Vasectomy Post Op Complications

Vasectomy Post Op Complications

From the American Heart Association to network television, no one can escape today’s messages about the dangers of obesity – dangers that are real, not hype. Ironically the epidemic of obesity is occurring in a country that seems to worship the streamlined body and physical fitness.

A recent 2008 update on overweight and obesity statistics from the American Heart Association indicate that:

• 142 million adult Americans are overweight
• 67.3 million of them are considered to be obese

Simultaneously, this has become a growing market for purveyors of weight loss programs, diet pills and medical treatments such as gastric bypass. Experts estimate that 140,000 patients underwent gastric bypass surgery in 2004 with that number increasing each year. Additionally, there has also been a growth in the number of adolescents undergoing such surgery.

On the surface, one would naturally expect medical malpractice claims to increase proportionately to the number of patients seeking help with their weight. However, that is only the surface. A study conducted by FLDIC (Florida Doctors Insurance Company), using nationwide medical malpractice insurance data, noted that 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 such allegations were primarily targeted against the following specialties: Gynecology, Obstetrics, Gastroenterology, Family & General Medicine, Internal/Geriatric Medicine, and Pathology.

Likewise The Doctors Company (which our agency represents) has also seen an alarming increase in lawsuits that involve obese patients. Loss analysis on claims from 1992-2002 identified 287 patients, ranging in age from 4 to 82, with 84 deaths. A significant factor is that 90% of these obese patients had diabetes.

Just as the weight loss industry has seen dollar signs in this growing market, lawyers are quickly jumping on this particular medical malpractice bandwagon. A quick Google of “medical malpractice, obesity” will prove that point. One website was advertising a recent case that resulted in an award of $1.5 million. Another offered a free case review based on an online survey. Their focus may be justified, as Surgery for Obesity and Related Diseases (Volume 3, Issue 1) published a review of 100 bariatric lawsuits by a consortium of surgeons and a med-mal attorney with evidence of negligence found in 28 of the cases.

However, as indicated in the Florida study, the risk is just a real for physicians in other specialties. In an overview of five obesity-related claims published by The Doctors Company, only one was directly related to gastric bypass surgery. The others included failure to diagnose a myocardial infarction and pneumonia, nerve damage caused by positioning on a treatment table, post-op complications and paralysis from spinal surgery, and complications from manipulation while under IV sedation.

Although the management of risk associated with obese patients could probably fill an entire book, rather than a column, there are some basic considerations that every physician should review:

• Are you prepared and equipped to manage large patients in your practice?
• Can your furniture, wheelchairs and examining tables accommodate the weight and size of extremely large patients?
• Is your staff properly trained in assisting obese patients transfer to exam or procedure tables?
• Have you implemented a process to educate patients on the health risks associated with weight?
• Do you openly and honestly discuss, encourage and motivate patients to reduce weight and exercise?
• Are you documenting all discussions and patient education relating to weight?
• Have you reviewed and documented any co-morbid health concerns of the patient related to obesity, such as diabetes, hypertension, sleep apnea, ulcers or other conditions?
• Does your diagnostic equipment have adequate weight ratings?

In cases of surgery, gastric or otherwise:

• Have pre-operative medical and anesthesia consultations been conducted for a thorough knowledge of the patient?
• Is the operating room equipment and treatment table capable of handling the patient?
• If the procedure is conducted in a stand-alone surgi-center, is the location prepared to deal with potential airway and cardiac complications?
• Should elective procedures (excluding bariatric surgery) be deferred until weight loss is achieved?
• Have plans been made for any necessary manipulation of the patient during the procedure?
• Has your informed consent form been expanded to its clearest and fullest potential, conveying additional risks and potential complications due to a patient’s size?
• Have you consulted with any outside specialists related to specific and/or potential risks?

This column is not meant to be a procedural guideline for obesity-related risk management. I merely hope to heighten the awareness of this alarming trend in obesity-related lawsuits and the need to implement detailed risk management strategies in your practice.

J Michael Rosenthal, ARM – President and CEO, RGI Insurance Services – Mike Rosenthal is an Associate in Risk Management (ARM) and CEO of RGI Insurance Services. RGI Insurance Services provides all types of insurance for doctors and medical groups such as medical malpractice, workers compensation and group benefits as well as risk management services, human resource services and OSHA compliance services.