Medical Approval Issues

[redacted]

Give your "could" and your "if" it seems pretty low probability, don't you think? In any case, recreational scuba divers are not licensed....they are certified as having passed a class. Your fear is really kind of out of bounds...it would be a state matter, not a federal matter, and the gains would be rather minimal for the effort and the bureaucracy. There are plenty of other personal safety issues that are higher on the list of concerns....and also ignored. Your very hypothetical argument is really a waste of your (and my) time.

I agree - very low probability; unless the scuba industry effectively lobbies for such actions. I used the term license as I suspect that if medical clearance became law, scuba certs would be replaced by scuba licenses. State matter, federal matter - do you think this is like marriage? I am not suggesting for a minute that is the way it should go. But, if it is really important to get entirely truthful and honest medical information, that is probably the route that will be required.

Wasting time!?!?!?! This is Scubaboard.

---------- Post added August 17th, 2015 at 08:19 PM ----------

Not sure where you get this; I've made no such "report" regarding this..

I'm pretty sure you did in another thread. Something about a diver who had a heart surgery scar. Am I mistaken?

And, I do understand. You are on the provider side and would like all the benefits and protection you can get. It is not like you need the money so there is no reason to compromise with any cost/benefit considerations.

I am on the consumer side and do not have to put up with the expense and burden of doing what you would like me to do. And I am pretty sure I am not alone. Perhaps there is a systemic problem here that could be addressed by....

Have you tried suing anyone for lying on that form? After all, anybody can sue anybody for anything. Perhaps you have some doubt you would prevail?

 

[RJP]

But, if it is really important to get entirely truthful and honest medical information, that is probably the route that will be required.

You know what seems to work pretty well... asking students who sign the medical form to also sign a separate form attesting to the fact that they have truthfully executed the medical form, and that they understand that:

• if it becomes known that this is not the case once the course begins they will be dropped as a student with no refund
• if anything on the form changes from "NO" to "YES" during the course they will be required to get physician clearance; if they are not cleared they will have the choice of receiving a pro-rated refund or completing the course at a future date if they are able to be cleared

You'd be surprised how people's "memory" improves after reading the second form.

 

[panzerbjorne]

Late last year, someone started a thread asking Would you let my wife dive? In this thread, some of us strongly but civilly debated the issue of falsely reporting a negative medical history to prevent being denied services, and the counter issue of potentially putting a burden on dive op.s & their staff should a significant medical event unfold. Since the topic has come up in this thread, I thought it worthwhile to link to one where it's been hashed out pretty well.

Richard.

Thanks for the link Richard. You had some interesting posts and points over on that thread. I don't really think that it's a parallel thread though considering that I've already been checked out by docs and their issue is not my fitness to dive but their lack of desire to be implicated in the liability process for a risky sport that they know nothing about. I'm already working on getting a referral to a DAN dive doctor in my region (I say region because the only DAN dive doc on my insurance network is 70 miles away and only works that location one day a week) in hopes that he's just willing to confirm the results of my FEV1/FVC functional tests before and after strenuous exercise and willing to put his neck on the line for my interest in a risky hobby. Living in California, everyone is afraid of being sued, and the dive operators and charters are no exception - they want to blame a doc and the doc doesn't want the blame.

I find lying on the medical questionnaire to be morally reprobate but given the broken system and lack of people being permitted to take personal responsibility for themselves (and yes RJP, the responsibility of others like DMs and instructors and buddies as well) you don't really have much of an option in California. You put all YES on your form regardless of your health conditions because that's the only way you get to dive in California. Blissful ignorance is more important here than informed honesty and compassion.

RJP, I still don't buy your argument, because by being an instructor to begin with, you take on the burden of responsibility every time you dive even for people in perfect physical condition. Do you test the IQ of divers before taking them in the water? Do you test their ability to follow clear orders? Do you test their ability to perform basic physical tasks quickly and effectively with little practice and training? You've already put yourself in the line of fire and you're still complaining that people shouldn't dive because it's a risk to people like you. Well, if nobody dives, how do you instruct them?

Don't take my word for it, ask DAN why 52% of divers intentionally lie on their medical forms. Every single time a diver of any condition goes on a dive with you, you're at risk. Picking on people who may have a VERY SLIGHT increased risk or people who can't find a doctor willing to paint a target on themselves and assume your responsibility for you doesn't justify your arguments. If you have a problem with the system, take it up with the system and push a torte reform platform. Your complaint is your personal liability, which is everyone else's complaint as well. If nobody is willing to take on the liability and the diver isn't allowed to, how does anyone dive at all? According to DAN 52% of them lie on the form. That means the system's broken my friend. Your argument should be directed to the dive agencies.

 

[tursiops]

You know what seems to work pretty well... asking students who sign the medical form to also sign a separate form attesting to the fact that they have truthfully executed the medical form, and that they understand that:

• if it becomes known that this is not the case once the course begins they will be dropped as a student with no refund
• if anything on the form changes from "NO" to "YES" during the course they will be required to get physician clearance; if they are not cleared they will have the choice of receiving a pro-rated refund or completing the course at a future date if they are able to be cleared

You'd be surprised how people's "memory" improves after reading the second form.

Brilliant!

 

[panzerbjorne]

It works here for flight physicals mandated by the FAA. Is that really where you want to go for scuba? One more nail?

OMG that nightmare. I'm a licensed private pilot in the US and the rigor you have to go through for your Medical Third Class certification is frightening. I've had to do sensory deprivation pods for 5 hours and the wakeful attentiveness test for 5 hours as well before to clear the MTC in prior years. Interestingly, all of the medical issues for flying are non-issues for diving, and my issues for diving are non-issues for flying. Ain't that the rub? The one condition that was never questioned for a pilot's MTC was asthma, and in diving it's the only thing questioned.

See, I figured the dive agencies would have the same kind of kickback deal already worked-out with the dive docs that the FAA has with flight docs. Color me surprised that's not the case. That being said, no doctor had to sign-off on a form that made them personally liable for my flying, so in that sense diving is a little medieval in comparison. Maybe a gov't oversight would actually improve that fact.

 

[tursiops]

The one condition that was never questioned for a pilot's MTC was asthma, and in diving it's the only thing questioned.

The inaccuracy of this statement is so high that it makes me question the rest of your "facts."
I assume it is just unthinking hyperbole.

 

[panzerbjorne]

You know what seems to work pretty well... asking students who sign the medical form to also sign a separate form attesting to the fact that they have truthfully executed the medical form, and that they understand that:

• if it becomes known that this is not the case once the course begins they will be dropped as a student with no refund
• if anything on the form changes from "NO" to "YES" during the course they will be required to get physician clearance; if they are not cleared they will have the choice of receiving a pro-rated refund or completing the course at a future date if they are able to be cleared

You'd be surprised how people's "memory" improves after reading the second form.

I'd sign that second form if I couldn't get a doc to bend over to assume your liability. I bet nearly 100% of the 52% of divers that have reported to DAN that they lied on their forms would, too.

Here's the funny thing about the internet and how law works, RJP. By coming onto a public forum and basically exuberantly trying to bully people into hiding their medical conditions instead of encouraging them to be honest about them, a smart prosecutor could easily pin MORE blame on your actions socially and sway a jury to find your negligent for not promoting an open and honest environment in your personal practice. Like that guy who has asthma but was cleared with a 97% on his FEV1/FVC action, but because you were a bully and he couldn't get reasonable medical sign-off due to liability concerns, he lied on his forms to take your class. On a dive, he had an asthma attack and was able to surface while still conscience and able to have their condition improved, but out of fear of being "outed" for a trivial medical issue didn't bring his inhaler or inform anyone he had asthma, the attack went untreated and he passed out and suffocated on the trip back to the dock. During the investigation it is found they have a medical history of asthma, and you know what? The jury is gonna be REALLLLY curious why that guy couldn't tell you that they had asthma. By denying service and bullying people you force them to become subversive and that comes back around on you when there winds up being an issue. You're breeding a social norm of subversiveness by discriminating against people (yeah, I'm using that word again, sue me) and that alone can get you in legal trouble when the poo strikes spinning blades...

---------- Post added August 17th, 2015 at 07:17 PM ----------

The inaccuracy of this statement is so high that it makes me question the rest of your "facts."
I assume it is just unthinking hyperbole.

The probability that you read the statement out of context is ridiculously high. Is it a fact? In the context of me, it absolutely is. The only "Yes" on my diving medical form is to asthma. Everything else is an honest "No". And for FAA MTC the asthma was not even questioned because it's treated and not identified by the FAA as a contraindication in any way to piloting a private aircraft. However they did indeed take issue with my sleep apnea (which isn't asked about on the diving form at all or in any way) which the FAA has a really big stiffy about because one pilot passed-out in-flight back in the 90's because of apnea-induced narcolepsy. Turns out that two 5-hour sessions in sensor-dep and wake-atten tests really makes them feel good about you being in the air (and a doctor's note wasn't good enough for them, because I had one of those too).

If it makes you feel better, though, most of my life is about hyperbole - mostly the hyperbole of governments, businesses and societies. Because I have to deal with those every day.

 

[oly5050user]

Not sure where you get this; I've made no such "report" regarding this.

Does having a truthfully executed medical form prevent any and all medical issues, including those not related to previously known underlying medical conditions? Of course not. To suggest otherwise would be silly.

Could having a truthfully executed medical form including physician clearance (or denial, if appropriate) prevent issues related to KNOWN medical issues? Of course. To suggest otherwise would be silly. I've mentioned two specific cases in this thread where the [-]diver[/-] victim would never have been in the water - and therefor would still be alive - if the medical form were truthfully executed.

Ultimately, I guess my issue with people lying on the medical form is the arrogant and selfish supposition that they have the right - absolutely, unilaterally, and completely without my knowledge - to increase the level of risk that I assume in accepting them as a student.

Please don't try to convince me - or yourself - that doing so is a matter of "accepting personal responsibility" in any way. It's the complete opposite.

If the drug using student I pulled out of the water was truthfully on the form I never would have had to put myself and others at risk in performing a rescue. Nobody has the right to put others at risk needlessly in this activity. Someone who lies on the form puts not only the instructor doing the training at risk or other students at risk, but also puts at risk any people they may dive with in the future.

 

[panzerbjorne]

Your PCP is already aware of the issue and I assume sent you to the first specialist. I don't see why a simple phone call and request to see the other doc could not be honored with out the need for another visit to the PCP.

Because in my PPO, a doctor's visit is required to get a referral to a specialist. I realize you're an NP, but I've never known a clinic/network to turn down free money by forcing patients to come in and pay a visit fee. I used to be married to a PAC and stupid rules like that infuriated him but that's the joy of networks.

---------- Post added August 17th, 2015 at 07:45 PM ----------

If the drug using student I pulled out of the water was truthfully on the form I never would have had to put myself and others at risk

Some recent studies by NIMH indicate that over 85% of American adults routinely use recreational drugs (including alcohol). Do you think they'll all mark "Yes" on the medical form? Let me rephrase that - do you think ANY of them will mark the line as "Yes"?

If they do, you're likely going to straight-up deny them training. Which means they will bop over to the next dive shop and, lesson now learned, not be truthful on the form.

Would that cocaine user still be alive if they had answered "Yes"? Maybe. Or maybe they would have died of a drug overdose instead of going on your dive had you denied them. The answer can only be speculation.

It's a fast and easy lesson to learn to not be truthful on your diving medical form, I learned it without even being denied a first time (thank the internet).

I see it as a failure of the diving industry to be realistic and fostering a culture of misplaced liability and bullying potential divers. Don't try to tell me that you never have a few drinks now and then - but then you'd have to change the answer on your medical form too - would your employer still keep you on as an instructor then?

At the end of the day, the decision to dive is between you and your doctor and family. And only you can be held accountable for your inclusion of a doctor and family in your decision. If dive instructors/operators are being sued over an individual's choice to take part in the hobby then I assume that's where the issue lies and needs to be addressed. If it's fear of death, well... You best enjoy an indoor life, because stepping outside your door exposes you to risks and a lot of stupid people more than happy to remove themselves from the gene pool. What would possess you to take up instructing in a risky hobby?

 

[uncfnp]

Because in my PPO, a doctor's visit is required to get a referral to a specialist. I realize you're an NP, but I've never known a clinic/network to turn down free money by forcing patients to come in and pay a visit fee. I used to be married to a PAC and stupid rules like that infuriated him but that's the joy of networks.

Unfornatuely I can't argue with this. I work in an Urgent Care that doesn't traditionally have the relationship with their patients that, at least in theory, a PCP should. And yet, I think that in many cases we are more responsive to patients and calls then their PCP's are. I have trouble getting through to my own NP and I know the system!

I realize it's strictly a theoretical discussion but making physicals federally mandated will not guarantee diver's honesty on the questionnaire. I do DOT exams and not only do drives lie on the form but to my face as well. Sleep apnea is a common one, as well as heart and lung issues, medications. Like oly5050user I have seen sternotomy scars on patients that deny any medical issues or medications.