Adjustable examination couches in Australian general practice
On February 15, 2006, Commissioner Graeme Innes hosted a meeting of representatives from a number of national peak disability organisations, representatives from the Royal Australian College of General Practitioners (RACGP), the Australian Medical Association (AMA), and Government advisory bodies. The purpose of the meeting was to discuss ways in which the availability of adjustable examination couches in General Practices could be improved.
Participants agreed to collaborate on achieving progress in this area. They agreed that a number of strategies aimed directly at improving the availability of adjustable couches and at providing general practices with more information on the importance of this equipment could be pursued together.
Reproduced below are Commissioner Innes's opening comments from the meeting.
Introduction by Commissioner Innes
The main purpose for the meeting is to discuss the issue of the availability of adjustable examination couches in general practices throughout Australia .
My intention in inviting you to this meeting is to create an opportunity for us to have an open discussion with interested groups on what issues need to be considered in trying to improve the availability of adjustable examination couches, what potential solutions there may be and what individually or collectively we might do to achieve change.
What do we know about the current situation
So what is it that we know about access to adjustable examination couches in Australia and elsewhere?
Firstly, we have the data collected by Sheila King and the Access for All Alliance which has provided us with a very clear picture of the lack of availability of adjustable examination couches throughout Australia in 2003.
In broad terms the survey of 3,553 General Practices nationally identified 14,008 fixed height examination couches compared to only 719 adjustable examination couches. Some General Practices had more than one adjustable couch so the figures did not mean that 719 General Practices had access to an adjustable couch.
In some areas such as the Northern Territory only 4 out of 168 couches were reported as being adjustable. Similarly the survey showed that in Victoria out of 3581 examination beds identified only 120 were adjustable.
A similar survey undertaken in UK in 1999 for the National Health Service Executive found that 67% of General Practitioners did not have adjustable examination couches.
We do not know what the situation is in Hospital emergency Departments or in other areas of health or therapy treatment such as Physiotherapists.
Secondly, we have anecdotal evidence form Sheila's work, other disability and health access advocacy groups, academics and medical practitioners that the lack of adjustable couches affects the ability of patients with disabilities to receive the quality of medical care others receive.
For example, in a 1997 study undertaken by Nosek and Howland into breast and cervical cancer screening among women with physical disabilities the authors found that one issue cited as giving rise to difficulty accessing services was access to surgeries and specifically access to examination beds.
In recognition of this, many organisations around the world have issued guides advising health professionals of the need to ensure they are able to respond to the needs of all their patients when it comes to examinations.
For example, the Centre for Universal Design and The North Carolina Office on Disability and Health has produced a guide which includes specific reference to the need for adjustable examination couches.
Similarly, the Association of State and Territorial Health Officials based in Washington has issued a guide to accessing preventative health care services for women with disabilities which specifically identified lack of equipment such as adjustable examination couches as being a barrier to access.
Thirdly, we know that quite apart from the question of quality of patient care General Practices are covered by anti-discrimination laws which require that services are delivered in a non-discriminatory ways.
In my letter of invitation I outlined my views on the potential liability of General Practices to complaints of discrimination from a person with a disability who believes they have not received equitable treatment as a result of the lack of an adjustable examination couch.
This liability exists in other countries such as the UK and USA . The Commission has received and conciliated a number of complaints in this area where the outcome was either the provision of adjustable couches or a means of providing access to fixed examination couches.
There have also been many international reported examples of where complaints have been successful. For example, a case between the United States of America and Exodus Women's Centre resulted in a settlement agreement which required the Centre to provide adjustable couches.
Before inviting other to comment on the importance of adjustable examination couches I would just like to summarise the contents of a guide developed by the Centre for Disability Issues and the Health Professions at Western University of Health Sciences in California .
This guide identified four main reasons for a physician to consider acquiring an accessible examination table:
- Improved quality of care to patients with disabilities
- Reduction of injury to employees in physicians' offices
- Tax credits under Section 44 of Title 26 in the IRS code
- Obligations under Title III of the Americans with Disabilities Act
Improved quality of care to patients with disabilities:
The guide suggests that when a physician is unable to perform an appropriate examination because a patient cannot transfer from a wheelchair onto the examination table, the patient receives a lesser quality of health care. The patient might be misdiagnosed, because the physician may not have thorough enough 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 they can give to their patients as well as the quality of their patients' lives
Reduction of injury to employees in physician's office:
The guide notes that when an examination table is not at wheelchair height, a patient who uses a wheelchair may need to be lifted onto the examination table. This type of lifting can cause back or other injuries to the staff in the physician's office. An examination table that can be lowered to wheelchair height can significantly reduce the chances of injury. The adjustable-height feature also enables the physician to elevate the table to a comfortable height for conducting an examination, thus diminishing the possibility of back strain for the physician.
Tax credits under section 44 of title 26 in the IRS code:
While not relevant to the Australian situation the guide notes the provision of a "Disabled Access Tax Credit" an important tax credit for access expenditures that are incurred in order to comply with the ADA . Eligible access expenditures specifically include amounts paid or incurred to acquire equipment such as adjustable examination couches to assist in meeting responsibilities under the ADA and provide services to people with disabilities.
Obligations under the ADA :
Finally the guide identifies responsibilities physicians have under the ADA to provide equitable services.
Unfortunately I have not been able to get information on the distribution of the guide and its effect on the availability of adjustable examination couches in the California area.
So in summary we know that at the time of the survey few General Practices had adjustable examination couches, we know that there is widespread acceptance of the effect that might have on the quality of care provided by health professionals and we know that there is a liability for discrimination complaints in situations where a person with a disability believes they have received an inferior service because they could not access a couch.
Our discussions today aim to work out what we can do about this situation.
Nosek and Howland research referenced in 'Preventative Women's Health Care for Women with Disabilities' at http://www.csp.nsw.gov.au/publications/index.html
Report from UK on need to comply with DDA 'Working in Partnership to implement section 21 of the DDA Act 1995 Across the national health service'. Feb 1999 Michael Freeney, Richard Cook, Beverley Hale and Dr Stephen Duckworth
Exodus Women's Centre case Department of Justice complaint number 202-17M-214
Guide on adjustable examination couches