QUESTION:        Our hospital does not have a bariatric surgical program. In fact, we are concerned that neither our equipment nor our staff are up for handling obese patients. Can the hospital set a patient weight limit for an area of care, like the OR or the ICU?

ANSWER:        It’s an interesting question.

Under certain states’ statutes, employment law protects the obese from being discriminated against.  It appears that this idea is gaining steam to potentially create a new protected area under the federal ADA, again in terms of employment.  But, as of now, there does not appear to be any clear law that makes obesity a protected class in terms of receiving health care services.  Nonetheless, for good risk management purposes, any hospital’s rules as to care for obese patients should be based in reasonable principles and concerns.

The risk management issue arises when it appears that a hospital has set a weight number arbitrarily.  Any hospital rule should be based upon sound information and supporting data as to why the rule is needed, be that for the protection of the patient and/or the hospital and its staff.  Otherwise, this practice is more likely to expose the hospital to complaints and ethical questions of discrimination.

The clearest situation is where the hospital’s equipment is incapable of supporting the patient’s weight.  But where the equipment can accommodate the weight, there should be good reasons for the hospital’s position, be that injury to staff, clinical difficulties for treating the patient (outside of equipment weight-support/ability, etc.).  These would be specifics to the nature of the patient and/or the nature of the hospital and its resources.

On the ethical front, a statement from the American College of Obstetricians and Gynecologists is helpful as a guiding principle: “It is unethical for physicians to refuse to accept a patient or decline to continue care that is within their scope of practice solely because the patient is obese. However, if physicians lack the resources necessary for the safe and effective care of the obese patient, consultation or referral or both are appropriate.”

Obesity has been increasingly held to be a protected area in employment law, and employment termination due to weight discrimination has been successfully challenged a few times by the Equal Employment Opportunities Commission (EEOC).   In 2014, the AMA classified obesity as a medical disease for the first time.  All of this is moving in the direction of obesity to be classified as a disability in terms of employment.  Only time will tell whether this becomes a stepping stone for further expansion into other areas.