DOJ ruling impedes disabled patients' access to imaging services

A decision made by the U.S. Department of Justice (DOJ) to formally withdraw four Advance Notices of Proposed Rulemaking related to Titles II and III of the Americans with Disabilities Act (ADA) has halted national efforts to ensure individuals with disabilities have access to medical diagnostic equipment, including medical imaging equipment.  

In accordance with the ruling, published online Dec. 26, 2017, to the Federal Register, the DOJ is "reevaluating whether regulation of the accessibility of non-fixed equipment and furniture is necessary and appropriate." This "non-fixed equipment and furniture" includes exam tables, weight scales, mammography equipment and other diagnostic imaging technologies, all which healthcare providers now lack the guidance to determine what constitutes as accessible medical diagnostic equipment for disabled patients.   

In an editorial published April 12 by the New England Journal of Medicine, Lisa Iezzoni, MD, a professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at the Massachusetts General Hospital, and Elizabeth Pendo, JD, a professor of law at the University of St. Louis School of Law, Center for Health Law Studies, explained that the DOJ's ruling only perpetuates confusion regarding the issue for health care facilities across the country and the estimated 22 percent of U.S. adults who have disabilities, including musculoskeletal disorders, diabetes, stroke, and cardiovascular disease. 

"People with substantial move­ment difficulties cannot indepen­dently get onto high, fixed height exam tables or imaging equip­ment—and too frequently, pro­viders don’t assist them with transfers or positioning, prefer­ring to examine them in their wheelchairs or not at all," the authors wrote. "These patients, therefore, often don’t receive important screening and diagnostic evaluations."  

The ADA currently requires health care facilities are accessible for people with a disability, such as setting standards for parking lots, restrooms and other public structures in and around it. However, Iezzoni and Pendo explained that the regulations neglect to set specific standards for features of medical diagnostic equipment, including dimensions, adjustability of height and the positioning of supports. 

Efforts to address these issues have included various legislations, the authors wrote.  Former Senator Tom Harkin, D-Iowa, introduced the Promoting Wellness of Individuals with Disabilities Act in 2007, which would have set established accessibility standards for medical diagnostic equipment and funded wellness grants to support health programs for people with disabilities. However, the bill was never passed. 

The 2010 Affordable Care Act (ACA) would have required the accessibility of medical diagnostic equipment and other concerns for individuals with disabilities, which, together with the FDA and the U.S. Access Board, did make a final ruling, effective Feb. 8, 2017. However, before the final rule could go into effect as a part the ADA, the DOJ issued new ADA rules that incorporated the final rule and addressed the public and health care settings where medical diagnostic equipment is needed, the authors explained. 

"The decision by the DOJ to withdraw proposed rulemaking and rescind guidance relating to the ADA comes in response to a broad executive order issued by President Donald Trump requiring all federal agencies to identify regulations for 'repeal, replace­ment or modification'," according to Iezzoni and Pendo. 

Additionally, the authors asserted that the DOJ would have a select amount of data regarding the current availability of accessible medical diagnostic equipment in health care facilities to help make its final judgement. Surveys or studies regarding the issue have not yet been conducted by the government, the authors explained. 

"Health care delivery systems have lagged far behind other sec­tors in ensuring access for people with disability. Without im­petus from the DOJ, health care providers may not make substan­tial changes to improve the accessibility of their medical diag­nostic equipment," the authors concluded. "Increasing the availability of accessible medical diagnostic equip­ment will help reduce disparities and improve care for people who have been denied access to es­sential health services."