WILDERNESS LAW: MEDICAL RELEASE FORMS—Who Needs Them?
by Jim Moss

Who should be required to complete a medical consent form? This is not an easy question to answer, and one that is not asked by many in the outdoor industry. Any activity that will demand more from a participant than his or her normal activity--sitting at a desk or pushing grocery carts down an aisle--should require a medical consent form. Any activity that will take a participant away from their home or regular health care center for more than a couple of nights may also require a medical release. Finally, anyone participating in any outdoor activity should provide the group leading the activity with the results of a recent physical exam.

Organizations that work with children have good reason to obtain a medical consent form because it ensures that the parents have a thorough knowledge of the activity or trip their child will be undertaking. It also allows the parents to consent to medical treatment in advance. Even though implied consent would be assumed in most cases of a minor needing treatment, having a medical release and consent form allows the health care facility to act more quickly.

Another issue with children is the necessity of obtaining a parent's consent before beginning treatment for an injury. You should notify the parent as soon as possible after an injury has occurred, but the wait to obtain consent may delay medical treatment. For instance, time always seems to be wasted when someone has a minor burn that does not require major medical care, but is always painful. Prolonging a child's pain in order to obtain a parent's consent has always seemed backward to me.

Implied consent is always relied upon by trip leaders, rescue personnel, and health care facilities, but it can have some major flaws. If you should have known that a person did not want medical treatment but medical treatment was given anyway, you may face criticism. Although most states will allow doctors to treat a patient without a release form, this form does allow doctors to act quickly.

The initial benefit of a medical form is that it allows you to eliminate someone from a backcountry trip who is not physically able to go on the trip. Injuries during a backcountry experience not only require extra work for the staff, but also decrease the quality of the experience for the other participants and may compromise their safety. Even if a participant can undertake the activity, he/she may have some medical problems that should be examined and observed. For example, diabetics need to be monitored and have their diets adjusted, and heart patients should be informed in advance of the rigors of the activity.

If a consent form is sent to your office with questions about a participant's physical ability, you must get qualified medical advice concerning their participation. If you decide that this person should not be allowed on a trip, send a letter to them and outline the reasons why he/she cannot go on this trip and suggest alternative trips. I always advise that a phone call be made in advance of the letter--human contact can help to smooth ruffled feathers. To better prepare someone for the reality of being physically unable to participate, every item of correspondence--and probably your advertising as well--should describe the rigors of your trips and clearly state that your organization reserves the right to deny anyone access to an activity because of medical reasons or failure to complete a medical release form.

Even more important is alerting the staff to potential medical or psychological problems of participants. You will not always receive all of the information you need. I was in charge of a program at a Boy Scouts summer camp and was at the firing range when a young Scout stood up and slowly circled the group, carrying a live round in the chamber of his gun. No one was injured; however, I lost several years of my life. We immediately checked his medical consent form but it showed no problems. We called the doctor listed on the physical and he said that the child's mother did not want the doctor to put her child's psychological history on the form. If we had had that information, we might not have allowed him on the range and could have taken additional steps to ensure the safety of everyone involved.

Anyone entering the Grand Canyon must agree to pay for their evacuation costs. These start at $800 for helicopter evacuations. Agreeing to pay for medical and search and rescue costs gives the participant a better understanding of the risks inherent to the proposed activity. It also helps you and your insurance company to better evaluate your own risk. Finally, it lets the health care facility know who will pay the bill.

Your consent form should state that a photographic copy is as binding as the original. A copy can be taken on the trip, the original kept in the office, and a file copy faxed to a hospital if needed.
Some consent forms also include a release from medical malpractice for anyone treating the participant. This is a questionable inclusion that could and should be handled in other ways. I write a medical release into the general release for staff administering First Aid, thereby differentiating between protecting my staff and protecting an outside professional. Some states, however, do not allow doctors to use a release for medical malpractice. If you contract for your health care services in advance, you may want to consider a malpractice release. The purpose of the medical consent and information form is not to prevent lawsuits, but to expedite medical care. Probably a more proper place for a general medical release is in your general liability release.

What do you look for in a medical form? First of all, you need the consent and the basic information (name, address, phone number, medical insurance, who to contact in case of an emergency, etc.). But the medical part of the form is also important: name of doctor(s), dentist, orthodontist, optometrist, and any other specialists; chronic health problems; childhood diseases; allergies (both natural and medical); serious injuries; epilepsy, diabetes, or heart disease; phobias; vaccines; general physical condition; normal and exercise-induced vital signs; and all required medications. Meal or dietary restrictions, religious affiliation, living wills, and location of wills or trusts can also be included. Every company, school, or outfitter should design their own form within the laws of the state in which they operate.

Upon entering an emergency room, we all have that television-inspired thought of a nurse bending down and asking us for insurance information. You can eliminate that problem for your trip staff and the patient by showing the attendant the medical consent form. This part of the form should include the insurance carrier, the company providing the insurance, the group number, and the policy number. If this information is not provided by the participant prior to the proposed trip, you may want to offer him/her health, disability, and life insurance specifically for the trip, or even require that it be purchased.

The Boy Scouts of America make it a practice to review the consent form with the participant. This allows the staff to understand and identify any potential medical problems prior to their occurrence, and to associate a name with a face. It also eliminates embarrassment on the part of the participant in advance of the trip, so that he/she will not hesitate to bring problems to the staff's attention quickly. Medical problems and first aid are serious issues and handling them properly at this pre-trip evaluation can set a good tone for medical evaluations later on. Also, a statement on the consent form stating that the health history is correct and complete to the best of the participant's knowledge will engender a little more honesty on the form and will underline the seriousness of the form.

We all hope that medical consent forms and questionnaires only gather dust in file cabinets and that our problems are minor, but if they are needed, medical information and consent forms can help to eliminate chaos and ease a stressful situation.