A primary care physician in suburban Boston is feeling the backlash of her decision to turn away patients weighing more than 200 pounds.
Dr. Helen Carter of Shrewsbury, Mass., told patient Ida Davidson, she would have to weigh 200 pounds or less to be treated by her practice
. Davidson, who is in her early 60s and lives in Shrewsbury, sought out Dr. Carter for a routine check-up, reported WCBV-TV, a Boston-based broadcast affiliate.
"I've never heard of anything like that," Davidson told the reporter at the television network. "She didn't care about my health that day. I think she just cared that I was a liability to her and too much work."
Dr. Carter says she didn't turn away Davidson, but will be happy to take her on as a patient once she's lost some weight.
"It's not that I forced her not
to come back," says Dr. Carter.
The doctor, who has been in private practice for 11 years, says her office is not physically equipped to handle the care of above-average weight patients, and that examining obese patients places physical demands on her staff that puts them at high risk for personal injury.
Last spring, Dr. Carter says she decided to limit the obese patients she sees, after a staff member suffered a cervical neck strain while assisting on routine physicals of two obese patients, one of whom weighed 284 pounds. The injury occurred when the doctor attempted to pull out the foot rest on the exam table while the patient was lying down. Dr. Carter says the incident put the physician out of commission for 12 weeks and the injury required substantial physical therapy, and she will require a maintenance care program to cope with the injury the rest of her life. She says some time ago, another staff member herniated two lumbar spine disks performing a physical on a patient.
"People make a choice about what they eat and don't eat," says Dr. Carter. "Why should someone be personally injured by someone else's life choices?"
To accommodate heavier patients, Dr. Carter says she would need a special electric exam table that costs $7,000. She says that is unaffordable.
A less costly solution, says the 50-year-old doctor, might be to request obese patients pull out the foot rest on their own. But she says she isn't sure her patients would be willing to comply if she enforced the rule.
The Massachusetts doctor isn't the only health practitioner to place weight restrictions at her practice. A 2011 survey conducted by the South Florida Sentinel
revealed that 14 out of 105 gynecologists in the area were refusing to see obese patients at their practice. Most cited inadequate medical equipment as a reason for this decision.
William Thompson, a medical malpractice attorney and partner at Lubin & Meyer in Boston, says he has yet to come across any resulting injuries from treating an obese patient. Thompson is not consulting either of the parties involved in this dispute, says it would be tricky to pin the negligence on either party involved in such an incident.
"You'd have to say someone is negligible," he says. "It's not the patient's fault. It's not the table's fault. It would be a freak accident."
Thompson speculates Dr. Carter's decision may mostly have to do with her bottom line. In July, Massachusetts lawmakers signed into law a health care bill that will force doctors to transition from fee-based pay per service to global payments, meaning insurance companies will pay a doctor an equal amount for each patient they treat at their practice. Dr. Carter insists the law did not influence her decision.
Obese patients can often require significantly more medical care
which can be costly. A 2009 study by the CDC found that annually obese patients spend $1,429 more on medical care than other patients
In its Medical Code of Ethics, the American Medical Association deems it permissible for a physician to refuse treatment for a patient
. ?A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.?
But Thompson questions if Dr. Carter's actions might be a slippery slope. "What's next? Are doctors not going to treat patients with diabetes or HIV?"
Some healthcare practitioners insist that a patient's weight should not influence the quality of care they receive or restrict their access to doctors.
Dr. Deborah Johnson, a certified gynecologist in private practice in Salem, Ore., says she's never refused to treat a patient because of weight, and that the standard metal exam tables she has at her offices are sufficient and safe for patients who weigh over 200 pounds. Dr. Johnson, 64, says she safely performed a pap smear on a 400-pound patient using a standard electric exam table. She says she purchased the exam table used for approximately $2,500.
Dr. Johnson says she believes Dr. Carter's concerns for her employees' safety is merely a way to hide her prejudice against obese individuals
"She may be within her rights legally, but ethically I would say she's on shaky ground."