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Civil rights extended to disabled.

Written to afford equal opportunities in employment, public accommodations, transportation, government services, and telecommunications, the Americans with Disabilities Act (ADA) of 1990 represents an unprecedented opportunity to eliminate barriers to independece and productivity for persons with disabilities. But ADA has generated some fear and much confusion concerning its requirements and the types of businesses and organizations that are covered.

The Purpose of ADA

For most Americans, the Civil Rights Act of 1964 rightfully restructured the attitudes of business, government, and society and expanded opportunities for all Americans. However, for basic privileges of access and employment, persons with disabilities were left outside the law. To correct these real and perceived oversights, ADA gives civil rights protection to individuals with disabilities that are like those provided to other individuals on the basis of race, sex, national origin, and religion. Specifically, it guarantees equal opportunity for individuals in dealings with public and private sector employment, accommodations, transportation, telecommunications, and state and local government services.

Disabilities Defined

The term "disability" covers a wider array of conditions than an easily spotted physical limitation. People who are considered "disabled" under the Act are individuals with physical or mental impairments that substantially limit one or more of the major activities of life, such as walking or talking. The term also applies to people with a record of an impairment, such as someone recovering from cancer, as well as people who are regarded as having a disability, such as a person with a disfiguring injury.

Covered Organizations

For the first two years after July 26, 1992 (when the employment provisions of ADA go into effect), only organizations or businesses (such as a mdical practice) with 25 or more employees are covered, that is, may not discriminate against qualified individuals with disabilities. Two years afterward, businesses with 15 or more employees may not discriminate against qualified individuals with disabilities.

Employment Discrimination Issues

ADA prohibits discrimination against qualified disabled individuals and contains specific requirements related to reasonable accommodation, qualifications standards, and other labor management issues such as:

* Discrimination against an individual with a disability in hiring or firing is disallowed if the person is qualified for the job.

* Employers cannot inquire whether an applicant has a disability but may ask about the applicant's ability to perform a job.

* Employers cannot limit advancement opportunities or job classifications for individuals with disabilities, or use tests or job requirements that tend to screen out the disabled.

* Employers cannot deny opportunity to anyone who has a relationship with a disabled person (such as a working mother with a disabled child).

Employers must make "reasonable accommodation" to disabled workers, which might include efforts to:

* Make existing facilities accessible.

* Provide special equipment and training.

* Arrange part-time and modified work schedules.

* Provide readers for the blind.

Employers are not required to provide accommodations that impose an "undue hardship" on business operations. While the specific wording of the law is vague, the interpretation of the costs or efforts have would result in hardship to small business operations is expected to be reasonable and to be judged on an individual basis.

The ADA guarantees the disabled the opportunity to participate in the "full and equal enjoyment of the goods, services, facilities, privileges, and advantages of any public place." Regardless of staff size, private practices, groups, clinics, and other health providers fall into this "coverage." Other private establishments considered "public accommodations" are restaurants, hotels, retail establishments, shopping centers or malls, office buildings, pharmacies, theaters, museums, libraries, parks, private schools, and day care centers. These establishments may not refuse to serve people with disabilities. Private businesses must remove barriers at existing facilities, if possible without "undue burden," and must make any new or renovated facilities accessible to the disabled. ADA also affects public services, such as the telecommunications industry and public transportation provided by state and local government (although commercial airlines are exempted from this law). The effective date for compliance with the new law is 18 to 30 months for most establishments.

ADA Enforcement

The physician executive will be wise to heed the provisions of ADA for both economic and altruistic reasons. Running afoul of these government regulations can result in fines and even the closing of a business. Employment discrimination complaints may be filed with the Equal Employment Opportunity Commission. Available remedies include back pay and court orders to stop discrimination, and there is the possibility of embarrassing negative publicity.

In public accommodations issues (such as physical accessibility of the premises from which medical services are rendered), individuals may bring private lawsuits to obtain court orders to stop discrimination, but the law contains no provision for awarding damages. However, individuals can also file complaints with the U.S. Attorney General, who may file lawsuits to stop discrimination and who may obtain damages and penalties. The key to compliance is knowing "the new rules," most of which involve common sense methods resulting from past civil rights enactments, such as Title VII. A summary of these previous regulations can be obtained from the Civil rights Division of the U.S. Department of Justice.

To deal most effectively in health care facilities with physical access and care delivery issues for the disabled, a new and wider mindset is required. Facilities should be thought of as "a retail establishment," such as a bank or even a supermarket. This mental projection can readjust perceptions and undercover problems that might be encountered by disabled staff members and patients.

Recognize the Differences

It's important that staff members realize that all disabilities are not created equal. People with disabilities are extremely diverse. The deaf, the blind, and the mobility-limited have different needs and require different methods of attention during medical services delivery. Disabilities fall into major groupings:

* Mobility impaired.

* Sight impaired.

* Hearing impaired.

* Speech impaired.

Planning for Improvement

To create your own "disabilities friendly" environment:

* Instruct the appointments staff to ask, during the initial telephone call, about the patient's ability to visit the office unaided; note discovered disabilities in the patient's chart for staff awareness in future visits.

* Think through a patient's journey to visit your office; the receptionist can verbally "walk" a mobility-impaired patient from the parking area to office door, warning of possible obstacles (escalators, slippery fountain areas, unlevel surfaces, and so forth).

* Pretend you're entering your office for the first time. Is the door easy or hard to pull open? Does it close fast or slowly behind you? Survey the waiting area furniture. Do you have at least one chair with arms for a patient's use to "push up" when rising? Is there a wide unobstructed path from the door to the sign-in area?

* Be sure the call system button or sign-in sheet is within reach of the wheelchair user.

* Be sure the examination room closest to the lobby door is easily accessed, with room for wheelchairmaneuvering. Can the patient be examined from his or her chair without transfer?

* Make the staff aware that extra time must be allowed for slow undressing and dressing when there are hand impairments related to arthritis or neurological ailments.

Sensory Impairments

While mobility impairments account for many physical limitations, thought should also be given to serving patients with sight, hearing, or speech disabilities. Again, the exercise of mentally adopting the limitation helps the manager focus on possible shortcomings of physical facilities or of staff attitudes:

* The receptionist should have a good view of the waiting area so that a sightless person entering the office can be seen, greeted, and seated easily. Have a staff member come forward to identify her-or himself and reconfirm the appointment time and doctor.

* Advise the staff to be sensitive about "surprising" sightless patients and about taking extra time to give explanations, information on instruments, or warnings on "what to expect" during the procedure.

* If the vision-impaired person remains in the office for several hours, it's wise to give directions in and out of the office building in case of emergency.

* In dealing with the hearing-impaired, make certain you face the patient directly; remember to keep your face well lit, particularly to make your mouth clearly visible for lip reading.

* Remind the staff not to speak with their backs turned to listeners or to speak from another room or the hallway; likewise, the intercom should not be used to address the hearing-impaired.

* Speak moderately, taking care not to shout. Shouting contorts the facial features, making lip reading more difficult.

A Leadership Attitude

The attitudes and actions of physician executives can set the tone and attention given to ptients with disabilities. Moreover, the Americans with Disabilities Act requires attention to both employment procedures and physician access issues that can affect the physician-staff-patient reltionship. Physician executives should recognize the opportunity to embrace the needs of disabled patients and serve them beyond the letter of the law. This process includes reevaluating facility accessibility and encouraging staff sensitivity training. Such compassion and service will lead directly to satisfying government requirements for public accommodations and to higher levels of patient satisfaction with the physician executive's health care organization.

Further Reading

The following additional sources of information on the Americans with Disabilities Act were obtained through a computerized search of databases. Copies of the articles cited are available from the College for a nominal charge. For further information on citations, contact Gwen Zins, Director of Information Services, at College headquarters, 813/287-2000.

Fishman, B., and others. "Disabilities Act to Influence Hiring Practices of Providers." Provider 16(12):11-2, Dec. 1990.

Mandelman, J. "Disabilities Act Could Spell Big Changes for Providers." Provider 16(2):24-5, Feb. 1990.

Morrissette, P. "The Americans with Disabilities Act of 1990: Health Care Aspects. Healthspan 7(10):8-12, Nov. 1990.

Tokarski, C. "Overcoming to Help Others." Modern Healthcare 20(49):38, Dec. 10, 1990.

Verville, R. "The Americans with Disabilities Act: An Analysis." Archives of Physical Medicine and Rehabilitation 71(12):1010-3, Nov. 1990.

Joel Reedy, MBA, has spent the past 20 years studying communications management. He works with a Tampa, Fla., advertising agency and is developing an independent practice in disability marketing. He is an adjunct instructor of marketing at the University of South Florida, Tampa, and is a volunteer with several health organizations.
COPYRIGHT 1991 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Americans with Disabilities Act of 1990
Author:Reedy, Joel
Publication:Physician Executive
Date:Jul 1, 1991
Previous Article:National health insurance - to be or not to be.
Next Article:The issue is effectiveness.

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