March 14, 2007

Structural Impairments That Limit Access to Health Care for Patients With Disabilities

Author Affiliations

Author Affiliations: Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill (Dr Kirschner); Disability Rights Education and Defense Fund, Berkeley, Calif (Ms Breslin); and Harvard Medical School, Institute for Health Policy, Massachusetts General Hospital, Boston (Dr Iezzoni).

JAMA. 2007;297(10):1121-1125. doi:10.1001/jama.297.10.1121

The following 3 cases represent substandard care for patients with disabilities, yet they occurred recently at US tertiary care medical centers with the latest technologies and well-qualified physicians. These failures resulted from basic, “low-tech” structural deficiencies—lack of accessible call systems, diagnostic equipment, and examination tables.

Joe is paralyzed, dependent on a ventilator, and unable to speak. His hospital room was at the end of the corridor and had no accessible call system to summon assistance. When his ventilator became disconnected and then was not promptly recognized, Joe became extremely anxious about being in a hospital.

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