Tuesday, 13 Nov 2018
News

For people with disabilities, a visit to the doctor can literally be an obstacle course – and laws can not help.


Laws that purport to prohibit discrimination against people with disabilities are inadequate when it comes to going to the doctor, forcing patients with disabilities to navigate a difficult obstacle course that not only hurts their lives. comfortable, but also compromises their care. Lisa Iezzoni, a professor of medicine at Harvard Medical School, uses a wheelchair because of multiple sclerosis. She has spent 20 years without being weighed correctly, which means that treatment plans, and even prescriptions, are based on informed assumptions rather than accurate information. Despite laws requiring ramps and wider doors, many medical practices do not have wheelchair-friendly scales or adjustable examination tables for patients who can not get up. . The Affordable Care Act was created to update the standards for medical treatment available in the Americans with Disabilities Act (ADA), which is enforced by the Department of Justice. However, the Trump administration put an end to this at the end of last year as part of its broader effort to lower regulation across the federal government. "I was shocked when I heard that [Attorney General Jeff] The Ministry of Justice Sessions has reduced its regulatory decisions, "said Iezzoni. Denise Hok, 54, lives in Colorado Springs and uses a wheelchair. She opts for home health care and avoids doctors' offices where "it seems like it does not matter if something is wrong". accessible equipment, she says, this "sends a message". The ADA, a 1990 civil rights measure designed to prohibit discrimination against persons with disabilities, requires public places to be accessible, which means that new buildings and certain commercial establishments must provide ramps and wide enough inlets for a wheelchair, handrails and lifts. However, the law only applies to fixed structures and does not deal with "furniture" not attached to buildings. In doctors' offices, this means that scales, tables, X-ray machines and other diagnostic devices are not legally circumscribed. The result is that movie theaters and laundromats must be accessible to everyone, but not important aspects of the medical industry, said Megan Morris, assistant professor in the Department of Family Medicine at the University of Colorado , who studied disabled patients and their access to health care. The ACA has asked a federal committee, the Council for the Compliance of Barriers for Building and Architecture and Transportation, also called the Access Council, to take steps to fill this gap by issuing standards allowing to determine which medical equipment could be considered "accessible". 2017, just before the departure of President Barack Obama. However, the decision of the Ministry of Justice in December not to update the enforcement measures thus reinforces disparities in the treatment of people, said patients and defenders of the rights of persons with disabilities. Paul Spotts, 58, paralyzed from the chest, said his exams were "a joke". His doctors check his eyes and ears but do not place him on a scale or an examination table, because they can not. They do not know how big he is and depend on the weight he thinks he weighs. Patients with disabilities report feeling "disgusted" – as if doctors and nurses did not want to touch them to examine them, Morris said, on the basis of his research, adding that being treated as " other "by the system doctor. Spotts, who also lives in Colorado Springs and has been using a wheelchair for 30 years, finds him infuriating. He spends a lot of time at his appointments explaining his care to doctors who do not understand how his bladder works, his circulation problems or how to treat his leg spasms. The lack of equipment reflects the lack of training of doctors and sensitivity to the issue, experts said. To come to this frustration, or even the perceptions that drive it, "we need to think more broadly: how do we equip our health care providers?" Morris said. There are "implicit prejudices, and they do not realize that they can treat patients with disabilities differently". Management of exam tables and scales can be the first step. "I think we all want to take the best care of our patients, we want to consider their needs," said Michael Munger, president of the American Academy of Family Physicians. Adjustments to physicians' practices are often linked to their population of specialized and primary patients, not to mention the financial calculation. A small practice might be reluctant to priced at $ 1,800 to $ 5,800 for an adjustable table. Sometimes these are "local solutions" and workarounds, such as sending a patient to a hospital to be weighed if a small office does not have an accessible scale, Munger said. It's easier said than done for a patient like Spotts, who will have to drive more than an hour to get to a hospital that can weigh him. Space is also a problem, said Munger. Sometimes the exam rooms are simply not big enough to accommodate larger tables and chairs for family members while leaving enough room to maneuver a mobility device. Spotts said the rooms are usually not big enough, period. Some medical systems take action. Veterans Affairs Canada has applied US accessibility standards to US standards. In Colorado, Centene, the largest Medicaid insurer in the country, has adopted similar guidelines. States use their Medicaid programs for similar and limited efforts. California has worked with the disability community to create a survey for Medicaid providers. She identified gaps and created regulations requiring accessible equipment, such as exam tables and scales, even to create a database of vendors with them. However, with the Trump administration not progressing, the care that people with disabilities receive can depend on where they live. Hok says, "Under certain conditions, [it seems as if] you do not count as much as someone who is not "broken". – Kaiser Health News Kaiser Health News is a non-profit news service covering health issues. This is an independent editorial program of the Kaiser Family Foundation which is not affiliated with Kaiser Permanente. Read more Rural Americans Turn to Disability While Jobs Dry Up I live with a debilitating disease. This has taught me to ask for help. Yes, I am disabled. But I still love sex. .

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