When Divers Get Benched: Part III

Judging a diver’s ability to handle the conditions at hand is a tough call for a captain or crew member. Several Undercurrent readers have reported operators benching divers due to medical conditions or physical limitations. It’s unlikely that one would book a dive trip he doesn’t think he can handle, but if a boat captain or divemaster doesn’t think so, there can be a nasty disagreement, with a few thousand diver dollars at stake.

One of our long time subscribers, whom we’ll call Mark, told us Captain Mike Lever barred him from diving on the Nautilus Explorer’s trip to Mexico’s Socorro Island in the Pacific. Mark had previously made a successful trip on the Nautilus Explorer in Alaska’s challenging waters, and was booked for back-to-back trips to Socorro. Lever said, “Diving at Socorro is not for folks who aren’t in good physical condition.”

We exchanged letters and emails with both parties and their accounts differ significantly; however there are important points to be made. Lever says when people signed up he asked if they have any medical conditions worth noting. When the trip was under way, he also asked if participants had any medical conditions they wished to discuss in private. In neither case did Mark come forward. On the second day, when Mark demanded help lifting a 2- kg camera and housing, Lever said “it set off alarm bells.” He asked to see Mark’s medical clearance. In Mark’s file, besides a letter from a physician’s assistant clearing him to dive, Lever discovered that Mark was taking medications for a variety of maladies. Lever maintains that Mark had not disclosed these problems when asked whether he had any special medical requirements, conditions or history of diving injuries.

However, says Mark, “my request for help with lifting my equipment due to a back injury I had sustained nearly two years ago caused him to conclude that I was unfit to dive . . . I had been on six live-aboard trips in the interim, had done over 200 dives since the accident.”

Mike and Mark then called Marks’s physician, who hadn’t signed off on Marks’s letter of clearance and didn’t know much about diving medicine. Lever asked the doc to discuss Mark’s conditions with Diver’s Alert Network (DAN). After talking to DAN, says Lever, the physician declined to clear Mark for diving, so Lever insisted that Mark sit out the rest of the Socorro dives. But he arranged an appointment for Mark with the hyperbaric chamber doctors in port. Lever claims that, when confronted about his medical nondisclosure, Mark said, “If I tell you or any other operator about my medical problems, you won’t let me dive.”

Lever allowed Mark to undertake rebreather training on the second trip in the company of a divemaster, but no deeper than 60 fsw. Mark was frustrated because he’d also planned to make open circuit dives with his camera, which he couldn’t use while training on the rebreather.

Lever refused to give Mark a refund, though he had logged only four dives on the first Socorro trip. He did refund deposits for the three June trips he had booked.

Lever told Undercurrent he believes he acted both in Mark’s best interest and that of his other passengers. A refund “didn’t enter my mind,” says Lever, because Mark “had lied to us and had ample opportunity to tell us about his medical challenges.” Mark filled a berth on the boat that could have gone to another paying customer.

And Mark, an extremely experienced diver, does concede that, “Lever is right. He is the Captain. He can stop everyone on the boat from diving for any reason at all.”

Glen Fritzler, owner of Truth Aquatics in Santa Barbara, CA, which operates three live-aboards, has a different point of view. “Although no one in my organization prefers to deal with diver emergencies,” says Fritzler, “I cannot condone keeping someone out of the water who could ‘potentially’ be a problem. It’s a fine line and it turns your hair gray, but it’s something we have come to live with. Diving is a unique activity where someone can really escape and I feel that your limits have to be decided by you and no one else. As an operator I simply pray that the individuals make the right choices.”

Judgments are often subjective, and therefore difficult to defend. Take the situation witnessed by Liam Gowers (Rockwall, TX) while diving out of Bud ’n Mary’s Marina in Islamorada, FL. After a 100-ft. wreck dive, the instructor of a group of advanced students informed a pupil that he had showed symptoms of nitrogen narcosis and recommended that he sit out the next dive. Gowers says, “If the instructor suspected narcosis during the dive, it was negligent of him to continue with a narc’ed student. He can’t keep his eye on a diver suffering from narcosis and five other divers simultaneously.” And, why does narcosis bench a diver the next time out, especially if he is in an advanced class? Should he not be learning to manage it?

Certifying agencies, and some dive operators, especially in heavily regulated countries like Australia, insist that divers fill out medical questionnaires when booking classes or a dive trip. Such a form is downloadable at www.padi.com/english/common/courses/forms. Under the heading “Have you ever had or do you currently have…” it includes such seemingly innocuous conditions as frequent or severe attacks of hay fever or allergy, recurrent back problems, ulcers, and high blood pressure (with or without medication). Answer “Yes” to any of these, and you may be required to have a doctor fill out a multi-page form or provide a letter certifying that you’re okay to dive. If there are items you must check, then learn in advance what documentation a dive operator will require, otherwise you may find yourself benched for ailments that you don’t believe affect your diving.

That’s what Ken Paff’s diabetic partner Martha does, after a Blue Bubbles instructor in Cozumel refused to allow her to dive after he saw her check her blood sugar level. “Although he was nasty about it,” says Paff, “his actions were actually in line with the guidelines of the agencies at that time.” Fortunately, they were able to get a letter of clearance from a doctor at a Cozumel chamber and Blue Bubbles allowed Martha to dive. She now carries a letter from her doctor, though few operators have requested to see it. “In the past decade,” Paff reports, “various agencies and operators have eliminated or lessened their prejudices against diabetics and perhaps other folks with medical disabilities. While the concerns with diving by people with type 1 diabetes are real, an absolute prohibition is certainly not.”

Tell the Truth

As Bret Gilliam pointed out in the March Undercurrent, some divers choose to falsify health information on dive operator applications. Occasionally, dive professionals even encourage the practice. During a Nitrox course at Buddy Dive in Bonaire, Jan Culbertson (Seattle, WA) saw how flawed the screening process can be. While filling out the PADI medical statement, one student answered “Yes” to the question “Have you ever had or do you currently have [a] history of diving accidents or decompression sickness?” Without discussing the diver’s history, the instructor told her she couldn’t take the course unless she changed her response to “No.” “So right there in front of the rest of the class,” reports Culbertson, “she changed her answer and she was allowed to enroll in the class. Didn’t seem like a very safe practice to me.”

Gilliam, the founder of Technical Diving International and a dive travel leader for many years, concluded: “You can bluff but that doesn’t help once you’re underwater.” If something goes wrong and you’re found out, the best that can happen is that you’ll get benched for the rest of the trip. The worst is that you’ll never come back.

Dive medicine specialist Ernest Campbell, MD, focusing on dive training, states, “Failure to report risky preexisting medical problems would certainly be adverse to diving safety, not only to the student but to the instructor and others on a dive excursion.”

The Prescription Drug Threat

Joel Dovenbarger, vice president of Medical Services for Divers Alert Network (DAN), points out that few conditions are, by themselves, severe enough to bar someone from diving (seizure disorders being the main one). The problem lies in combinations of conditions, particularly when they are treated with combinations of medications. Dovenbarger notes that many central nervous system meds contain nitrogen, so “risk is relative to depth” for divers. He also points out that the most common side effects of drugs at depth are anxiety and panic.

One of our writers has his own story. To sleep when he travels, at his doctor’s advice, he often takes a small dose of lorazapam. It’s actually an anti anxiety medicine that, he reports, doesn’t cause him to sleepwalk to the refrigerator. One morning he intentionally took a tab before a dive to see what effect it might have underwater. Below 100 feet, he says, he felt as if he were on an acid trip, most likely a combination of the drug’s effect at four atmospheres and narcosis. “I had told my experienced companion what I was doing so we managed it, but an unsuspecting diver on the same drug might indeed panic.”

Have Your Doc Call DAN

In determining what degrees or combinations of conditions are safe for diving, Dovenbarger insists that a physician should decide, not an untrained individual (neither the diver nor a local dive operator). If you and your physician have questions, DAN will be happy to field a call from your physician to discuss the specifics of any situation or even to walk through the filling out of a medical questionnaire such as PADI’s.

Like Gilliam, Dovenbarger urges divers to tell the truth on medical forms. Otherwise, if a health crisis occurs on a dive trip, in or out of the water, the victim may not get proper treatment. Remember the scene in “Something’s Gotta Give” when Jack Nicholson, suffering a heart attack, lies about using Viagra until his doctor warns him that the nitro in his drip could be fatal in combination with the drug? “Unless you start with the truth,” says Dovenbarger, “you won’t be happy with the outcome.”

Some dive operators, especially live-aboards, offer medical questionnaires that must be completed to the satisfaction of the operator before the trip is confirmed. But others wait until the diver arrives, paid up. It would be useful if an industry-wide standard could be developed, but then not only would it require agencies to agree, it would require countries to agree. So, without a standard, a diver with any medical condition whatsoever needs to do his homework before committing to a dive operator, assess the situation and respond accordingly. Otherwise, as our friend Mark discovered, it could be a long trip, with little diving, and a lot of money down the drain.