Viewpoint: Consider Tough Penalties To Boost Disabled Patients’ Access To Care

We already know that patients with disabilities face major obstacles when trying to access basic medical care. Now, a team of researchers are proposing some novel strategies to help fix the system, including withholding payments to health care organizations and making accreditation contingent on compliance with disability law.

The researchers, Dr. Tara Lagu and colleagues at Baystate Medical Center, Tufts University School of Medicine, and a Massachusetts not-for-profit organization, the Disability Law Center, suggest that this is the first time these types of strategies have been proposed.

“The goal of this paper was to start the conversation,” says Dr. Lagu via email.

Dr. Tara Lagu, M.D., MPH (Courtesy)

Dr. Tara Lagu, M.D., MPH (Courtesy)

Lagu’s groundbreaking earlier study on access to care for people with disabilities found that even in the current high-tech health care environment, many elements of routine medical care — like getting a patient on to an exam table — remain elusive.

The latest article, published in JAMA Internal Medicine, describes the range of barriers, including:

“…physical barriers to entering health care establishments, lack of accessible equipment, lack of a safe method for transferring the patient to an examination table, and the lack of policies that facilitate access.The barriers persist despite 2 federal laws (the Americans With Disabilities Act [ADA] of 1990 and Section 504 of the Rehabilitation Act of 1973) that explicitly state that health care settings must be accessible to patients with disabilities.

And here, Lagu offers some possible solutions:

As our study last year reported, patients with disabilities face real difficulties when they try to access health care. This suggested that our current strategy for enforcement, lawsuits, have fallen short. In part, this is because patients don’t want to bring lawsuits against doctors with whom they have an existing relationship and because lawsuits are extremely unpopular with physicians. More importantly, lawsuits have failed to initiate system-wide change: it is not clear that, in recent years, there have substantial improvements in access to care for patients with disabilities.

For these reasons, we believe that novel strategies are needed. As we considered what such strategies might look like, we considered other mechanisms of enforcement that have been successful at motivating change in health care settings, and we came to four possibilities: withholding payment, making accreditation contingent on compliance, regulation, and lawsuits at the state or national level aimed at initiating large-scale policy change. Continue reading

Is There Really A Link Between IVF And Autism? You Decide.

By Karen Weintraub
Guest Contributor

At what point does health journalism veer into fear-mongering?

This week, the Journal of the American Medical Association published a study looking at the health of babies born via a fertility treatment designed to give sperm a boost.



As with many studies published in the prestigious journal, the media coverage was extensive, with headlines in Businessweek, Reuters, Newsday, The New Republic, Huffington Post, and many other outlets. Most of the headlines trumpeted the study’s finding that a form of in vitro fertilization increased the risk of autism and intellectual disabilities (defined as having an IQ below 70 and limitations in adaptive behavior).

That is factually accurate. But was it right?

I’ll lay out the details of the study, and let you decide.

Out of 2.5 million children born in Sweden from 1982 to 2007, the study looked at the 30,959 born with the help of fertility treatments.

It found that IVF, in general, didn’t increase the risk of autism any more than conventional birth; but it slightly increased the risk of intellectual disability. But media coverage focused on autism worries, and the one form of six techniques examined that appeared to be riskiest: a procedure in which sperm is surgically removed from the man and then injected into the egg. This is relatively rare (representing only 3 percent of the studied births between 2003 and 2007, according to Businessweek), but is generally done when the man has weak sperm or is unable to ejaculate it, perhaps because of a previous vasectomy.

In babies born of this technique, the risk of developing intellectual disabilities was slightly elevated – 93 children out of 100,000 had low IQ’s compared to the expected 62. Continue reading

Report: People With Disabilities Still Face Major Disparities In Health Care

Dr. Lisa Iezzoni, Massachusetts General Hospital, reports that people with disabilities were less likely to get standard treatment for breast and lung cancer, and more likely to die from their cancers.

Twenty-years after the Americans With Disabilities Act took effect, people with disabiliites continue to face major obstacles getting a range of health services, from preventive care such as cancer screening to various treatments for disease.

This bleak analysis comes from Lisa Iezzoni, MD, director of the Mongan Institute for Health Policy at Massachusetts General Hospital and is published in the October edition of the journal Health Affairs.

According to the MGH press release:

Iezzoni, who has used a wheelchair for nearly 25 years because of multiple sclerosis, explains, “An analogy I use to illustrate how disparities among racial and ethnic minorities differ from those affecting people with disabilities is that Rosa Parks made progress towards civil rights when she could get onto that bus and sit anywhere she wanted to. I can’t even get onto a bus unless it is adapted for my needs, the bus driver notices me, recognizes my disability, and reacts to it. That kind of need for proactive accommodation applies to health care facilities as well.”

The 2010 census found that 54 million Americans — nearly 20 percent of the population — were then living with disabilities. Less than half of adults with disabilities were employed, and 27 percent of those with severe disabilities fell below the poverty rate, compared with 9 percent of those without disabilities. Iezzoni’s review of several broad-based surveys found that people with disabilities were significantly more likely to report being in fair or poor health than were those without disabilities. Continue reading