Are You Ready to Care for Obese Patients?


The growing problem of obesity in America could pose a future liability issue for hospitalists and their employers, according to a bariatric surgeon.

Michael Jay Nusbaum, MD, FACS, FASMBS, FACN, says it's all too common for hospitalists and other physicians to "turf that patient out" to larger medical centers, but he cautions those doctors might be opening themselves to liability issues unless they can explain why they sent a patient elsewhere for care. For example, many hospitals lack wheelchairs, stretchers, tables, and gantries to hold morbidly obese patients.

"Is it really because you feel that the hospital lacks the infrastructure or because you just don't feel like taking on the additional liability that you're transferring the patient?" says Dr. Nusbaum, chief of bariatric surgery at Morristown (N.J.) Medical Center. "That's the question."

Dr. Nusbaum says hospitalists who believe their hospitals lack the proper equipment to treat obese patients should be "going out to the administration and saying, 'Look, we've got a liability issue. We don't have the equipment to take care of these patients if they start coming in.'"

He also believes that some physicians try to avoid obese patients for fear that their quality scores will drop. Dr. Nusbaum says that "disincentive" is built into the system, and it is incumbent on HM leaders and other physicians to push for change.

"The healthcare system in general is unprepared for the obesity epidemic," he adds. "And quite a bit of that is due to decreasing reimbursement and the fact that they need to lay out a lot of capital to take care of morbidly obese patients. ... It comes down to money."

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