Do You Know Your Legal Obligations to Disabled Patients?

The Americans with Disabilities Act (ADA) was passed in 1990 to protect the civil rights of people with disabilities. This law, and amendments passed in 2008, resulted in rules and regulations opening access to private settings serving the public, including doctors’ offices and medical facilities.

The ADA includes a three-pronged definition of disability. If any one of the three prongs is satisfied, the individual is disabled. The individual must:

• Have a physical or mental impairment that substantially limits one or more major life activities;
• Have a record of such an impairment; or
• Be regarded as having such impairment.

Barriers After Nearly 30 Years

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“There are a lot of barriers still in existence even though the ADA has been in effect for nearly 30 years,” says Lisa I. Iezzoni, MD, the Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, and senior author on a recent article on physicians’ knowledge about their obligations under the ADA appearing in Health Affairs. “Many doctors don’t understand who is responsible for making decisions on accommodating patients with disabilities. Because of this, they may break the law.”¹

Studies have shown this is a patient care issue. Those with disabilities are a population with significant healthcare disparities. It is the responsibility of every physician to alleviate these concerns. In addition, civil penalties can range up to a maximum of $75,000 for the first offense and up to $150,000 for each subsequent violation. Most complaints are settled for much less money, but even then, with the costs of attorneys and compensation, settlements can run in the tens of thousands of dollars.

Survey Shows Physician Education Needs

Dr. Iezzoni

Dr. Iezzoni and colleagues interviewed 20 physicians in preparation for launching a more comprehensive survey. The protocol called for open-ended questions over the telephone. They addressed issues related to caring for patients with physical or mental health disabilities.

Participants were veteran physicians with a mean number of years in practice of 24.7. Eleven had completed medical school prior to the ADA’s enactment in 1990. Two participants were rheumatologists.

Among the findings: Three physicians indicated they would refuse to see a patient with a disability. Sixteen thought they could not refuse, and one was unsure. None of the physicians stated definitively that patients with disabilities could be required to cover accommodations costs, but eight were not certain.

“Both of these [responses—refusal to see a patient and requiring patients to pay for accommodation] are against the law,” notes Dr. Iezzoni. “But there are still some doctors who don’t know it is illegal.”