Non-cooperative DCI patient

[Manneca]

Maybe you and awap are missing the point: he WAS allowed to dive. His body rejected the dive; now it is a new ball game. Now there is more info than a signature on a medical form.

I do realize he was allowed to dive. The question raised was should he have been allowed to dive. No one seems to have mentioned that the condition the OP was concerned with was a heart attack. The diver had (maybe) DCS. DCS is totally unrelated to heart attacks.

The question is, if a diver comes with a certificate from a doctor saying s/he is fit to dive, should a dive shop employee take a look at the person and decide that the person is not fit. (OK if the diver is drunk or high that could be an exception.)

 

[Duke Dive Medicine]

Klausi, well done. I think you did the best you could for this fellow under the circumstances. You can't force someone to get medical treatment and you can't fix ingratitude or denial.

Re turning down a diver who is holding a medical clearance to dive, I don't believe it's as clear-cut as some posters are asserting. Though it may not apply to this particular individual, I think you have every right to deny service to someone who clearly is not healthy enough to dive. I'm thinking of a person I met once who was obviously in ill health - morbidly obese, legs swollen from fluid retention, pale and sweating after having walked a couple hundred yards indoors - and was telling me all about his technical diving. Or, the individual who's so hung over from the night before that he's vomiting before he even gets on the boat. It doesn't always take a doctor to look at someone and conclude that he or she is at an unacceptably high risk of an adverse event in the water. You can always require that they see a local physician for clearance to dive at at that time. Posters who are castigating you are perhaps forgetting that it may well be you or one of your crew members performing CPR or placing yourself at risk rescuing someone in the water, and your other clients who have to witness the event and may have their boat trips interrupted.

Best regards,
DDM

 

[ev780]

OP Not sure what your role was or how you are involved but I can comment as a once practicing paramedic turned administrator.

Question 1: Should I have nevertheless rejected the person as a diver right away at this point? Can it be reasonably safe at all to dive with 2 previous heart attacks, even for easy recreational dives? Pointers to relevant studies are appreciated. I knew I was legally safe with the medical certificate, but that's not the main point - I just want everybody to be safe.

In my opinion no. Your due diligence ended with a doctor's note. As a physiologist/zoologist you are probably pretty smart in the ways of all creatures but that that was not your role here, I don't think. If it were me (and it is clearly not) I would feel fine with the decisions you made.

Question 2: There is nothing one can legally do to force an adult to accept medical treatment, correct? That's why sometimes Jehovah’s witnesses die from refusing blood transfusions, right? What is the proper procedure in such a situation? I was quite surprised that anyone would be rejecting medical help like that. I made sure he had stated his intention not to go to the hospital to me before witnesses. What else would there be to do?.

More below but in the US for sure there is no forcing anything on anyone. You used some good communications skills and tried your best.

Question 3: How do you best communicate to people ignorant in diving medicine that they are/were in trouble?

You did it.

Based on your post I think you did a great job.

I have no idea what the legal standard for dive operators or doctors in the Philippines is. In the US, if someone shows decision-making capacity, they have the right to make stupid decisions. In the ER, we require them to sign a form, documenting that we informed them of the risks of their decision, and that they are going to do it anyway. We also document meticulously what we said, what they said, and what risks were discussed. If I were in the situation of a dive op or resort that had a patient like this, I would document very thoroughly what the interactions were, and I'd make the person sign something attesting that he was advised to go for treatment and refused. He could have awakened paraplegic, and at least the US reaction to that would be immediately to sue anybody in sight for having allowed it to happen.

This is my world. Paramedics deal with just this sort of thing many times each day. The doc nailed it above although I mildly object to the term "stupid." Everyone is entitled to their own privacy and choices. Picture a flow chart in your head. Does the patient have capacity to make decisions? Do you agree with that decision? Try and convince them to take another path. Still no go? Reassess decision making capacity and then move on. Then go to bed and sleep like a baby. You do not have to be responsible for their decisions and should take no ownership of their choices. Sometimes that is the hardest part. You did your best and gave good advice from what I can see I your post.

I think you are missing the point. Divers who travel to such destinations spend thousands of dollars on such trips. They should not have to be concerned about what additional conditions a dive op may choose to add when they walk into the shop. If shops want to add additional conditions up front, before a contract is accepted, then that is fine. No divers with a BMI over 25%, no divers over age 60, no divers with any history of heart or respiratory problems, PFO free; just put then up front somewhere rather than surprise the arriving customer.

If the shop really thinks it will benefit them to eliminate such potential problems, in advance, then have at it. I'm sure it can only help their bottom line.

It is easy to pick the winning lottery ticket the day after the drawing.

Although a little strongly stated the first time I agree 100%. I would be apoplectic if someone tried to ground me after spending thousands to get there. Let me make my own decisions. Yeah, yeah, yeah, my decisions affect others I know and that is another debate we can have on a different thread.

Had a student once who put "NO" for everything on the medical form... but when he stripped down to his bathing suit he had obviously recent (within ~12mo) saphenectomy and CABG scars.

I do that too! I don't have a CABG scar but I will never give my medical history to some random dive op. That is between me and my doctor. The fact of the matter is that these medical questionnaires and releases aren't worth the paper they are written on most of the time. It will be litigated or it won't. The paper is just one small piece of the big legal picture. Feel lucky that when I die underwater you can point to the form that I lied on and get the case dismissed if by some chance one of my heirs decides to sue. They won't but I guess they could.

If this is something our sport wants to address then we should require a medical certificate similar to pilots. The FAA approved doctor says things are good or not. That is it. No history to anyone other than the doctor or the doc at the FAA if they are working through some issue. Since that is not going to happen in diving anytime soon we need to accept the small number of divers that will get in trouble with their medical history. Just a Darwinian cleansing.

---------- Post added July 9th, 2015 at 12:49 PM ----------

Here in the US you can't turn a patient over to somebody with lesser qualifications, but if you turn them over to somebody more qualified they're no longer your responsibility.

Sure you can. Happens everyday.

 

[redacted]

Klausi, well done. I think you did the best you could for this fellow under the circumstances. You can't force someone to get medical treatment and you can't fix ingratitude or denial.

Re turning down a diver who is holding a medical clearance to dive, I don't believe it's as clear-cut as some posters are asserting. Though it may not apply to this particular individual, I think you have every right to deny service to someone who clearly is not healthy enough to dive. I'm thinking of a person I met once who was obviously in ill health - morbidly obese, legs swollen from fluid retention, pale and sweating after having walked a couple hundred yards indoors - and was telling me all about his technical diving. Or, the individual who's so hung over from the night before that he's vomiting before he even gets on the boat. It doesn't always take a doctor to look at someone and conclude that he or she is at an unacceptably high risk of an adverse event in the water. You can always require that they see a local physician for clearance to dive at at that time. Posters who are castigating you are perhaps forgetting that it may well be you or one of your crew members performing CPR or placing yourself at risk rescuing someone in the water, and your other clients who have to witness the event and may have their boat trips interrupted.

Best regards,
DDM

While I agree you can get into a grey area in this matter, are you suggesting that the op would have been justified in denying service to the customer in this situation? That is, a " 60yo, moderately overweight, and had suffered two heart attacks 8 years ago. He had a medical certificate stating that he was still fit to dive. He was not smoking (anymore?) but drinking alcohol regularly."

 

[PfcAJ]

I, too, just want to be safe. Safe from foolish dive operators who would wait until a fully qualified customer shows up at their shop only to be denied service because someone of limited qualifications thinks he knows more than the doctors.

Scratch another dubious scuba destination. To be fair, I had already scratched the Philippines as a destination based on previous similar threads by local dive professionals. In other words, this is not an isolated incident.

I was in the Philippines a few years ago and I can say with absolute certainty that some shops (maybe even most?) give precisely zero ****s about anything. Tons of fun and I highly recommend.

 

[Duke Dive Medicine]

While I agree you can get into a grey area in this matter, are you suggesting that the op would have been justified in denying service to the customer in this situation? That is, a " 60yo, moderately overweight, and had suffered two heart attacks 8 years ago. He had a medical certificate stating that he was still fit to dive. He was not smoking (anymore?) but drinking alcohol regularly."

Not at all. It's in the fine print above - I wrote, "Though it may not apply to this particular individual..."

Sorry for any misunderstanding.

Best regards,
DDM

 

[spc751]

I do that too! I don't have a CABG scar but I will never give my medical history to some random dive op. That is between me and my doctor. The fact of the matter is that these medical questionnaires and releases aren't worth the paper they are written on most of the time. It will be litigated or it won't. The paper is just one small piece of the big legal picture. Feel lucky that when I die underwater you can point to the form that I lied on and get the case dismissed if by some chance one of my heirs decides to sue. They won't but I guess they could.

I wonder. If you lie on your medical form to the dive op and have a diving accident will your diving insurance company cover you?

 

[BRT]

I wonder. If you lie on your medical form to the dive op and have a diving accident will your diving insurance company cover you?

If it doesn't my heirs will have to use my life insurance.

 

[chillyinCanada]

Wouldn't the dive accident have to be specifically related to the pre-existing condition in your scenario spc751?

I don't share my medical history with dive ops.

 

[WarrenZ]

I don't share my medical history either unless I was injured then it all comes out. Not that there is much to tell.