More than one in six Boston doctors offices refused to schedule appointments for callers posing as disabled patients in wheelchairs, researchers at Baystate Medical Center reported Monday in a study of specialty practices in four cities.
Legal experts say the practice violates a federal law requiring that people with disabilities have access to appropriate medical care.
Gynecologists had the highest rate of inaccessible practices in the four cities, with 44 percent informing patients that they need to seek a specialist elsewhere because their offices lacked exam tables that can be raised and lowered, or a lift for transfer out of a wheelchair. The findings were published in the Annals of Internal Medicine.
“Many doctors may not be aware that they need to see patients with disabilities,” said study leader Dr. Tara Lagu, an academic hospitalist at Baystate in Springfield and an assistant professor at Tufts University School of Medicine. I’m shocked every time I hear from patients in wheelchairs that they can’t get an appointment with a urologist or gynecologist or that the doctor wants them to come in an ambulance for transfer to an exam table by an emergency medical technician.”
Lagu and colleagues at Tufts University School of Medicine, the University of Massachusetts-Amherst, and elsewhere called up 256 speciality practices posing as disabled, overweight patients with various medical problems—diabetes, unexplained uterine bleeding, depression—that related to particular specialties such as endocrinology, gynecology, or psychiatry. Overall, 56 practices, or 22 percent, told the callers that they could not be seen, either because the office was in a building without wheelchair access or more commonly becauase the staff would be unable to lift the patient out of the chair and onto an exam table.
Practices in Boston denied access to disabled patients about 17 percent of the time, compared with 30 percent in Houston, 27 percent in Dallas, and 14 percent in Portland, Ore.
“The medical community hasn’t understood the importance of equal access,” said Bill Henning, executive director of the Boston Center for Independent Living. His organization three years ago convinced Massachusetts General and Brigham and Women’s hospitals to spend millions on architectural improvements, medical equipment upgrades, and staff training to better serve those with disabilities.
“It’s been very positive,” he said, “but the challenge has been trying to change the culture; they’re big institutions, and there’s still a lot of work to be done.”
Massachusetts General has required its staff to participate in training to help them become more sensitive to the needs to disabled patients and has purchased adaptive equipment such as scales that can weigh patients in wheelchairs and mammogram machines that don’t require patients to stand for the X-ray. “The shift in culture is difficult since it’s such a big hospital,” said Zary Amirhosseini, the disability services manager at Massachusetts General who was hired soon after the institution pledged to make changes. “It’s an ongoing process.”
A Brigham spokesman said the hospital also has purchased specialized equipment and staff training on disability issues is in progress.
The 23-year-old Americans with Disabilities Act requires that medical facilities provide full and equal access to their patients and make “reasonable modifications” when necessary, such as providing wider doorways for wheelchairs or equipment that can be manuvered around patients who cannot rise from their chairs. Health care providers are not allowed to tell patients that they cannot be seen because of their disability nor require them to bring a person along to help lift them onto the exam table.
“Doctors have to make reasonable accommodations or find an alternate way to provide the service. Turning people away simply because they use a wheelchair would be a clear violation of the federal law,” said Dan Manning, director of litigation for Greater Boston Legal Services, which provided legal advice to the Boston Center for Independent Living in pursuing its initiative with the two Boston hospitals.
Physician groups viewed the study in a positive light. “It is gratifying to note that the overwhelming majority of specialists could indeed accommodate the request,” said Dr. Richard Aghababian, president of the Massachusetts Medical Society. “Still, there may be circumstances where a patient request may not be able to be fulfilled, and we encourage those providers to make efforts to arrange for care.”