RERC on AMI logoThe Importance of Accessible Examination Tables


Updated 11.22.04

June Isaacson Kailes MSW, Associate Director
Christie Mac Donald MPP, Senior Policy Analyst
Center for Disabilities Issues and the Health Professions
Western University of Health Sciences
309 E. Second Street, Pomona, CA 91766
Voice-909.469.5213/TTY-909.469.5520, Fax 909.469.5503, ahcs@westernu.edu

Contents of this briefing

Other briefs

Introduction

Health care providers should have accessible examination and treatment tables for these important reasons:

  1. Improve quality of care for people with disabilities and activity limitations;
  2. Comply with legal obligations under Title II or Title III of the Americans with Disabilities Act.
  3. Serve Individuals with disabilities who represent a sizable portion of the population;
  4. Reducing health care professionals' workplace injuries, and
  5. Take advantage of the federal tax incentives for improving accessibility.

Many height-adjustable examination and treatment tables and chairs are available from a number of manufacturers. A few examples are shown here. Note that these examples are not intended to be exhaustive, only illustrative of some of the types of tables and chairs on the market that may increases access for patients. No endorsement of any product is intended or implied.

ACCESSIBLE-Height Adjustable vs. NON-ACCESSIBLE-Standard (box) Examination Tables

2 men. 1 sitting on an accessible height adjustable examination table with his feet level on the floor and 1 man sitting on a non-adjustable (box) examination table with his feet dangling approximate 1 to 1 and 1/2 feet above the floor. An accessible height adjustable examination table lowered to 19 inches from the ground parallel to a non-adjustable (box) much higher examination table which requires standing on a step to get up on.

High-low examination tables

Man sitting on height adjustable examination table with feet flat on ground and his walker in front of him. Welner OB/GYN height adjustable examination table

Adjustable high-low treatment tables

Wheelchair accessible height adjustable flat treatment table that lowers to 19 inches above the ground Wheelchair accessible height adjustable flat treatment table that lowers to 19 inches above the ground

Adjustable high-low treatment chairs

Wheelchair accessible height adjustable treatment chair that lower to 20 inches above the ground parallel to a manual wheelchair; both appear to be equal in height. Man sitting in an accessible height adjustable treatment chair that lowers to 20 inches above the ground with his feet flat on the ground.

The tables and chairs shown can be lowered to 17"-20" from the floor making transferring easier for wheelchair users and people with activity limitations. This includes people with conditions that interfere with mobility, walking, climbing, using steps (joint pain, short stature, pregnancy, fatigue, respiratory and cardiac conditions); and/or who use mobility devices (e.g. canes, crutches, walkers); or who have post surgical conditions, or orthopedic injuries.

Woman using wheelchair parallel to height adjustable examination table lowering to 19 inches which is level to her wheelchair Woman with hand on the exam table preparing to transfer. Woman transferring from her wheelchair with her bottom sitting on the exam table.

CHOOSING AN ACCESSIBLE EXAMINATION TABLE:

Desirable features of accessible examination tables and chairs include:

1. Improved Quality of Care for People with Disabilities and Activity Limitations

When a physician is unable to perform an appropriate examination because a patient cannot get onto an examination table, the patient may receive a lesser quality of health care. The patient might be misdiagnosed, because the physician may not have sufficient information. Or, the patient might miss the benefit of early detection of a developing condition such as cancer. By providing accessible examination tables, physicians improve the quality of care provided to people with disabilities and activity limitations. In addition, the use of an accessible exam table may also reduce the frequency and time required in using a lift team or lift equipment for lifting and/or transferring assistance.

"In addition to getting on the table, patients will find another benefit during their wait for the doctor. The low height of the table allows many people to sit with their feet still on the floor, eliminating strain on their back and legs. It also allows people who prefer a chair to remain in the chair while waiting for the provider and then to easily move on to the table. In addition to increasing the benefits to the patient, exam tables with greater access decrease the need for staff assistance and maintain the patient's sense of confidence and dignity." 1

From the provider's perspective, limitations in the physical environment, such as the lack of appropriate equipment, may cause doctors and other professionals to forgo, omit, or not recommend procedures or portions of procedures for people with disabilities, that would otherwise be commonplace.

"When a wheelchair user began to have irregular vaginal spotting, she tried to ignore it. She had not had a pelvic exam for a number of years because she wasn't able to find a facility where she could get on the examination table. When she finally did find such a facility, after much searching, she was diagnosed with endometrial cancer. Had accessible exam tables been in routine use in gynecological clinics and offices, this woman might have been diagnosed and treated earlier." 2

For 18 years, John Lonberg, a man in his early 60's with quadriplegia from a spinal cord injury, urged his health care clinic to install an accessible exam table. The clinic refused. Often no one was available to lift him onto the standard-height table; his clinicians frequently performed cursory examinations, while John sat in his wheelchair. 3

His clinicians missed the pressure ulcer developing on his buttocks. When they finally examined him about a year after it began, the ulcer was infected and required surgery. John was not only seriously injured by inadequate care, in addition to the physical and psychological damage to John, this inaccessible and inadequate treatment caused a preventable medical condition that was far more costly to treat than it would have been to prevent. 4

John's story exemplifies a common problem, failure to provide safe and accessible care. This failure produced disastrous consequences, both for John and for the health care system that now needed to expend a substantial amount of funds for the costs of surgery and lengthy postoperative care. 5

2. Individuals with Disabilities Represent a Sizable Portion of the Population

According to the US Census of 2000 people with disabilities represent 19.3 percent of the 257.2 million people who were aged 5 and older in the civilian non-institutionalized population or nearly one person in five. Fifty percent of people over age 65 have some form of disability. 6

With the average age of patients on the rise, more people will require easier access to equipment. The average life span today is 75 years, and is projected to rise to 85 years by 2050. The Census Bureau cited that the two highest causal factors of disabilities include arthritis or rheumatism and back or spine injuries - both of which can cause patients difficulty getting on or off an exam table. 7

In addition to improved access for people with physical disabilities, accessible medical equipment makes life easier for everyone.

Bar chart of population with a disability by age and sex for year 2000 - approximately 4-7% of people age 5-15, 17-19% of those age 16-64, and 40-43% of those 65 or older have a disability. Men had slightly more disabilities up to age 65; women that were 65 and older tended to have more disabilities. Bar chart of population with a disability by age and sex, and by type of disability for year 2000 overall ranked physical disabilities most frequent, followed by difficulty going outside, sensory, mental, and self-care disabilities. All percentages increased significantly and consistently from the age ranges of 16-61 and 65 and over.

3. Reduction of Workplace Injuries

When the height of an examination table is not adjustable, wheelchair users and people with other activity limitations may need to be lifted onto the examination table. This type of lifting can cause back or other musculoskeletal injuries to the medical facility staff. Once the patient is on the table, an adjustable-height feature also enables health care providers to elevate the table to a comfortable height for conducting an examination or procedure, thus, decreasing the risk of back strain or other injuries to these health care professionals. 8

"The Occupational Safety and Health Administration (OSHA) estimated that 1.8 million US workers develop work-related musculoskeletal disorders. According to the US Department of Labor's Bureau of Labor Statistics, healthcare-related services reported over 59,000 musculoskeletal injuries in 1999. The majority of the injuries reported were strains and sprains to the back and shoulder caused by overexertion in lifting and resulted in the employee being off of work for several days." 9

Nursing is considered to be the riskiest occupation in the US, because it is most associated with work-related musculoskeletal disorders and back injuries. Nursing has the second-highest incidence of all types of non-fatal work-related injuries. 1998 injury data show that nearly 12 out of 100 nurses in hospitals and 17.3 out of 100 nurses working in nursing homes report work-related musculoskeletal injuries, including back injuries, which is about double the rate for all other industries combined. 10

One of the responsibilities of many nurses is getting patients onto (and often, off of) the examination table. The height of the table determines how much bending and reaching is required to accomplish these tasks. However, the height of nurses varies, and so a simple-to-operate, height-adjustable table is important to allow the height to be appropriately adjusted to the nurse's height, to suit the nurse and facilitate a safer transfer for the patient. 11

4. Tax Credits Under Section 44 of Title 26 in the IRS Code 12

The "Disabled Access Tax Credit" (Internal Revenue Code, Title 26, Section 44), is allowed for expenditures that are incurred in order to comply with the Americans with Disabilities Act (ADA). This enables an eligible small business to elect to take a nonrefundable tax credit equal to half of the expenditures it makes on eligible accommodations that exceed $250. The maximum credit a business can elect to take in any tax year is $5,000 for eligible expenditures of $10,250 or more. (See: CDIHP Brief: Disability Access Tax Incentives)

5. Comply With Legal Obligations Under the ADA

Title II of the Americans with Disabilities Act (ADA) covers health care activities of state and local government. Title III covers privately operated medical and health care facilities. Title III coverage includes physician offices located in private homes. Physicians often perform examinations that require patients to lie prone or supine on an examination table. If the patient cannot get on the examination table because of the table's design, the ADA requires that the physician's office provide an accommodation that will enable the physician to perform the appropriate examination.

If a physician's office does not provide an examination table that can be accessed, the office must provide assistance to help patients onto the high tables, including lifting them if necessary. Such measures must be undertaken in a safe manner to avoid injury to the patient and to preserve the dignity of the patient as much as possible. 13

A growing number of private and public disability discrimination cases have been successfully filed over the past ten years. Individuals with disabilities and the disability community have become increasingly public and diligent in asserting their civil rights to equal access, specifically, requiring the courts to enforce ADA requirements in the health care field.

Several examples from the Department of Justice include:

In a private action, Metzler v. Kaiser Permanente of California, 2001, an agreement settled a class-action lawsuit filed against Kaiser Permanente, on behalf of all its California members with disabilities. The lawsuit argued that Kaiser discriminated against patients with disabilities by giving inferior medical care. 17

Some of the term of the agreement include:

Resources

Manufacturers of Accessible Exam Tables and Scales

To download a 880KB Excel file containing a list of examination, procedural, and treatment tables with accessible features,including manufacturers and contact information, click here.

Endnotes

  1. ACCESSIBLE EXAMINATION TABLES IN PHYSICIANS' OFFICES, www.members.aol.com/criptrip/accessible-exam-tables.htm (last updated August, 2002)
  2. J. M. Glionna, California and the West; Suit Faults Kaiser's Care for Disabled; Courts: Advocates Say Provider Fails to Give Equal and Adequate Treatment to the handicapped. Chain Says it Complies with Disabilities Act, Los Angeles Times (Record edition), 27 July 2000, p. 3.
  3. J. M. Glionna.
  4. J. M. Glionna.
  5. J. M. Glionna.
  6. U.S. Bureau of Labor Statistics. www.bls.gov/news.release/osh.t02.htm (16 Sept. 2002).
  7. U.S. Bureau of Labor Statistics. (16 Sept. 2002).
  8. Wells, J., Achieving the Highest Level of Efficiency and Comfort in the Examination Room for both Physician and Patient. Midmark Corporation (August 2002).
  9. Wells, J.
  10. Hedge, A. Spine Universe: Back Care for Nurses www.spineuniverse.com/displayarticle.php/article1509.html
  11. Hedge, A.
  12. U.S. Department of Justice, Americans with Disabilities Act, FACT SHEET 4, Tax Incentives for Improving Accessibility, Series, September 4, 1998.
  13. Wells, J.
  14. U. S. Department of Justice, Enforcing the ADA: A Status Report from the Department of Justice, Washington, D. C., Apr-Jun 2002.
  15. U. S. Department of Justice, Oct-Dec 2002.
  16. Settlement agreement between the United States of American and Georgetown University, under the Americans with Disabilities Act, Department of Justice complaint number 204-16-92; L. Einstein, Department of Justice staff attorney. Telephone conversation with author. 28 Jul 2003. Full settlement available at www.usdoj.gov/crt/ada/gtownhos.htm#anchor262953
  17. Metzler v. Kaiser Foundation Health Plan, Inc., No. 829265-2 (Calif. Super. Ct., Ala. Cnty) (Dismissal Based on Settlement Agreement March 2001) [full settlement available at www.dralegal.org/downloads/cases/metzler/settlement.pdf].

Disclaimer: The Center for Disabilities Issues and the Health Professions does not endorse nor profit in whole nor in part, from any manufacturer or vendor whose equipment appears in this publication. Illustrations of specific equipment are provided for information and educational purposes only.

Distribution is encouraged, and permission is granted provided that:

(1) This copyright notice and citation is attached to each copy;

Kailes, J., and Mac Donald, C., The Importance of Accessible Examination Tables, 2004. Published and distributed by the Center for Disability Issues and the Health Profession, Western University of Health Sciences, 309 E. Second Street, Pomona, CA 91766 1854, (available at www.cdihp.org/products) Email: ahcs@westernu.edu Voice-909.469.5213/TTY-909.469.5520, Fax 909.469.5503,

(2) No alterations are made to the contents of the document;

(3) The document is not sold for profit; and

(4) The Center for Disability Issues and the Health Professions is notified of such use. Please contact the Center by way of fax (909) 469-5503 or e-mail: ahcs@westernu.edu

The Rehabilitation Engineering Research Center (RERC) on Accessible Medical Instrumentation is a five-year project that evaluates methods and technologies to increase the accessibility and usability of diagnostic, therapeutic, and procedural healthcare equipment, and associated assistive technologies, for people with disabilities. This brief was funded, in-part, by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, under grant #H133E020729