By Jim Salter, The Associated Press, April 1, 2006

ST. LOUIS - Going to the hospital is rarely fun. If you weigh over 300 pounds like Beth Henk, it can be embarrassing. "I've flipped an exam table - I sat on the end of it and it just flipped up," said Henk, whose weight peaked at 745.

When her son was born three years ago, "I had to sit in the hospital bed the whole time - the hospital's rocker wouldn't fit my butt."

Today Henk helps Barnes-Jewish Hospital in St. Louis find better ways to deal with the growing number of very obese patients, an issue for many U.S. hospitals. Barnes-Jewish is replacing beds and wheelchairs with bigger models, widening doorways, buying larger CT scan machines, even replacing slippers and gowns.

Last year, patient care director Colleen Becker decided to check the numbers. She looked at a daily hospital census - about one-third of the 900 patients weighed 350 pounds or more.

Startled, Becker checked another date, then another. The numbers were consistent. On some days, half the patients were obese. Some weighed 500 pounds or more.

"We ran the data again to make sure we weren't hallucinating," Becker said. "We weren't. So we had to somehow figure out the appropriate supplies, equipment, training and care for the patients we're dealing with."

The answer was a "bariatric care team," which Henk serves on, to address the challenges posed by obese patients. Those challenges are many.

Hospitals around the nation are working with equipment suppliers to accommodate larger patients, said Elizabeth Lietz, a spokeswoman for the American Hospital Association. And it's not just for the patients.

ATF Healthcare, a union representing 70,000 nurses and other workers at hospitals in 18 states, last week called for new laws forcing hospitals to buy equipment such as portable hoists to prevent worker injuries.

A union-commissioned survey of more than 900 nurses and X-ray technicians found the majority have chronic pain or have suffered injuries from lifting and moving patients.

At Barnes-Jewish, lift machines help some patients get in and out of bed. Chairs have been made stronger and wider. Lights have been added at floor level because the bodies of extremely obese people can cast a shadow that makes it hard to see the floor.

The hospital is replacing many of its beds - built to handle people weighing up to 350 pounds - with beds for 500-pound patients.

"Three-hundred-fifty pounds is nowhere near what we need for beds now," said Art Kisrow, a nurse manager at Barnes-Jewish. "We've had some 650-pounders up here."

Some wings of Barnes-Jewish are replacing 36-inch-wide doorways with those that are 48 or 52 inches wide. The bathrooms are being fitted with floor-mounted commodes that can't be pulled out of the wall, and rooms reconfigured so patients can essentially get out of bed and step into the bathroom.

Gowns are bigger. Wheelchairs are wider. Even hospital-issued slippers come in extra-large sizes because the standard-issued footies were cutting off circulation for some patients.

Issues extend beyond the patient's room. Operating tables have been widened because the girth of some patients was lapping over the table, in some cases all the way to the floor, Becker said. CT scan machines weren't wide enough. Syringes with the longest available needles - 4 1/2 inches - couldn't penetrate the fat.

Along with doctors and nurses, the hospital's 30-member bariatric care team includes former patients like Henk and people from the hospital's engineering and housekeeping units.

Henk, 41, represents both patients and those who try to help the obese - she is program manager for Washington University's weight management program.

She's been heavy for as long as she can remember - she was in Weight Watchers by age 5. "Everybody in my family is at least 100 pounds overweight," she said.

Gastric bypass surgery seven years ago helped her shed some weight, but she's dropped to 315 pounds mostly through better eating and exercise.

Still, she knows what larger people go through at the hospital.

"I believe in dignity for whomever you are," Henk said. "It can be scary, too. If people are trying to lift you up and somebody doesn't have the strength, it's very scary."

Based on recommendations from the team, Barnes-Jewish has developed a protocol for lifting heavy patients.

The hospital is also working with suppliers. Manufacturers now offer more than 1,000 items specifically for obese patients, said Sandy Wise, of Novation LLC, a Texas-based company that provides contracting services between hospitals and manufacturers.

"It's been a trend probably for the last four or five years," Wise said. "Hospitals are continuing to see an increase in obese patients, and it affects every department. You have to think of the patient from head to toe, everything they do in the hospital until they walk out the door or they die."

In fact, Barnes-Jewish is striving to make even the end more dignified. Becker said the law requires a leak-proof body bag. Some patients were so large they wouldn't fit in them. The hospital is working with a vendor to develop a wider bag.