Medical Malpractice News

The Liability Insurance Risk for Bariatric Surgery

Tags: | Comments: 0 | May 23rd, 2011

Bariatric surgeons are classified at nearly the highest level of risk classifications with professional liability insurance companies today. The risks of lawsuits are very high and can result in expensive payouts. Exploring the basics of bariatric surgery and the medical malpractice risk associated with this specialty can give bariatric surgeons a better understanding of how their liability insurance protects their practice.

What is Bariatric Surgery?

Bariatric surgery is a sub-specialty of general surgery and involves surgeries performed that aid in weight loss for morbidly obese individuals. Physicians who wish to become a bariatric surgeon are first residency trained as general surgeons. After they complete their residency in bariatric surgery they will go on to complete a fellowship in bariatric surgery. Such fellowship training programs typically may last two years or more. Physicians are covered for their medical malpractice insurance during this training through their residency and fellowship programs.

Patients Qualify for Bariatric Surgery

In order to qualify for bariatric surgery, a patient must meet certain criteria. If these criteria are met and the patient’s risk of health after surgery is greater than the risk of death without surgery then a patient can become a candidate for bariatric surgery. The ideal qualifying criteria include, but are not limited to, the following:

  • At least one hundred pounds over normal body weight
  • A Body Mass Index (BMI) of between forty and sixty
  • A previous effort to lose weight non-surgically

Bariatric surgery comes with an important program for patients. Baratric surgery includes meeting with dieticians for a diet program, meeting with a work out trainer, and meeting with a counselor. Bariatric surgery is not for someone who is just searching for a quick fix.

Given the above criteria a patient must meet, along with the very specialized nature of bariatric surgical procedures, bariatric surgeons are at a much higher risk of filing a medical malpractice insurance claim than an average general surgeon. There have been many improvements in bariatric surgical training and bariatric surgical procedures since this relatively new medical field was introduced.

However, the malpractice insurance risk is not decreasing. Currently, over 150,000 bariatric surgeries are performed each year in the United States. It is estimated that over 11 million adults are eligible for bariatric surgery, with this amount of exposure; a bariatric surgeon will almost certainly be sued at least once within their career whether or not true surgical or follow-up care negligence was a factor.

Types of Bariatric Surgeries Performed Today

There are two accepted types of bariatric surgery, they include restrictive surgeries and malabsorptive/restrictive surgeries. Restrictive surgeries will actually limit the amount of food that can be ingested and will slow down one’s digestion. The malabsorptive/restrictive surgeries are typically more invasive procedures and will change the way your body accepts food—the stomach size will be restricted and the food will change course in order to reduce calorie absorption. The only restrictive-only procedure is the laparoscopic adjustable gastric banding procedure and it is only done via laparoscopic surgery, never open surgery.

The two malabsorptive/restrictive surgeries include the Roux-en-Y gastric bypass (restrictive and malabsorptive) and bilio-pancreatic diversion with duodenal switch (only malabsorptive), depending upon the bariatric surgeon’s skill and the patient’s needs, these can be done either via open or laparoscopic surgery. Professional liability insurance companies prefer surgeons to perform bariatric lap band procedures as opposed to bariatric gastric bypass surgery. There is a significantly higher risk of complications with gastric bypass surgery leading to more medical malpractice insurance claims.

Patient Resources for Bariatric Surgery

Despite the increasing number of bariatric surgeries performed, the high risk of the bariatric procedures themselves, and the relatively high medical malpractice insurance risk associated with bariatric surgery, there are tools available to help bariatric surgeons reduce their risk of being sued for medical malpractice. The most effective method of risk management for bariatric surgeons is developing an open, honest, and transparent patient-physician relationship. Across all medical specialties, a strong relationship between the patient and physician is the best defense against being sued for medical malpractice.

Next, bariatric surgeons need to be certain they are following the guidelines set in place by the American Society for Metabolic and Bariatric Surgery (ASMBS), American Society of Bariatric Physicians (ASBP) and the American Board of Bariatric Medicine (ABBM). The ASMBS offer a certification course that many professional liability insurance companies require a surgeon to complete in order to get coverage. The ASMBS also has a certification program for hospitals.

In order to become a “Bariatric Surgery Center of Excellence,” hospitals must meet a stringent set of guidelines. The guidelines are set to give patients the best possible bariatric medical care. Many professional liability insurance companies view centers of excellence as providing a good risk management program and lowering the risk of a claim.

Physician Medical Malpractice Insurance and Risk

Finally, in order to ensure your business’ and personal financial security as a bariatric surgeon, you need to have a strong medical malpractice insurance policy in place that insures you for indemnity and defense costs associated with any medical malpractice claim you may file arising from your practice of bariatric surgery.

The Most Common Causes of Bariatric Surgery malpractice:

  • Inexperience of the bariatric surgeon performing bariatric procedures – it has been estimated by the American Medical Association that bariatric procedures performed by bariatric surgeons who have performed less than one hundred bariatric surgeries are approximately two times as likely to result in complications.
  • Bariatric surgery performed on a patient who is not a qualified candidate – the criteria include: one hundred pounds over the normal body weight, a Body Mass Index (BMI) over 40, and a previous effort to reduce weight non-surgically.
  • Failure to timely and properly  treat gastric fluid leaks
  • Failure to timely and properly treat a pulmonary embolism
  • Failure to timely and properly treat a gastric bleed

The good news is that, with time, bariatric surgeons will become more experienced and the bariatric surgery field will provide more data to better analyze the medical malpractice insurance risk associated with its practice. However, mistakes are made and the fact that the number of annual bariatric surgical procedures is projected to increase will not help with reducing medical malpractice insurance claims. It is of utmost importance for every bariatric surgeon to review their medical malpractice insurance policy with a qualified medical professional liability insurance broker to ensure proper, strong, and quality medical malpractice insurance coverage is in place.