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By DAN REYNOLDS, senior editor of Risk & Insurance®

Picture this: Some hospital patients are so overweight their paper gowns sometimes split, exposing folds of copious nakedness to a room full of doctors and nurses.

Who's at fault for the embarrassing exposure in the first case, or the physical injuries in the second? You are, Mr. and Mrs. Healthcare Risk Manager, and you better get used to it.

A national obesity epidemic is placing more of a burden on the healthcare industry to properly handle the obese when they enter a hospital or some other healthcare facility, according to presenters at the annual conference of the American Society for Healthcare Risk Management in Denver on Oct. 22 through Oct. 25.

Preparing hospital emergency rooms can be key to mastering the many challenges posed by overweight patients, according to Geri Amori, vice president of the educational center at the Lansing, Mich.-based Risk Management and Patient Safety Institute and a presenter in Denver.

Preparation is also the easiest way for hospitals to avoid liability in cases involving obese patients.

That means investing in tools with larger specs: from medical equipment, to hospital furniture, to surgical gowns and even doorways--make them 48 inches wide--to make sure that obese patients aren't embarrassed or harmed in a hospital facility.

That also means governing how your staff, or even how other patients, talk about and address fat people. Careless whispers and derisive glances are no longer tolerated.

"Sensitivity to weight is the same as sensitivity to any other issue, shortcoming or determinant," Amori said.

Courts are weighing in, treating obesity like any other disability. That means the burden to accommodate an obese patient, no matter how big they are, is on the healthcare giver.

Janelle Mickelson, a clinical risk and patient safety specialist with the Risk Management and Patient Safety Institute, referred to Smith v. Bottsford.

In that case, a Michigan man who weighed more than 600 pounds was in a car accident and his SUV rolled over. He fractured his leg and was admitted to the emergency room of a local hospital for care. But guess what? He couldn't fit through the CAT scan. The equipment at the hospital wasn't big enough.

After 25 minutes en route to another hospital, the man died.

The jury award against the first hospital for not having the right-sized equipment? Make it $35,000 in economic damages, and another $5 million in noneconomic damages.

Under Michigan law, the noneconomic damages were capped at $359,000. That's not small change either, but then again you might not be in Michigan.

Do you want to get really irritated? Well don't, because merely displaying irritation at the plight of an obese patient could be construed as insensitivity, and could thus be grounds for litigation.

Compounding the difficulties in properly caring for or triaging obese patients is the fact that 21 percent of the U.S. population is illiterate and 25 percent of the U.S. population is moderately illiterate, according to Mickelson.

That means that, in admitting or discharging patients, either post-operative for bariatric surgery, or before admittance, as in the case of an obese pregnant woman who needs to know the risks involved in giving birth in her condition, hospital instructions have to be in the plainest of English.

That means eliminating medical jargon from verbal or printed consultations--never a bad idea anyway.

"Does the patient have informed consent, do they truly understand the risks?" is how Mickelson put it.

According to the World Health Organization, 1 billion people worldwide are overweight, 100 million of them in the United States alone.

November 2, 2009

Copyright 2009© LRP Publications