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Disabled people may struggle to get specialty care

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.

SOURCE: http://bit.ly/bN9DEh Annals of Internal Medicine, online March 18, 2013.

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