Victoria Hospital Won't Hire Very Obese Workers

The Citizens Medical Center policy, instituted a little more than a year ago, requires potential employees to have a body mass index of less than 35 -- which is 210 pounds for someone who is 5-foot-5, and 245 pounds for someone who is 5-foot-10. It states that an employee's physique "should fit with a representational image or specific mental projection of the job of a healthcare professional," including an appearance "free from distraction" for hospital patients.

"The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance," hospital chief executive David Brown said in an interview. "We have the ability as an employer to characterize our process and to have a policy that says what's best for our business and for our patients."

Employment lawyers say Citizens Medical Center's hiring policy isn't against the law. Only the state of Michigan and six U.S. cities -- including San Francisco and Washington, D.C. -- ban discrimination against the overweight in hiring.

"In Texas, employers cannot discriminate against employees because of their race, age or religion," said DeDe Church, an Austin-based employment lawyer. "Weight is not one of those protected categories."

But such a hiring policy is virtually unheard of in medical circles. And it seems an unusual risk for a hospital already battling allegations of discrimination over -- among other things -- a memo Brown wrote in 2007.

In the memo, one of several records used by three physicians of Indian descent to lodge a racial discrimination suit against Citizens, Brown wrote that he felt "a sense of disgust" that more "Middle-Eastern-born" physicians were demanding leadership roles at the hospital. "It will change the entire complexion of the hospital and create a level of fear among our employees," he wrote.

Brown said he's prohibited from speaking about the lawsuit. But defense attorneys have said that the racial discrimination claims are bogus and that the lawsuit stems from an escalating disagreement between doctors and administrators over how to run the hospital.

Both the Texas Hospital Association and the American Hospital Association said that although they've seen more hospitals restricting employment for job candidates who smoke -- Baylor Health Care System, for example, no longer hires employees who use tobacco -- they hadn't heard of any hospitals with weight or body mass limits.

Lance Lunsford, spokesman for the Texas Hospital Association, said such a policy could open a hospital up to litigation. People with disabilities are protected under the Americans with Disabilities Act, and in some court rulings, obesity has been interpreted as a disability. "There is an indication that not hiring someone due to obesity might be successfully challenged in court," he said.

Citizens Medical Center's written policy doesn't indicate that paying for the health insurance of obese workers is too expensive -- the reason some companies have been able to ban workers who use tobacco -- or suggest that obese employees are unable to do their jobs. Mostly, it references physical appearance, and puts overweight applicants in the same category as those with visible tattoos or facial piercings.

"This is discrimination plain and simple," said Peggy Howell, public relations director for the National Association to Advance Fat Acceptance. She said a hospital should know that lots of medical conditions lead to obesity or weight gain. "So the field of medicine is no longer an option for people of larger body size? What a waste of talent."

But Brown, the hospital CEO, said there's more to the story than what's written in the policy. He said that excessive weight has "all kinds of encumbrances" for the hospital and its health plan, and that there's evidence that extremely obese employees are absent from work more often.

At Citizens, a physician screens prospective employees to assess their fitness for work, including their body mass index. Some job candidates have been turned away for being too overweight, Brown said, but current workers who become obese over the course of their employment are not terminated. Brown said the hospital also offers to help heavy job candidates get their body mass index down.

"We have some people who are applicants and they know the requirements, and we try and help them get there but they're not interested," he said. "So that's fine, they can go work somewhere else."

A doctor at Citizens who declined to be named acknowledged that employees -- and patients -- who are overweight cost the health care system more. But he said body mass index as a primary measure of obesity is not a good indicator: A professional football player might have a body mass index of 32, which is technically obese, but only have 7 percent body fat.

And unless obese job applicants have other precipitating health factors, he said, their weight wouldn't get in the way of being a successful hospital employee. "If more people knew about it," the doctor said of the employment policy, "they would be justifiably pissed." 

This article originally appeared in The Texas Tribune at http://www.texastribune.org/texas-health-resources/health-reform-and-texas/victoria-hospital-wont-hire-very-obese-workers/.