Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Trump rollback of disability rules can make doctor’s visits painstaking

Trump rollback of disability rules can make doctor’s visits painstaking

Going to the doctor’s office can feel so routine. You sit in the waiting room, fill out the paperwork, get measured and hop onto the exam table.

But medical appointments for patients with disabilities require navigating a tricky obstacle course, full of impediments that leave them feeling awkward and could result in substandard care.

Despite laws that require ramps and wider doors for access, many health care providers don’t have scales that can accommodate wheelchairs, or adjustable exam tables for patients who can’t get up on one by themselves.

Dr. Lisa Iezzoni, a professor of medicine at Harvard Medical School who has multiple sclerosis and uses a wheelchair, said she went 20 years without properly being weighed. This can result in treatment plans, and even prescriptions, based on educated guesses rather than exact information, she said.

The Affordable Care Act was set to update standards for accessible medical treatment within the Americans with Disabilities Act (ADA), which is enforced by the Justice Department. But the Trump administration stopped action on this change late last year as part of its sweeping effort to roll back regulations across the federal government.

“I was in shock when I heard that [Attorney General Jeff] Sessions’ Justice Department had pulled back on their rule-making,” said Iezzoni.

Denise Hok, 54, who lives in Colorado Springs, Colo., and uses a wheelchair, opts for home health care when possible and avoids doctors’ offices where “it feels like it doesn’t really matter if something is wrong.” When offices don’t have accessible equipment, she said, it “sends a message.”

Hok holds her 4-year-old cat, Moo.(Dougal Brownlie for KHN)

The ADA, a 1990 civil rights measure designed to prohibit discrimination against people with disabilities, requires that public places be accessible, meaning new buildings and certain commercial establishments must provide ramps, doorways wide enough for a wheelchair, handrails and elevators.

The law applies only to fixed structures, though, and doesn’t address “furnishings” unattached to buildings. At doctors’ offices, that means scales, tables, X-ray machines and other diagnostic equipment aren’t legally circumscribed.

The result is that movie theaters and laundromats have to be accessible to all people, but important aspects of the medical industry do not, said Megan Morris, an assistant professor in the department of family medicine at the University of Colorado who has studied patients with disabilities and their access to health care.

The ACA directed a federal panel, the Architectural and Transportation Barriers Compliance Board, to take steps to close this gap by issuing standards for determining what medical equipment could be deemed “accessible.” Their report was finalized in January 2017, just before President Barack Obama left office.

But the DOJ’s decision in December not to update enforcement accordingly reinforces the disparities in how people are treated, said patients and disability rights advocates.

Paul Spotts, 58, who is paralyzed from the chest down, said his checkups are “a joke.” His doctors check his eyes and ears but they don’t put him on a scale or exam table because they can’t. They don’t know how tall he is and they rely on how much he thinks he weighs.

Patients with disabilities report feeling “icky” — as if doctors and nurses don’t want to touch them to examine them, explained Colorado’s Morris, based on her research, adding that there’s a psychological toll to being treated as an “other” by the medical system.

Spotts, who also lives in Colorado Springs and has used a wheelchair for 30 years, finds it exasperating. He spends a lot of his time during appointments explaining his medical care to doctors who don’t understand how his bladder works, what his circulation problems are or how to treat his leg spasms.

The lack of equipment mirrors a lack of physician training and sensitivity to the issue, experts said. To get at this frustration, or even the perceptions that lead to it, “we need to think more broadly: How do we equip our health care providers?” Morris said. There is “implicit bias, and they don’t realize they may or may not be treating patients with disabilities differently.”

Dealing with exam tables and scales may be the first step.

“I think that all of us want to take the absolute best care of our patients, we want to account for patient needs,” said Dr. Michael Munger, president of the American Academy of Family Physicians.

How physician practices adjust often relates to their specialty and primary patient population, not to mention the financial calculation. A small practice might balk at the $1,800-to-$5,800 price tag for an adjustable table.

Under certain conditions, [it seems as if] you don’t matter as much as someone who’s not ‘broken.’

Denise Hok

Sometimes it’s a matter of “local solutions” and workarounds, such as sending a patient to a hospital to be weighed if a small practice doesn’t have an accessible scale, Munger said. That’s easier said than done for a patient like Spotts, who would have to drive more than an hour to reach a hospital that could weigh him.

Space is also an issue, Munger said. Sometimes exam rooms simply aren’t big enough to accommodate larger tables and chairs for family members and still have enough space to maneuver a mobility device. Spotts said the rooms generally aren’t big enough, period.

Some medical systems are taking action.

The Department of Veterans Affairs has used the U.S. Access Board’s standards to adopt similar accessibility guidelines. In Colorado, Centene, the largest Medicaid insurer nationwide, adopted similar guidelines.

States are using their Medicaid programs for similar, limited efforts.

California has worked with the disability community to create a survey for Medicaid providers, finding where gaps are and creating regulations requiring accessible equipment like exam tables and scales, going so far as to create a database of which providers have them. But with the Trump administration failing to move forward, what care people with disabilities receive may depend on where they live.

Said Hok: “Under certain conditions, [it seems as if] you don’t matter as much as someone who’s not ‘broken.'”

Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles