Monday, June 28, 2010

Physicians and the Americans with Disabilities Act (ADA)

Do state medical board applications violate the americans with disabilities act?  This question was asked by some academic individuals (Schroeder R, Brazeau CM, Zackin F, Rovi S, Dickey J, Johnson MS, Keller SE.) at UMDNJ-New Jersey Medical School, Newark, New Jersey. Here's what they found:
PURPOSE: To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990.
METHOD: Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel.
RESULTS: Of the 51 applications reviewed, 49 (96%) contained questions pertaining to the physical or mental health or substance use history of the applicant. Thirty-four of the 49 (69%) state medical licensing applications contained at least one "likely impermissible" or "impermissible" item based on the ADA and appropriate case law.
CONCLUSIONS: Most state medical licensing applications contain questions that ask about the physical or mental health and substance use of physician applicants. Many licensing applications appear to be in violation of the ADA, even 19 years after enactment of the regulation. These questions do not elicit responses by which professional competence can be judged. The presence of these questions on licensing applications may cause physicians to avoid or delay treatment of personal illness.
PMID: 19474558

Schroeder R, Brazeau CM, Zackin F, Rovi S, Dickey J, Johnson MS, Keller SE. Do state medical board applications violate the americans with disabilities act? Acad Med. 2009 Jun;84(6):776-81.

Department of Family Medicine, Student Health and Wellness Center, and assistant professor, UMDNJ-New Jersey Medical School, Newark, New Jersey 07103, USA. schroers@umdnj.edu

Friday, June 25, 2010

Can disabled physicians safely practice medicine?

I came across another interesting journal article on PubMed. This one was a commentary titled, "Commentary: Granting medical licensure, honoring the Americans with disabilities act, and protecting the public: can we do all three?"

Here's the abstract:
Physicians suffer from the same illnesses as others do, and some of these illnesses may limit their ability to safely practice medicine. Individuals with of some of these same illnesses may also suffer from denial, blinding them to their limitations. Data support that, while many of these physicians do voluntarily limit their practices or seek help, not all do. Schroeder and colleagues demonstrate in this issue that in their attempts to protect the public, state medical licensing boards may have asked questions prohibited by the Americans with Disabilities Act. They point out an ethical tension between nonmaleficence (protecting the public from harm) and individual autonomy (respecting the rights of each individual physician), amplified by the different approaches lawyers and physicians use to address conflicts. The classic legal approach is adversarial, whereas the classic medical approach is collaborative. Both are valid approaches, but neither works well in tandem with the other. The time has come for all sides of the licensure debate to acknowledge the legitimacy of the others' concerns, to recognize the different approaches they each take, and to work together with others to find a common solution. The solution must allow boards to identify individuals with illnesses that impair their ability to practice safely and that also lead to denial of these very limitations. The solution must respect the autonomy of the individual licensee with a disability who can practice safely with an accommodation and who respects the need for that accommodation. The solution must protect the public.
PMID: 19474533

Altchuler SI. Commentary: Granting medical licensure, honoring the Americans with disabilities act, and protecting the public: can we do all three? Acad Med. 2009 Jun;84(6):689-91.

Division of Psychiatry and Psychology Specialty Programs, Mayo Clinic, Rochester, Minnesota 55905, USA. altchuler.steven@mayo.edu

Wednesday, June 23, 2010

Doctors with disabilities: licensed to practice?

Here's an interesting journal article that was published last year titled, "Doctors with disabilities: licensed to practice?"

Here's the abstract:
Doctors deal with patient's disabilities every day but many in the profession have been nonplussed to see the focus of the disability rights lobbies shift from the recipients of care to the carers themselves. Until recently the number of practising doctors known to have significant disabilities was very low and for many reasons potential medical students were deterred from entering medical education. This piece would not even have been commissioned 14 years ago when the U.K. Disability Discrimination Act 1995 was passed. It is a measure of the change in society's view of disability, reinforced by law, that the issue of whether there are disabilities which, in themselves, render a doctor Unfit to practise can be analysed and discussed.
PMID: 19728501

Snashall D. Doctors with disabilities: licensed to practice? Clin Med. 2009 Aug;9(4):315-9.
King's College, London. David.Snashall@gstt.nhs.uk

Monday, June 21, 2010

Medical students with disabilities

Here's some information from the AAMC (Association of American Medical Colleges) about medical students who have disabilities:
The Americans with Disabilities Act (ADA) has afforded new rights and protections to persons with disabilities and heightened public awareness of the needs of this population. This handbook (published in 1993) provides an overview of the ADA and the antecedent Rehabilitation Act of 1973. It is intended to assist medical schools in the review and refinement of institutional policies. It is not intended as a comprehensive treatment of all the issues that might arise under the ADA or the Rehabilitation Act, no is it intended to provide legal advice. Schools should consult legal counsel regarding any specific questions about particular situations or decisions.

The purpose of the ADA is to provide opportunities for persons with disabilities to compete with other applicants on the basis of their ability. Like the Rehabilitation Act, the ADA requires many entities—including medical schools—to provide certain accommodations to persons with disabilities so that they may enjoy the same benefits, services and opportunities as those without disabilities. Schools must judge persons on the basis of their ability to complete the educational program rather than on their status as disabled persons. Persons seeking admission must be able to perform the "essential functions" or meet the "essential eligibility requirements" of the program once they have been provided with any needed accommodation or modification. Each school must determine the "essential functions" or "essential eligibility requirements" of its educational program. Preadmission inquiry as to whether a person is disabled is not permitted, but a school may seek as much information as is needed to make a determination that an individual can perform the "essential functions" or meet the "essential eligibility requirements" of the educational program.

In 2005, the AAMC published an updated version of this document, Medical Students with Disabilities: A Generation of Practice, which includes a discussion of ADA-related case law generated since the early 1990s.
You can read the full document here (PDF)

Wednesday, June 16, 2010

Disabled physician wins fight against Unum Life Insurance Company of America

Here are some interesting snippets from a legal case where a physician fought against Unum Life Insurance Company of America:
This matter is before the Court pursuant to post trial motions brought by both Plaintiff Albert David Matthew, M.D. and Defendant Unum Life Insurance Company of America. Plaintiff brings a Motion to Correct Special Verdict, Award Prejudgment Interest, and Enter Final Judgment and a Renewed Motion for Judgment as a Matter of Law or, in the Alternative, a New Trial Solely on the Total Disability Claim. Defendant brings a Motion for Judgment as a Matter of Law, a New Trial, and a Declaration of Mistrial.

Based upon the submissions of counsel, the Court having reviewed the contents of the file and evidence in this case, and the Court being otherwise duly advised in the premises, the Court hereby enters the following:

1. Plaintiff's Motion to Correct Special Verdict, Award Prejudgment Interest and Enter Final Judgment (Doc. No. [137]) is GRANTED as follows:

a. The Special Verdict is corrected to reflect the amount of $922,906 as the residual disability benefits awarded to Plaintiff;
b. Plaintiff is entitled to the return of premium benefits in the amount of $47,358.15 as stipulated to by the parties;
c. Plaintiff is awarded prejudgment interest in the amount of $498,340 on Plaintiff's residual disability claim; and
d. Plaintiff is awarded prejudgment interest on the return of premium benefits in the amount of $28,810.
You can read the rest here.

Saturday, June 12, 2010

AMA/CMA/BMA International Conference on Physician Health 2010

The AMA/CMA/BMA International Conference on Physician Health 2010 is coming up October 3-5 in Chicago, IL. Will you be attending?

The theme this year is "Physician Health and Resiliency in the 21st Century"

Learn more about the conference here.

Monday, June 7, 2010

Accommodations for Medical Faculty With Disabilities

In 2002, there was an article in the Journal of the American Medical Association (JAMA) titled, "Reasonable Accommodations for Medical Faculty With Disabilities." Here's the abstract from that article:
An unknown number of medical school faculty have disabilities, and their experiences have generally escaped notice and scrutiny. Although most medical schools offer long-term insurance and extended leaves of absence for disability, relatively few have policies explicitly addressing accommodations for faculty with disabilities as they perform teaching, research, and clinical duties. We discuss accommodating active medical school faculty with disabilities, drawing on University of Pennsylvania School of Medicine initiatives exploring the concerns of faculty with sensory and physical disabilities. Anecdotal reports suggest that many faculty, fearing reprisals, resist seeking job accommodations such as those mandated in the 1990 Americans with Disabilities Act (ADA). Although some faculty with disabilities have found supportive academic mentors, others report that lax institutional enforcement of ADA requirements, including physical access problems, demonstrates a tepid commitment to disabled staff. Potentially useful job accommodations include adjusting timelines for promotion decisions; reassessing promotions requirements that inherently require extensive travel; improving physical access to teaching, research, and clinical sites; and modifying clinical and teaching schedules. Faculty with disabilities bring identical intellectual and collegial benefits to medical schools as their nondisabled counterparts. In addition, they may offer special insights into how chronic illness and impairments affect daily life.
This article was written over 7 years ago. How far have we come? Are we making progress in this area?

Reasonable Accommodations for Medical Faculty With Disabilities
Annie G. Steinberg, MD; Lisa I. Iezzoni, MD, MSc; Alicia Conill, MD; Margaret Stineman, MD
JAMA. 2002;288:3147-3154.

Wednesday, June 2, 2010

Disabled physician denied license

This is an old story, but it may be interesting for those of you who are disabled and still practicing medicine. What will you do if you are denied medical licensure? 

Disabled physician denied license
Supreme Court to rule on whether doctor may sue under AwDA
J Am Dent Assoc, Vol 134, No 3, 370-371.

Click here to read the article.