Here are a couple questions regarding Medical Diagnostic Equipment (MDE) and a medical service provider (provider) and regarding ADA accessibility.
First, is it OK to examine a patient who uses a wheelchair in the wheelchair, because the patient cannot get onto the exam table independently?
ANSWER: Generally no. Depending on the exam required, examining a patient in their wheelchair usually is less thorough than on the exam table. Furthermore, examing a patient in a wheelchair may not provide the patient equal medical services. It is important that a person with a disability receives equal medical services to those received by a person without a disability. If the examination does not require that a person lie down (for example, an examination of the face), then the exam table is not important to the medical care and the patient may remain seated.
Second question. Can a medical service provider tell a patient that they cannot treat him/her because the provider does not have the necessary accessible medical equipment?
ANSWER: Generally no. The medical service provider cannot deny service to a patient whom they would otherwise serve because he/she has a disability. The provider must examine the patient as they would any patient. In order to do so, the provider may need to provide an accessible exam table, an accessible stretcher or gurney, or a patient lift, or have enough trained staff available who can assist the patient to transfer.
Exam Tables and Chairs
Traditional fixed-height exam tables and chairs (also called treatment tables or procedure tables) are too high for many people with a mobility disability to use. Individuals with mobility disabilities often need to use an adjustable-height exam table which, when positioned at a low height, allows them to transfer from a wheelchair. See the image below for a comparison of an adjustable-height exam table and a conventional fixed-height exam table.
Adjustable (left) and Fixed Height Exam Tables
There are several ways to make the exam table accessible to a person using a wheelchair. A good option is to have a table that adjusts down to the level of a wheelchair, approximately 17-19 inches from the floor, as shown in the photo above on the left. A handle or support rail is often needed along one side of the table for stability during a transfer and during the examination. Individuals transfer to and from adjustable-height exam tables and chairs differently. Some will be able to transfer on their own by standing up from a mobility device, pivoting, and sitting down on the exam table. Those using walkers may simply walk to the exam table and sit down, while others with limited mobility may walk more slowly and need a steadying arm or hand to help with balance and sitting down. Some people using wheelchairs may be able to independently transfer to the table or chair, while others will need assistance from a staff member. Transfers may also require use of equipment, such as a transfer board or patient lift. See the diagram below for an example of an assisted gait belt transfer using a transfer board. Item 1 is the gait belt transfer strap with handles to assist with guiding along the transfer board. Item 2 is the transfer board.
Assisted Transfer with a Gait Strap and Transfer Board
An accessible exam table or chair should have at least have the following:
ability to lower to the height of the wheelchair seat 17-19 inches from the floor;
elements to stabilize and support a person during transfer and while on the table, such as rails, straps, stabilization cushions, wedges, or rolled up towels;
removable/adjustable support rails with continuous gripping surfaces.
Different types of exam tables are used for different purposes. Some exam tables fold, or articulate, into a chair-like position; while others remain flat. Tilt, adjustability, and headrests, footrests, and armrests may make the examination more accessible for the patient and also easier for the doctor. See the diagram below for an example of an exam table that articulates to form an exam chair.
Item 5 is the exam table articulated into a chair to provide support during patient transfers and positioning. Item 6 is the rails/armrests that can be moved for transfers. Item 7 is the rail that can be added beside the table/chair surface to assist transfers, provide support, or prevent falls. Item 8 is the space to position a wheelchair alongside table that is critical for transfer.
See the diagram below for another example of an accessible chair.
In the diagram above the following items are discussed below.
1. When adjustable, head and back support provided throughout the entire range of the incline (M302.3.3).
2. Transfer surface 21 inches wide minimum and 15 inches deep minimum (M302.2.2).
3. Armrest folds up to permit unobstructed transfer (M302.2.3 EXCEPTION).
4. Transfer surface 17 inches minimum and 19 inches maximum. Above floor (M302.2.1), when not needed to facilitate transfer, the transfer surface may be positioned above or below the height range (Advisory M302.2.1).
5. Required armrest serves as transfer support within reach of transfer surface (M302.3.1, M302.3.2, and M305.2.1).
6. Transfer support resists vertical and horizontal forces of 250 lbs. at all points and does not rotate within its fittings (M305.2.2 and M305.2.3).
7. One short side (depth) and one long side (width) of the transfer surface permit unobstructed transfer from a mobility device (M302.2.3).
8. Base permits clearance around base for a patient portable floor lift (M302.4 and M302.4.2).
In summary, medical service providers must provide access for handicapped individuals to receive medical care similar to that provided for individuals without handicaps. This access goes from the site arrival point (accessible parking spaces) to the medical diagnostic equipment in the medical service facility. Failure to provide this access is a violation of ADA laws.