- The Washington Times - Friday, October 23, 2009

TOPEKA, Kan. (AP) | The memory still bothers Ken Keller: A panicked ambulance crew had a critically ill patient, but the man weighed more than 1,000 pounds and could not fit inside the vehicle. And the stretcher wasn’t sturdy enough to hold him.

The crew offered an idea to Mr. Keller, who was then an investigator with the Kansas Board of Emergency Medical Services. Could they use a forklift to load the man — bed and all — onto a flatbed truck? Mr. Keller agreed: There was no other choice.

“I’m sure it was terribly embarrassing to be in his own bed, riding on the back of a flatbed with straps tying him down, going to the hospital, and then have a forklift at the hospital unload him,” Mr. Keller said.

As the nation battles the obesity crisis, ambulance crews are trying to improve how they transport extremely heavy patients, who become significantly more difficult to move as they surpass 350 pounds. Caring for such patients is expensive, requiring costly equipment and extra workers, so some ambulance companies have started charging higher fees for especially overweight people.

Ambulance companies say it’s time for insurance providers, Medicaid and Medicare, or patients themselves, to begin paying the added costs, which are cutting into their razor-thin profit margins. In the past, ambulance companies often absorbed the extra expense of serving the obese. Now they are adding charges similar to those already imposed on intensive-care patients, people requiring multiple medications and patients on ventilators.

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

Mr. Keller, now an operations manager for the American Medical Response unit in Topeka, successfully petitioned the Shawnee County Commission last summer to raise ambulance fees from $629 to $1,172 for critical-care patients and people who are 500 pounds or heavier.

In Colorado Springs and the Nebraska cities of Omaha and Lincoln, the fees are $1,421 for an extremely obese patient, compared with $758 for a typical patient. Before those ambulances had heavy-duty equipment, crews just had to make do, often calling in burly firefighters to help lift patients.

“I’ve heard stories of people moved by U-Haul trucks and sides of mobile homes having to be removed to move patients out, things of that nature,” said Ted Sayer, a general manager for the American Medical Response unit.

Some critics say the higher fees are a form of 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 Obesity Action Coalition, a group that advocates for the obese.

But proponents of the extra fees say obese patients are grateful for equipment that eliminates the need for flatbed trucks and forklifts.

“We’ve noticed that people who are heavy know that they are heavy, and they don’t want to impose on others, and they don’t want someone injured while moving them,” Mr. Sayer said.