Just Hop up on the Table...

ADA requires equal access to health care

by Christina Medvescek on November 1, 2006 - 2:06pm

QUEST Vol. 13, No. 6

A big reason wheelchair users put off getting routine health care and checkups is because they can’t get onto the examining table.

Without accessible examination tables and weighing scales, wheelchair users may be examined in their chairs, or may not receive important diagnostic tests needed for basic preventive health care, such as palpation of internal organs and breasts, pap smears, mammograms, rectal exams and more.

This means they’re receiving substandard medical care — something expressly illegal under Titles II and III of the Americans with Disabilities Act (ADA).

For example, Marilyn McMahon, 51, of Grand Prairie, Texas, stopped going to her gynecologist several years ago when her ALS (amyotrophic lateral sclerosis) made it too difficult to transfer from her wheelchair onto the high, narrow examining table. “So we just kind of put it off,” she explains.

But ALS didn’t stop her body’s natural hormonal changes as she neared her 50s. Heavy premenopausal bleeding caused a lot of distress and caregiving difficulties before she finally heard from her MDA clinic doctor about a nearby gynecologist with an accessible examining table.

"If I’d gone to a gynecologist yearly, this is something that could have been discussed and maybe not come to this extreme," she says. "I definitely think it [the lack of an accessible examining table] affected my health care."

The law

Under the ADA, doctors are required to give patients with disabilities the same access to medical care they provide patients without disabilities.

Doctors can’t refuse to treat a person simply because of the disability, or refer them to another doctor for treatment they routinely provide to others, or require patients to bring their own assistants to help with transfers. Medical staff can’t blithely say, "Oh, we don’t do that here," when asked for help transferring to the table.

But the ADA doesn’t specifically require accessible examining tables and weighing scales, calling instead for "readily achievable accommodations." This definition varies depending on the resources and size of the facility, with large hospitals required to do more than small practices.

The Midmark 623 Barrier-Free table
The Midmark 623 Barrier-Free table lowers to 18 inches above the floor, for easy patient seating and wheelchair transfers.

The ideal solutions are roll-on scales and powered examining tables that can be raised and lowered. However, other reasonable accommodations might include a less expensive nonpowered wheelchair-height exam table; safe staff-assisted transfers; mechanical lifts; and making arrangements to weigh or examine you at an alternative location, such as a hospital.

Try it, you’ll like it

The problem isn’t that doctors don’t like accessible tables and scales. It’s that they aren’t aware of the need, says Jon Wells, director of marketing for the medical division of Midmark Corp. in Versailles, Ohio, an accessible exam table manufacturer.

Doctors still are two doors down when patients have to be helped onto the scale and exam table by nurses and aides. These staffers (who suffer significant injury rates in transfers) see a great need for the equipment.

Wells has seen a slight increase in sales of his company’s Barrier-Free exam tables in recent years, but certainly not a surge. With more than 500,000 standard box tables currently in use, “we’re just scratching the surface.”

Accessible exam tables lower to 17 to 20 inches above the floor, for easier wheelchair transfers. Other desirable features include foot/leg supports that can be adjusted for contractures, wider tabletops and a higher weight capacity than box tables, which usually come with a drawer step and sit 32½ inches high.

Although they’re about three times as expensive as box tables, height-adjustable tables are a “practice enhancer,” says C. Glenn Saunders, McMahon’s gynecologist in Arlington, who bought a used accessible table on the Internet that looks like a chair but lies flat like a table.

Saunders, who bought the table to better serve his elderly patients, likes the fact that once a patient is seated, “she doesn’t have to do anything else.” When the chair reclines, the calf and foot supports automatically come up, “so the patient doesn’t have to scoot down to the end of the table and put her feet in stirrups.”

Ask and ye shall receive

It appears that one of the keys to greater accessibility may be to just ask for it — something patients often feel uncomfortable doing. But take heart: A recent small survey of doctors showed that about a third of them made accommodations just because they were asked by their patients.

Midmark 263
Once a patient is seated, the Midmark 623 is raised and the backrest gently lowered to a variety of comfortable positions. This model comes with optional heated upholstery, for added comfort.

In another example of the power of the few, several people with disabilities filed a class action suit against Kaiser Permanente in California, resulting in a settlement agreement in 2001 ensuring accessible tables and scales throughout Kaiser’s California health care system.

When you’re ready to ask, here are some talking points:

Accessible equipment creates safer conditions for the office staff, reducing injuries, sick time and workers’ compensation claims. Height-adjustable tables also are easier on doctors’ backs. And the ease in transferring and positioning “kind of speeds things up as well,” notes Saunders.

Most doctors will ask themselves, “Do I have enough patients who would benefit from this to justify the expense?” says Saunders. Point out that many people other than wheelchair users would be helped, such as those who are elderly, obese, pregnant, mobility-impaired or simply short.

For qualifying small practices, half the cost of the new equipment can be regained through a federal tax credit under Section 44 of Title 26 in the IRS Code, the “Disabled Access Tax Credit.”

If a physician is unresponsive to requests and doesn’t provide acceptable alternatives for getting onto the table or scales, he or she may be in violation of the ADA. The Department of Justice (DOJ) takes these complaints seriously, an agency spokesperson told Quest, and has required violators to buy equipment, train their staffs and, in some cases, pay fines.

For free information about individual health care rights and options under the ADA, including free mediation, call the Disability Business and Technical Assistance Center (DBTAC) at (800) 949-4232 or the ADA Hotline at (800) 514-0301. On the Internet, visit adata.org.

For fact sheets about accessible tables and scales, equipment manufacturers and tax breaks for health care providers, visit the Center for Disability Issues & Health Professions at the Western University of Health Sciences, Pomona, Calif. (CDIHP), at www.westernu.edu or call (909) 623-6116.

To read DOJ settlement agreements with medical practices that violated the ADA, go to www.ada.gov, click on “Enforcement,” then “Settlements.” Check out settlements involving the Exodus Women’s Center, Dr. Robila Ashfaq, Valley Radiologists and Washington Hospital Center.

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