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The University of South Carolina School of Medicine Greenville is asking students to sign a waiver acknowledging risk and absolving the school of liability before starting their next clinical rotation, officials confirmed to 番茄社区 this week. If students do not sign, they risk delaying their graduation.

This came despite that "strongly suggest that medical students not be involved in any direct patient care activities" unless there is a "critical [healthcare worker] need locally." It's not apparent that this would apply to Greenville now or in the future.

Nevertheless, said medical school dean Marjorie Jenkins, MD, in a statement emailed to 番茄社区, "Future doctors, nurses, pharmacists, and other health professionals are tasked with understanding the challenges they face as they return to in-person patient care." The school's goal, she said, was thus "to ensure students know what to expect when they enter the clinical environment."

By signing the waiver, students would waive their right to legal action should they develop COVID-19 resulting from clinical rotations. "I am solely responsible for my choice to engage in an on-site clinical rotation," reads one stipulation, and "voluntarily choose to participate. I therefore assume all dangers and risks inherent with participating."

"I understand that by participating in a clinical rotation at this time, I may be exposed to certain dangers and risks, including but not limited to all risks associated with contracting COVID-19," reads another. "I understand that care of COVID-19 positive patients may occur as part of my participation."

Signing the waiver would "waive and discharge" the university and state of South Carolina, among other parties, from legal actions "arising as a result of being exposed to or contracting the COVID-19 coronavirus in connection with my participation."

Students can decline to sign the waiver, but in that case they will be kept out of the mandatory clinical rotations for an indefinite period. They must acknowledge that "I will be given an opportunity to complete the required in-person clinical experience in an upcoming academic term... when the clinical learning environment can accommodate an additional student without negatively impacting the educational experience for all other students."

Further, students who don't sign the waiver agree that "my academic progression toward degree completion may be delayed."

Jenkins told 番茄社区, "Our faculty and leadership spent countless hours advocating for the best possible educational experiences and outcomes for our students, allowing them to continue with high quality learning experiences, while prioritizing their health and safety. ...There isn't a binary choice between entering a high-risk clinical environment or delaying their education or careers. We continue to offer alternatives to clinical care for students who choose not to reenter the CLE."

She did not say what those alternatives are.

"Our faculty, however, must adhere to the national standards for graduation requirements," Jenkins wrote. "Students who delay reentry into clinical learning experiences too long may find it necessary to extend their educational track."

Sections of the waiver seem to be derived from the AAMC's guidelines, last updated on April 14. "Schools must be clear in policies, language, and actions to consistently and genuinely convey that students' participation is voluntary," according to the guidelines. "The school should also confirm and document that student volunteers have been informed, to the extent possible based on current knowledge, of all risks associated with the clinical care of patients in the pandemic, particularly of patients with known or suspected COVID-19."

As of Friday, Greenville County had reported 1,382 cases -- second-most in the state, tracker. It ranked 15th out of 46 counties in cases per 100,000 residents, and second in deaths (56). But case counts have stayed mostly flat since the end of April, with a handful of rising days in mid-May; it is not designated a hot spot.

South Carolina's case count has gradually increased since late March, newspaper Tuesday; slight weekly increases as summer approaches.

Little evidence suggests the state is short of healthcare workers. Its largest health system, Prisma Health, plans to reassign some employees and cut jobs, , while also rehiring some furloughed workers and increasing hours for employees whose hours were previously cut.

It is unclear whether other medical schools are also demanding liability waivers as a condition of clinical rotation. The AAMC and the American Medical Student Association declined to comment. The American Association of Colleges of Osteopathic Medicine told 番茄社区 it was unaware of any members seeking similar waivers.

The issue was hotly debated online. "I think the waiving of liability is insane. Nobody can guarantee you won't get COVID on the wards but they shouldn't be like 'tough, that's on you to deal with.' Students are a captive population," one poster .

"Teams let med students sit out of all sorts of higher risk or more uncomfortable cases, so making a blanket ban on MS3s/MS4s treating COVID patients would've gone a long way to communicate that the school is in fact making a good faith effort to protect its students and act in their best interests," another wrote.

But another social media post defended the school's policy. "As far as I know, most of my classmates and I want to be back in CLE and our school worked hard to get us back in while providing a way for students to delay if they wished."

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