Bariatric surgery (also called “weight-loss surgery” or “obesity surgery”) is a common source of medical negligence claims in Ohio. The surgery is very dangerous, with a complication rate estimated to be as high as 40%. However, when the growing and desperate population of obese patients meet physicians who are vying to perform this lucrative procedure, risks can be understated.
Medical negligence claims arising out of bariatric surgery typically fall into the following four categories: (1) failure to obtain informed consent; (2) negligent patient selection; (3) surgical errors; and (4) inadequate post-op monitoring. Here is a look at how these common medical malpractice claims arise out of weight-loss surgery.
Complications from bariatric surgery are common. These complications include gastric dumping syndrome, hernia, infection, damage to adjacent organs, leaks at the surgical site, nutritional and metabolic disorders, bleeding, bone loss, gallstones and death. The complication rate is reduced when the procedure is performed by an experienced surgeon at a high-volume center. The American Society for Metabolic and Bariatric Surgery (ASMBS) administers a program for certifying centers as “Centers of Excellence,” but the ASMBS does not publish outcomes data to permit consumers to evaluate and choose programs with better track records. Until it does, the Center of Excellence designation will be mere windowdressing or, worse, a marketing gimmick for the 400 centers and 750 surgeons who have obtain it.
Because the procedure is risky, the indications for surgery should be narrow. However, current indications for the procedure include any patient with a body mass index of at least 40 who failed an adequate weight loss program. Further, the patient must pass a psychiatric assessment meant to determine the likelihood of success. These indications have not been adjusted despite studies showing that the procedure is particularly risky for older patients and the lack of strict criteria for defining the adequacy of nonsurgical weight loss programs or defining the optimal patient psychological profile.
A health sociologist who studied patients after bariatric surgery, Dr. Samantha Thomas, expressed concerns about how bariatric surgery is over-sold: “This is being sold as the quick-fix magic bullet for obesity. In actual fact, what we’re doing is putting the ambulance at the bottom of the cliff rather than the fence at the top. **** There are many concerns that many of us have around the marketing of this type of surgery, and in particular the parallels that we see between the marketing of something like obesity surgery …, and the marketing strategies of the diet industry and cosmetic surgery industry.” One need only look at the ASMBS’s own website to see that the potential benefits of surgery get marquee treatment while the risks are hard to spot: http://asmbs.org/benefits-of-bariatric-surgery/.
In light of these marketing practices, patient selection and informed consent may not receive adequate attention. Further complicating patient selection and decisionmaking is the fact that the long-term results of obesity surgery are not well-studied. A major study of long-term results is under way but will not be completed until 2017. Many study patients will inevitably be lost to follow up by virtue of the very complications that should be reported in the study.
Another major problem associated with obesity surgery has to do with post-operative monitoring. In the short-term, bariatric patients can develop life-threatening leaks, bleeds and infections. Any delay in diagnosing these common surgical complications can be fatal. In the long-term, post-op patients should be monitored carefully throughout their life for dietary compliance and nutritional status. However, again, no strict guidelines exist for life-long monitoring.
Like any new and profitable surgical procedure, bariatric surgery is being widely promoted, as more and more providers aggressively pursue their share of the market. With obesity rates climbing, there is no end in sight to this gravy train. Such a scenario is ripe for overuse and avoidable injury.