Access To Health

Reprinted from PN/Paraplegia News January 2017

No matter where health care is offered, there are rules to make sure people with disabilities have the access they need to stay well

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If you have a spinal-cord injury or disease (SCI/D) or help someone who does, there’s no secret about the amount of specialized medical care and multiple health professionals required to stay in good condition. 

Among the health professionals needed are a SCI/D specialist to treat the primary condition. However, these specialists usually don’t offer the services of a primary care provider (PCP) who renders aid that everyone needs, such as treatment of common sicknesses and preventive health care.

Veterans with SCI/D can receive care from a SCI/D specialist and PCP under one roof through the Department of Veterans Affairs medical system. However, if you’re not a veteran, you’ll probably need to go to multiple locations and/or medical professionals for your health care.

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Going to several places can sometimes mean problems, including physical barriers that make taking good care of yourself tough.

Coordination Of Care

One problem is that a PCP needs to consider issues related to SCI/D when providing care, but the PCP often lacks knowledge about secondary conditions.

Last year, the University of Alabama-Birmingham Spinal Cord Injury Model System (UAB-SCIMS) launched a website for PCPs in an effort to help solve this problem by providing them information on secondary conditions that they can consider when providing care.

A lack of transportation is also a problem for many, especially in areas with limited public transportation. It’s an ongoing problem with no easy solution.

Physical barriers remain troublesome, too. Some offices aren’t fully accessible or lack an accessible exam table. Transferring can be a problem. Specialized screening equipment is often not accessible.

For example, women who use a wheelchair are often unable to get breast and cervical cancer screenings because examination tables aren’t height-adjustable.

You probably know the law requires equal access. Sadly, however, you likely also know that the “law” and the “real world” are often two different things. You know the real world, but do you know what “equal access” to health care means?

Here is what you need to know.

What Is The Law?

The Rehabilitation Act of 1973 was the first anti-discrimination, civil rights law to prohibit discrimination based upon disability. However, it was limited to only covering “any program or activity receiving federal financial assistance.”

It took roughly 20 years before laws improved with the signing of the Americans with Disabilities Act (ADA) in 1990. The ADA basically prevents any discrimination against people with disabilities.

It requires barriers to be eliminated in all areas of public life, including jobs, schools, transportation and places that are open to the general public.

The ADA & Health Care

Generally, the ADA requires medical care providers (doctors’ offices, clinics and other health care providers) to:

  • Provide persons with disabilities full and equal access to health care services and facilities
  • Make reasonable modifications to policies, practices and procedures when necessary to make health care services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services

Some ADA requirements aren’t easily implemented in the real world, so there’s flexibility. For example, not every medical diagnostic machine has to be accessible so long as there are enough accessible machines to serve persons with disabilities.

The ADA requires private businesses to make changes in most older buildings that are “readily achievable” to make those buildings and services accessible and usable by persons with disabilities. This means they’re to make any and all changes that are easily accomplished and can be made without much difficulty or expense.

For instance, adding a wall or an elevator isn’t readily achievable. Restriping a parking lot to add accessible spaces is doable.

Can medical providers refuse to treat you because the office isn’t accessible or there’s no accessible medical equipment?

No. You can’t be denied the same treatment as someone without a disability.

This means providers must have a wheelchair-accessible entrance and the office must be accessible, no matter if the office space is owned or leased by the provider. They must also provide an accessible examination table, stretcher or gurney if it’s needed for treatment. 

If accessible equipment isn’t needed, it’s reasonable for the provider to examine you as you sit in your wheelchair.

Can you be required to bring someone with you to help with transferring during the exam?

No. You can choose to bring someone, but you can’t be told to bring someone to help.

Providers can ask you if you need help and, if so, what’s the best way to help. But they must use a patient lift or have trained staff available to assist you if needed. This assistance may include helping you to dress or undress, transfer to and from an exam table or other equipment.

If needed, providers must also have
staff to stay with you to help maintain balance and positioning.

What can you do if you’re denied medical service, the office isn’t accessible or there’s no accessible medical equipment?

The quickest and easiest way to improve access is to try and handle things yourself.

First, ask to speak to the person in charge. This may be the doctor or office manager. Be polite but clear in telling that person what the barriers are and request that the barriers be removed.

Many medical providers don’t own the facility and are only leasing it. They may not know that both owners and tenants are equally covered by the ADA. You can tell the provider that they both have a responsibility for complying with ADA requirements.

Second, get the provider’s address or email. You should follow up in writing to check on progress. Be sure everything is dated.

Third, be mindful that some barriers may take longer than others to be removed. Allow a reasonable amount of time for the barriers to be removed.

Finally, if all reasonable efforts to make the services accessible have been unsuccessful, you can file a complaint.

  • Contact the U.S. Department of Justice at 800-514-0301 or
  • Contact your state or local bar association to get a referral to an attorney who may be able to assist you.
  • You may also obtain the services of a private attorney and file a complaint in federal court.

This article was reprinted with permission from the  Pushin’ On digital newsletter at UAB-SCIMS. Phil Klebine is the editor of  Pushin’ On and Graham Sisson, JD, is executive director of the Alabama Governor’s Office on Disability, the state’s ADA coordinator and assistant attorney general with the Alabama Department of Rehabilitation Services.   


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