An Open Letter of Personal Perspective to the Diving Industry by NetDoc

[Ayisha]

Those expert witness statements are not the only expert witness statements, and not all of the expert witness statements agree with the Instructor's witness statements that you quoted.

They still agree on some things, however. From your quote:

David was cleared to dive:

FROM the Motion to Dismiss, but the expert report of the Instructor's Expert witness:

However, a document was provided to Douglas signed by a medical professional that specifically cleared Tuvell for diving activity and
made no mention of any other predisposing conditions including recent
manifestations of RAD. At face value, this document met the review criteria for medical fitness to dive required by a PADI instructor and Douglas accepted it in good faith with no knowledge that the full disclosure of Tuvell’s respiratory
conditions had not been made.

David's mother was forthcoming:

On October 1, 2010, just 11 days after he prescribed antibiotics and daily doses of inhalants to treat Tuvell’s ongoing respiratory problems, Shrawder completed the “Physical Examination” page of the Annual BSA Health and Medical Record (“BSA form&#8221 on behalf of Tuvell. Shrawder indicated on the form that Tuvell’s ears, nose, and throat were “[n]ormal” despite the fact that Sherry Tuvell indicated on an earlier page of the form that he had “[e]ar/sinus” problems and asthma—and her son was taking medication to treat asthma.

In the blank to the left of the “Do you have active asthma…?” question,
Christopher Tuvell wrote, “YES” in capital letters. In the blank to the left of the “Do you have a history of respiratory problems…?” question, the word “NO” is written in capital letters.

In the event of any “YES” answer, the short PADI form requests that the participant consult with a physician prior to diving and to bring an instructor supplied PADI Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination (“long PADI form”). The long PADI form is an extremely comprehensive document that informs a physician of medical conditions that can pose a risk to divers.

The Tuvell's were not provided a long PADI form and did not fill one in. Yet the expert witness mentions "if completed correctly", implying it was filled in incorrectly:

Because the BSA did not provide the PADI long form to scuba participants, the long PADI form was never completed by the Tuvells or any physician.

If completed correctly by the Tuvells and a physician, the long PADI form may have prevented Tuvell from scuba diving. This is especially true given that Tuvell was taking daily medication for asthma and RAD, and he had been treated for an acute throat infection and bronchitis after participating in Boy Scout overnight camping just six weeks earlier.

David was never diagnosed with asthma:

and from the medical expert:

David certainly appears to fit this description but it is impossible to know for sure if he had RAD/asthma and Case 1:12-cv-00128-DB Document 200-1 Filed 12/15/14 Page 10 of 36 Expert report by Dr. David Sawatzky reference David Tuvell Page 10 how serious it was because the testing required to clarify the extent of his disease was never performed.

David was "medically fit":

On 1 October 2010, the rest of this form was completed by Brian Shrawder, the Physician’s Assistant who worked at Anthem Hills Pediatrics, indicating that David was medically fit to participate in every Scouting activity including Scuba diving.

Isn't there or shouldn't there be a time limit that the form is valid for? For example, 6 months or less...

It is also of note that this form, clearing David as medically fit to scuba dive, was completed 9.5 months before the dive actually took place.

In summary, David clearly had allergies, RAD and most likely asthma...
From a diving medical perspective, it does not matter whether David’s respiratory problems were RAD or asthma. The significance of RAD and asthma for scuba diving are the same. They both greatly increase the risk of a diver suffering from pulmonary barotrauma and arterial gas embolism, even with a slow and controlled ascent. David Tuvell should not have been scuba diving on 13 July 2011, and his parents and medical care providers should have known this before they allowed him to do so.

Again, a reference to if the Tuvells had "accurately" completed a form which they were never given and never filled in. The entire section after this, that I didn't include, is items from the long form that the Tuvells were never given:

If the Tuvells had accurately completed this form,
they would have answered “YES” to at least two questions:
1. “Are you presently taking prescription medications?”
and
2. “Have you ever had or do you currently have… [a]sthma, or wheezing with
breathing, or wheezing with exercise?”
In addition, the Tuvells sould have answered “YES” to the questions:
3. “Have you ever had or do you currently have . . . [f]requent colds, sinusitis or
bronchitis?”
and/or
4. “Have you ever had or do you currently have… [r]ecurrent ear problems?”
Any “YES” answer requires the participant to get a physician to certify their
fitness for diving. The physician is referred to four pages of attached medical
guidelines and is then required to choose one of two “impressions”:
1. “I find no medical conditions that I consider incompatible with diving”
or
2. “I am unable to recommend this individual for diving.”

Douglas reports that the long PADI form was not used. Instead, protocol was to accept the BSA medical form and the short PADI form. If this was the protocol, it is not written anywhere. In fact, Blue Water Scuba of Logan’s own web site indicates that the Tuvells should have been required to complete the long PADI
form.

So, David was never diagnosed with asthma.
Asthma was checked off on the PADI form.
David's mother was forthcoming about his health issues.
David's father checked off yes for asthma, but no for a history of respiratory illnesses, so that appeared to have not been correctly filled in.
David was cleared to dive.
A 9 1/2 month old medical form was accepted.
The family was not given a long PADI form to fill in, as they should have been given.
There is no evidence that asthma contributed to David's death.

How about including some of the other expert witness statements to give a more balanced view?

 

[Omisson]

Ayisha -So let me get this straight - in YOUR WORLD-

According to you - David was NOT Asthmatic - BUT his father checked YES to that in the Medical Form...

And that IS an Accurate Statement....

David's father checked NO to David having a history of respiratory illness (which David clearly did have in spades according to his own medical records ).

But THAT is JUST mistake...not an incorrect answer on the medical firm- right?

Gotcha.

BS.

 

[Ayisha]

Ayisha -So let me get this straight - in YOUR WORLD-

According to you - David was NOT Asthmatic - BUT his father checked YES to that in the Medical Form...

And that IS an Accurate Statement....

David's father checked NO to David having a history of respiratory illness (which David clearly did have in spades according to his own medical records ).

But THAT is JUST mistake...not an incorrect answer on the medical firm- right?

Gotcha.

BS.

I wrote that was not correctly filled in. Which means the same as "incorrect" as you just stated. That part of my post again since it wasn't clear to you:

David's father checked off yes for asthma, but no for a history of respiratory illnesses, so that appeared to have not been correctly filled in.

What do you think the difference would have been? A long PADI form was supposed to have been given to the family and filled in by a physician even with just the asthmatic condition being checked off. The Boy Scouts didn't give the long form to the family. The instructor didn't give the long form to the family as he is required to by PADI. The Instructor said it was not even a policy of the dive shop to give a long form, so what makes you think another "no' answer would have suddenly inspired this instructor to suddenly adhere to procedures and standards?

The majority of mistakes were made by the instructor, some by the physician's office, and perhaps one by the parents. The physician, physician's assistant, the mother who is a respiratory therapist, and some of the expert medical witnesses believe the child was fine to dive. There is no evidence that asthma contributed to David's death.

I had said way back in one of these threads that if all the forms were filled in correctly, that child may not have gone diving that day and may have lived to see another day. Not necessarily because of the condition of his health, but the entire fateful dive and series of events wouldn't have happened.

 

[Huzzar]

This is what the medical professional signed on the 2011 printing of the BSA medical form, Part C. Each is actually a True/False check box. Note that the last one is a True/False for a youth that wants to SCUBA.

EXAMINER’S CERTIFICATION
I certify that I have reviewed the health history and examined this person
and find no contraindications for participation in a Scouting experience.
This participant (with noted restrictions above)
True False
Meets height/weight requirements
Does not have uncontrolled heart disease, asthma, or
hypertension
Has not had an orthopedic injury, musculoskeletal
problems, or orthopedic surgery in the last six months
or possesses a letter of clearance from their orthopedic
surgeon or treating physician
Has no uncontrolled psychiatric disorders
Has had no seizures in the last year
Does not have poorly controlled diabetes
If less than 18 years of age and planning to scuba dive,
does not have diabetes, asthma, or seizures

Part A of the form is the parents' assessment of the child's medical history and includes Yes/No and an opportunity to explain the following conditions:

Asthma Last attack: ____________
Diabetes Last HbA1c:____________
Hypertension (high blood pressure)
Heart disease (e.g., CHF, CAD, MI)
Stroke/TIA
Lung/respiratory disease
Ear/sinus problems
Muscular/skeletal condition
Menstrual problems (women only)
Psychiatric/psychological and
emotional difficulties
Behavioral disorders (e.g., ADD,
ADHD, Asperger syndrome, autism)
Bleeding disorders
Fainting spells
Thyroid disease
Kidney disease
Sickle cell disease
Seizures Last seizure:____________
Sleep disorders (e.g., sleep apnea) Use CPAP: Yes No
Abdominal/digestive problems
Surgery
Serious injury
Other



Wouldn't these items tip off a licensed respiratory therapist that SCUBA and respiratory problems might not be compatible?

 

[RJP]

David was never diagnosed with asthma:

How do you figure that? Why was he taking asthma medication (albuterol and montelukast) then?

 

[The Chairman]

Let's say you are OK with it philosophically. The second issue is whether it will do any good.

I mentioned this earlier, but it is hard to think of an occupation with more intense oversight built into the system than with public school teachers. When you count the totals for college preparation classes, student teaching, state exams, other certification requirements, continued observation, evaluations, continuing education, and recertification, the cost and the number of people involved is really a staggering portion of the total cost of education today. Yet, you don't hear a lot of people talking about how it has produced a teaching force uniformly filled with exemplary instructors.

Great points, John.

Yes, I would like to see a higher (more neutral) bar for instructors.
No, simply adding bureaucracy does not necessarily give us better results.

I would suggest that at this point, we've all but left the original topic. We're probably doing ourselves a disservice by devolving into the tangential issues that should be the target of the inquiry. My problem is with Carney and SDI using this tragedy to increase their market share by feigning outrage at events that simply did not happen. Am I being too cynical here? Do you think Carney was being manipulated or is he being disingenuous and doing the manipulating? The charges against PADI are as clever as they are false as far as I can see. What I would like know, and probably never will, is what Carney was thinking? It's my cynical belief that he either contrived this whole unethical attack, or he was dumb enough to allow himself to be the lackey for it. Are there any other options that I am missing, because both of these are rather harsh? Is there some evidence that we have not been given that will show that he was on target in his attack? If there isn't any additional evidence, will this faux pas cause any lasting damage to SDI? I hope not and I hope it doesn't hurt PADI either.

Yes, the interwebs have left me cynical as all heck. When Sony pulled the Interview, all I thought was "what a great marketing ploy!" I even suggested to others that the movie would be shown on Christmas day and it was. It's not getting good reviews, it's a turkey and it really doesn't matter since they made it patriotic to go see the movie. Brilliant! But they didn't use the death of a Boy Scout in the process. That's what really galling me, I think. If someone trips and stubs their toe, go ahead and laugh, making fun of their seeming inability to walk a straight line. If the trip results in much worse than that, then we need to refrain from taking advantage of the situation. That's only ethical to me.

How do you figure that? Why was he taking asthma medication (albuterol and montelukast) then?

Interesting point. I know that Scouts' parents learn quickly that admitting medical issues often result in their child being left out of certain activities. This can be compounded by instructors telling the parents before or during them filling out the forms that indicating any problems will keep their children out of diving. Ethical parents will still be truthful. The "I didn't understand the risks" is a BS move on their part. Denial runs rampant in our society and it's costing us billions of dollars in litigation. I would love to see tort reform and limits liabilities to out of pocket expenses only: no more injury/death lottery awards. We just can't afford them.

 

[29Clyde]

OK here it is:

I believe Brian was given BAD info, the rumor mill spurred it on, the anti-PADI crowd took up the charge and then legal parasites needed to create a narrative that shifted the blame to the deep pockets- and here we are.

I am curious why you are willing to give Carney the benefit of the doubt in this case. Suspending my belief that he knowingly penned a letter full of lies, as a person in a highly visible leadership position within the industry he has an obligation to be extremely thoughtful with his public statements. That bar is at its highest when he is publicly attacking a competitor with highly damning allegations. Layer on the fact that he knew, or should have known, that the timing of his letter's release was bound to raise eyebrows even among those who accept his words at face value and you have a situation that demanded he know all of the details of this case, the issues that are known as fact, and those that are subject to debate. People are elevated to leadership positions in part because they show good judgement. If he failed to perform independent research of the facts prior to writing this letter, he failed. If he trusted the words of others around him without double checking the facts, his judgement was wrong and he failed. If he knowingly penned a letter with lies, he failed.

Remember, according to his own words, nobody forced Carney to write this letter. He made a choice, he signed his name at the bottom of the letter, and at this point he needs to own it. I realize that his lawyers are likely preventing him or the organization from further commenting but without any additional facts or explanation, I do not see how it is possible for me not to view both Carney and SDI in the dimmest possible light.

 

[The Chairman]

In the "Almost 2phunni2b true" category: I just learned that Brett Gilliam is the "expert witness" for the defense. He's also the guy who founded SDI/TDI. Could we get any more of an impeachable witness here? I'm sure Gilliam is a great guy and an expert in his own right (or at least his own mind), but he's far from ever being perceived as non-biased when it comes to his baby agency. How could anyone trust a single thing he has to say on this topic? The irony is too sweet here and I'm finding my self chuckling the more I think about it. Kudos to the attorneys if they pull this off with out the obvious connection being seized upon by opposing attorneys and being paraded around as the farce that it is. They say that reality is stranger than fiction and in this case, that's a true, true statement.

People are elevated to leadership positions in part because they show good judgement.

That's not always true. Luck, money and the Good ol' Boyz club can bypass that easily. Heck, I'm here mostly by luck.

If he failed to perform independent research of the facts prior to writing this letter, he failed. If he trusted the words of others around him without double checking the facts, his judgement was wrong and he failed.

It's why I took so long to pen my letter. I checked. I double checked. I let both sides woo me and critically evaluated their every argument. It upset my sense of fairness, that's for sure.

 

[decompression]

Stunned...


Sent from my iPhone using Tapatalk

 

[Ayisha]

How do you figure that? Why was he taking asthma medication (albuterol and montelukast) then?

Those medications are prescribed not only for asthma, but suspected RAD's as well. Each year, I have at least 2 or 3 students with prescribed inhalers, but most have not been diagnosed with asthma, they are prescribed them for symptoms of RAD during respiratory illnesses, and most outgrow them. I'm not a doctor, I can't diagnose anyone. I don't know how anyone here can diagnose this child either unless they are a physician who actually examined the child. Even the expert medical witnesses cannot say that this child was in fact asthmatic.

Something that is interesting is that even in these expert medical witness statements above, wheezing never seems to have been documented, even though the illnesses David had would be known to trigger wheezing in a person with asthma. Where are asthma attacks documented?

Again, why are we indicting the child and assigning a cause of death simply because he may have had asthma? By the logic of some people on this thread, if for example, someone is hypertensive and going toward the surface with the reg out of their mouth, can't quite get there and sink, they must have died because they were hypertensive. Can't possibly be any other explanation. Right.

If the instructor felt that people with asthma should arbitrarily not dive, the instructor had the ultimate choice of whether to accept the child or not based on even his short medical form clearly marked with yes to asthma and he may have had access to the BSA medical with more details. The instructor chose to accept the child anyway. The information that the instructor had should also have been a gateway to requesting clarification of the severity, frequency and nature of his illnesses before deciding on a course of action, diving or not.