Avoid risk from obese with specific policies, rules

(Editor's note: This is the last of a two-part series on the liability risks associated with treating morbidly obese patients. Last month's Healthcare Risk Management explored the obligations to prepare for these patients. This month's issue details how one insurer has provided specific guidelines to mitigate the risk.)

As Americans get bigger and hospitals see more large patients seeking bariatric surgery, risk managers are worried about the increased liability risk they pose. These patients can be injured if you do not have the proper equipment for patients of this size, and you may need to change policies and procedures to protect both the patient and your staff.

One insurer has addressed the problem head on with a set of guidelines for its clients who provide bariatric surgery. PHT Services (PHTS) in Columbia, SC, provides risk management services to South Carolina's health care industry, and Brian J. Teusink, CPA, CCM, AIAF, executive vice president and chief risk officer, says the company developed the guidelines after realizing that its members were caring for obese patients more frequently than in the past. The obese patient brings special concerns in any health care setting, but bariatric surgery is a relatively new field with a substantial risk for complications, he notes.

The guidelines are intended to help risk managers address the inherent risks of obese patients and to ensure that bariatric surgery is provided in the safest manner, Teusink says.

Their approach has been to look at the risk enterprisewide, which means taking into consideration the risks not only to the patients but also the staff, he says. "Our workers' comp program has been moving toward minimal lift, making sure hospitals are getting the proper equipment in place and lift teams to prevent staff injuries," he says. "The increase in bariatric surgery is putting more emphasis on that effort."

In addition to lift and transfer equipment, obese patients require beds rated for their weight and size, toilets and chairs designed for the large patient, and various medical equipment that is required to adequately and safely provide medical care, Teusink says. Surgical tools must be longer, blood pressure cuffs bigger, and it's a good idea to bolt exam tables to the floor so they can't tip over.

PHTS provides guidance to risk managers concerned about adequately caring for large patients, but any provider who will perform bariatric surgery must meet PHTS' guidelines in order to be insured by the company.

"If you're considering doing bariatric surgery, get started early on putting together a team that will oversee this, because you're going to need to pull together representatives from many disciplines," Teusink says. "You don't want to get the program up the 11th hour and realize you don't have some key people involved."

T. Stephen Helms, CPCU, ARM, a risk management consultant with Palmetto Healthcare Liability Insurance Program, the insurance division of PHTS, explains that the guidelines were devised by a bariatric task force of experts from different hospitals. The guidelines must be adopted or PHTS will not provide coverage for claims arising from bariatric surgery.

The guidelines require hospitals to invest in additional equipment that is designed especially for obese patients, and Teusink explains that most hospitals see that investment as a cost of doing bariatric surgery. But for hospitals that don't do bariatric surgery and might see the extra large patient for other care only occasionally, how do you know if the expense is justified?

"Those business decisions can be made based on the history of who has shown up in your emergency department in the past, the community you serve, and whether there is another facility in the same region that might be better able to handle the obese patient," Teusink says. However, they encourage their member hospitals to be prepared for these patients, he says. "If they don't have specialized equipment available, then they need to have administrative controls in place with their staff to ensure that they have lift teams ready to respond and other ways to respond," he says.

Helms notes that it is risky for a hospital to avoid preparing for obese patients, because they eventually will come to your facility for one reason or another. With the growing numbers of obese people and the health care industry's recognition of their special needs, it is getting harder for a hospital to claim it didn't expect to treat them, he says. "The question is going to be what is the reasonable standard, and I think it's reasonable to think that you're going to treat obese patients," Helms says.

Diversion can be an option

Teusink says it can be acceptable in some circumstances to divert extra large patients to another facility more capable of treating them, but that would not be acceptable when the patient has an emergency medical condition. That means your emergency department might be the first place to start investing in the special equipment and staff training, he suggests.

Wendy G. Stephenson, MS, senior risk management consultant with PHTS, also notes that much of the equipment and staff training is useful for standard patients, not just the obese. Lifting and transfer devices, for instance, also can prevent injuries when the patient is a 100-pound elderly woman who cannot assist with her transfer.

"It's a good business decision for any kind of patient you have coming in to have adequate lift equipment available," she says. "It's not as if you're going to buy this equipment and never use it until a very large patient shows up."

Sources

For more information on the liability risks of treating obese patients, contact:

  • T. Stephen Helms, CPCU, ARM, Risk Management Consultant, Palmetto Healthcare Liability Insurance Program, 250 Berryhill Road, Suite 402, Columbia, SC 29210. Telephone: (704) 895-4732. E-mail: steve_helms@aig.com.
  • Wendy G. Stephenson, MS, Senior Risk Management Consultant, PHT Services, 250 Berryhill Road, Suite 402, Columbia, SC 29210. Telephone: (803) 731-5300, ext. 504. E-mail: wstephenson@phts.com.
  • Brian J. Teusink, CPA, CCM, AIAF, Executive Vice President and Chief Risk Officer, PHT Services, 250 Berryhill Road, Suite 402, Columbia, SC 29210. Telephone: (803) 731-5300, ext. 585. E-mail: bteusink@phts.com.