When President George H.W. Bush signed the Americans with Disabilities Act into law on July 26, 1990, he proclaimed, “Let the shameful wall of exclusion finally come tumbling down.”1 But 27 years later, that wall will grow a little taller.
On December 26, 2017, the Department of Justice (DOJ) ruled to formally withdraw 4 Advance Notices of Proposed Rulemaking related to Titles II and III of the Americans with Disabilities Act.2 The withdrawal included rulemaking that addressed making non-fixed medical equipment and furniture, such as examination tables, scales, and mammogram equipment, accessible to individuals with disabilities.2
The DOJ is “reevaluating whether regulation of the accessibility of non-fixed equipment and furniture is necessary and appropriate,” according to the withdrawal document.3
In the United States, 53 million adults have a disability, according the Centers for Disease Control and Prevention.4 Mobility limitation, which involves difficulty walking or climbing stairs, is the most common functional disability type, affecting 1 in 8 adults.
“As a staff attorney for the National Disability Rights Network and as a person with a physical disability, I found this decision incredibly disappointing, both professionally and personally,” said Amy E Scherer, JD, in an interview with Medical Bag. “The goal should be to increase access to medical care for people with disabilities, and this is a step in the wrong direction.”
People with mobility disabilities rely on accessible medical equipment to get proper care. For example, simply getting onto the examination table unassisted can be challenging if the table is at a high, fixed height. The same can be said for imaging machines.
The inability to adjust equipment so that it can be used properly by people with disabilities can too often result in subpar care. As a result, some may not receive the screening or diagnostic evaluations they need to manage and treat their health conditions.
“Health care delivery systems have lagged far behind other sectors in ensuring access for people with disability,” wrote Dr Lisa I Iezzoni, MD, of the Mongan Institute Health Policy Center at Massachusetts General Hospital, and Elizabeth Pendo, JD, of the St Louis University School of Law Center for Health Law Studies, in a New England Journal of Medicine perspective article.2 “Without impetus from the DOJ, health care providers may not make substantial changes to improve the accessibility of their medical diagnostic equipment.”
The number of people with disabilities is growing in the United States, and more effort must be made to eliminate their disadvantages and provide them with accessible health care both in and out of the examination room.
“It’s difficult to ensure that people with disabilities have equal access to medical services if the equipment and furniture [are] not accessible,” said Ms Scherer. “Accessibility issues and concerns make it less likely that people with disabilities — especially those with the most significant disabilities — seek the medical care that they need.”
- Equal Employment Opportunity Commission. Remarks of President George Bush at the signing of the Americans with Disabilities Act. https://www.eeoc.gov/eeoc/history/35th/videos/ada_signing_text.html. July 26, 1990. Accessed April 17, 2018.
- Iezzoni LI, Pendo E. Accessibility of medical diagnostic equipment — implications for people with disability. N Engl J Med. 2018;378(15):1371-1373.
- US Department of Justice. Nondiscrimination on the Basis of Disability; Notice of Withdrawal of Four Previously Announced Rulemaking Actions. Federal Register. https://www.federalregister.gov/documents/2017/12/26/2017-27510/nondiscrimination-on-the-basis-of-disability-notice-of-withdrawal-of-four-previously-announced. Published December 26, 2017. Accessed April 17, 2018.
- Centers for Disease Control and Prevention. CDC: 53 million adults in the US live with a disability. https://www.cdc.gov/media/releases/2015/p0730-US-disability.html. Updated July 30, 2015. Accessed April 17, 2018.