PADI Policy Re Medical Releases

[Mike Boswell]

Among the questions raised about medical forms and doctor releases is whether a dive operation is obliged to treat medical questionnaires as confidential, and whether they are obliged to accept a prospective diver's signed medical release.

It seems to me that PADI and/or other agencies should have a policy in place to protect the rights and interests of both divers and dive businesses. If they do, what is the policy? If they don't, why not?

 

[AndyNZ]

To be honest, what has the agency got to do with it?

Local law will always override agency policy, and businesses are driven by local privacy law. I know, for example, that privacy law in New Zealand is significantly different from what it is in the US.

I agree in principle that a dive centre should treat a medical questionnaire as confidential - but for a global organisation to mandate that in some way that conforms to all local law requirements would seem to me nigh on impossible.

As for obligation to accept a signed medical release? As an instructor, I am in no way obligated to accept a student at all! Just because a student has a signed medical release, I can still turn them away. Yes, I need to be mindful of local discrimination laws, but ultimately if I think someone is not fit to dive then I can choose to not teach them.

 

[boulderjohn]

Ask yourself this question: why would the dive operation turn away a prospective customer who has a properly signed medical release? Is it because they have way too much business and want to get rid of customers?

I cannot imagine what it would take for me to refuse to accept a properly signed release. I suppose it would have to be for something where I really had to question the doctor's judgment, as in giving permission to someone who is pregnant. In that case, I would question whether the doctor was properly informed on the risk to the fetus.

 

[Mike Boswell]

To be honest, what has the agency got to do with it?

Local law will always override agency policy, and businesses are driven by local privacy law. I know, for example, that privacy law in New Zealand is significantly different from what it is in the US.

I agree in principle that a dive centre should treat a medical questionnaire as confidential - but for a global organisation to mandate that in some way that conforms to all local law requirements would seem to me nigh on impossible.

As for obligation to accept a signed medical release? As an instructor, I am in no way obligated to accept a student at all! Just because a student has a signed medical release, I can still turn them away. Yes, I need to be mindful of local discrimination laws, but ultimately if I think someone is not fit to dive then I can choose to not teach them.

Here is a hypothetical situation: Two divers are planning a week long dive vacation to a destination where there is a dive operator billed as a "5 Star PADI" dive business. The dive operation teaches PADI training courses, accepts PADI certificates, and uses PADI medical release forms. One of the divers has one of the medical conditions on the PADI form and truthfully answers "Yes" where designated and provides a doctor's signoff on the PADI form.

Without some policy, the truthful diver has now placed his medical information, himself and his buddy, and their entire trip at the mercy of the individual who happens to be behind the desk that day. And many divers are not inclined to rely on faith.

MY question is, does PADI have a business policy in place to protect the integrity of this process and the parties involved?

 

[AndyNZ]

Here is a hypothetical situation: Two divers are planning a week long dive vacation to a destination where there is a dive operator billed as a "5 Star PADI" dive business. The dive operation teaches PADI training courses, accepts PADI certificates, and uses PADI medical release forms. One of the divers has one of the medical conditions on the PADI form and truthfully answers "Yes" where designated and provides a doctor's signoff on the PADI form.

Well, PADI don't have a medical release form as such. They utilise the RSTC form and just happen to put their logo on it. So maybe question the role of the RSTC here, not just the agency.... just being picky!

In your hypothetical situation, did teh diver knowingly have a medical condition and did they bother to check what the business policy was before turning up and hoping they could go diving?

Without some policy, the truthful diver has now placed his medical information, himself and his buddy, and their entire trip at the mercy of the individual who happens to be behind the desk that day. And many divers are not inclined to rely on faith.

Well, consider the alternative. It's a fact of life that coroners worldwide share information... a few years ago, as a result of a very small number of fatalities involving divers who lied about a know existing medical condition, it very nearly became law in New Zealand that all divers, including visitors, would require a dive medical by an approved diving physician to enable to them to do a course or dive off a professional charter. In this context, approved physician would have meant a diving doctor who can conduct diving medicals in accordance to Australian Standard AS4005.1.

That would have put us bang up there with Southern Queensland as the most heavily regulated dive industry in the world. If a visitor for the US came through with a signed medical form, it wouldn't have mattered - they still would have had to have had a medical done locally be a very small number of approved doctors.

What would you rather? have someone use their judgement, or have to comply with some heavy handed law that wasn't really necessary?

I still don't see why you think this is an agency issue.

MY question is, does PADI have a business policy in place to protect the integrity of this process and the parties involved?

Your question is confused. Are you talking about signing up for a course? Or are you talking about divers going on a dive vacation?

 

[Crowley]

Indeed it is not a PADI medical form, it's a consensus agreement between agencies who subscribe to the RSTC (Recreational Scuba Training Council)

A medical with a "Yes", properly signed and/or stamped by a physician should be all that is required for the counter staff to accept the person for training, HOWEVER, it is still down to the instructor's discretion. I will quote from the PADI instructor manual (2009 electronic version, General Standards and Procedures, page 6; bold type is the "standard"):

a. Any question of medical fitness is solely the physician’s area of
expertise. Ultimately, however, you have the right to make the final
decision about who you will accept into your scuba course after medical
approval is obtained. Instructors have no obligation to accept
every applicant.

This means I cannot medically diagnose a condition but I can still refuse a student even if signed off by a doctor, if I think the student might be at risk underwater, or I might require the student to get a second medical from a local hyperbaric physician whose judgement I will take over a general practitioner with no diving experience.

For example: A recent student of mine had obtained clearance from his GP in the UK prior to arriving at my dive centre in Egpyt. His GP had signed his medical with the following "student has asthma, but good lung volume" and was cleared to dive. I am very sorry to say that this doctor clearly has no idea what he was talking about when it comes to diving and when I questioned the student it was apparent that a proper test had not been conducted. I could have refused him, but I sent him to the local hyperbaric physician who did indeed clear him to dive after conducting the appropriate tests. I *still* could have refused the student, but I didn't. (BTW please let's not get into a discussion about asthma or other conditions here)

It is not an agency issue, be it PADI or anybody else. Some divers, when presented with the medical, refuse to go ahead with the training. Some instructors will get the student to cross out the Yes and write No. I will not compromise my job security and risk a person's life for the sake of a few extra bucks, and I have indeed had to turn away students, and lost personal income as a result.

If it's a matter of confidentiality (I had one lady with a bipolar disorder who was uncomfortable declaring this on the medical, and other students with serious medical problems that prevented them from diving) then I will treat it with as much confidence as possible, but aside from me, several people at the dive centre need to be aware of underlying medical condition just in case something really does go wrong.

Hope that helps clarify things a little,

C.

 

[Jax]

Among the questions raised about medical forms and doctor releases is whether a dive operation is obliged to treat medical questionnaires as confidential, and whether they are obliged to accept a prospective diver's signed medical release.

It seems to me that PADI and/or other agencies should have a policy in place to protect the rights and interests of both divers and dive businesses. If they do, what is the policy? If they don't, why not?

Mike, the Privacy Act of 1975, as amended, covers this completely. The firm is required to tell you why they are requesting information, and what will be done with it. They must get your permission for anything they do with it.

The latest law, The Health Insurance Portability and Accountability Act of 1996 (HIPAA) [1], has even strictor rules on handling health information.

DIVE OPS, take note! -- better have this stuff locked away, not in some accessable filing cabinet.


[1] Understanding Health Information Privacy

 

[oly5050user]

Indeed it is not a PADI medical form, it's a consensus agreement between agencies who subscribe to the RSTC (Recreational Scuba Training Council)

A medical with a "Yes", properly signed and/or stamped by a physician should be all that is required for the counter staff to accept the person for training, HOWEVER, it is still down to the instructor's discretion. I will quote from the PADI instructor manual (2009 electronic version, General Standards and Procedures, page 6; bold type is the "standard"):



This means I cannot medically diagnose a condition but I can still refuse a student even if signed off by a doctor, if I think the student might be at risk underwater, or I might require the student to get a second medical from a local hyperbaric physician whose judgement I will take over a general practitioner with no diving experience.

For example: A recent student of mine had obtained clearance from his GP in the UK prior to arriving at my dive centre in Egpyt. His GP had signed his medical with the following "student has asthma, but good lung volume" and was cleared to dive. I am very sorry to say that this doctor clearly has no idea what he was talking about when it comes to diving and when I questioned the student it was apparent that a proper test had not been conducted. I could have refused him, but I sent him to the local hyperbaric physician who did indeed clear him to dive after conducting the appropriate tests. I *still* could have refused the student, but I didn't. (BTW please let's not get into a discussion about asthma or other conditions here)

It is not an agency issue, be it PADI or anybody else. Some divers, when presented with the medical, refuse to go ahead with the training. Some instructors will get the student to cross out the Yes and write No. I will not compromise my job security and risk a person's life for the sake of a few extra bucks, and I have indeed had to turn away students, and lost personal income as a result.

If it's a matter of confidentiality (I had one lady with a bipolar disorder who was uncomfortable declaring this on the medical, and other students with serious medical problems that prevented them from diving) then I will treat it with as much confidence as possible, but aside from me, several people at the dive centre need to be aware of underlying medical condition just in case something really does go wrong.

Hope that helps clarify things a little,

C.

Just as Crowley states.If the physican writes anything other than"I find the patient fit to dive" then I question the release and will not let student dive.There should be NO limitations placed on form by the physican such as can only dive to 30' or patient can only dive after taking xyz medication..

 

[Mike Boswell]

Hi All,

My original post above was vaque in several respects. It was motivated by an earlier thread where some divers advocated lying on the health forms for various reasons. Being opposed to lying, I began to ask myself if the industry (PADI, dive operations, RSTC, etc.) should and could do more to address the issues.

AndyNZ has said "It's a fact of life that coroners worldwide share information... a few years ago, as a result of a very small number of fatalities involving divers who lied about a know existing medical condition, it very nearly became law in New Zealand that all divers, including visitors, would require a dive medical by an approved diving physician to enable to them to do a course or dive off a professional charter. In this context, approved physician would have meant a diving doctor who can conduct diving medicals in accordance to Australian Standard AS4005.1.

That would have put us bang up there with Southern Queensland as the most heavily regulated dive industry in the world. If a visitor for the US came through with a signed medical form, it wouldn't have mattered - they still would have had to have had a medical done locally be a very small number of approved doctors.

What would you rather? have someone use their judgement, or have to comply with some heavy handed law that wasn't really necessary?"

So it seems that a few individuals lying on a form might well cause problems for many others.

AndyNZ - Your reference to the "very nearly became NZ law" story would be a useful addition to that thread.

For that thread, go to:

http://www.scubaboard.com/forums/ba...-those-health-forms-truth-consequences-5.html

 

[AndyNZ]

My original post above was vaque in several respects. It was motivated by an earlier thread where some divers advocated lying on the health forms for various reasons. Being opposed to lying, I began to ask myself if the industry (PADI, dive operations, RSTC, etc.) should and could do more to address the issues.

It's interesting, this actually came up at a recent PADI Staff Instructor Update that I attended.

The wording on the RSTC form is really clear:

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities.

Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with an RSTC Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination to take to your physician.

So it seems that a few individuals lying on a form might well cause problems for many others.

It definitely will.

As for what happened here, long story short the industry managed to move to a self-regulation model thanks to the hard work of a small group. Every dive student is required - by industry best practice - to have a dive medical with in the last twelve months when they start a course, any course. Whilst it is preferred that this be done by a diving physician, it can be done by a normal GP. This differs somewhat than Southern Queensland where the medical requirements are mandated by law, and must be conducted in accordance with the appropriate Australian Standard - have a look at the requirements:

Dive Medical Requirements For Diving Courses And Dive Liveaboards Australia