Doctor won't sign medical release. What to do?

[HBO MD]

They say the definition of a good doctor is..."someone who tells you what you want to hear."
Whether your family doc is motivated by fear of litigation or not, what needs to be considered is the potential risk that your dad would face and also for the dive buddy/group. Inability to complete a basic course is worrisome, but that aside consider the potential for back injury while diving. That alone could have serious ramifications for a spinal fusion patient. Areas of devascularized tissue may be more prone to the development of DCS, while soft tissue injury may be unavoidable. It may actually not be in his best interests to dive.

 

[pasley]

...During his Cert course he wasn't able to complete the 200m swim, after his failed attempt, and injury to himself at this swim the instructor found out about his issue. ...?

My concerns: First of all you father should have told his instructor about this condition before he started. The instructor would have then required the medical evaluation. Full disclosure of medical conditions affects your dive buddy as well as yourself. Failure to disclose can place yourself and others at risk. In this case the instructor was placed into a position of assuming some liability that he may not have been willing to, or have been trained to assume.

Second, he injured himself doing the 200 yard swim. This is and should be a concern. I don't care that he can't swim 200 yards, some of the divers we dive with who have quadriplegia can't swim 2 feet. But he injured himself. That would/should be cause for pause and re-evaluation. How did he hurt himself? What was the injury? Will it happen again? What are the potential outcomes?

PROBLEM: ...Doctor refused to sign the damn release! He told my father if he did he would be open to a lawsuit if something happen.

Yes, the divers and the family before the accident all say "We won't sue." After the accident they all say, "But you were the medical expert, you should have stopped us. We didn't know the full risk and you did." The doctor is looking at the medical aspects and the past history (injured doing a 200 yard swim) and has made a medical judgment. Now it is true that many physicians do not understand SCUBA diving and will say no when it is really not a SCUBA concern, and yes when there is a concern for SCUBA and then the instructor has to say no. So seeing a competent qualified Dive Medicine professional is recommended. Or at least a doctor who will call DAN and discuss it. Are you using the Handicapped SCUBA Association (HSA) medical release?

Third, is he taking the HSA course? With a totaly fused spine that is what I would suggest. They also use a different medical release.

End of the day, while I would love to see him diving again, diving is not for everyone with all medical conditions.

 

[Scared Silly]

I notice that this post is in the Divers with Disabilities forum rather than the Medical Forum. To me it says subconsciously the OP feels his father has a disability that is perhaps limiting for the std. rec diving cert.

I would say call DAN and get their opinion and perhaps a referral to a doc that dives. Otherwise your father has a doc with his best interests at heart and he should think about why the doc made that decision (If the doc feels he will open himself up to liability he probably feels that is not a activity he should doing).

 

[qrpc]

PROBLEM: Doctor refused to sign the damn release! He told my father if he did he would be open to a lawsuit if something happen.... My father even offered to sign a Liability Release for Doctor. Still No.

Sometimes, saying things like "the lawyers or insurance won't let me" is code for "You should not do it, but I don't want to be the one that gets blamed for the bad news." Sometimes, of course, it's just the truth.

Also, a liability release isn't a "get out of jail free" card.

The medical form your agency wants the doctor to sign probably has some language that says that in his professional opinion he finds nothing to suggest that your father has an inability to perform necessary skills. If that isn't the case, and he signs anyway, a waiver from your father won't protect the doctor if the authorities want to take his license or if his insurance company wants to raise his rates.

Even if a lawsuit is the big fear, your father's release says he won't sue. What happens if letting your father dive results in someone else getting hurt or killed?

 

[reticentDiver]

TC gives you good advice. If your dad can't do a 200m swim he needs to reconsider. He can still scuba, but he might have to make some concessions for his own safety and the safety of those diving with him.

Someone who can't swim that distance unencumbered needs special care when diving in normal situations in open water, where currents and winds are regularly present besides the heavy gear. It is easy to surface at a distance from the boat and to have to wait or swim to it. I can imagine than getting back on the boat and doing surface swims with a fused spine may require learning special techniques or counting with help from others.

Don't give up, but do not blame the doctor, his answer (the getting sued stuff) would have ticked me off too, but he is actually just putting your dad's safety first.

 

[Green_Manelishi]

During his Cert course he wasn't able to complete the200m swim, after his failed attempt, and injury to himself at this swim the instructor found out about his issue. He told my father to go see his Doctor and get the doctor to sign a medical release. With the release my father can skip the swim and continue on.

He failed the test and injured himself. Was his failure and injury due to the fused spine? If so, why is he so intent on SCUBA diving? How much potential damage to his fused spine could be caused by slipping while carrying SCUBA gear, etc? SCUBA diving is not a sport for everyone, and some "types" of SCUBA diving are not for all SCUBA divers.

 

[AndrewST]

UPDATE:

My fathers medical history was disclosed to our instructor, but my father also said he should be able to get re-certified and make it without issue. So taking his word the Instructor did not have him go do a medical exam. Upon injuring himself the instructor said he needed to see the doctor.

Well after my fathers Primary Care refused to sign the release, my father had another discussion with him. My fathers PC didn't care about the liability issue, our Primary Care Doctor simply doesn't know a thing about SCUBA diving and wasn't comfortable about making the call as it turns out. So he suggested my father go see his Specialist who performed a lot of my fathers Surgery.

The Specialist turns out knows a lot about SCUBA and did indeed clear my father for diving. My father was able to finish the swim, just on his back instead of stomach. Also as the instructor thought a lot of the dive skills are quickly coming back to my father, even though it has been over 30 years since his last dive, which back then was Deco Diving/Tech Diving.

So I guess to answer the question as why my father was so hell bent on diving. Well he wants to get back into it, and when under the water does fine. Putting on the gear and taking it off he is fine, it was just that damn swim. As odd as it sounds, he simply flips/rolls into his gear like he did back in the day to get it on . Which almost defies his injury..but it works. The Specialist suggested that he injured himself on a stroke by over extending muscle, as the soft tissue in his back is heavily scarred due to multiple surgeries.

If he slipped and fell while carrying scuba, he would be hurt I am sure. He is over 50 years of age, so lets hope he doesn't fall.

One thing my father has taken into consideration is his physical condition, and solo diving is obviously out. Also he will now have several family members, myself, mother, and younger brother, as dive buddies. All of us are capable of helping him when needed, also the Instructors have been great and have taken into consideration his condition.

All in all I think he is going to do fine as a casual relaxed diver, he won't be getting into any tech diving again, just floating along at a gentle pace.

I also thank you all for your input and information. This is a great community with what seems an endless amount of knowledge!

 

[Jayde323]

It's good to hear your dad has been given the go-ahead. It may be good for your family to go through the rescue course. This way, if there was a situation you had to rescue your dad, or another diver for that matter, you and your family are prepared.

Make sure the time spent out of the water and how his gear is handled is part of your dive plan. Who will carry the tanks/gear to the boat/shore/car. If doing a beach dive, when will he put his gear on, in the water or on the shore? Make sure the captain and DM on the boat are aware of his injury as well. They can make things alot easier for dad on the boat such as assisting him with gear and putting him at the back of the boat so he is closer to the dive platform/ladder.

Happy (and safe) diving!

 

[DevonDiver]

My father is getting back into diving after 34 years... his entire spine is fused, he had a horrible dirt bike accident and a few other accidents that caused disk damage. After several surgeries......he wasn't able to complete the 200m swim, after his failed attempt, and injury to himself at this swim the instructor found out about his issue.....Doctor refused to sign the damn release....He told my father if he did he would be open to a lawsuit if something happen.

A few notes....

1. Your father failed to declare his major injury and subsequent surgery on his medical statement at the dive center. Dishonest, dangerous and irresponsible. These conditions have to be ticked YES/NO on the statement. If your father had ticked YES, then he would have had to get the medical release prior to starting his in-water training.

2. Neither Dive Instructor or Doctor believe your father should be diving. The decision is taken with his safety (and their legal liability) in mind.

3. Your father could not complete a basic 200m swim. In his current state, it is highly unlikely he could cope with scuba equipment in any sort of current, swell, waves or surge. It could lead, at best, to further injury or, at worst, death.

4. Your father is entitled to a medical second opinion. However, this should be an honest inspection....not a hunt for a doctor who is likely to 'just sign the release'. If I were the instructor concerned, then I would be extremely dubious if your father returned to me waving a signed release...and... I might be likely to refuse training (signed medical release or not). Especially after I was aware that your father had already concealed his injuries in one medical form...maybe I could expect him to do the same to the doctor concerned?

With the release my father can skip the swim and continue on.

Nope.... a signed medical release just means that the instructor could accept him to continue the training course. He would still have to complete the swim, as it is a performance requirement for certification.

Disabled divers are allowed to undertake diving courses (if medically approved), but they must still complete all performance requirements of the course in order to be certified.

My fathers medical history was disclosed to our instructor, but my father also said he should be able to get re-certified and make it without issue. So taking his word the Instructor did not have him go do a medical exam. Upon injuring himself the instructor said he needed to see the doctor.

Firstly....the instructor was not qualified to make a medical diagnosis of the condition or how it would impact on diving or the health of the student. That is why instructors HAVE TO refer any declarations of major injury or surgery (amongst other things) to an MD. If your fully disclosed the injuries/surgery to the instructor...and completed the required medical statement.... then the instructor concerned committed a huge breach of standards in accepting him for training.

If he slipped and fell while carrying scuba, he would be hurt I am sure. He is over 50 years of age, so lets hope he doesn't fall.

Personally, this would be my least concern. I would be far more concerned about a problem arising underwater.

Also he will now have several family members, myself, mother, and younger brother, as dive buddies. All of us are capable of helping him when needed, also the Instructors have been great and have taken into consideration his condition.

Frankly...no dive is THAT important. Yes, you may be able to help him, but should his condition ever lead to an incident underwater, then it will be his own family that have to risk their lives to recover him.

 

[AndrewST]

Devon,

I can see some of your points but one bit of contention I have with your statement is in regards to the comment of my father "concealing" his injury. At no point did he conceal his physical condition, it was declared. However he felt having a solid fused spine wouldn't cause any problems with diving. Which after seeing his specialist it more than likely wasn't the spine being the issue, but the scarred soft tissue being stretched.

He was able to go back and finish the swim on his back, see my previous post, and the original doctor ended up telling him it wasn't a liability issue. But a lack of SCUBA knowledge on the Dr. part. Again see previous post.

So far the confined water dives are going well, they haven't gotten to OW yet and as you said, will be a big deciding factor. Everything changes once you hit the OW and honestly, his back might not stand up to strong currents and rough seas. If it turns out he can only dive in gentle mild conditions, then that is what he will do.