NAUI and Diabetics

[uncleavi]

I have two passports and under UK law it is termed death by misadventure.
I miss my lower liability and Cornish Pasties but, I am here and at least there is nice diving.

 

[MeiLing]

This board is used internationally, so let me point out that the insane liability laws that you are referring to apply in the US only. In every other country that I've lived in the initial presumption is "caveat emptor", modified according to what actually transpired.

The fact is that many diabetics do dive safely, so defending yourself in the event that your diabetic student died as a consequence of diabetes should be quite simple. Just quote cases to illustrate that your stance was reasonable.

You're right about this kind of liability existing only in the US. Yes, everywhere else the presumption is "caveat emptor". In the US, it is more like "whoever has the deepest pocket should pay in spite of the fact that I should know what my risks are".

When it comes an arguement of whether or not many diabetics can and do dive safely, one could easily make the reverse argument, that many drunks can and do make it home alive without hurting themselves (or someone else). Just because an accident didn't happen this time wouldn't mean it couldn't happen the next time. Forget the fact that a diabetic could, theoretically, die just as easily sitting on their living room sofa!

Yes it is a weak argument, but when some high-priced lawyer, working on contingency, trots out the grieving relatives, American juries fold like a lawn chair. Furthermore, can you really afford that kind of a fight.? Here a contested divorce can run you $100K.:11: I would imagine defending a personal injury suit is far worse!

 

[peterbj7]

Well, fortunately I don't have to put up with that nonsense as I don't live in the USA. I get Americans coming down here who try to inject that sort of thinking into what we do here in Belize, but I and most others just ignore them. They'll learn.

I've lived and worked in Hawaii (at the Observatory on Big Island) and found that once you get away from the tourist areas there's quite a groundswell of thinking of the USA as an occupying force. A lot of people there seemed to wish to return to independence with an association with the USA. Am I right? I'm wondering whether the American litigious society permeates Hawaii to the same extent as the mainland.

 

[MeiLing]

I've lived and worked in Hawaii (at the Observatory on Big Island) and found that once you get away from the tourist areas there's quite a groundswell of thinking of the USA as an occupying force. A lot of people there seemed to wish to return to independence with an association with the USA. Am I right? I'm wondering whether the American litigious society permeates Hawaii to the same extent as the mainland.

There is that thought process of the US as an occupying force on all the islands among the Hawaiian population. However, the population with Hawaiian blood here is very small overall.

It may have seemed as though it was stronger on the Big Island because of the socio-economic conditions there. Quite frankly, there isn't much at all in the way of industry on the Big Island at all. No work breeds disenfranchisement pretty quickly. My Mom lives on the Big Island in Volcano Village.

Yes, the litigiousness is everywhere in the US including the locals. I have a co-worker whose husband's job once was to court clients for one of the really big ambulance chasers here. He's Vietnamese and anytime something bad happened to someone in that community it was his job to go and sell his boss to them.

I remember one client that he got sent out to sell to was these folks who weren't watching their small child and the kid ran out into the street and got hit. Yes, that is horrible and sad, but I remember just thinking about it from the driver's perspective. How horrified they must have been as well and then having to fend off a lawsuit because the parents weren't minding their child in the first place!

Interesting to note: In my previous post, I couldn't think of the word "contingency". Just slipped my mind. I did a Yahoo search on "ambulance chasing lawyer fee" and found the word I was looking for!

 

[Dr. Doug Ebersole]

I just wrote an article for this month's Underwater Journal (Underwater Journal) laying out the controversy in diving with diabetes (yes, I am an M.D.). As you have stated the main issue in diving with diabetes is one of hypoglycemia (low blood sugar). The risk of this is extremely variable based on the individual AND based on what medications they are taking for their diabetes. Some of the oral agents for Type 2 diabetes are the worst offenders while others are much less of a risk. My article goes over this in detail.

I don't know about NAUI specifically (the original issue in the thread) but many agencies follow the DAN guidelines outlined above and in my article. SSI even has a form on their website for instructors to give to diabetics and have them sign.

As you've said, in the U.S. you can get sued for anything. The best you can do is take care of the patient (or student in this case) as best you can, discuss all of the issues with them, and then document the results of that discussion in writing. I've learned over many years in the practice of medicine you can't live your life worrying about lawsuits. In our society they are going to happen. Just do the best you can for your patient.

 

[peterbj7]

I just wrote a long reply to this thread, and as I was in mid-sentence my submission vanished, and seems to have gone totally. I can't be bothered to type it again. This is not the first time this has happened to me on SB and similar fora, and it's extremely irritating.

 

[peterbj7]

I just wrote an article for this month's Underwater Journal (Underwater Journal) laying out the controversy in diving with diabetes (yes, I am an M.D.). As you have stated the main issue in diving with diabetes is one of hypoglycemia (low blood sugar). The risk of this is extremely variable based on the individual AND based on what medications they are taking for their diabetes. Some of the oral agents for Type 2 diabetes are the worst offenders while others are much less of a risk. My article goes over this in detail.

I don't know about NAUI specifically (the original issue in the thread) but many agencies follow the DAN guidelines outlined above and in my article. SSI even has a form on their website for instructors to give to diabetics and have them sign.

As you've said, in the U.S. you can get sued for anything. The best you can do is take care of the patient (or student in this case) as best you can, discuss all of the issues with them, and then document the results of that discussion in writing. I've learned over many years in the practice of medicine you can't live your life worrying about lawsuits. In our society they are going to happen. Just do the best you can for your patient.

Interesting. What oral agents taken for type 2 can give rise to a hypo?

 

[Dr. Doug Ebersole]

The classic oral meds to cause hypoglycemia are the sulfonylureas (Glipizide, Glyburide, etc). On the other hand, Metformin is not commonly associated with hypoglycemia and is a better choice -- for diving, that is, as long as it's also the best medication for the diver the other 350 or so days per year.

 

[MeiLing]

I just wrote a long reply to this thread, and as I was in mid-sentence my submission vanished, and seems to have gone totally. I can't be bothered to type it again. This is not the first time this has happened to me on SB and similar fora, and it's extremely irritating.

It is probably not SB, it is probably that you hit a key on your computer that made made it go back. Pretty common occurance on these type of BB, or things like Yahoo mail, especially if you are working on a laptop where the keys are so close together.

If I plan to write something lengthy, I will open a Window in Word or something like that that is more stable than being on the net. Then save it occasionally as I am working. Once done, you can cut and paste it into your SB reply. Saves a lot of that, "Damn I've been working on that for an hour and half and now it's gone!" headache!

 

[peterbj7]

It is probably not SB, it is probably that you hit a key on your computer that made made it go back. Pretty common occurance on these type of BB, or things like Yahoo mail, especially if you are working on a laptop where the keys are so close together.

If I plan to write something lengthy, I will open a Window in Word or something like that that is more stable than being on the net. Then save it occasionally as I am working. Once done, you can cut and paste it into your SB reply. Saves a lot of that, "Damn I've been working on that for an hour and half and now it's gone!" headache!

Except that I wasn't typing. I had sat back thinking about what to type next when suddenly the screen went to the top of the page, and when I checked my post had gone. Oh well, c'est la vie!