HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, February 11, 2014

Guest Blogger Associate Dean Elizabeth Pendo: New Study: Quantifying Lack of Access for People with Disabilities

PendoMany thanks to Katharine and the other editors for inviting me to share my thoughts this month.  One of my areas of interest is the impact of inaccessible medical and diagnostic equipment on access to basic health care for people with mobility disabilities.  In the course of my research, I see many stories such as this one:  

It took a while . . . but I gradually realized that I wasn’t getting the same level of care I had received when I could walk, and get on the scale, and climb up on the examination table. Doctors were prescribing dosages based on what they guessed I weighed, so I began thinking maybe I should be weighed. And doctors stopped routinely examining the back of my body, because it's so difficult to get clothes on and off when you can't stand up that they took the easy way out.

This was from a quote from John Lonberg, a plaintiff in the first class-action challenging inaccessible medical equipment, Metzler v. Kaiser Foundation Health Plan.  He eventually developed a pressure sore, which required surgery by the time it was detected.  How many other men and women across the country share his experience?  The Annals of Internal Medicine recently published a study focused on that question, one of the first to quantify the lack of access to subspecialists for people with mobility impairments.

The surveyors used a “secret shopper” method, reminiscent of the investigatory testing model used to document discrimination in housing, lending, employment and public accommodations. Posing as fictitious patients, they attempted to make appointments with a variety of subspecialists in four large cities. In each case, the surveyor explained to the scheduler the chief symptoms relevant to the practice and medical history, which included obesity, a condition requiring the use of a wheelchair, and the inability to self-transfer during the appointment.

The researchers found that men and women with mobility disabilities have difficulty making appointments for care with subspecialists, and may receive less or lesser care as a result.  Of the 256-subspecialty practices surveyed, 56 practices (22%) reported that they could not accommodate a patient in a wheelchair, typically because they could not transfer a patient to an examination table.  Only 22 practices (9%) reported the use of accessible equipment such as height-adjustable tables or lifts.  A few other findings stood out:

  • Gynecology had the highest rate of inaccessible practices (44%).
  • Several practices reported a willingness to provide a less-than full examination of the patient (from his or her wheelchair, instead of an examination table), or to use potentially risky methods to transfer the patient to the table. 
  • Almost all inaccessible practices provided reasons for refusing to see a patient who uses a wheelchair.  As noted by the authors, “[t]his willingness may indicate that many practices are simply unaware that such a refusal is a violation of federal law.”
The findings on lack of access and lack of knowledge about the ADA’s requirement of equal access are significant even if the practices, locations, and fictitious patients are not fully representative. The focus on inaccessible medical equipment is also timely.  The Access Board has issued its final report on standards for medical and diagnostic equipment as required under the ACA, setting the stage for the Department of Justice to consider whether to include scoping requirements specifying the minimum number and types of accessible equipment required in various health care facilities in future regulations.

-Guest Blogger Associate Dean Elizabeth Pendo

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