Hospitals super-sizing equipment for obese patients

• Some of the new equipment can help people of normal weight
• Doctors use robots with cameras to help with operations on obese patients
• Hospital staff also may need training on sensitivity issues

INDIANAPOLIS — Hospitals are getting super-sized.

Waiting room chairs are being built with wrought iron for heavy patients. Wheelchairs and beds are made to sustain extra weight. And toilets are being mounted to the floor, not the wall.

In response to America's obesity epidemic, health-care facilities nationwide are making accommodations to make sure they can take care of their heaviest patients.

The trend started about a decade ago when bariatric surgery took off in popularity and the American public began ballooning in weight. By the mid-2000s, hospitals had started to update with these patients in mind. That can mean anything from wider doorways to bigger commodes.

"It really runs the gamut," said Cathy Denning, a vice president at Novation LLC, an Irving, Texas-based health-care supply chain company that produces an annual report on the cost of bariatric care.

And they're finding that those products have uses for other patients.

Vein viewers can locate veins in patients whose fat obscures their vascular access; they're also useful in patients with difficult-to-find veins. Scanners need wide enough holes and strong enough tables to accommodate larger patients; patients with claustrophobia may also appreciate them.

Some doctors are developing reputations for treating larger patients. They use longer needles to deliver injections into thicker arms or special surgical equipment that let the surgeon reach deeper inside a patient's abdominal cavity.

Dr. Hubert Fornalik's average patient at St. Vincent Indianapolis has a body mass index of 38. Normal BMI is considered to be 18.5 to 24.9. That means a person who stands 5-foot-9 would weigh 125 to 168 pounds.

Recently Fornalik, a gynecological surgeon, operated on a woman who had a BMI of 83 and weighed more than 400 pounds.

"We see more and more of those patients, and those patients are unfortunately bigger and bigger," he said.

The increase in patients helps drive the increase in costs. More than a third of all U.S. adults — 35.7% — are obese, according to the Centers for Disease Control and Prevention.

In the past year, some hospitals have spent as much as $5 million in updates for obese patients, said the 2012 Novation report, released last month.

The Novation study found that hospitals have seen slightly more morbidly obese patients in the past 18 months. Morbid obesity refers to patients whose BMI exceeds 40, about 280 pounds for a person who stands 5-foot-10. About 18 million Americans fall in this category.

More than a third of U.S. hospitals invested in physical renovations in the past year to serve obese patients better, the Novation study found.

During the past four years, the number of facilities that make changes increased each year, Denning said.

Hospitals must make changes sensitively, said Terri Hohlt, administrative director for St. Francis' bariatric and medical weight loss program. For instance, furniture that can support a large patient should blend into the environment. Staff may also need training.

"You don't want to say, 'Hey go get the big wheelchair for this patient,' " Hohlt said. "We want to do everything to make sure that they are not identified as an obese patient through their whole journey."

Her hospital replaced a MRI scanner with a wide-bore machine that features a larger opening for the patient. It is similar in price to standard scanners.

Franciscan St. Francis staff used to turn away three to four patients a week who were too big for its MRI scanner. Sometimes they would recommend Purdue's veterinary scanner.

"That's a hard conversation to have with somebody," said Paul Minnis, the hospital's MRI imaging team leader.

Now, the hospital can handle people up to 600 pounds, Minnis said. After that, they do individual evaluations; taller patients, for instance, spread their weight over a longer area.

Despite all these efforts, obese people say they still suffer prejudice in doctors' offices and hospitals because of their weight.

The National Association to Advance Fat Acceptance recently surveyed members about what issues they face. Most said finding good health care tops the list, said Peggy Howell, the organization's public relations director.

Many people responded that doctors tend to brush off their concerns and just recommend they lose weight even if the symptom has nothing to do with their size, she said.

"That's really inappropriate," Howell said. "What we tell people to ask the doctor if they get that response is, 'If a thin person came in with these issues, what kind of treatment would you recommend?' "

However, sometimes doctors can't treat a person with excess pounds the same way.

Fornalik's patients often have seen other doctors before they come to his exam room. He operates with the assistance of robots, which studies have shown result in a better prognosis than open procedures for heavy patients. The robotic arm with its camera on the end gives the surgeon a view inside the body that leads to fewer complications and a quicker recovery.

But Fornalik never had a patient whose BMI exceeded 80 — until a few months ago when he saw the 33-year-old woman with a BMI of 83 and severe menstrual bleeding. She carried 435 pounds on her 5-foot-2 frame.

Morbidly obese patients pose more challenges, Fornalik said. They have limited activity levels and rarely push themselves physically, so doctors can't predict how they will respond to the stresses of surgery.

Surgery presents another problem. On the operating table, the patient is positioned so the abdomen puts pressure on the lungs. Heavier patients, therefore, need sufficient reserve in their lungs and heart. Normal lung pressure ranges from 30 to 35. Fornalik's patient with the BMI of 83 measured close to 55 when she lay flat.

Another doctor might have canceled the surgery, but Fornalik realized that this patient always lived under such conditions and decided to go ahead.

Fornalik's first attempt did not fly. The anesthesiologist refused to proceed, fearing what might happen. In addition, the nurses had difficulty positioning the patient for surgery because her legs were too big for the stirrups.

But Fornalik did not let that dissuade him.

He found an anesthesiologist who was willing to use a larger tube to intubate the patient and made some other adjustments. About four weeks later, he performed a successful procedure.