Honor the ADA: Medical Diagnostic Equipment Accessibility
Last month I stood at the base of a waterfall at Yosemite National Park, thinking, "How am I going to hike 3,327 feet of elevation?" I looked up to see the rugged terrain--shuffled rock, slippery from the waterfall mist, with trees impeding the paths. It seemed daunting. I think of moments like this when a challenge seemed insurmountable. But then I think of my younger brother who was born with Spina Bifida, a defect that disables him from the waist down. For him, the hike would certainly be impossible. But every set of stairs, every uneven sidewalk, and every high-top chair feels like that kind of exhausting challenge.
Why then would anyone take away protections given to the disabled population under the Americans with Disabilities Act (ADA)? Last year, the U.S. Department of Justice formally withdrew four proposed regulations to the ADA. These regulations would have required healthcare facilities to make medical diagnostic equipment (MDE) handicap-accessible. Exam tables, X-ray equipment, and scales are the most basic pieces of MDE. These are also the most inaccessible because there are no federal minimum technical requirements. This is a barrier to care as many with disabilities cannot get onto high, fixed-height equipment. Due to issues of access, the disabled are discouraged and sometimes unable to get appropriate preventative care such as a weigh-ins, blood pressure checks, and cholesterol screenings despite the disabled having an increased prevalence of those health issues.
The MDE regulations were withdrawn as opponents deemed them "unnecessary". Easier said when you are not the person sitting in the wheelchair, where spending 20 minutes trying to find someone to help you onto an exam table can make you feel degraded. Other opponents said many facilities lack space and that disabled persons can travel to larger, accessible facilities. These opponents failed to consider that accessible facilities may be over an hour away and many disabled persons are unable to drive themselves. Is public transportation available? Can a family member spend 2 hours to drive them?
October marks National Disability Employment Awareness Month. In spirit of this month, I challenge readers to write their legislators to reinstitute these MDE regulations and urge all healthcare practices to conduct an accessibility survey of their facility.
Approximately 1-in-4 U.S. adults have a disability with every 1-in-7 having a physical disability affecting mobility. This population not only faces barriers to activities of daily living but also to access to primary and preventative healthcare. A survey of 2,400 California primary care offices found that only 8.4% of offices had an accessible exam table and only 3.6% had an accessible scale. Through my 24 years attending healthcare appointments with my brother, I vouch these statistics are similar across the nation. Most exam tables are set at 32" despite the recommended handicap-accessible maximum being 19". How do I know these numbers? Because they make a difference whether my brother must make multiple heartbreaking attempts to use his arm strength to lift his entire weight onto an exam table.
The intent of the ADA is to prevent discrimination and disparities experienced by the disabled. However, the disabled continue to face healthcare disparities including poorer overall health and less access to healthcare. Research shows 31% of disabled persons report fair or poor health in comparison to 6% of the general population. Furthermore, disabled women are 30% less likely to have breast cancer screening compared to able-bodied women. Without the proposed MDE regulations, mammography equipment remains unregulated and potentially inaccessible. This inequity is similar across other cancer screenings, eye exams, and dental checkups and is directly linked to disparate health outcomes unrelated to a patient's disability.
As the ADA approaches its 30th anniversary in 2020, healthcare institutions should embrace the intent of the ADA with or without federal mandates. Healthcare institutions should follow their ethical obligation to equitable healthcare by making non-fixed MDE accessible and height-adjustable. If promoting social justice is not enough motivation, money should be. With age, disability becomes more common, affecting 40% of adults over 65 years old. As disability affects the Baby Boomer generation, providers who lack accessible equipment may lose a significant number of patients.
The disabled are already a vulnerable population. Advocate to legislators to include MDE regulations to increase access to care for the disabled. If we fail to do so, we fail our moral obligations to our fellow Americans and allow the healthcare disparities to not only continue but grow.