Kirschner KL, Breslin ML, Iezzoni LI. Structural impairments that limit access to health care for patients with disabilities. JAMA 2007;297:1121-5.

Rachel steered her wheelchair into a Chicago area medical center for a series of upper gastrointestinal tests. But when Rachel, 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,” Rachel explained. The medical center, however, had no alternate strategy, and sent her home without having the test.

People with physical disabilities endure substandard health care and a pervasive sense that they are a burden to doctors and medical centers. “Disabilities have been invisible in health care settings,” said Kristi Kirschner, MD, 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 Journal of the American Medical Association that identified structural problems encountered by disabled patients.

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,” said Kirschner.

According to the 2000 U.S. Census, an estimated 49.7 million Americans report a disability. Likewise, nearly 19 million adults report arthritis-related physical limitation. Physical disability goes hand-in-hand with aging. About 30 percent of people 65 and older have a physical disability, compared to 7 percent of people 16--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. For example, one 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.

To remedy the problem, Dr. Kirschner 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.

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.