Steven Baruch - Health Care Compliance Association

for the nurse with the bad back, the guidance
provides that while staff should be protected
from injury, that concern does not justify the
failure to provide equal medical services to
disabled patients. Staff injuries can be avoided
by providing accessible equipment (e.g., adjustable
exam tables, patient lifts) and training on
proper patient handling techniques.
Several questions address assistants; namely,
whether a patient with a disability must bring
an assistant to the exam, and if he or she does,
whether the assistant must remain in the room
while the patient is being examined and his or
her condition is being discussed. The manual
provides that a patient with a disability can,
if he or she chooses, bring a friend or family
member to the exam, but the patient is not
required to do so. If the patient comes to the
exam alone, then the provider must provide
reasonable assistance (e.g., help with dressing
and undressing, getting on and off equipment)
so that medical care can be delivered. When
the patient brings an assistant, the provider
should address the patient. Whether the
assistant remains in the room for the exam and
ensuing discussion is the patient’s choice.
Other questions concern exam tables. For
example, can a doctor examine a patient who
uses a wheelchair in that wheelchair because he
or she cannot independently get onto an exam
table The answer is generally no, because an
examination in a wheelchair is less thorough
than an exam on a table. The technical guidance
manual makes clear that it is important that the
patient with a disability receives medical services
equal to those received by the patient without a
disability. The manual also addresses the question
of whether an office or clinic with multiple
exam rooms must have an accessible exam table
in every room. The answer is probably not,
as the number of accessible exam tables will
depend on several factors, including the size of
the practice and the patient population.
Two questions deal with the financial cost
of making exam rooms and other parts of
the office accessible to the patient with a
disability: (1) Whose responsibility is it and
(2) Are there tax benefits for making accessibility
changes The manual provides that
both tenants and landlords are responsible
for complying with the ADA, and the lease
may speak to who in particular must make an
accessibility change. As for tax breaks, both
tax credits and deductions are available to
private businesses to offset expenses incurred
to comply with the ADA.
A final question asks what a provider should
do if the staff does not know how to help a
disabled patient. Training is the answer –
training on how to operate accessible equipment,
on how to assist with transfers and positions
of disabled individuals, and on how not
to discriminate. The manual identifies several
resources where such training can be found.
Accessible exam rooms
For the patient with a mobility disability
to receive appropriate medical care, it is
critical that they are able to enter the exam
room, move around, and use the accessible
equipment provided. Features that make an
exam room accessible to the disabled patient
include:
n an accessible route to and through the
room;
n an entry door with adequate clearance
width, maneuvering clearance, and
accessible hardware;
n appropriate models and placement of
accessible examination equipment; and
n adequate floor space inside the room.
An accessible doorway must have a minimum
clear opening width of 32 inches when the
door is opened to 90 degrees. Door hardware
must not require tight grasping, tight pinching,
or twisting of the wrist in order to use it.
The hallway outside the door should be kept
clear of obstacles, such as boxes or chairs.
Once inside the exam room, a patient who
uses a wheelchair or other mobility device
must be able to approach the exam table
and other areas of the room. There must be
sufficient clear floor space next to an exam
table so that a patient with a disability can
approach the side of the table for transfer
onto it. The minimum amount of space
required is 30 inches by 48 inches.
While clear floor space is needed along at
least one side of an adjustable-height examination
table, providing clear floor space on
both sides allows one table to serve both right
and left side transfers (for those individuals
who can only transfer from the right or left
side). Where more than one accessible room
is available, a reverse furniture layout in the
additional room allows for transfers from
either side of the exam table.
Accessible exam rooms should also have
enough turning space for an individual in a
wheelchair to make a 180-degree turn, using
a clear space of 60 inches in diameter or a 60
inch by 60 inch T-shaped space. Chairs and
other objects should be moved to provide
sufficient clear floor space for maneuvering
and turning. Where portable patient lifts or
stretchers are used (as opposed to ceilingmounted
lifts), additional clear floor space will
be needed to maneuver the lift or stretcher.
Accessible medical equipment
To ensure that a person with a mobility
disability receives medical services equal
to those received by a person without a
disability, accessible medical equipment is
important. If a patient must be lying down
to be thoroughly examined, then a person
with a disability must also be examined lying
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Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
5
December 2010