"Access to Medical Care and the Americans with Disabilities Act: Educating Health Professionals as a Force for Culture Change"

Long-Bellil, L.M., Graham, C.L., Robey, K.L., Smeltzer, S.C., Woodard, L., Reiss, J.G.

"The cultural context of law both promotes and subverts efforts at legal change” (Engel, 1991). The Americans with Disabilities Act (ADA) imposed requirements that medical providers afford access to persons with disabilities and modify their policies, procedures and practices to ensure that individuals with disabilities can benefit from the “full and equal enjoyment” of their services (Americans with Disabilities Act, 42 USC §12182(a)). These requirements were imposed on a health care workforce whose attitudes and level of experience with persons with disabilities, for the most part, rendered it no more prepared to respond than the rest of society. It also had a culture that was perceived as inhospitable to patients generally and was undergoing a transformation of its own due to increasing resource constraints.

Twenty years later, despite repeated calls from the Office of the Surgeon General (2002; 2005) and the National Council on Disability (2009), along with lawsuits against several large providers, individuals with disabilities continue to experience health disparities and lack of access to appropriate care (Office of the Surgeon General, 2002 and 2005; NCD, 2009). However, there is a nascent movement among educators to provide the health care workforce with the tools it needs to afford the access to care contemplated by the ADA. A new organization, the Alliance for Disability in Health Care Education, comprised of educators from various medical and nursing schools is actively working toward increasing the inclusion of disability content in the curricula of schools of medicine, nursing and other health professions. The goal is to instill positive attitudes and appropriate knowledge and skills in emerging health care professionals. This educational effort, combined with other initiatives at the federal, state and local level may create the culture change necessary to ensure appropriate and effective care for persons with disabilities.