WhiteCoat

Too Heavy to Fly

Photo credit and further story at http://www.inquisitr.com

Medical care for the morbidly obese is back on the radar.

Today this blog got several inbound clicks from a site where a bunch of apparent doctor haters have used one of my blog posts and the comments to the post as an example of how much the medical profession allegedly likes to bestow shame upon others. It seems that the discussion we had regarding whether it is ever acceptable to refuse medical care to morbidly obese patients was something that Ms. Marianne’s readers were cautioned that they may not be able to “stomach.”

The author and most of the people who commented to her article seem to believe that they have the right to demand that any doctor at any time must provide any type of services to them that they demand. Whether or not the doctor is comfortable providing those services or whether the doctor even has the knowledge and training to provide those services is irrelevant. Any doctor who doesn’t agree to their demands is hated and publicly shamed. This doctor who chose not to treat patients weighing more than 200 pounds was one example of their wrath.

I left a comment to Marianne’s rant back when she first posted it.
I don’t remember the comment verbatim, but the gist of my comment was that there are specialists for a plethora of conditions who provide care to patients when other providers are uncomfortable caring for those conditions – HIV, diabetes, organ transplants, ophthalmology, etc. Why shouldn’t doctors be able to refer obese patients to other physicians more experienced in caring for obese patients?
In addition, there is no “right” to force any person to provide you with any services against their will. The Thirteenth Amendment to the Constitution addressed that.
Finally, I noted that when there is a bad outcome related to a patient’s obesity, one of the first things that a plaintiff’s attorney will allege is that the patient should have been referred somewhere else.
My comment was never approved. Non-conforming, I suppose.

Today there also happened to be an article in the NY Post – linked by the Drudge Report – about how a morbidly obese woman with multiple health problems traveled to Hungary for a month-long stay in their family vacation home. When she tried to board a flight back to New York to resume her medical treatment, the airline refused her because she had gained water weight and could not be safely strapped into three seats. The airline tried to make alternate arrangements for the patient’s travel back to the US, but those plans also fell through due to the patient’s size.
There was no mention that the woman ever went to a hospital for care of her medical problems while trying to secure travel back to the US. Both the patient and her husband were quoted as saying that they “didn’t trust” doctors in Hungary.
Nine days after first attempting to return to the US, the woman died.

Difficult situation. Comments to the article were mixed. Some people blamed the patient for allowing herself to become so obese. Others blamed the airline because it was able to get the patient to Hungary and then left her stranded there.

This case illustrates the point that I was trying to make in my previous post about providing medical care to morbidly obese patients. At some point, the safety and well-being of the patient and of others must be taken into account when deciding whether to provide care. These decisions are made all the time in medicine. A patient with severe lung disease may be deemed too great a risk for surgery. The doctors aren’t “discriminating” against people with lung disease, they are making a decision that the risks of surgery are too great given the patient’s condition. Some orthopedists choose not to perform knee or hip replacements in morbidly obese patients. Again, not “discrimination,” but rather the significantly increased risk of complications in morbidly obese patients.
In the Hungarian patient’s situation, what if the patient suffered an injury on the plane because she wasn’t able to be properly restrained? What if the patient had a medical emergency and died on the plane over the Atlantic Ocean because of her untreated medical conditions? Would these same people then point fingers at the airline for allowing the patient to fly in the first place?
Rather than engage in a rational discussion about the issues, some people would rather sensationalize, cry discrimination, and call names.

Something about the patient’s situation just doesn’t make sense to me.
I question how much “water weight” the patient gained during her vacation.
I also wonder whether the patient and her husband checked into the flight restrictions that might be imposed on the patient before taking their trip.
And why it was appropriate for the patient and her husband to discriminate against all doctors available to provide them medical care in Hungary solely because of the doctors’ national heritage?

Apparently “doctor hating” is still socially acceptable.

UPDATE
See additional stories and pictures here:
http://www.inquisitr.com/412995/sick-obese-woman-dies-after-airlines-turn-her-away/
http://gothamist.com/2012/11/26/overweight_woman_dies_in_hungary_af.php
http://www.upi.com/Top_News/US/2012/11/26/Woman-dies-after-airline-turned-her-away/UPI-70441353953221/

14 Responses to “Too Heavy to Fly”

  1. Pattie, RN says:

    I caught this story this morning, and according to the version I read (supported by several photos) this woman was a diabetic, in ESRD, and a single BKA amputee. For the record, I am personally obese, but more in the “need to wear capri pants instead of shorts” manner, not the “killing myself daily” manner.

    I add this information only because I have never before, in five decades of life and 20+ years as a nurse, seen a totaly ROUND human form. She was shaped like a beach ball, with head and limbs. I have seen bigger bodies, but not one shaped like this.

    So….how did she fly over? Why didn’t she seek care in her NATIVE country? Did her doc in the US give her permission to fly AND be off medical care for a month?

    But, as you have discussed in other columns, it does come down to choice and realities. I really like the analogy that if you climb Mt. Everest, you must know that there is no hospital at base camp, and that what you are doing has KILLED lots of other people.

  2. Tarl says:

    Three different planes, three different airlines, three different crews at three different airports all came to the conclusion that she was not safe to fly (note, it’s not just her safety that was of concern, the safety of the other passengers is a problem – a person who cannot be fastened down is a hazard to everyone else during turbulence).

    As for not trusting doctors from Hungary… Not all doctor education programs are created equal. In Hungary, as in much of the ex-warsaw pact, the standard of care has been lower than in the industrialized west. Given a choice, her doctors back home might have been better – but she’d run out of choices.

    • Pattie, RN says:

      Amen….she cut her choices by choosing to leave the US and its health care system!

      This is like being malnourished and immunocompromised with anti-rejection drugs and going on safari in Durfur for fun—three weeks post transplant!

  3. Bill Alexander says:

    If she didn’t like the doctors in Hungary, and felt their standards of education are inferior, how about Germany? It seems to be possible to travel from one to the other without using airplanes, in fact by high speed rail.

    • Ed says:

      The article states that they drove, by van, 4 hours to one of the airports. One can safely assume that they could have gone to almost any other European country for care, but chose not to.

  4. Gwen says:

    She had a choice in not going to her holiday vacation home in Hungary. VACATION HOME. She decided to go to a vacation home. Yes I said that a few times to get my point across. Her husband is suing for 6 million dollars because of what exactly? They knew what they were getting into when they flew to Hungary. She was on dialysis. What were they going to do in Hungary for that? The risks were there already and going for 9 more days without dialysis was just plain negligence on both the husband and the woman’s part. The 3 airlines that they tried to fly on spent an extraordinary amount of time trying to get her on the planes and strapped down to no avail. On one plane the captain came out and just told her to get off because she did not fit. Just because you buy 2-3 seats does not mean you can actually fit in them.

  5. Isabella B says:

    My heart goes out to the family. I wish they would’ve given the hospitals in Hungary a chance. My mom and dad were born in Hungary and then came to the US in 1965. In 1991 my mom woke up one morning, paralyzed from Guillian Barre. She was in/out of hospitals here in the US and they said she would never walk again. Her sister, Clari, came her from Hungary to help us take care of her. Clari felt it was best to take her back home to Hungary for treatment and I Thank God she did. After 9 months, in 3 different hospitals in Hungary, my beautiful mother came home and walked. Plasmapheris, the treatment in Hungary, helped give me back my dear mother. I will forever be grateful for the time we had with my dear mother. Sadly, she passed this year but without the knowledge of the doctors. in Hungary I would’ve lost her a long time ago. Always have hope. If this email helps one person on a path to better health, then I am spreading my moms unconditional caring heart and love. My best to all of you.
    Isabella NJ

  6. Student Paramed says:

    Recently, my home town newspaper ran a story about a lady who died (of an ami) waiting 6 hours for an ambulance. I was horrified…. What was I getting myself into?
    Further investigation revealed she died waiting for one of the state’s 2 bariatric ambulance as our normal ones have a load limit of 250kgs (550 pounds).
    As Peter Porker’s Uncle Ben reminds us…. “With great weight comes great risks”.

  7. Allison says:

    This lawsuit is just absurd, and I have a hard time understanding how the husband will manage to win.

    I’m very curious about the nature of the woman’s medical problems and her ultimate cause of death. All I’ve been able to find is that she had diabetes, a BKA and kidney disease and that she died of kidney failure. Someone above stated she was on dialysis: I haven’t read that anywhere, but if that’s the case, how could she have gone on vacation for even one week without it, let alone 3? If that’s what happened, this trip was a suicidal decision on her part.

    The airline was screwed either way here, but I don’t see how they’ll lose this case. There was the safety of the other passengers to consider as well: what if there was an emergency that required use of the emergency exits and this obese woman either couldn’t make it to the exit or blocked the way from other passengers? What if she had to go to the bathroom mid-flight? If a fire brigade couldn’t move her from a wheelchair to the airplane seats I doubt she could make it to–or even fit inside of–the airplane bathroom.

    This wasn’t discrimination. This was common sense!

  8. Allison says:

    ….also, I think when you decline medical care that is readily available to you and then die because of a lack of medical treatment, your death really can’t be blamed on anyone else.

  9. Steve MD says:

    The general public and even many non surgical physicians have no idea how much more difficult and potentially complicated even routine surgeries are in morbidly obese patients.
    I absolutely cringed whenever I had to do a pelvic surgery in morbidly obese women (I’m a gynecologist) because exposure is difficult, bleeding is difficult to control (imagine tying a knot which is in a deep hole filled with fluid, at least a foot away from you, and you get some idea). I felt much more comfortable referring these patients to a gyn oncologist who was more adept at radical surgery which even a routine surgery turned into in most of these patients.

  10. Kipper says:

    What a bizarre situation. I can’t imagine being that sick and deciding international travel was a good plan.

    Regarding the “doctor haters”: The problem you aren’t seeing is that there are quite a few doctors out there who are unprofessional towards patients at body sizes well below anything that introduce logistical or safety considerations. (In my own life, I once received a mortifying lecture about my weight and diet at a BMI of 21…I can’t even imagine what set that off.) Unsurprisingly, patients who have been treated badly get upset. It’s a shame when doctors who are professional towards their patients feel attacked by that anger.

Leave a Reply


three + 8 =

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM