Wheelchair Patients Find Obstacles at Doctor’s Offices

Wheelchair Patients Find Obstacles at Doctor’s Offices

Almost one-fourth of doctors are unable to accommodate and treat patients who use wheelchairs more than 20 years after the passing of the Americans with Disabilities Act, a study found.

About 22 percent of 256 doctor’s offices surveyed said they couldn’t assist people in wheelchairs, with most of those saying it was because they weren’t able to safely transfer the patient to an exam table, according to research published today in the Annals of Internal Medicine. Lack of access to the building was a secondary reason, the researchers said.

The Americans with Disabilities Act, passed by the U.S. Congress in 1990, is aimed at ending discrimination for people with disabilities in everyday activities including access to medical care facilities and the services provided there. Today’s findings are one of the first to show where barriers to medical services remain for wheelchair-bound patients, said Tara Lagu, the study’s lead author.

“This is affecting a large number of patients, certainly the 3 million who use a wheelchair, but many more than that who have difficulty getting up to an exam table,” said Lagu, an academic hospitalist at Baystate Medical Center in Springfield, Massachusetts, and an assistant professor at Tufts University School of Medicine, in a March 15 telephone interview. “The point of the study is to help doctors realize what the problems are and to help them become more aware of the Americans with Disabilities Act and to identify what the difficulties patients who use wheelchairs are having in accessing health care.”

Fictional Patient

Researchers in the study called the doctor’s offices in four U.S. cities to make an appointment for a fictional patient who was female, obese and had suffered a stroke and couldn’t use half of her body. They also said the patient was unable to transfer herself to an exam table.

They found that 56 practices said they couldn’t accommodate the patient. Of those, 47 said it was because they weren’t able to help the patient onto a table and nine said it was because of their building.

Of the 200 practices that said they could accommodate the patient, 103 said they would manually transfer the patient from the wheelchair to a standard exam table that didn’t adjust its height without the use of a lift. Only 22 said they had accessible tables that lowered to the height of the wheelchair or a lift to transfer the patient. Manually transferring a patient to a table that’s unable to adjust its height is considered unsafe, Lagu said.

Unsafe Practices

“It was troubling to us that many surveyed practices were inaccessible, but it was equally problematic that few accessible practices possessed equipment that would facilitate the safe transfer, from chair to table, of our fictional patient,” Lagu said in a statement. “A majority of accessible practices reported that they planned to have practice staff manually lift the patient from a wheelchair to an unadjustable, standard- height exam table, a method that disability experts consider to be unsafe for both the patient and those lifting her.”

An adjustable table costs about $5,500 while a standard table costs $1,500, Lagu said. Tax credits are available for doctors to purchase the adjustable tables. Also, doctors that refuse to make appointments for patients in wheelchairs could face lawsuits, she said.

“Approximately 16 percent of civilian, non- institutionalized Americans aged 18 years or older have physical functional limitations and these numbers will rise sharply in the coming decades. Thus, all physicians can expect to see numerous patients with impaired mobility,” wrote Lisa Iezzoni, a professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, in an accompanying editorial.

“That practices would decline to see patients with disabilities raises troubling questions about their commitment to the core tenet of professionalism: increasing access and reducing barriers to equitable health care,” she said. “Height-adjustable examination tables can improve physical comfort, safety and access for many patients in addition to persons with disabilities. These tables also offer important benefits to physicians and practice staff.”

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net

Disabled people may struggle to get specialty care

5:15pm EDT

By Genevra Pittman

NEW YORK (Reuters Health) – Rachel Markley often feels uncomfortable when she goes to the doctor.

A 22-year-old student at The Ohio State University in Columbus, she uses an electric wheelchair and finds waiting rooms and examination rooms are often hard to maneuver.

“I’ve been in exam rooms where I’m kind of afraid, if they open the door, are they going to bang into me?” said Markley, who has spinal muscular atrophy.

Other times, she said, she can’t get an appointment at all – because a facility’s entrance has steps, without a ramp or a lift.

A new study suggests she’s far from alone. More than one in five specialty practices told referring doctors they couldn’t accommodate a wheelchair-bound patient during phone surveys of 256 U.S. offices.

Another 40 percent of practices told callers they could accept the patient, but would have to transfer her manually to an examination table – which could be risky for patients and healthcare workers alike, researchers said.

“Barriers to care are well known for wheelchair-using patients, where they simply cannot get services,” said Dr. Lisa Iezzoni, head of the Morgan Institute for Health Policy at Massachusetts General Hospital in Boston.

According to the Americans with Disabilities Act of 1990 (ADA), doctors have to provide equal access to services and facilities to people with limited mobility.

“The fact that some patients would still not be able to get care because of inaccessible facilities is extremely troubling,” Iezzoni, who wrote a commentary published with the new study, told Reuters Health.

For their survey, researchers led by Dr. Tara Lagu from the Baystate Medical Center in Springfield, Massachusetts, called specialty practices, including gynecologists, urologists and ophthalmologists in their own state as well as in Georgia, Oregon and Texas.

The caller was a medical student or doctor who tried to make an appointment for a hypothetical obese patient who was wheelchair-bound due to complications from a stroke.

Fifty-six of the offices, or 22 percent, said they couldn’t accommodate the patient – typically because they wouldn’t be able to transfer her to the exam table.

Another 40 percent said they would see the patient and planned to transfer her manually to a standard exam table. Just 9 percent of practices would use a height-adjustable exam table or lift for transferring the patient, the research team wrote Monday in the Annals of Internal Medicine.

ADA VIOLATIONS?

Because of Markley’s condition, she has to be lifted on to most exam room tables.

Sometimes, she added, she has to put her chair in the hallway and be carried on to the table. “That can be embarrassing, depending on who’s around,” Markley told Reuters Health.

Other times, she’s been on exam tables with an elevated back and found herself sliding off.

Iezzoni said manual transferring patients on to exam tables can be done safety, but often risks injuries to both patients and staff, and can be uncomfortable for the patient. In the new study, the hypothetical wheelchair-bound patient weighed 218 pounds.

“It’s really kind of an accident waiting to happen,” Iezzoni said.

She said it’s hard to say for sure whether an inability to provide care for a hypothetical less-mobile patient would be “absolutely illegal,” but that it most likely would be in violation of the ADA.

“It does seem that if a real patient called them, they would not be accessible, therefore it appears that they’re in violation of the Americans with Disabilities Act,” Lagu told Reuters Health.

She said many doctors simply may not be aware of how the ADA applies to them, and that future regulations on specific required equipment could help clarify that.

“They were very willing to explain to us why they couldn’t accommodate the patient. That said to us that they were unaware they were violating federal law.”

If people with disabilities are having trouble getting an appointment, Lagu said they can call a disability lawyer – not necessarily to sue the practice, but to let doctors know they are in violation of the ADA. That could encourage practices to put in the right type of equipment and train staff to accommodate those people, she added.

Markley said that even little things – giving her a corner exam room that’s slightly bigger, or having medical techs that have been trained in attending to people with disabilities – go a long way toward making her more comfortable at the doctor.