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Obesity Alters Valley Hospitals: Larger Patients Require Bigger Wheelchairs, Beds and Scanners.

Posted on: Friday, 14 April 2006, 09:01 CDT

By Barbara Anderson, The Fresno Bee, Calif.

Apr. 14--The supersizing of America is reshaping the hospital bedside -- and none too soon for thousands of patients who are obese.

Extra-wide wheelchairs, heavy-duty walkers, beds built to hold someone weighing 500-plus pounds, extra-large operating tables and extra-long surgical instruments now sit next to smaller, one-size-fits-all equipment in many central San Joaquin Valley hospitals.

Health workers and paramedics increasingly use special lift machines to move heavy patients, sparing their necks and backs while preserving the dignity of the invalid.

Hospitals have little choice but to accommodate heavier patients. They're serving more and more of them. Nationwide, about 65% of adults are overweight or obese. In the Valley, 55% of adult women are considered overweight or obese, and 71% of adult men fall into those two categories.

Valley hospitals also have incentive for providing for the needs of larger patients.

The Fresno area is a destination for many seeking gastric bypass, the most popular weight-reduction surgery and one that is lucrative for hospitals, with a typical surgery costing $25,000 to $30,000.

Three Fresno-area hospitals -- Community Medical Center-Clovis, Saint Agnes Medical Center and Fresno Surgery Center -- received a "Centers of Expertise" designation for the affordability and quality of bariatric surgery last year from the insurer Blue Cross of California. Bariatrics is the medical specialty dealing with the treatment of obesity.

Bariatric surgery can help a hospital's bottom line, but providing accommodations for large patients isn't cheap. Hospitals spend thousands of dollars for equipment, such as extra-wide operating tables, beds, chairs and lift devices.

One indication of the obesity revolution in hospitals: Specialty bed manufacturer KCI of San Antonio reports about 20% growth in product use this year over last.

The company's bariatric beds cost between $17,000 and $28,000 -- about twice as much as regular hospital beds, said Bruce Allen, KCI senior product manager. But demand remains high for the large beds.

"There's no indication at this point that [the market] is slowing down," Allen said.

Two years ago, Physicians Imaging of Fresno bought an open magnetic resonance imaging machine capable of holding a patient up to 500 pounds. Many of those machines are closed and unable to hold larger patients. Physicians Imaging also bought a computer tomography machine, or CT scanner, that can accommodate patients weighing up to 450 pounds.

The machines stay busy, said Rob Tookoian, chief executive officer. "Probably a few times a month we're getting patients from facilities that send them to us because of the weight issue."

Paying for special equipment can be especially costly for small and medium-size hospitals that have fewer resources than large medical centers, but they too are confronted with an increasing number of obese patients who need services.

"This is something we're all challenged with and we're all seeing," said Lori Ruffner, a registered nurse and director of surgical services at Kaweah Delta Hospital in Visalia.

Hospitals are recognizing the "epidemic nature of the problem in the country and the need to address it," said Walter Lindstrom, founding partner of the Obesity Law and Advocacy Center based in Chula Vista.

Whether it's a bed designed to hold their weight or a blood pressure cuff big enough to wrap around an arm, those who are overweight and obese welcome changes -- big and small -- to make a hospital visit a better experience for the heavy patient.

Aimee McFarland, 37, of Madera, was accustomed to restaurant booths and seats in movie theaters being too narrow to accommodate her when she weighed 300-plus pounds, but she wasn't prepared for a too-small wheelchair after the birth of her oldest son eight years ago at a Fresno hospital.

"I ended up walking out of the hospital after a C-section with my baby in my arms," she said. "I couldn't help but wonder if I was a skinny person if that thing would happen."

McFarland had a second son six years ago at the same hospital. After that delivery, she was provided a wheelchair that fit. She has since had gastric bypass weight-loss surgery and has lost 136 pounds.

It's important hospital officials understand how obese and overweight patients feel, she said.

"People who are overweight have a stigma to them everywhere they go. You'd think in the hospital ... they'd have equipment there to accommodate larger people," she said.

In her particular case, when they didn't provide an extra-large wheelchair, McFarland said, "it just kind of amazed me."

Most hospitals try to accommodate obese patients, said Dr. Daniel Swartz, a Fresno surgeon who specializes in advanced laparoscopic and bariatric surgery. But Swartz said: "I think if a hospital is not doing bariatric surgery, they're not going to make all the changes."

At Community Medical Center-Clovis, more than 700 bariatric procedures were done last year. The hospital has special equipment, from reinforced toilets to roomy chairs minus arms, to make the hospital stay easier.

Mario Encinias, 46, of Hollister, had gastric bypass surgery and spent five days at the Clovis hospital last year. He weighed 558 pounds at the time of his surgery.

Encinias said nurses were sensitive to his needs.

"They got me a speciality bed," he said. The bed expanded from a single to a queen size and had the flotation mattress, which Encinias needed.

On Wednesday, he returned to the Valley for a one-year checkup. He weighed 381 pounds.

Encinias said he understands obese patients present challenges to medical providers but wondered why more accommodations aren't provided since obesity is so widespread.

Five years ago, he was in a car accident outside Hollister and needed to be airlifted by helicopter to a hospital.

"They didn't have a helicopter that could fit me," Encinias said. "They squeezed me in."

Todd Valeri, general manager at American Ambulance in Fresno, said transporting obese patients requires special planning to avoid injuring employees and for the safety of the patient.

Ambulance crews transported an average of 77 patients yearlywho weighed in excess of 500 pounds between the years 2002 and 2005, according to company records. During the first three months of this year, 28 patients heavier than 500 pounds were transported, with the heaviest weighing 900 pounds.

American Ambulance plans to retrofit an ambulance with equipment capable of lifting 1,200 pounds once a vendor is selected for the work, Valeri said. Some of the company's ambulances now have the capacity to lift up to 800 pounds.

Making lifting easier also can reduce on-the-job neck and back injuries that take health-care workers off the job, adding to the nursing shortage and increasing costs to hospitals in work-related insurance claims.

About 12% of registered nurses report leaving bedside care as a result of work-related injuries, said Donna Gerber, director of government relations for the 65,000-member California Nurses Association.

The nurses' association is the sponsor of Senate Bill 1204, legislation that would require hospitals to implement safe lifting policies. Similar bills introduced in the past two years failed to win the governor's signature.

Jan Emerson, vice president of external affairs for the California Hospital Association, said her association supports the idea of policies to reduce injuries but opposes the nurse-sponsored legislation. Language contained in the bill is too restrictive, she said.

Kaiser Permanente Northern California favors the nurses' legislation.

Last June, Kaiser implemented its own "patient mobility program" for safely lifting and moving patients. The Kaiser policy goes beyond proposed requirements in the legislation, said Mike Green, regional managing director for workplace safety.

The lifting policy works, he said. Employee injuries fell 38% regionwide from 2001 to 2005. The effect was even greater in Fresno, he said, where injuries dropped 50% over the same four-year span after the policy was implemented.

Thus far in 2006, injuries regionwide are down an additional 14% from 2005, he said.

Kaiser has spent $3.5 million to $5 million in the past three years on portable lift equipment that can be used throughout the medical complex, Green said. The health organization viewed it as a good investment, he said.

At the 163-bed Sierra View District Hospital in Porterville, officials hope spending $60,000 on new lift equipment will pay off in two ways: reduction in workplace injuries and more mobility for patients.

One of the 13 pieces of equipment lifts a patient weighing up to 500 pounds. "Before, it would take as many people as you could reasonably fit along either side of the patient," said Brenda Welling, the hospital director of health and safety.

McFarland applauds hospitals for being sensitive to the needs of large patients.

"There's always a constant reminder you have a problem," she said. "You're out of the ordinary. You're too big."

In a hospital, you shouldn't be concerned about fitting into a chair or a bed, she said. "That's the last thing in the world you need to worry about."

The reporter can be reached at banderson@fresnobee.com or (559) 441-6310.

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Copyright (c) 2006, The Fresno Bee, Calif.

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Source: The Fresno Bee

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