In medical settings, accommodations for people with intellectual or physical disabilities can be a matter of life and death. If a doctor refuses to see certain patients, the result may be an irreversible delay in a necessary procedure. To take just one example, without a sign language interpreter, a deaf individual may be unable to communicate her symptoms and provide the necessary information for a doctor to accurately diagnose her.
Nonetheless, many doctors appear to be woefully uneducated about their legal obligations to accommodate people with disabilities under the Americans with Disabilities Act (ADA).
In April, the journal Health Affairs published the results of in-depth interviews with 20 randomly selected physicians, which found that the participating physicians “exhibited a superficial or incorrect understanding of their legal responsibilities to patients with disability.”
For the study, participating physicians were asked questions relating to three main topics: their obligations to accommodate people with disabilities in their practices, their discretion to refuse patients with disabilities, and whether they could hold patients accountable for the costs of accommodations.
Nearly half the physicians were unsure who is responsible for making accommodation decisions, and most of the respondents said that they personally had had no formal guidance—either in medical school or in subsequent training sessions—about their ADA obligations.
Three respondents (incorrectly) replied that physicians could flatly deny services to people with disabilities. None of the physicians stated that patients should be required to pay the costs of accommodations, but some were uncertain if the ADA barred patients from having to do so.
“The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted,” the study’s authors state.
The ADA expressly provides that patients cannot be refused medical services on the basis of their disabilities. Rather, medical care providers are required to ensure “full and equal access to their health care services and facilities.” Among other requirements, this mandate requires providers to provide effective communication services, such as auxiliary aids and interpreters, and offer reasonable modifications of policies and procedures, except in the rare circumstances where such accommodations would impose an undue burden.
Fortunately, there appears to be a growing movement to expand ADA education within the medical field. Eleven medical schools, including Harvard, the University of Louisville and Georgetown, have already begun a collaborative effort to require ADA training in their curriculums.
At the same time, the Liaison Committee on Medical Education (LCME), a group that accredits medical schools, is reviewing two proposals that would make ADA education mandatory in medical schools nationwide, one from the federal National Council on Disability (NCD) and one from the Association of University Centers on Disabilities.
“Some providers incorrectly assume that people with disabilities don’t have a good quality of life or people with intellectual and developmental disabilities don’t experience pain. We think the recommendation we’re making could help rectify that,” NCD Attorney Amged Soliman told Disability Scoop.
To read a letter from the NCD to the LCME about the proposal, click here.
To purchase a copy of the Health Affairs article, click here.