People with physical disabilities endure substandard health care

[Guest guest]

People with physical disabilities endure substandard health care

http://www.news-medical.net/?id=23085

steered her wheelchair into a Chicago area medical center for

a series of upper gastrointestinal tests. But when , who has

cerebral palsy, entered the radiology lab, the technician told her

she had to stand up to take the test.

" But I can't stand, " explained. The medical center, however,

had no alternate strategy, and sent her home without having the

test.

Across town, , who also uses a wheel chair, arrived at the

office of her new gynecologist for a routine exam and Pap smear. But

there was nothing routine about it. The doctor's office did not have

a wheelchair accessible examination table or transfer equipment.

Instead, staff members awkwardly grabbed and hoisted , her

flimsy paper gown fluttering, onto the table.

" It was one of the most humiliating, terrifying experiences of my

life, " recalled.

People with physical disabilities endure substandard health care and

a pervasive sense that they are a burden to doctors and medical

centers, according to a Northwestern University physician. These

patients often ram into roadblocks when they try to obtain basic

care and life-saving diagnostic tests.

" Disabilities have been invisible in health care settings, " said

Kristi Kirschner, M.D., associate professor of physical medicine and

rehabilitation, and of medical humanities and bioethics at

Northwestern's Feinberg School of Medicine. Kirschner was lead

author of a recent commentary in JAMA (Journal of the American

Medical Association) that identified structural problems encountered

by disabled patients and offered a blueprint for overdue change.

Kirschner believes the Americans with Disabilities Act of 1990 had

less impact on health care than other areas of society such as

public transportation.

" Health care has been a laggard in becoming accessible to people

with disabilities. It's still in its infancy, " said Kirschner, who

also is director of The Rehabilitation Institute of Chicago

Donnelley Family Disability Ethics Center.

According to the 2000 U.S. Census, an estimated 49.7 million persons

ages 5 and older report a disability, many of whom struggle with

structural impairments to health care. This number likely will soar

as the population ages.

" Physical disability goes hand- in- hand with aging, " Kirschner

noted. About 30 percent of people 65 and older have a physical

disability, compared to 7 percent of people 16 to 64, according to

the American Association of People with Disabilities.

People with physical disabilities have been injured and even died as

a result of inadequate health care facilities or neglect. A man with

quadriplegia died after he fell from an examination table. Delayed

diagnoses are another problem. Surveys show significantly fewer

women with major mobility impairments have mammograms or Pap smears

than non-disabled women.

Health care workers also suffer injuries when they try to transfer

disabled patients without proper equipment. A 2006 survey reported

an estimated 40 percent of nurses and radiology technicians

experienced lift-related injuries within the prior two years.

The lack of attention to disabled patients' needs extracts a psychic

toll. " It heightens people's sense of being stigmatized, " Kirschner

said. " What makes the experience so awful is the sense that you're

such a burden to people -- that you're different and abnormal and

creating all this inconvenience. It's not something a person should

internalize as a defect or problem with themselves, but a lot of

people do. "

" We're health care providers. We should be therapeutic. These are

not therapeutic ways to treat people, " she added.

To remedy the problem, she proposes the health care industry,

including accreditation organizations and the American Hospital

Association, publish a " report card " that grades health care

providers' patient safety and quality of care for the disabled.

" That would give us some teeth, " said Kirschner. " Hospitals and

health care professional education programs also need to do a better

job training physicians, nurses and hospital staff about disability

accommodations. "

Kirschner also said hospitals and doctors offices should purchase

universal design equipment. A universal design examination table,

which is wheelchair accessible and accommodates obese patients,

costs more, but will save money by preventing injuries.

" Bodies come in lots of shapes and sizes, " she said.

She also suggests Medicare, Medicaid and private insurers tie their

contracts to whether health care providers are accessible to people

with a wide range of disabilities.

" We've got to attack this from all levels, " said Kirschner, who

previously wrote a white paper with her colleague, Judy Panko Reis,

director of The RIC Women with Disabilities Center.