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    Obesity reshapes hospital care

    Hospitals need lifts and larger beds and chairs for the rising number of patients weighing more than 400 pounds.

    By TAMARA LUSH, Times Staff Writer
    © St. Petersburg Times
    published July 14, 2002

    TAMPA -- When Joann Shea started her career as a nurse, a 400-pound patient might come into her hospital once a year.

    Now, 20 years later, Shea is the director of employee health and wellness at Tampa General Hospital. She says people weighing that much and more are admitted to the hospital every day.

    Although TGH has one of the larger surgical weight-loss facilities in the area -- which helps explain the startling increase in obese patients -- a similar phenomenon is occurring at hospitals throughout the United States.

    The fattening of America is forcing hospitals to change their practices, in ways both large and small.

    TGH recently hired a six-man "lift team" to help transport and turn large patients safely. Bayfront Medical Center in St. Petersburg is using bigger operating room tables and floor lifts. Community Hospital in New Port Richey has armless chairs in some waiting rooms so obese patients can sit more comfortably.

    "It's unfair for the patients not to have a bath just because we don't have a wide enough shower chair for them," Shea said.

    "Everything you do to a regular patient, you have to accommodate to 400, 500, 600 pounds," said Dr. Eneida O. Roldan, a Miami clinician who focuses on the needs of obese patients. "Obviously, the epidemic is here."

    In part, hospitals are adjusting to larger patients because it's good business: Nearly 55 percent of the U.S. population -- or 97-million adults -- are now classified as overweight or obese.

    Obesity can exacerbate diabetes, heart disease and hypertension. Most at risk, according to the National Institutes of Health, are those classified as "morbidly obese," defined as being 100 pounds or more overweight.

    A woman who is 5-feet-4 and weighs about 240 pounds is considered morbidly obese. So is a man who is 5-feet-10 and 280 pounds.

    Because obese patients are at greater risk for health problems, and because hospitals are increasingly offering in-patient surgical procedures to facilitate weight loss, larger people are filling more hospital beds.

    TGH is one of the more innovative hospitals. Along with the lift team, the hospital has installed steel ceiling tracks to hook harnesses, allowing the team or nurses to slide patients on and off beds. The lifts can handle as much as 400 pounds.

    If a patient is larger, the hospital has a portable floor lift that can accommodate up to 1,000 pounds. Some of those tools also are used to move smaller patients who aren't mobile, such as quadriplegics.

    The costs of such equipment are enormous. A single large recliner costs $15,000; TGH only has one. Sometimes, if staff is aware of an incoming large patient, they will rent an entire "suite" of equipment, which includes a bed, wheelchair, walker and commode, at a cost of $145 a day.

    TGH will soon create a task force to evaluate the needs of bigger patients. From hospital gowns to in-room recliners to commodes, everything will be scrutinized to better accommodate large patients.

    St. Joseph's Hospital in Tampa also is considering hiring a lift team, in part because it will begin bariatric surgery in August. "Bariatric" is the medical term used for obesity; it stems from the Greek word barros, which means large or heavy. Bariatric surgery includes stomach stapling procedures and gastric bypasses, combined with treatment by nutritionists and other doctors.

    Experts say that if such patients are treated with dignity and respect the first time they visit a doctor or hospital, they are more likely to return. Roldan hopes that a positive experience with a doctor can keep a 300-pound patient from becoming 600 pounds.

    Obese people often shy away from doctors and hospitals because they are afraid of being embarrassed, chided or humiliated by medical workers or their surroundings, she said. "You know how embarrassing it is for a 400- or 500-pound person to come in, and when the nurse hands them a gown, they break, they tear?" said Roldan. "If you look at that from the standpoint of, is that person really receiving maximum quality care, that person is not."

    Community Hospital of New Port Richey had its first bariatric surgery in April. Before the patient even walked into the hospital, administrators held sensitivity training for its employees. From nurses to therapists to the valet attendants in the parking lot, they heard from the administrators about the need to handle large patients with compassion.

    "It becomes hospital-wide," said Mary Jones, Community Hospital's marketing director.

    The American Society of Bariatric Physicians says the economic cost of obesity to U.S. business represents about 5 percent of total medical care costs.

    Hospital employees are among those most at risk.

    Last year, 78 Tampa General Hospital employees were injured while moving patients. In each of four cases, it cost the hospital $500,000 for medical treatment, Shea says.

    Those four employees were hurt when they tried to move large patients, Shea said. "It's a double-edged sword," she said. "The patients are getting heavier, and the nurses are getting older."

    Jeannie Kouwe, a nurse, knows firsthand the risks posed by larger patients. In 1994, she was injured at TGH while trying to help move a 500-pound woman from the bottom of a hospital bed.

    "It eventually took six nurses to move her after I got hurt," Kouwe said.

    A lift team wasn't even a concept back then. Kouwe admits that trying to move the woman with only the help of the woman's husband was bad judgment on her part.

    "It was a knee-jerk reaction," said Kouwe, who is 5-feet-1 and weighed 125 pounds when she tried to move the patient. "I just wanted to help."

    Kouwe suffered a herniated disc. Eight years and three back surgeries later, she has returned to TGH as a part-time volunteer.

    "I found something I absolutely loved," said Kouwe, who is now 50. "But I can never really return to what I loved most, which is direct patient care."

    -- Times researcher John Martin contributed to this report.

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