Medical Facilities: The Doctor Is In … But Not For Everyone

DISABILITY RIGHTS LAWS CAN HELP ADDRESS DISPARITIES IN HEALTH CARE RESULTING FROM DISCRIMINATORY POLICIES AND UNLAWFUL PHYSICAL BARRIERS[1]

       The accessibility and usability of hospitals, doctors’ offices, rehabilitation centers and other providers of health care services is essential in providing necessary medical care to people with disabilities. Due to discriminatory policies and physical barriers in our health care system, individuals with physical disabilities are frequently prevented and deterred from getting the medical care they want and need. Moreover, these policies and barriers in our health care systems often cause individuals with physical disabilities to receive inferior medical care and services when compared to the general population, and/or cause individual with physical disabilities to delay treatment or drop out of care prematurely, unnecessarily compromising their health and quality of life.[2]

Federal anti-discrimination laws can be used to challenge discriminatory policies and barriers in the health care system and improve health outcomes for people with mobility disabilities. Under the Americans with Disabilities Act of 1990 (ADA), both public and private health care providers must provide their services to people with disabilities in a nondiscriminatory manner. Section 504 of the Rehabilitation Act of 1973 (Section 504) extends similar obligations to programs or activities that receive federal financial assistance, including health care programs. To comply with these legal mandates, health care providers must modify their policies and procedures where necessary to avoid discrimination, remove barriers from existing facilities, and follow accessibility standards for new construction and alteration projects.

 

ILLUSTRATIONS:

  • Modification of Policies – Allowing Service Animals: Service animals must be allowed to accompany individuals with disabilities in all areas of a medical facility where health care personnel, visitors, and patients are normally allowed during inpatient services, unless the animal’s presence or behavior creates a fundamental alteration in the nature of a facility’s services in a particular area or a direct threat to other persons in a particular area.
  • Barrier Removal in Existing Facilities – Useable Parking and Restroom Facilities: To the extent that health care providers offer patients parking and restroom facilities, such facilities must be readily accessible and usable by patients with mobility disabilities. In the case of parking facilities, this may require the re-striping and/or reconfiguration of parking stalls. With regard to restrooms, grab bars may be required, as well as the lowering of amenities such as soap and paper towel dispensers.
  • Compliance with Accessibility Standards for New Construction and Alteration Projects: New and altered examination rooms must meet requirements of the ADA Standards for Accessible Design, 28 CFR Part 36, App. D. These standards allow a patient with mobility disabilities to enter the examination room, move around in the room, and utilize the accessible equipment provided. The features that make this possible are
    • an accessible route to and through the room;
    • an entry door with adequate clear width, maneuvering clearance, and accessible hardware;
    • appropriate models and placement of accessible examination equipment (See Part 4 for detailed discussion of accessible examination equipment.); and
    • adequate clear floor space inside the room for side transfers and use of lift equipment.
Plan view of part of an examination room showing clear floor space for turning a wheelchair. This space can also make it possible for use of a portable patient lift
Assisted Transfer to Stretcher Utilizing a Portable Floor Lift

A SPECIAL NOTE ABOUT MEDICAL DIAGNOSTIC EQUIPMENT:

Availability of accessible medical equipment is an important part of providing accessible medical care, and doctors and other providers must ensure that medical equipment is not a barrier to individuals with disabilities. “The provision of accessible equipment and furniture has always been required by the ADA and the Department’s implementing regulations under the program accessibility, reasonable modification, auxiliary aids and services, and barrier removal requirements.”[3] Accordingly, compliance with the anti-discrimination mandates of the ADA and Section 504 may require the acquisition of accessible equipment and furniture.

The United States Access Board is in the process of developing detailed accessibility standards for medical diagnostic equipment, including examination tables and chairs, weight scales, radiological equipment, and mammography equipment under the “Patient Protection and Affordable Care Act.” The standards address independent access to, and use of, such equipment by people with disabilities to the maximum extent possible. The Board proposed standards for public comment and will finalize them according to the comments received and recommendations from an advisory committee it chartered.

 

HAVE YOU EXPERIENCED DISCRIMINATORY POLICIES OR PHYSICAL BARRIERS TO HEALTH CARE?
If so, please call or email Mark Potter at the Center for Disability Rights for help.
Your health and well-being are too important not to take action!

Toll Free: 800-383-7027 or Mark@PotterHandy.com

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FOOTNOTES:

[1] This blog entry deals primarily with the barriers and discrimination experienced by individuals with physical disabilities. Significant barriers to health care also exist for persons with other disabilities, particularly sensory disabilities and mental health disabilities, and may be dealt with in a future blog post.

[2] See Centers for Disease Control and Prevention (CDC). CDC Health Disparities and Inequalities Report – United States, 2011. MMWR 2011; 60(Supplement): 1-114. (People with disabilities have been reported to experience fair or poor health approximately four times more than their peers without disabilities. In addition, a disproportionate percentage of people with disabilities experience the social determinants of poor health.)

[3] DOJ Advance Notice of Proposed Rulemaking, Nondiscrimination on the Basis of Disability by State and Local Governments and Places of Public Accommodation; Equipment and Furniture (E&F ANPRM), Section IV. Background, Subsection B Legal foundation for equipment and furniture coverage.

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