Treatments of obese patients

The case of Luis Almario made headlines and is being described by some as a landmark decision that may change the role of a general practitioner in the treatment of obese patients. The hype surrounding the case commenced after Mr Almario was awarded damages by the Supreme Court NSW on 21 December last year. Turner Freeman brought the case against Mr Almario’s previous general practitioner, Emmanuel Varipatis.

The essence of the case was an allegation that Dr Varipatis was legally responsible for the consequences of Mr Almario’s liver disease progressing to cirrhosis, liver failure and now liver cancer. The fact that Mr Almario is still alive is a miracle. At best, he has only has a few months to live. His morbid obesity and its ramifications on his liver is what is killing him. The allegation against Dr Varipatis was that he should have acted on Mr Almario’s consistently abnormal liver function tests by addressing his morbid obesity in a number of possible ways, including referring him to a hepatologist (a liver specialist) for active treatment of his obesity. The allegations were strongly disputed by the medical insurer.

Of interest is that Dr Varipatis is a general practitioner who had a particular specialty in nutritional and environmental medicine. One of the allegations made against Dr Varipatis was that he entrenched a belief in Mr Almario that his liver problems were related to his toxic exposure at work. He referred Mr Almario for a serious of detoxification treatments. An allegation made against Dr Varipatis was that a reasonable general practitioner in his position ought to have known that Mr Almario’s health problems, including his liver problems, were not caused by toxic exposure in the workplace but were due to the combined effects of his morbid obesity. As a result, the argument was that a referral should have been made to a suitable specialist.

GP failed to refer client to a specialist

Ultimately, the Supreme Court found that Dr Varipatis was negligent in failing to refer Mr Almario to a bariatric surgeon for consideration of his suitability for surgery and in the alternative, for failing to refer Mr Almario to an obesity clinic and also for failing to refer him to a hepatologist or similarly qualified physician for specific investigation and treatment of his liver disease.

The case was appealed by Dr Varipatis and he was successful on appeal.

The case continues with an application for special leave being lodged on behalf of Mr Almario by our firm in the High Court of Australia.

Whatever the outcome will be, the case highlights the importance of obesity in our community. It is a serious disease. It is difficult to treat and its causes are multifactorial. Despite the media frenzy surrounding the case, the case does not change anything in relation to a general practitioner’s obligations, that being to investigate, treat and refer patients with serious problems to appropriate specialists.