Higher Ambulance Fees For Obese: Fair or Discrimination?

Imagine this: your typical two-person EMT crew gets a call to rush to the aid of a critically ill man – and when they arrive, sirens blazing, they find that he weighs over a thousand pounds. How are they going to get this patient onto a standard stretcher, lift him into their rig (if he'll even fit), then out again, and through the emergency room doors?

According to a report by the Associated Press, this happened to a man in Kansas. The crew's stretcher wasn't strong enough to carry him. Nor was the crew. Even if they could pick him up, he wouldn't fit into the back of the ambulance.

The crew called in an idea. Ken Keller of the Kansas Board of Emergency Medical Services approved it: hire a flatbed truck and a forklift to transport this man safely to the hospital, bed and all, where they had another forklift waiting to get him down.

Not the most dignified way to get to the hospital, but it saved his life.

The ambulance company picked up the tab for the equipment rentals and extra labor needed to get this man to the ER. Until very recently, ambulance companies all over the US have been absorbing these unusual expenses as a part of doing business…sometimes even partnering with local fire departments to get extra muscle to move heavier patients.

But with more Americans growing larger and larger, and ambulance companies' profits pared down to the bone, some have lobbied to pass these costs on to their heaviest customers…or, more frequently, to these customers' insurance providers, or Medicaid or Medicare. This, they reason, will cover modified ambulances and sturdier stretchers. After all, hospitals have been doing it for years. They offer special beds, wheelchairs and walkers for larger patients, and sometimes charge insurance companies more for them, as they would for patients who are on many prescription drugs, or require ventilators, or ICU stays.

Fair is fair, according to some ambulance companies.

"In order for these systems to survive and continue to provide their services there has to be some way to recover those costs," said Jim Buell, a director at the American Ambulance Association.

The Obesity Action Coalition calls it discrimination. "Ambulance services are a critical public service and should accommodate the needs of all of those who require them at a fair cost," said Joseph Nadglowski, president of the OAC.

But "fair cost" is something that's still up for debate. Many small-town ambulance companies simply can't afford the specialized equipment needed to transport heavier people with dignity. In Topeka, the ambulance squad shelled out around $10,000 to retool a rig designed to carry patients up to 1,600 pounds. (I can't even imagine how someone can get to be that obese, but if you live in Topeka, the EMTs are ready for you.)

Colorado Springs has also raised their rates, as have Washington and Oregon. On average, it costs roughly two and a half times as much to transport an extremely obese patient than it does to bring in someone of normal weight.

"It's really an emerging area," said Susan Pisano, a spokeswoman for an insurance industry trade group. "It is one more way that obesity is contributing to health costs."

Obesity also hits us in our collective healthcare pocketbook because of increased rates of diabetes, heart disease, stroke and over a dozen other diseases, including some cancers. The costs to treat these diseases is pooled into the rates we all pay for health insurance.

As far as increased ambulance costs, I think that it's a case of personal responsibility coming smack up against public welfare. Yes, we can all hit 911 and get help in an emergency, regardless of our ability to pay. In America, we often take this for granted, or at least I have. If your size could cause great hardships to those whose job it is to save your life (including not just costs of extra equipment but possible back injuries to those who are transporting you), then you should pony up the fees.

In many communities, the ambulance companies are strictly volunteer and only work for donations. But how can they accommodate people who can't be lifted by the crews, or transported using their equipment? How can they afford all that specialized gear, especially when so many of us are growing larger and larger (30% of us are obese and among those, 5% are morbidly so – 100 lbs or more over their healthy body weights)? Where is that extra money supposed to come from?

But I can see the other side of this coin: Where does that point of "inconvenience" stop? Should ambulance companies charge you extra if you live up five or six flights of stairs in a building with no elevator? Or if your excess poundage is not due to personal responsibility but to a medical disorder? Or if you are an alcoholic or abuse drugs, and this makes you violent causes risk or even harm to the EMT crews? Where does it stop?

Sigh. Well. I'm tired of talking now. It's your turn. Do you think it's fair for the ambulance companies to charge obese patients at higher rates? Or do you think it's a fairly obvious case of discrimination?

Photo courtesy of Dick Blume/The Syracuse Post Standard