The Diver Medical Form: Part 1

If you have gone to a diving resort or liveaboard in the last couple of years, there is a good chance you have been asked to complete a complex medical form and perhaps even been required to get a doctor's signature stating you're medically cleared to dive.

Historically, most operators used a liability form that, when you signed it, you may have indicated you had no significant medical issues, and you agreed to accept all liability for any accident, assigning none to the operator. Most operators still use some sort of liability waivers, but some have added a new form, designed to prevent divers with medical issues from diving. But just what is a "medical issue"?

With the backing of the Recreational Scuba Training Council, a form was developed by the Divers' Alert Network and the Underwater Hyperbaric Society. Today, many operators are using this more complicated form to screen certified divers who wish to dive with them, even though the form clearly states: This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For divers, the problem is that you don't have to have anything wrong with you, but you still might be required to march into a doctor's office for a note stating you're fit to dive. And if you don't, the slightest thing may disqualify you.

Why? Perhaps the main pressure comes from their insurers, but training agencies with which operators have a business affiliation beyond teaching classes (for example, PADI's Five Star Operators) aren't keen to face liability lawsuits from the families of deceased divers (though in third world countries they may not go very far).

Of course, no operator or its staff want injuries or deaths to happen on their watch, knowing the effect that such traumatizing events may have on the victims' families and friends, but also for other divers aboard and the entire crew. And practically speaking, there are economic reasons. It's not a good advertisement for business if an operator has an injury or death. Furthermore, the cost implications of returning a liveaboard to port in an emergency and the possible refunds to passengers for lost diving time could be considerable.

Not every operator requires the form. Christian Menard, while headed for a liveaboard trip on the Seaisee in Raja Ampat, told Undercurrent, "If I will have to show a medical form and I have been told it is not necessary, I know I will not have a bad surprise when I arrive."

Regardless, the System is a Mess

A traveling diver may have no idea what will be required unless they ask. Some operators are very clear on their websites; others don't tell you whether you have to complete a form until your booking, and some say, when you walk in the door, "oh, by the way, fill out this medical form, please."

Furthermore, no standards regulate what an operator does with the information, whether they ask for a physician's clearance, or whether they let you dive at all, which means some young dive instructor with a high school education sitting in a Philippines dive shop may be deciding whether you are a medical risk.

And because it can be a big workload for dive operators, do they even check the forms? Many divers don't think so, such as Gregory White (Cobden, IL). "A dive shop in Fiji and the Maldives required the form. I do not like that it requires approval from a physician if the diver is taking any prescription medication other than birth control pills or malaria preventive. Because I am taking a prescription medication, I was required to obtain approval from my physician. In both of the cases above, I'm not sure anyone in the dive operations even looked at the forms. Maybe the purpose was just to scare off anyone with a medical problem."

We have received scores of comments from our readers over the years, and divers have reported being turned away for no other reason than they are too old, like a 75-year-old woman who had just spent a week on a liveaboard, then on Grand Cayman was not allowed to dive with Living the Dream Divers only because of her age, Others are prohibited because they are ingesting common meds, or even after getting a clearance at home, were restricted when they arrived. Some divers, so unsure of the requirements and the mindset of the local operator, decide to skip the trip.

Ridiculous Treatment

As an example of the mindless decisions made by dive operators, Scott Cragin (Joplin, MO) told us that a few years back he took a trip on the Spirit of Freedom in Australia. When completing the form, "I noted that I was on drugs for hypertension, but that my BP was under control due to the meds. Didn't matter. While I have hundreds of dives under my belt, they put me with the most inexperienced divers under tight supervision. This definitely had a negative impact on my enjoyment of the trip."

Susan Norton (Tiburon, CA) received a medical questionnaire from Blackbird Caye before her trip, and "Because I indicated that I took ANY prescription medication other than birth control or anti-malarial medication (other than Larium), I had to complete another two pages and have [an] MD sign it with OK to dive. Kaiser has a medical records department that reviews and provides an activity certification. The MDs do not do that. I provided Blackbird with the certification from Kaiser, which included the words this patient has no known activity restrictions or health issues that impair normal daily activities for the patient's current age . . . electronically signed on behalf of the doctor. Blackbird said it wasn't sufficient. Fortunately, I was working with Blue Water Travel, and dumped it in their lap. Happily, Blue Water Travel agreed that Blackbird was wrong, interceded, and [I] was subsequently cleared. I heard from Blue Water that Blackbird admitted to them that they had not read the Kaiser form."

Kelly Price (Kirkland, WA) wrote, "I know a woman whose dive operator in St. Lucia didn't allow her to dive because she was on an estrogen patch! Of all the ridiculous things!"

And Sudafed requiring a doctor's sign-off? Scott Kaufmann (Fairway, KS) found out that earlier this year, before he embarked on the Seadoors boat in the Philippines. They asked if I used any medications, and I put Sudafed, which can be purchased over the counter. Seadoors wanted a release from my ENT doctor, which I obtained. That will be the last time I list it. God help me if I were crazy enough to take Ibuprofen."

We asked Dr. Dan Orr, a former President of the Divers Alert Network, what he thought about that, and he said, "That is taking medical clearance to a ridiculous extreme."

See Our Doctor

Occasionally, a local dive operator, seemingly concerned about a diver's questionnaire answers or perhaps his health, may require a client to get signed off by a local doctor. An Undercurrent member and physician, who asked to remain anonymous, got such a request. "I'm 59, and never say I'm on a cholesterol agent because it's irrelevant. Regardless. after doing eight dives at one resort, I went to a second, where they asked me when my last dive was, and I said truthfully yesterday. They still made me see the onsite doc for clearance. I was completely annoyed even though the doc cleared me to dive."

I, too, would be annoyed. It may be that for some reason a resort needed a CYA statement, but let me suggest something more nefarious. Years ago, when I arrived at a Fiji resort (now long gone), I completed a liability waiver and that was that. A few days later, a young couple arrived, and they were required the next morning to get clearance from a local doctor before they could dive. A few nights later, a dive instructor with too many drinks under his belt told me the resort got kickbacks from the doctor. One has to wonder.

Some Operators are Reasonable

Before we sound too disrespectful of the industry, let us note that plenty of operators take a reasonable approach to the forms and those we indeed appreciate. One diver, who chooses to remain anonymous, said, "We had booked a dive trip to a Belize resort and got an email about a month ahead asking us to fill out medical forms. In my email back to the manager, I noted that the form states that a doctor's approval is required if you take any prescription medication. The manager responded, "If it's normal medication, you can just cross no; it's fine." (That suggested to me that they just wanted the paperwork to show to PADI and/or their insurance company.)

But our reader also had a reason to have his diving limited: "In 2023 we were traveling to Fiji, and the resort manager emailed to say that if we had had any recent medical issues or any surgeries within the past three months, they would need a note from a doctor that it is OK to dive. They said they were "going by the PADI standards." As it happened, I had developed a medical issue that was still being investigated just before the trip, and there was a legitimate question as to whether I should dive. My doctor wrote a note that it was OK for me to dive but only in very limited depths. The resort team gave me a separate divemaster so I could go with the group but stay at a shallower depth."

Yes, Medical Clearance is a Good Idea

Before we give the impression that divers are opposed to medical clearance, let me cite 80-year-old Craig Carnick of Manitou Springs, Colorado, who said that before his seven-day trip on the Nai'a in Fiji he was required to have his personal physician sign off on a general medical questionnaire. "I was a tad bit angry, but upon reflection, I concluded that making sure divers are in good health makes sense in order not to endanger other divers on the trip. Yes, divers who are injured or die because of their own health reasons put others in danger: those diving with them who try to help and those who try to rescue. Too often, one diver in distress harms another. And that is one thing those medical forms try to prevent." But do they?

Indeed, divers should be healthy to dive, and operators have a right to ask. But it seems that the current widely used medical form which seems to require anyone taking anything, even the most benign drug, to get a doctor's clearance, regardless of their age. That is creating the opposite response dive operators or divers themselves need.

Divers are lying. (More about that next issue.)

So, while we certainly don't believe that a diver with a medical issue that is a contraindication to diving should ignore it, let's next month have a look at the unanticipated consequences of medical forms for certified divers.

Ben Davison