Infectious Disease

What legal obligations do physicians have under the Americans with Disabilities Act?

January 21, 2022

4 minutes read

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Source:
Healio Interview

Disclosure:
Iezzoni does not report any relevant financial information.

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The results of a new survey suggest many doctors don’t fully understand what the Americans with Disabilities Act means to them.

Lisa I. Iezzoni, MD, MSc, a professor of medicine at Harvard Medical School, and colleagues surveyed 714 U.S. physicians working in outpatient facilities about their knowledge of the Americans with Disabilities Act (ADA), a 1990 law that provides statutory reasonable accommodation for people with disabilities.

References: Iezzoni LI, et al. Health Ape (Millwood). 2022; doi: 10.1377 / hlthaff. & 2021.01136.

Among the survey participants, 62% were men; 64.5% were white; 61.7% worked in private, community-based practices; 66.5% had finished medical school more than 20 years ago; and 36.2% either had a significant disability or had a family member with a significant disability. Most respondents were internists or general practitioners. Others were rheumatologists, neurologists, ophthalmologists, orthopedists, and obstetricians/gynaecologists.

According to the researchers:

  • 71.2% of the participants did not know who determines reasonable accommodation under the VAG;
  • 68.4% felt threatened by ADA lawsuits;
  • 35.8% said they knew “little or nothing” about their legal obligations under the ADA; and
  • 20.5% did not know who would pay for accommodations that would make their practices ADA compliant.

The results build on previous survey data from the same group of respondents. In this survey, Iezzoni and colleagues asked participants about their perceptions of patients with disabilities. Only about 40% of them said they were very confident that they could provide their patients with disabilities with the same quality of care as those without disabilities. In addition, only 56.5% agreed that they welcome patients with disabilities into their practice and 82% said that people with significant disabilities have a poorer quality of life than non-disabled people.

“When we put these two data together, there’s a concern that we need to better understand what’s going on among our patients with disabilities,” said Iezzoni, who is also a professor at Massachusetts General Hospital’s Health Policy Research Center.

Healio asked Iezzoni to discuss the legal responsibilities of physicians under the ADA, how physicians can improve the care of patients with disabilities, and more.

Healio: What are the legal obligations of physicians under the ADA?

Iezzoni: Physicians must accommodate their patients with disabilities to ensure that the patient receives appropriate care and is communicated with effectively.

The ADA does not specify exactly what to do for each patient because the law assumes that each individual has their own specific needs. In other words, it sets out basic principles, but the manner in which those principles are achieved is very specific to the context and needs of the individual patient.

For example, I am a wheelchair user with multiple sclerosis. Although I still have enough leg strength to stand for very short periods and sit on an examination table if necessary, someone with SCI may not be able to put weight on their legs. We would need different types of housing to get us onto the examination table. The ADA is not a cookie cutter. Doctors need to talk to their patients to find out what works best.

Salvation: How can doctors help patients with disabilities feel more free and independent?

Iezzoni: That’s a great question.

Doctors can have office equipment that allows the patient to do as much as possible on their own. For example, there are examination tables and electronic devices that go up and down at the touch of a button.

Lisa I. Iezzoni

Section 4203 of the Affordable Care Act required the federal government to develop standards for the accessibility of medical diagnostic equipment, including examination tables, scales, mammography machines, stretchers, and diagnostic imaging equipment. However, jeff sessions, while an attorney general during the former president’s tenure donald j Trump card, announced that they would not enact scoping rules dictating how widespread this accessible equipment must be for patients with disabilities.

Salvation: Who is responsible for paying for upgrades that make facilities ADA compliant?

Iezzoni: The ADA covers structures, parking lots, and sidewalks, but not the contents of the structure or its furnishings. It doesn’t cover the cost of things like the adjustable exam table we talked about earlier, but the federal government is offering tax credits to improve accessibility under the ADA.

While it’s true that auto-adjustable exam tables are slightly more expensive, physicians must weigh this increased cost against things like staff injuries that can occur when patients are lifted onto a non-adjustable exam table. Nurses and medical assistants are the second highest group of workers with work-related injuries. If a doctor can prevent staff injuries by having equipment that doesn’t require lifting and moving patients, it’s a win-win. Height-adjustable examination tables are also ergonomically best for the doctor, so another win-win. The cost issue of making medical practices ADA compliant must be weighed against the savings of some of these other concerns.

Healio: When to do general practitioners do you need to worry about ADA lawsuits?

Iezzoni: One of the most common complaints stems from the lack of communication facilities for deaf patients. Some doctors offer to write notes back and forth, and some doctors offer no assistance at all.

Physicians who refuse to provide American Sign Language interpreters for doctor visits can find themselves in problematic situations. For example, a focus group conducted among deaf people once learned from a man who described the doctor and wrote him on a note, “Do you use coke?” The patient wrote back, “Yes, I really love it.” The patient was immediately asked to provide a urine sample, although further investigation revealed it was not required. The doctor was referring to cocaine, the patient was referring to the drink.

In another example, a woman was told by her doctor that an American Sign Language interpreter was not needed to explain what a Pap smear was because she was young and it was a routine test. The ensuing experience was so terrifying that she said she would never return for another pap smear. Think about how preventable cervical cancer is.

Salvation: What type of educational programs do you think are needed to improve physicians’ knowledge of ADA?

Iezzoni: That’s a really great question.

People always say, well, we should teach this in medical school, and I agree. But it takes 7 years to train a doctor and right now 25% of Americans have a disability. Therefore, we must also talk about the ADA at specialist conferences and in medical training.

Healio: Is there anything you would like to add?

Iezzoni: The results of our studies really make you wonder if some doctors choose not to perform routine screening tasks like peptides or maybe don’t communicate well with people with disabilities because they don’t respect their lives.

references

Iezzoni LI, et al. Health Ape (Millwood). 2022; doi: 10.1377/hlthaff.2021.01136.

Iezzoni LI, et al. Health Ape (Millwood). 2021; doi: 10.1377/hlthaff.2020.01452.

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