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What is ROPE, and did a tourist in Hawaii die from it after snorkeling?

According to the woman, her husband died from fluid in his lungs that was not caused by drowning, but by something called Rapid Onset Pulmonary Edema.

A Michigan woman is suing a resort in Maui, the Hawaiian Tourism Authority and the Hawaii Visitors and Convention Bureau after her husband died while he was snorkeling.

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Patricia Johnson said her husband, Ray, went snorkeling around Wailea Beach on Feb. 4, 2022, when he suddenly appeared to be in trouble.

Ray Johnson was snorkeling with friends, according to a story from USA Today, and Patricia Johnson had been hiking nearby when she noticed her friends trying to help her husband.

At first, she said, he had his head above water and was returning to the beach, but then the 64-year-old fell backward and had to be helped ashore.

Ray Johnson died soon after, according to ABC News.

According to the medical examiner, Johnson’s cause of death was accidental drowning. Johnson said she does not believe her husband drowned.

“I was watching him come in, how could he be drowning?” According to her friends, who were snorkeling with him, Ray was talking and also diving down under the water.

At one point, a friend who was with Ray Johnson said he came up out of the water and said, “You gotta help me, I’m having trouble breathing,” and that’s when he decided to head back to shore, according to Honolulu Civil Beat.

“I don’t think when people are drowning in a conditional manner, you’re going to be conversing,” Patricia Johnson said of her husband’s final actions.

What Patricia Johnson believed killed her husband was Rapid Onset Pulmonary Edema.

Johnson is suing Hawaii travel entities and the Maui resort for having failed to educate the public on ROPE, resulting in “an important public health concern,” according to the complaint filed in the Circuit Court of the First Circuit in the State of Hawaii in February 2024.

The Hawaiian Tourism Authority, Hawaii Visitors and Convention Bureau and Fairmont Kea Lani declined to comment to USA Today on the lawsuit.

What causes ROPE?

According to the Mayo Clinic, pulmonary edema is a condition caused by too much fluid in the lungs. This fluid collects in the many air sacs in the lungs, making it difficult to breathe.

Fluid can collect in the lungs for many reasons, though heart issues are the most common.

Other causes include pneumonia, contact with certain toxins, medications, trauma to the chest wall, and traveling to or exercising at high elevations.

Snorkeling can cause the issue, as well. ROPE occurs when the negative pressure on the lungs ends up sucking bodily fluids out of the capillaries and into the airways, Dr. Raj Dasgupta, a California-based pulmonologist, told USA Today.

Drowning by ROPE is “fundamentally different” than typical drowning, when people are aspirating water or submerged and often showing signs of distress, according to the complaint Patricia Johnson filed.

“Patients or people who are out snorkeling will notice an increase in shortness of breath …, but then they’ll also become confused,” Dr. Meilan Han, chief of pulmonary & critical care medicine at the University of Michigan told ABC News.

Jay Stuemke, Johnson’s attorney, says the couple’s long flight and lack of knowledge about ROPE contributed to Ray Johnson’s death.

“What long haul flights do, is it has an effect on your lungs,” Stuemke said. “After 3 days you are back to normal, but if you snorkel after that long flight there is a substantial increased risk of death.”