reason warrants it. Additional services will include sonograms & hysteroscopy, the dispensing of contraceptives and vaccinations, and providing 2 or more early-trimester or other surgical procedures, per day, in each of 2 ambulatory surgical rooms, and even potentially male health services. .

To ensure their privacy & security, patients may only initially engage the clinic for the mandatory Well Woman exam, and or a recreational day at sea. Though freely available is appropriate, only when onboard can a doctor and the patient approve of controversial services.  Based on capacities, transit and other down-times, clinic operations will be over 5 days a week, and at least 21 days per month. With a daily capacity of about 80 patients, including follow-up visits, that equates to about 22,000 annual 90 minute appointments. That may sound like a lot, but it’s less than 10% of the estimated need within the proposed service area. Thus, demand for the clinic’s service is sure to exceed its capacity.

It is instructive to compare Mariner Medical to the Mercy-Ship floating clinics, whose medical staffers work for free (and also must contribute to their own room and board). In addition, the larger Mercy-Ships handle less than one third of the anticipated annual Mariner Medical patient-load, but have an operating budget at least 5 times larger than that projected for Mariner Medical. In comparison, Mariner Medical staff incentives will include compensation exceeding average US maritime wages, plus a generous allowance toward the cost of their uniforms, travel and their mandated certifications. They’ll have paid off-ship excursions on some of their days-off and will receive a bonus for successful contract-completion. Plus, during their 6-month contracts, staffers’ average workdays will be less  than 9 hours, (far below the maritime average), and they’ll enjoy the same room, board and amenities as Retail Cruisers. .

This proposal is the result of over a year of extensive research and analysis. Rather than just structuring creative financing, the planning process had to deal with each challenge’s solution bringing multiple new complications. This tedious cobra chain was like a game of whackamole. But, this intensive forensic planning was needed, to avoid the failure of similar well-intentioned, but rushed and flawed proposals, whose more than double implementation cost was not feasible. They also would not have serviced as large a region, and were not structured specifically to be attractive to investors, promoters, operators or patients. The means for them to actually operate in compliance with international maritime law, while still being safe and secure from third party intervention was not determined. Nor did solve how to overcome dozens of other complications, including that the Texas and Florida offshore state limits are nine miles, not the three miles of other coastal states. Importantly, since patients can’t be picked up in port, not devising the means to overcome the most dangerous of maritime activities, that of ship to ship patient or personnel transfers, is a guarantee of failure of any other proposal. .  

As a result of this farsighted planning, Mariner Medical’s comprehensive strategy, synergistic team, state of the art facilities, classy fully-certified ship and company-owned high-speed ferry, will facilitate more comprehensive and affordable service than land-based clinics provide. And it will do so safely and confidentially, and profitably but affordably, together with those competitive staff wages and incentives, as well as significant commissions, interest and returns, or profits for successful promoters, lenders, investors and the clinic and maritime operators. Plus, the associated classic retail cruise service, to the entire gulf coast, is something currently unavailable in the region.

While the clinic strategy was designed to be attractive to a profit-oriented medical operator, the clinic could be run as non-profit, if the operator has the wherewithal to source the necessary contributions. If excluding Florida is ever appropriate, 50% more itineraries of 14 days each, for the smaller service area, would be facilitated. If ever appropriate, general medical-surgical service could be extended to the coast of Central & northern South America, where such service is limited. And, the ship could affordably revert back to 100% retail cruising, if appropriate. This flexibility should ensure a good return on the investment under any future scenario. .

The operators will be handed turn-key modern facilities without a large initial capital investment. and most engagement fee will be loaned back as initial operating reserves. The complete operation start-up and out-fitting can be accomplished within 60 days of initial capitalization. Profitability is expected within 6 months and, the anticipated pre-tax income of all operations, capitalized at 8.5%, imputes a total enterprise value of over triple the initial project cost. .

If I’ve peaked your curiosity, please register for more information. Whether as a promoter, investor, lender or operator, we hope you’ll help to get this vital service on the water! That’s it for now. Thanks for your kind attention!

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