Should Providers Refuse to Treat Overweight Pregnant Women?
Various media sources (including social media) have been abuzztoday regarding news of some ob-gyns in Florida refusing treatment to some patients on the basis of weight/BMI alone. The Baltimore Sun article on this practice is one of the more detailed pieces to come out; please read the original article here, as only portions will be dealt with here.
Now, for the “fisking.”
In a nation with 93 million obese people, a few ob-gyn doctors in South Florida now refuse to see otherwise healthy women solely because they are overweight.
It is important to keep in mind that these women are being denied care *solely* as a result of being obese/overweight, before developing any particular complications related (or not!) to their weight.
Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier.
While this isn’t a terribly scientific method of inquiry, it’s still over 10% of the area ob-gyns interviewed who felt it necessary to develop weight guidelines for accepting patients. It is unclear here whether the women are denied care if they are/were above the guidelines before pregnancy or if they reach them during pregnancy as well. A cutoff of 200 lbs. could impact a number of women, both before and during pregnancy, particularly women who already tend towards that end/are taller/athletes/etc. It is also unclear how “obesity” is measured, although it is assumed that the ob-gyns use BMI to determine whether a woman should be denied care. The problems with BMI (and pregnancy) have been dealt with here, as well as at The Well-Rounded Mama and a number of other blogs.
“People don’t realize the risk we’re taking by taking care of these patients,” said Dr. Albert Triana, whose two-physician practice in South Miami declines patients classified as obese. “There’s more risk of something going wrong and more risk of getting sued. Everything is more complicated with an obese patient in GYN surgeries and in [pregnancies].”
“People don’t realize the risk we’re taking by taking care of these patients.” Would these people be the pregnant women, taking their own risks in pregnancy and childbirth? And why are the risks of the situation focused on the physicians, and not the patient? If the reason that these ob-gyns are turning down patients due to weight is because of complications, why not deal with that? Ah…”more risk of getting sued.” Dr. Triana’s practice also declines “obese” patients, which can range from a very unhealthy person prone to complications to, say, an athlete.
Plantation ob-gyn partners Jeffrey Solomon and Isabel Otero-Echandi turn down any woman weighing more than 250 pounds.
Solomon and Otero don’t want to begin seeing heavy women and then have to send them to specialists if they later develop problems, said their office manager, who asked not to be named. The two doctors, like several of the others with weight cutoffs, declined to comment.
These two physicians do not want to later have to refer women out; what do they do with patients who develop actual complications later in pregnancy? One presumes that they refer them out to the needed specialists.
“This is not a high-risk practice,” the office manager said. “They are not experts in obesity.”
If the ob-gyn’s office is not high-risk, whom is it designed to handle? In addition, is there a specialty in pregnancies of obese women? If not, then to whom are these women being referred, since the regular ob-gyns - the people trained to assist in higher-risk births - are refusing to see them? The hospital the practice refers to had, in 2008, a Cesarean section rate of 46.7%, significantly above the state average.
Turning down overweight people is not illegal for doctors, but the policy worried leaders of physician groups, medical ethics experts and advocates for the obese, all of whom said it violates the spirit of the medical profession.
While it is completely understandable to refer patients out if a practice if unable to take care of them, it is something else entirely to deny women care simply because they might possibly have complications at some point.
So far, the weight cutoffs have been enacted only by South Florida ob-gyns, who have long complained of high numbers of lawsuits after difficult births and high rates for medical-malpractice insurance. More than half go without coverage.
It is interesting that an area decried by the doctors as having a high rate of lawsuits, and where many of the doctors do not carry malpractice insurance (!!!) is one of the same areas where women are constantly faced with a lack of choice around pregnancy and birth.
Several ob-gyn offices said their ultrasound machines do not give good images of internal anatomy in obese women, making it harder to diagnose medical problems.
A lack of appropriate equipment is an understandable reason to refer someone out - for that procedure, much like patients are referred out for x-rays, CT scans, and even ultrasounds during pregnancy, as many offices only maintain older or more basic equipment in office, referring out for detailed images.
The Plantation office manager said weight limits are not uncommon at offices owned, like hers, by the Coconut Grove medical services company VitalMD.
VitalMD Group Holding, LLC describes itself as “a large group practice focused on delivering high-quality women’s health care. Founded by an expert team of savvy physicians and business professionals, VitalMD was formed to help its physician members achieve their financial, operational and clinical goals through the group practice model while allowing them to refocus their time on providing quality patient care.”
VitalMD treasurer Kerry Kuhn, an ob-gyn in Coral Springs, said he was unaware of his doctors setting weight limits, adding the company has nothing to do with doctor decisions.
“This is individual choice by a doctor,” Kuhn said. “Doctors know who they want to treat.”
Doctors. know. who. they. want. to. treat.
Doctors also are allowed to drop patients, if they believe they lack the medical skills to properly treat them. They must send notices and refer them to other doctors.
If this significant a proportion of physicians are unable to properly treat obese/overweight patients, it begs the question as to why these professionals are not trained to treat these patients.
But decisions about patients typically are made after assessing the individual’s condition during an exam, not by ruling out an entire group, said Dr. Robert Yelverton, a board member of the Florida Obstetric and Gynecologic Society. He said he would discourage physicians from excluding the obese.
“Do I think it’s a good policy? No,” Yelverton said. “Overweight people need doctors. I don’t know where a patient in that situation would go if every practice had that policy.”
Do you know of any physicians/midwives who use the same or similar criteria in accepting patients for care? Have you been denied care as a result of your weight or BMI? Are you a provider who denies care to patients not meeting certain weight/fitness guidelines?