ER resident filed lawsuit that she was discriminated against for morbid obesity

[JacobMcCandles]

I’ll bite: selecting residents based on appearance instead of their ability to perform their job duties seems pretty clear cut.

Our group wouldn't hire a 400lb physician or midlevel.

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[JacobMcCandles]

Her medical school failed guiding her. Why would they even recommend a physically demanding specialty.

Could have done rads/psych/path etc without any physical issues.

Someone should have had a frank discussion with her.

In this age of being politically correct, no one was willing to step up and do the right thing.

And the attending that gave her honest feedback is sort of getting into trouble.

 

[RustedFox]

Chill out man. I'm not sure you get what think the Hmm thing means. Maybe I'm the only one who uses it this way, but for me it means "that's an interesting point that needs thinking about".

Hahaha. It's cool, amigo.
Remember: I am the stick that stirs the coffee on here. Best part is the "Hmm" that GassYous immediately gave you.

 

[RustedFox]

Also kinda interesting correlation that as the rates of smoking decrease the rates of obesity went up

Bullying works.

 

[Apollyon]

That's a reasonable interpretation. Other than Prader-Willi what medical conditions can CAUSE you to be obese? At the end of the day it's just stuffing your face with way too many calories.

I saw this dichotomy in Hawai'i. I saw folks in HI that were 300, 400, 500lbs - and healthy. No diabetes, HTN, CAD, hyperlipidemia, nothing. They were just big. To ask them, though, they say, "I eat too much". Conversely, on the mainland, big folks are afflicted with all that, and more, but, what do they say? "I can't help it. It's in my genes." - while two-fisting hot dogs, burgers, or bags of Cheetos. One can claim it, but doesn't, while the other claims it, but isn't entitled.

 

[BoardingDoc]

Thanks to @Birdstrike for the link to the actual case opinion.

TL;DR for people that didn't read it: They comment on her weight and how she didn't seem to be physically able to do the job. There were also a slew of complaints about being a crappy doctor / being lazy / being unprofessional from several attendings as well as her residency classmates. At the end of the day, being unable to physically do procedures was but one factor that led to this person's evidently deserved dismissal from their program.

 

[DocEspana]

I saw this dichotomy in Hawai'i. I saw folks in HI that were 300, 400, 500lbs - and healthy. No diabetes, HTN, CAD, hyperlipidemia, nothing. They were just big. To ask them, though, they say, "I eat too much". Conversely, on the mainland, big folks are afflicted with all that, and more, but, what do they say? "I can't help it. It's in my genes." - while two-fisting hot dogs, burgers, or bags of Cheetos. One can claim it, but doesn't, while the other claims it, but isn't entitled.

+ brick wall genes. They are built like one from shortly after birth.

 

[wamcp]

Our group wouldn't hire a 400lb physician or midlevel.

Nah bro that’s gonna be illegal soon

Ban on Weight Discrimination Becomes Law in New York

The bill, signed by Mayor Eric Adams on Friday, adds weight to the list of characteristics protected from discrimination in areas like employment and housing.

www.nytimes.com

https://www.cnn.com/2023/05/11/business/new-york-weight-discrimination/index.html

 

[bravotwozero]

Nah bro that’s gonna be illegal soon

Ban on Weight Discrimination Becomes Law in New York

The bill, signed by Mayor Eric Adams on Friday, adds weight to the list of characteristics protected from discrimination in areas like employment and housing.

www.nytimes.com

https://www.cnn.com/2023/05/11/business/new-york-weight-discrimination/index.html

people will just get around that by pointing directly to the end result of the weight, namely inability to do the job.

 

[Siggy]

That's a reasonable interpretation. Other than Prader-Willi what medical conditions can CAUSE you to be obese? At the end of the day it's just stuffing your face with way too many calories.

Longstanding severe hypothyroidism, cushings, anything that either futzs with appetite or metabolism really.

 

[Siggy]

Nah bro that’s gonna be illegal soon

Ban on Weight Discrimination Becomes Law in New York

The bill, signed by Mayor Eric Adams on Friday, adds weight to the list of characteristics protected from discrimination in areas like employment and housing.

www.nytimes.com

https://www.cnn.com/2023/05/11/business/new-york-weight-discrimination/index.html

I think there's a problem if the reasons someone isn't hired or is fired is just because "go be fat somewhere else."

If it's "You're so fat you literally can't do the job" then that's protected just like no group is going to be required to hire a blind emergency physician.

 

[BoardingDoc]

people will just get around that by pointing directly to the end result of the weight, namely inability to do the job.

Still opens up the door to a slew of nonsense lawsuits though unfortunately. The CNN article talks about how "sitting in restaurant and theater seats, bikes having a weight limit, taxi cabs requiring seat belt extenders" could all be scenarios where someone could now sue for discrimination.

 

[TooMuchResearch]

Meh. I’m a ‘biggest.’ My own personal bias is that I have strong feelings against obesity. For a select few it’s not their fault; either through genetic abnormalities or epigenetic changes. For the vast majority of obese individuals though it is due to a lack of exercise and poor diet. A lack of discipline. Economic disparities certainly contribute and sometimes deal a bad hand. Those individuals also have an argument, but not as convincingly. People around the world still suffer from starvation - and die… Good luck defending your disability to someone who is perishing from hunger.

That last line seems like it's about cannibalism.

 

[TooMuchResearch]

Fight the good fight. Refuse. That’s the job of an intensivist. There is only one person that needs to step up and be responsible for the patient if coming from the hospital floor to the ICU and requires intubation.

When EMS brings a patient to the ED that needs resuscitating I don’t get off the hook by calling someone else.

I don’t buy at all that it is quite common for many level 1 trauma centers.

We do this at our small hospitals, but it's part of the package and why they're willing to pay our group above what we actually produce (i.e. we save them some call/in house money and on rare occasion, we intubate, run a code, maybe even the occasional NRP provider, etc). However we won't leave unstable patients in the ED to do it.

 

[Siggy]

Fight the good fight. Refuse. That’s the job of an intensivist. There is only one person that needs to step up and be responsible for the patient if coming from the hospital floor to the ICU and requires intubation.

When EMS brings a patient to the ED that needs resuscitating I don’t get off the hook by calling someone else.

I don’t buy at all that it is quite common for many level 1 trauma centers.

As an intensivist, I feel that it's my responsibility to own the hospital above the 1st floor. Diagnostic spaces (CT/MRI) are mutual as you don't know at the time of the code whether it's an ED patient or inpatient. I've had the ED intubate coding floor patients in CT and I've intubated and resuscitated ED patients who coded in the scanner as well.

However every hospital I've been at since residency has had 24 hour in house intensivist coverage. If there is no in house intensivist at night, the EMP should certainly be billing these procedures. Lets be honest, a code and intubation is likely the easiest 7 RVUs ever.

 

[ScepticSkeksis]

As an intensivist, I feel that it's my responsibility to own the hospital above the 1st floor. Diagnostic spaces (CT/MRI) is mutual as you don't know at the time of the code whether it's an ED patient or inpatient. I've had the ED intubate coding floor patients in CT and I've intubated and resuscitated ED patients who coded in the scanner as well.

However every hospital I've been at since residency has had 24 hour in house intensivist coverage. If there is no in house intensivist at night, the EMP should certainly be billing these procedures. Lets be honest, a code and intubation is likely the easiest 7 RVUs ever.

Agreed that we should be getting RVUs for them, however Envision literally steals these RVUS. In mid-size hospitals we are expected to cover floor codes, and intubations for the whole hospital after 5PM. We then generate a note and put them with a face sheet in the "RTI Billing box". We are told "Don't worry we pay you for these!", but there's never a breakdown on the monthly spreadsheet detailing how many RVUS generated by physician for procedures. Given the lack of transparency I can only assume that cash goes to Envision directly.

 

[CoolDoc1729]

Interesting.. are programs continuing to offer zoom interviews or was that only for 2020 +/- 2021? I wonder if they were surprised when she showed up the first day that she was like ~400 and not like ~250ish. I had attendings during residency that were at least 250-300, never saw procedures make it to them though.

 

[medninja]

The original article suggests that at least one attending thought she was doing a good job and had potential.

I really would think a young 400lb person could do my job. Patients would treat them poorly, but where I am most patients think they only saw a niurse if the doctor is female. Don’t get me started on the abuse our minority docs take. I’d get to codes faster, but that’s about it. With how exhausted I am at the end of a shift, I’m generally surprised at how low my step count is.

Also, I work hard to stay fit. I accept a measure of cognitive dissonance knowing how hard I work on fitness and accepting that obesity isn’t solely a failure of willpower. I won’t feign shock, but I wouldn’t have guessed so many of my counterparts really believe obesity is simply a personal failing. Don’t make me go pubmed on you, but the evidence really suggests otherwise.

 

[HemorrhagicShock]

And the attending that gave her honest feedback is sort of getting into trouble.

Anybody giving honest feedback to somebody lower than them on the training pathway in this day and age is at risk for retaliation. This is yet another reason why an academic job is a non-starter for me. Why would you deal with all that HR risk which can ruin a career?

 

[Goro]

It is interesting that most Americans were not overweight until the 90's, and obesity was relatively rare. Rather than as a society try to find the root cause and fix things, we just have decided that being fat is okay, and we will just encourage it.

Blame high fructose corn syrup, for starters

 

[RustedFox]

Meh. I’m a ‘biggest.’ My own personal bias is that I have strong feelings against obesity. For a select few it’s not their fault; either through genetic abnormalities or epigenetic changes. For the vast majority of obese individuals though it is due to a lack of exercise and poor diet. A lack of discipline. Economic disparities certainly contribute and sometimes deal a bad hand. Those individuals also have an argument, but not as convincingly. People around the world still suffer from starvation - and die… Good luck defending your disability to someone who is perishing from hunger.

"Big-gist".
BIG-ot.

I like it.

 

[JacobMcCandles]

Nah bro that’s gonna be illegal soon

Ban on Weight Discrimination Becomes Law in New York

The bill, signed by Mayor Eric Adams on Friday, adds weight to the list of characteristics protected from discrimination in areas like employment and housing.

www.nytimes.com

That's why I live somewhere that won't put up with this silly nonsense.

 

[JacobMcCandles]

Still opens up the door to a slew of nonsense lawsuits though unfortunately. The CNN article talks about how "sitting in restaurant and theater seats, bikes having a weight limit, taxi cabs requiring seat belt extenders" could all be scenarios where someone could now sue for discrimination.

MSN

Article I saw from yesterday. I guess airlines should start putting a question asking if the person flying has a massive *** before letting them purchase the ticket.

 

[anonperson]

The original article suggests that at least one attending thought she was doing a good job and had potential.

I really would think a young 400lb person could do my job. Patients would treat them poorly, but where I am most patients think they only saw a niurse if the doctor is female. Don’t get me started on the abuse our minority docs take. I’d get to codes faster, but that’s about it. With how exhausted I am at the end of a shift, I’m generally surprised at how low my step count is.

Also, I work hard to stay fit. I accept a measure of cognitive dissonance knowing how hard I work on fitness and accepting that obesity isn’t solely a failure of willpower. I won’t feign shock, but I wouldn’t have guessed so many of my counterparts really believe obesity is simply a personal failing. Don’t make me go pubmed on you, but the evidence really suggests otherwise.

Doesn't matter what the reason is. In a neurologically intact person, if they want to lose weight, they can.

Weight loss is a math problem.

If you consume more calories than you burn, you will gain weight. If you consume less, than you will lose weight.

And losing weight will require you to be a bit uncomfortable and maybe experience some hunger discomfort. For some reason, this is not acceptable to people.

If this resident is 400lbs, she's been stuffing her face with thousands of calories a day for a long time.

 

[FlaminHotER]

MSN

Article I saw from yesterday. I guess airlines should start putting a question asking if the person flying has a massive *** before letting them purchase the ticket.

Yes. Planes can only handle so much freakin weight to get off the freakin ground and fly safely.

You’re 400lbs you better buy another ticket

 

[rokshana]

If obesity is considered a disability, then our nation is in the toilet.

If there is a code on the 8th floor and elevator is busy/broken, I run up 8 stairs just about as quick as the elevator. Said ER doc would break down after the 2nd stairs.

How is this any different than if I broke my arm and can't intubate?

She is not fit to do the job. An Er doc has to be fit.

So if you broke your arm, they could dismiss you?

I would imagine that said resident didn’t become 400lbs overnight… she probably looked that way on her interview… they didn’t have to rank her.

 

[rokshana]

Physicians, especially those involved in direct patient care shouldn't be obese. As part of our training we learn about healthy lifestyles, healthy diet, and the problems that obesity cause. If a physician doesn't understand and enact aspects of healthy living into their own life then they have no business counseling patients on anything health related. Is the half-tonner going to give patients realistic advice on weight loss to control arthritis, healthy diet to control diabetes? It's a joke that we accept being obese as normal and "okay" in this country.

Hon…if physicians had to practice what they preach? There would barely any physicians…how many physicians eat poorly( have you looked in a lounge lately?), smoke cigarettes, pot, chew tobacco, drink alcohol, dont exercise…etc?

 

[rokshana]

That's a reasonable interpretation. Other than Prader-Willi what medical conditions can CAUSE you to be obese? At the end of the day it's just stuffing your face with way too many calories.

Cushings? Hypothyroidism? Insulin use for diabetes?

 

[Clean7795]

I've seen some big surgeons, and the occasional big ER doc.

There shouldn't be anything she can't do in a major ER, although it would take a lot more effort.

I don't think it's clear in the article what exactly got her fired. Could be competency/professionalism related, maybe not.

 

[Arcan57]

Fight the good fight. Refuse. That’s the job of an intensivist. There is only one person that needs to step up and be responsible for the patient if coming from the hospital floor to the ICU and requires intubation.

When EMS brings a patient to the ED that needs resuscitating I don’t get off the hook by calling someone else.

I don’t buy at all that it is quite common for many level 1 trauma centers.

Are most ED docs going to be working in level 1 trauma centers? Is having to run to a floor code once every couple of months worse than having to transfer out every ICU patient because they couldn't hire enough intensivists to staff in house 24/7?

 

[Mount Asclepius]

Are most ED docs going to be working in level 1 trauma centers?

Ok, add in the level 2s and some of the 3s. They also have intensivists. If you are running floor codes, you aren’t working as an EP. You aren’t working in an ED. You are acquiescing a flawed hospital that isn’t paying for and providing the right coverage. If they can’t do that they should…

Is having to run to a floor code once every couple of months worse than having to transfer out every ICU patient because they couldn't hire enough intensivists to staff in house 24/7?

Yes, they should transfer to somewhere that can appropriately staff.

 

[xaelia]

Here's a thought experiment:
A morbidly obese ED physician is unable to complete a procedure because their body habitus precludes them from doing so. The family watches the physician fail to do so for the obvious reason. The failure to complete the procedure in a timely fashion leads to delays in definitive care and a poor outcome. The family sues the clinician for their inability to perform the procedure in their scope of practice and names the hospital for employing someone who was clearly unable to perform said procedure.

 

[xaelia]

Here's a thought experiment:
A morbidly obese ED physician is unable to complete a procedure because their body habitus precludes them from doing so. The family watches the physician fail to do so for the obvious reason. The failure to complete the procedure in a timely fashion leads to delays in definitive care and a poor outcome. The family sues the clinician for their inability to perform the procedure in their scope of practice and names the hospital for employing someone who was clearly unable to perform said procedure.

... let's say it was an airway complication related to a procedure, and part of the issue was there wasn't enough space in the treatment area for the obese clinician to position themselves appropriately. Can the obese clinician then sue the hospital for not providing treatment workspaces able to accomodate their physical size?

 

[RustedFox]

... let's say it was an airway complication related to a procedure, and part of the issue was there wasn't enough space in the treatment area for the obese clinician to position themselves appropriately. Can the obese clinician then sue the hospital for not providing treatment workspaces able to accomodate their physical size?

Clearly, what we need is an infinitely large room, inside an infinitely large department, with infinite time, staff, and resources.

 

[emergentmd]

So if you broke your arm, they could dismiss you?

I would imagine that said resident didn’t become 400lbs overnight… she probably looked that way on her interview… they didn’t have to rank her.

If I broke my arm and I could not do my job, then yeah they can. If my arm prevented me from intubating/procedures, then yeah I am kind of useless.

 

[Birdstrike]

We buy disability insurance for a reason. It’s so we can handle the responsibility, and take care of our families, if we become disabled and can’t do our job. Never do we expect our employer to have to pay us our salary, for the rest of our career, if we can’t perform our job.

 

[emergentmd]

If obesity ever becomes a permanent disability, I am going to eat myself into retirement.

 

[Arcan57]

Hi, If you're dealing with hip problems and you weigh around 400 lbs, here are some things you can consider:

Talk to a doc: First and foremost, get yourself checked out by a doctor or a physical therapist. They can give you the best advice for your situation.

Lose some pounds: It might help to work on losing some weight to ease the pressure on your hips. But don't rush it; take it slow and steady with a balanced diet.

Take it easy: Opt for low-impact exercises like swimming, water aerobics, or biking. These won't put too much stress on your hips.

Get physical: Consider working with a physical therapist to develop a custom exercise plan that strengthens your hip muscles and improves flexibility.

Use support: If needed, you can use assistive devices like canes or crutches to help you get around more comfortably.

Deal with pain: Pain management is essential, so listen to your doc's advice and take any prescribed medications.

Surgery is an option: If things get severe and other methods don't work, surgery could be an option, but only if your healthcare pro recommends it. Take it slow and don't be too hard on yourself.

ChatGPT?

 

[PikminOC]

What does she hope to gain from this? Residency slots are renewed from year to year. Does she want to continue this residency? That would be very awkward

 

[IMGASMD]

What does she hope to gain from this? Residency slots are renewed from year to year. Does she want to continue this residency? That would be very awkward

To put a target on her back? To finish residency? To be reinstated? Will they really try to “fire” her again, if she won? She can always go back to the same argument, they hate me because of X.

 

[DeadCactus]

So basically, she's overweight and everyone just assumes at face value that she actually couldn't do the job because they don't like people who are overweight...

 

[JacobMcCandles]

So basically, she's overweight and everyone just assumes at face value that she actually couldn't do the job because they don't like people who are overweight...

No, people here understand how physical the job can be and understand that things are made much more difficult by being 400 lbs. She’s not overweight, she’s morbidly obese.

 

[VA Hopeful Dr]

So basically, she's overweight and everyone just assumes at face value that she actually couldn't do the job because they don't like people who are overweight...

If you read the actual documents, this was a fairly small part of the multitude of complaints against her.

 

[DeadCactus]

If you read the actual documents, this was a fairly small part of the multitude of complaints against her.

That requires an assumption that the complaints are legitimate and not just evidence of the discrimination overweight patients experience as so well demonstrated in this thread. Maybe she's bad at her job. Maybe she's under undue scrutiny because of her weight. But people are so quick to assume everything is valid and accurate because she's overweight.

 

[Mount Asclepius]

Stereotypes occasionally have partial merit because there is a partial truth.

 

[VA Hopeful Dr]

That requires an assumption that the complaints are legitimate and not just evidence of the discrimination overweight patients experience as so well demonstrated in this thread. Maybe she's bad at her job. Maybe she's under undue scrutiny because of her weight. But people are so quick to assume everything is valid and accurate because she's overweight.

That's certainly possible, but many of the complaints seem to be dealing with behavior during specific instances that should be pretty easy to confirm. Its not "she was unprofessional on multiple occasions" it was "left during a shift once her co-residents agreed to see one of her patients for a procedure" or "told a nurse to give fentanyl without seeing the patient".

 

[MechEDoc]

ermmm...serious question.

How do you reduce a hip if you're 400 lbs?

Put your weight into it?

 

[wholeheartedly]

That's certainly possible, but many of the complaints seem to be dealing with behavior during specific instances that should be pretty easy to confirm. Its not "she was unprofessional on multiple occasions" it was "left during a shift once her co-residents agreed to see one of her patients for a procedure" or "told a nurse to give fentanyl without seeing the patient".

Generally agree that some of the other complaints were quite concerning if true. and that you have to be able to do key parts of job or get accommodations to be able to do them if needed.

I have some issues with how this played out though. 1st is that according to the documents i read, the weight complaint was first by one person, led the assoc prog dir to email other faculty asking if there were other issues with weight and performance they’d noticed as she’d been made aware of several concerns about it (despite there actually only being one at that point according to documents), got one reply that the resident had done a procedure well but sweat a lot which could be a pt safety issue (some healthy wt ppl also just sweat a lot?). that was enough to lead the assoc program director to meet with legal about dismissing resident and after that convo ultimately state she’d have to “find other reasons to dismiss the resident” at which point she seemed to go actively looking for stuff and put resident under microscope.

documents indicated that the apd didn’t even check on the subsequent email complaint to see if true. she should have at least talked to some other people/witnesses and tried to corroborate as was reported policy. after all my years in healthcare its been made pretty clear that just one side of the story rarely gives you anything close to the whole picture. the actual PD indicated that he would’ve done an investigation before going to the committee if he’d gotten that complaint, instead he just assumed one had been done.

she passed her sicu rotation but then the apd brought up concerns that she was late with charting. resident indicated that her fellow interns were also late with charting at the beginning of the rotation but they all had addressed the issue during the rotation. i don’t think it’s uncommon for interns to struggle with finishing charts on time on busy rotations and I’m curious how she was relative to her peers. the lack of gown stuff should be easy to fix and seemed to take longer to address than needed.

So if the complaints were accurate, and most didn’t really have anything to do with weight, that’s a major issue. OTOH if she wound up under a micrscope and extra scrutiny and complaints were fudged or exagerrated and she wasn’t evaluated consistenly with her peers, then that’s also an issue.

I think it’s interesting that she did rotations at this place as a med student and was ranked 4th overall. they were clearly fine with her performance then.

it seems like everyone was kinda stupid about how this was handled.

 

[BoardingDoc]

I think it’s interesting that she did rotations at this place as a med student and was ranked 4th overall. they were clearly fine with her performance then.

Took me a while to see where you got this from. I didn't see any mention of her having been ranked 4th overall in the above docs, though it seems you got it from the original appeals court ruling prior to it being overturned by the TX supreme court (here for the curious: https://caselaw.findlaw.com/court/tx-court-of-appeals/2161378.html)

That case reads much differently than the supreme court case and I'm not entirely certain where the difference comes from. Clearly each court wants to justify their opinion, but these read as very different cases. The appeals court opinion makes it seem like she was directly targeted almost exclusively because of her weight. The supreme court opinion makes it look like her weight was getting in the way of her job, but that she was additionally doing rather poorly as a resident overall. Unsure what to make of the difference.

As an aside however, one would think that the fact that she was ranked 4th overall after having rotated at the program would make her weight less likely to be the reason they got rid of her. You can't always tell how a resident will perform based on how they do on a rotation. On the other hand, it's unlikely she put on a couple hundred pounds between her rotation and the start of residency. As such, I don't know why the program would have zero qualms about her weight (to the point that she was ranked as a guaranteed match) and then suddenly target her just because she was obese.

 

[Emapp20177]

So if you broke your arm, they could dismiss you?

I would imagine that said resident didn’t become 400lbs overnight… she probably looked that way on her interview… they didn’t have to rank her.

Probably a Zoom interview. Camera angles pal. Camera angles.