Bristol inquest of 2018 Tulum student fatality

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DandyDon

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Questions remain after UK diver's death - Divernet
A newly graduated British doctor died on Mexico’s Yucatan peninsula during an open-water course dive – and her instructor called for her phone to seek advice rather than trying to rescue her.

That was the claim made at an inquest held in Bristol this week (24 November) into the death of Dr Olivia Byrom on 8 June, 2018.

Shortly after the fatal incident, a friend of Byrom’s contacted DIVER magazine to say that her family had been left in the dark about the circumstances of her death. DIVER subsequently contacted the main dive-centres in the Tulum area for information but there appeared to have been a news black-out.

PADI told DIVER at the time that a report had been filed and was under review, and that “there will be Quality Management action taken as a result of an incident occurring while the victim was in training”.

Byrom, 29, had gone travelling in Mexico with friend and fellow-doctor Olivia Bird soon after completing her six-year medical degree at Bristol University.

Bird was a qualified PADI diver, though it is unclear to what level. She had enrolled on a refresher course and Byrom on a five-day entry-level course in the resort town of Tulum, though the name of the dive-centre was not given in reports on the inquest by the Bristol Post and Daily Mirror.

Coroner Jason Pegg heard that Byrom had dived on 5 and 6 June without issues, but had taken the following day off after showing signs of heatstroke. Feeling better on the day of the incident, she had gone for an 18m dive with her friend and an instructor named only as Peggy.

It was not clear from the reports at which point if any on the dive the instructor had left the other two divers. Bird told the coroner that Byrom “was ahead of me all the time, and I was conscious that when diving you need to be close to each other”. They had ascended a buoyline and carried out their 5m safety stop, during which she said Byrom had “seemed fine”.

They had stopped again 1.5m below the surface, and Bird said she had given the OK signal to Byrom before completing the ascent, but that she had shaken her head.

“I was quite confused, I didn’t really know what was wrong,” Bird told the coroner. “She then turned away from me as if she was fiddling with something.” At the surface she realised that Byrom was no longer with her, and looking down could see her descending “almost horizontal – on reflection, I wonder if she was unconscious”.

At the surface Bird had alerted the instructor, who she described as “confused”. She said that instead of diving in to look for her friend she had asked someone to fetch her mobile phone from her car so that she could call a superior for advice.

Byrom’s body was later found by another diver on the seabed at a depth of 25m. A post mortem showed that she had died from drowning, and that there were no other medical conditions. No problems were found with her BC or other diving equipment.

The coroner commented that, although he would normally have the power to make a report to avoid the risk of future deaths of this sort, his jurisdiction did not extend to Mexico.

“There was a delay in seeking assistance for Liv, the instructor didn’t go down to seek to rescue Liv and the safety system in place was inadequate,” he said, concluding that Byrom died of drowning caused by a scuba-diving accident. “I find the procedures in place, the safety mechanisms, were inadequate and that did play a part in Liv’s death.”
 

nolatom

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Don, I have neither the experience to say much, nor enough info to discuss even if I did.
The dive was two and a half years ago. And no one knows why this physician-diver had such trouble at the safety stop? And there was an Inquest by a Coroner in Bristol, UK, last month? Where have PADI, and instructor "Peggy" been in any of this?

If the point of the inquiry is to warn others that a Tulum dive outfit/instructor, local authorities, and PADI, didn't investigate and thereafter blew everyone off about this incident until a valiant Coroner far away rattled the cage (though he wasn't going to write up a report?), then okay I guess.
 

DandyDon

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If the point of the inquiry is to warn others that a Tulum dive outfit/instructor, local authorities, and PADI, didn't investigate and thereafter blew everyone off about this incident until a valiant Coroner far away rattled the cage (though he wasn't going to write up a report?), then okay I guess.
Hypothetically speaking, if it happened to me, I'd expect the locals and Padi to ignore it and hope it goes away before it hurts business.
 

boulderjohn

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PADI has no power over anything other than the instructor's credentials. In all other cases I know of in which an instructor was determined to be negligent in the case of a fatality, PADI expelled the instructor, usually pretty quickly. That's the most they can do.

So what else can happen? As shocking as this may seem, there may have been no law broken here. I don't know what such a law would be. The only recourse really would be a lawsuit, and it is my understanding that such lawsuits are rare in Mexico.

About a week after this incident, there was a fatality on the mainland, near Tulum, and it makes a telling comparison. I know the details pretty well because I wrote the official report of it for the NSS, which documents caving and cave diving incidents in North America.

A group of tourists contracted with an instructor to provide a Discover Scuba experience for 10 of them. He chose to do it in the Cenote Manati, a very large cenote just off the ocean north of Tulum. It is a very dangerous dive site because the exit tunnel from the cenote runs under the road and into the ocean, creating an effect similar to the outlet of a funnel. When they arrived, there was a whirlpool visible on the surface at the exit tunnel. The visibility was very poor. The instructor who had been contracted apparently did not enter the water but instead stayed on the shore while two other instructors he had brought along took care of the 10-person Discover Scuba class. (I hope you have all seen enough red flags at this point to have your eyes wide with wonder.)

Not long after the Discover Scuba started, students started popping to the surface in fear. This was not what they were expecting. Two of the students were too near the exit tunnel, and they were being pulled into it. One of the instructors managed to pull one of them out, but the other was sucked in. They hoped he would pop out into the ocean, but that didn't happen. They contacted nearby cave divers for help, but they were not able to recover the body, wedged in some rocks, until the next day.

As all this was happening, the two instructors who had been in the water with the students realized things were not looking good for them, and they fled. They were never identified, and some believe they were not even instructors. The instructor who had hired them for the class apparently refused to identify them. He himself was expelled as an instructor immediately, but when I wrote that report, he was still advertising his services for instruction with a different agency. At the time I wrote the report, no legal action had been taken against anyone.

By the way, the main reason I believe the instructors in the water were not actually instructors is that the one named instructor is the only PADI member expelled in that area that week. It is possible that the instructors were actually named, but the agency could take no action because they were not actually instructors. It is also possible that no actual law was broken, so that is why no legal action was taken against them.
 

rjack321

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KathyV

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This is from Undercurrent:

Mexican Dive Centers Close Ranks over Fatality. There was an apparent information blackout regarding the death of a newly graduated British doctor, Olivia Byrom, 29, while diving in Mexico's Yucatan peninsula in June 2018. British journalists found Tulum dive centers to be tight-lipped when they contacted them for further information about the guide's actions, and they would not name the dive center involved. (We're not surprised. Undercurrent has been warned in the past when making similar inquiries about other fatalities in Mexico.) The deceased's buddy, Dr. Olivia Bird, told the Bristol Inquest (UK) last month that she only knew their dive guide as Peggy, and that they had ascended to within six feet of the surface when Byrom began descending again. (On reflection, she wondered if Byrom was unconscious at that time.) The Coroner concluded that "an inadequate safety process contributed" to the death. Daily Mirror
 
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Very shocking to read this and it just should not have happened. I knew Liv and her family pretty well as a fellow skier and her accident was truly saddening.
I was really surprised when this happened that there was almost nothing on social media - a complete lockdown. I was in touch with Diver Magazine who contacted the British embassy in Mexico at the time and got very little info other than the accident had happened and that "an investigation" was underway.
An awful loss still felt.
 

Kinasi

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It seems that the least experienced diver was the last to be left in the water when she should have been the first to leave the water safely. According to PADI within a buddy team the higher qualified diver is responsible for the less qualified diver. I think that rule was broken in this case. Poor lady, may she rest in peace. What a terrible loss, and so easy avoidable.
 

Sevenrider860

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It seems that the least experienced diver was the last to be left in the water when she should have been the first to leave the water safely. According to PADI within a buddy team the higher qualified diver is responsible for the less qualified diver. I think that rule was broken in this case. Poor lady, may she rest in peace. What a terrible loss, and so easy avoidable.
In what training material does PADI state that one diver in a buddy team has a higher level of responsibility than the other?
 
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