Two out of three people in Florida are overweight, and one out of four is obese!
Obesity not only affects the patient, but it also affects medical facilities and physicians in many ways, some of which one may not be alert to. A study conducted by Florida Doctors Insurance Company (FLDIC) using nationwide medical malpractice insurance data noted an increasing number of malpractice cases cite failures by physicians to monitor, treat, or educate patients regarding the risks of their obesity. The study found that allegations were principally targeted against the following medical specialties:- Gynecology
- Obstetrics
- Gastroenterology
- Family and General Medicine
- Internal/Geriatric Medicine
- Pathology
The study further highlighted obesity related risk issues linked to the equipment and environment of the hospitals and other care facilities, including physician offices. The most prominent risks include use of exam tables unable to support heavier patients, wheelchairs incapable of supporting excessive weights, and facility flooring or carpeting that promotes slip and falls or tripping. Facilities need to review the weight capacity of exam and procedure tables, radiology equipment, wheelchairs, waiting chairs, etc. Facilities should also inspect and ensure an environment that decreases the chance of trip and fall hazards. It should ensure that properly trained staff provides assistance for obese patients as they move throughout the facility and into vehicles.
Patient education regarding the effects of obesity is not only encouraged, but required in order to provide evidence of proper medical practices followed. Education should include regular discussion of health risks associated with weight. Extensive notes should be documented in the patient medical record. Notes should indicate discussions with the patient and encouragement to reduce weight and exercise, if appropriate. To decrease obesity related risk, facilities should consider the following for its patients:- Is the facility properly equipped and set up to manage large patients?
- Will staff be involved in helping obese patients transfer to exam or procedure tables? Is staff properly trained to assist in these transfers without injury to themselves or patients?
- Does the patient have co-morbid health concerns that may be related to obesity such as diabetes, pressure ulcers, sleep apnea, or other conditions?
- Is a scheduled surgery or procedure going to be more difficult due to obesity concerns?
- Has patient education regarding obesity risks been documented in the medical record?
- Is the patient a candidate for procedure or surgery only after they lose weight? Is surgery delayed until a proper weight loss is achieved?
- Does diagnostic equipment have adequate weight ratings?
- Do we record the exact patient weight and compare this to equipment ratings?
If an obesity related risk arises and the facility or physicians have reason to believe that a lawsuit may arise from the subject treatment, or a Notice of Intent to file a lawsuit is received, the facility or physician should provide a written precautionary report to his or her medical malpractice insurance carriers claims department. Such notification not only allows the insurance carrier to monitor the situation and ensure the facility or physician has coverage, but it also allows for possible prevention of a lawsuit through utilization of risk management resources.
A facility or physician should not attempt to handle the pre-suit process alone! If insured, such an action would likely violate the terms of the medical professional liability policy, and could possibly result in the denial of insurance coverage for that claim. Whether insured or self-insured, the facility and/or the physician also runs the risk of violating pre-suit provisions, and having the defenses dismissed in the ensuing litigation. See FLA. STAT. CH. 766.106(7) (2007). For this reason, when a Notice of Intent is received, the facility or physician should immediately notify their insurance carrier if insured. If the physician is self-insured, an attorney specializing in medical malpractice defense should be contacted as soon as possible. Pre-suit for an obesity related risk is only the beginning of a complex and lengthy process. While following the above advice will not prevent a Complaint from being filed and will not circumvent litigation, it will help ensure that there are not any unexpected and preventable complications that arise because of the facility or physicians own actions. Hence, it will make a difficult and stressful process easier to manage for the facility, the physician, the defense attorney, and the insurance carrier.
