8 ms·

Could the ADA itself be the cause of at least some of this hesitation by some doctors to want to deal with disabled patients? With a disabled patient, there's

Could the ADA itself be the cause of at least some of this hesitation by some doctors to want to deal with disabled patients? With a disabled patient, there's a larger chance that something about your medical practice (the parking lot, the hallway, the stairs and ramps, the chairs in the waiting room, the equipment in your office, etc) aren't going to satisfy somebody and you're faced with a dumb legal headache even though you might have been genuinely trying to satisfy everybody and would be willing to provide reasonable accommodation.

CoastalCoder 4y ago
I just assumed that ADA requirements made their way into commercial building codes a while ago. And because of that, physicians would rarely bump into that issue, whether leasing office space or building new space. Am I mistaken?
- ChrisMarshallNY 4y ago
  I believe that you are correct. The doctor's office, as a business, already needs to abide by the ADA. It could be a convenience store, and still have the same requirements.
  - fhsm 4y ago
    This is true but really doesn’t capture much of the truth. As a first approximation you can split spaces into licensed and unlicensed spaces. The former are the conventional purview of “private practice”. The latter are the typical purview of “hospitals”. These are in quotes because this is merely a correlation and neither concept has a strict definition. Critically without domain knowledge it’s unlikely you’d be able to tell which a “doctors office” is. An unlicensed space is a business with all the usual obligations and the doctor is a doctor with all the usual obligations. When you move to the practice of medicine to a “hospital” (again as a licensing and finance idea which is separable from a sort of basic idea of building X) all that comes along but now with an additional regulatory overlay. Big picture this doesn’t change much about the Ada except to say that many medical practices are happening in spaces where the Ada is just the beginning.
    - deleted 4y ago
      [deleted]
- Siddarth1977 4y ago
  Unfortunately, it's not that simple. ADA requirements are incredibly complex, at times very specific and at times very unclear and open to interpretation. The truth is that almost every building could be found to be in violation, no matter how hard the builders tried to make it ADA compliant. In practice, this rarely matters. 99% of people with disabilities are just trying to get around, not looking for an opportunity to sue. But, the risk is still there, all it takes is one litigious individual to make your life a lot worse.
  - rdtwo 4y ago
    Usually it’s the building inspector that gets you because they have a different view of Ada code then you do.
octokatt 4y ago
This is covered in the article, and yes. Specifically: > Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations.
nvr219 4y ago
It probably is but it's important to remember that without ADA this would be much worse. It's not like physicians were so great with people with disabilities before 1990.
Test0129 4y ago
The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years. I wish it differentiated between necessary things like ramps, spots in a waiting area, etc, vs unnecessary things. There are just simply too many disabilities for even an honest, well intentioned business owner to keep up with. Of course, without retaining an insanely expensive lawyer.
- kayodelycaon 4y ago
  What’s an example of an unnecessary thing?
  - Test0129 4y ago
    I dunno, that's the point. Since it only technically requires "reasonable accommodation" it's up to interpretation. "Reasonable accommodation" has been used by ambulance chasers to sink businesses. I'm sure a set of absolutes could be codified. I'm getting downvoted to death for having an opinion again so I'm just gonna leave the topic.
    - lotsofpulp 4y ago
      The ADA should have been the government providing disabled people with sufficient cash to purchase the services or products they need to address their disability, or the government can provide it directly. But by diffusing the responsibility across businesses, the government can say they helped people without spending any money or taking responsibility to help people. For example, why would a doctor need to arrange for translation or sign language services? If the government wants to give a disabled person those benefits, the government should pay the disabled person to purchase the services of a sign language interpreter, or provide them one directly.
      - 4y ago
knaekhoved 4y ago
Absolutely - the ADA makes it incredibly risky to deal with disabled people in any kind of formal interaction, so anyone who can avoid it rationally will do so.
chromatin 4y ago
Yes, since ADA mandates that accommodations must be provided at no cost to the patient (an unfunded mandate). Here is a tidbit from the article: Participants described both financial and time-related challenges of accommodating communication needs. One non-rural-practicing primary care physician stated: “I took it upon myself to actually hire an outside service to do [sign language interpretation]. They billed the office. …Their bill was higher than what we were making, so it was a losing venture. …It cost me $30 per visit for that patient, out of pocket.”
- bombcar 4y ago
  This is the problem - people reduce "ADA mandates" to "lol you had to install a ramp or elevator" but it's much more than that. As a society we need to provide for those who are disabled, but we need more than just "lol pay for it" as a method. From one point of view a sign-language interpreter for someone who is deaf and cannot read is entirely a "reasonable accommodation" and from another (losing money on the transaction) it is not. While there's no guarantee that every customer is "profitable" we should work to make sure that the "disabled" aren't always in that group. For example, the ramp is a one time cost and amortized over all customers forever, and so it's not noticed much. But the interpreter was - because there is nothing that disconnects the cost from the service. If instead there was a city-wide pool of translators and interpreters that can be summoned/scheduled, and the pool was paid for by a tax/fee across all interactions, then it would barely be noticed, and those who have to use it wouldn't feel like they got cheated.
- chromatin 4y ago
  Downvoted for directly answering the parent post's question and supplying a supporting reference to the posted article. Nice.

CoastalCoder 4y ago

I just assumed that ADA requirements made their way into commercial building codes a while ago. And because of that, physicians would rarely bump into that issue, whether leasing office space or building new space. Am I mistaken?

ChrisMarshallNY 4y ago
I believe that you are correct. The doctor's office, as a business, already needs to abide by the ADA. It could be a convenience store, and still have the same requirements.
- fhsm 4y ago
  This is true but really doesn’t capture much of the truth. As a first approximation you can split spaces into licensed and unlicensed spaces. The former are the conventional purview of “private practice”. The latter are the typical purview of “hospitals”. These are in quotes because this is merely a correlation and neither concept has a strict definition. Critically without domain knowledge it’s unlikely you’d be able to tell which a “doctors office” is. An unlicensed space is a business with all the usual obligations and the doctor is a doctor with all the usual obligations. When you move to the practice of medicine to a “hospital” (again as a licensing and finance idea which is separable from a sort of basic idea of building X) all that comes along but now with an additional regulatory overlay. Big picture this doesn’t change much about the Ada except to say that many medical practices are happening in spaces where the Ada is just the beginning.
  - deleted 4y ago
    [deleted]
Siddarth1977 4y ago
Unfortunately, it's not that simple. ADA requirements are incredibly complex, at times very specific and at times very unclear and open to interpretation. The truth is that almost every building could be found to be in violation, no matter how hard the builders tried to make it ADA compliant. In practice, this rarely matters. 99% of people with disabilities are just trying to get around, not looking for an opportunity to sue. But, the risk is still there, all it takes is one litigious individual to make your life a lot worse.
- rdtwo 4y ago
  Usually it’s the building inspector that gets you because they have a different view of Ada code then you do.

octokatt 4y ago

This is covered in the article, and yes. Specifically: > Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations.

nvr219 4y ago

It probably is but it's important to remember that without ADA this would be much worse. It's not like physicians were so great with people with disabilities before 1990.

Test0129 4y ago

The ADA is a definitely a case of great idea, terrible execution. Unfortunately, doctors (and really businesses in general) are forced into a no-win situation where as you stated you either comply in the fullest legally, or face a potential customer looking for a reason to sink your business. Where I live, the ADA is also responsible for some of the large increase in home prices over the last 20 years. I wish it differentiated between necessary things like ramps, spots in a waiting area, etc, vs unnecessary things. There are just simply too many disabilities for even an honest, well intentioned business owner to keep up with. Of course, without retaining an insanely expensive lawyer.

kayodelycaon 4y ago
What’s an example of an unnecessary thing?
- Test0129 4y ago
  I dunno, that's the point. Since it only technically requires "reasonable accommodation" it's up to interpretation. "Reasonable accommodation" has been used by ambulance chasers to sink businesses. I'm sure a set of absolutes could be codified. I'm getting downvoted to death for having an opinion again so I'm just gonna leave the topic.
  - lotsofpulp 4y ago
    The ADA should have been the government providing disabled people with sufficient cash to purchase the services or products they need to address their disability, or the government can provide it directly. But by diffusing the responsibility across businesses, the government can say they helped people without spending any money or taking responsibility to help people. For example, why would a doctor need to arrange for translation or sign language services? If the government wants to give a disabled person those benefits, the government should pay the disabled person to purchase the services of a sign language interpreter, or provide them one directly.
    - 4y ago

knaekhoved 4y ago

Absolutely - the ADA makes it incredibly risky to deal with disabled people in any kind of formal interaction, so anyone who can avoid it rationally will do so.

chromatin 4y ago

Yes, since ADA mandates that accommodations must be provided at no cost to the patient (an unfunded mandate). Here is a tidbit from the article: Participants described both financial and time-related challenges of accommodating communication needs. One non-rural-practicing primary care physician stated: “I took it upon myself to actually hire an outside service to do [sign language interpretation]. They billed the office. …Their bill was higher than what we were making, so it was a losing venture. …It cost me $30 per visit for that patient, out of pocket.”

bombcar 4y ago
This is the problem - people reduce "ADA mandates" to "lol you had to install a ramp or elevator" but it's much more than that. As a society we need to provide for those who are disabled, but we need more than just "lol pay for it" as a method. From one point of view a sign-language interpreter for someone who is deaf and cannot read is entirely a "reasonable accommodation" and from another (losing money on the transaction) it is not. While there's no guarantee that every customer is "profitable" we should work to make sure that the "disabled" aren't always in that group. For example, the ramp is a one time cost and amortized over all customers forever, and so it's not noticed much. But the interpreter was - because there is nothing that disconnects the cost from the service. If instead there was a city-wide pool of translators and interpreters that can be summoned/scheduled, and the pool was paid for by a tax/fee across all interactions, then it would barely be noticed, and those who have to use it wouldn't feel like they got cheated.
chromatin 4y ago
Downvoted for directly answering the parent post's question and supplying a supporting reference to the posted article. Nice.