QUESTION:  What is the Americans with Disabilities Act and does it apply to my clinic?

ANSWER:  The Americans with Disabilities Act (ADA) is a Federal civil rights law that prohibits the exclusion of people with disabilities from everyday activities in the community because of lack of access to public facilities.  The ADA established requirements for private businesses of all sizes, including health care practices, so YES, IT DOES APPLY TO YOUR PRACTICE.   These requirements first went into effect in 1992, and continue to be a requirement for both for-profit and non-profit organizations and include private chiropractic clinics and care facilities, regardless of size or number of employees.   The ADA also prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities. The employment requirements only apply to practices with 15 or more employees.

Private businesses that provide goods or services to the public are defined in the law as "public accommodations". Places of public accommodation include over 6 million privately owned business establishments of all sizes.  The ADA establishes requirements for twelve categories of public accommodations, including stores and shops, restaurants and bars, service establishments, theaters, hotels, recreation facilities, private museums and schools and others. Nearly all types of private businesses that serve the public are included in the covered categories, regardless of size, including chiropractic clinics in all U.S. jurisdictions. Title III of the ADA prohibits discrimination against persons with disabilities in places of public accommodation and commercial facilities.

The ADA provides that public accommodations must: provide goods and services in an integrated setting, unless separate or different measures are necessary to ensure equal opportunity; eliminate unnecessary eligibility standards or rules that deny individuals with disabilities an equal opportunity to enjoy the goods and services of a place of public accommodation; and make reasonable modifications in policies, practices and procedures that deny equal access to individuals with disabilities, unless a fundamental alteration would result in the nature of the goods and services provided. They must also ensure effective communication through the use of auxiliary aids and services when necessary, unless an undue burden or fundamental alteration would result. They must remove architectural and structural communication barriers in existing facilities where readily achievable, and provide goods and services through alternative measures when removal of barriers is not readily achievable.

If you own, operate, lease, or lease to a business that serves the public, then, you are covered by the ADA and have obligations for existing facilities as well as for compliance when a facility is altered or a new facility is constructed. Existing facilities are not exempted by "grandfather provisions" that are often used by building code officials.

Many business facilities were built without features that accommodate people with disabilities, including people who use wheelchairs. This lack of accessibility makes it impossible for many people with disabilities to take part in everyday activities such as going to work, eating in a restaurant or shopping in a store. The ADA recognizes that, for people with disabilities to participate in the everyday activities in their communities, they need to have access to the goods and services provided by businesses.

While it is not possible for many businesses, especially small businesses, to make their facilities fully accessible, there is much that can be done without much difficulty or expense to improve accessibility. Therefore, the ADA requires that accessibility be improved without taking on excessive expenses that could harm the business.

If you own or operate a business that serves the public you must remove physical "barriers" that are "readily achievable," which means easily accomplishable without much difficulty or expense. The "readily achievable" requirement is based on the size and resources of the business. So larger businesses with more resources are expected to take a more active role in removing barriers than small businesses. The ADA also recognizes that economic conditions vary. When a business has resources to remove barriers, it is expected to do so; but when profits are down, barrier removal may be reduced or delayed. Barrier removal is an ongoing obligation -- you are expected to remove barriers in the future as resources become available. 

When parking is provided for the public, designated accessible parking spaces must be provided, if doing so is readily achievable. An accessible parking space must have space for the vehicle and an additional space located either to the right or to the left of the space that serves as an access aisle. A sign with the international symbol of accessibility must be located in front of the parking space and mounted high enough so it is not hidden by a vehicle parked in the space.  Accessible parking spaces should be the spaces closest to the accessible entrance and be located on level ground.

 

Patients who have hearing or speech disabilities may need to communicate with your staff without using speech. For example, some people who are deaf are able to use speech but unable to understand words spoken by others while other people who are deaf are not able to communicate with speech. People with speech or hearing disabilities may require extra time to complete their message or extra attention by staff to understand what is being said. When communication by speech is not possible, simple questions, such as the price of an item, may be handled with pen and paper by exchanging written notes or a mixture of speech and written notes. Staff should be aware of the need to use notes or both speech and communication with pen and paper. It is appropriate to ask the customer what is their preference for simple communication.

When more complex or lengthy communications are needed, or complex clinical issues need to be addressed, it may be necessary to provide a sign language interpreter.  Most communications with patients, however, involve only simple communications that can be done using pen and paper.

Many people with hearing or speech disabilities use a telecommunications device for the deaf (TDD) instead of a standard telephone. To make it easy for people who use a TDD to communicate with businesses and individuals who do not have a TDD, the ADA established a free state-by-state relay network nationwide that handles voice-to-TDD and TDD-to-voice calls. Patients who use a TDD to make telephone calls may telephone your clinic using a relay network. The relay consists of an operator with a TDD who translates TDD and voice messages. For example, a caller using a TDD calls the relay operator who then calls your business. The caller types the message into the TDD and the operator reads the message to you. You respond by talking to the operator who then enters your message into the TDD.  You can easily find information on your community's TDD network from any information resource such as the public library.

You may even be eligible for tax benefits for expenses related to ADA compliance.  For example, the Internal Revenue Code (IRS) allows a deduction of up to $15,000 per year for expenses associated with the removal of qualified architectural and transportation barriers. The IRS also permits eligible small businesses to receive a tax credit for certain costs of compliance with the ADA

General information from the federal government on the Americans With Disabilities Act (ADA) is available on the Internet at ada.gov.  Additional information and help in compliance or dispute resolution is available on the

Internet from the U.S. Department of Justice at: http://www.usdoj.gov/crt/ada/q&aeng02.htm

Small business information and assistance is available at: http://www.usdoj.gov/crt/ada/smbustxt.htm