Broe, Stephen James

45y · Male·Fulminant cardio-pulmonary decompression sickness incidental to deep water technical diving

Dr B., a 45-year-old experienced recreational diver with multiple medical conditions including obesity, hypertension, Conn's syndrome, and severe obstructive sleep apnoea, died from fulminant cardio-pulmonary decompression sickness following a technical deep dive to 50 metres. The dive medical examination conducted by Dr E. in January 2005 was inadequate—he failed to make thorough inquiries about Broe's sleep apnoea and its implications for pulmonary hypertension and diving safety. While the dive operator conducted the technical course reasonably in accordance with industry standards, the pre-dive medical clearance process was deficient. The coroner found the dive operator reasonably relied on the medical certification, but highlighted systemic issues: inadequate dive medical guidelines, lack of clarity on medical examiners' roles and responsibilities, and the need for improved protocols for investigating diving deaths and managing equipment handling post-dive.