October 17, 2001
The Honorable Rick Santorum
United States Senator
Suite 250 Landmarks Building
One Station Square
Pittsburgh, Pennsylvania 15219
Dear Senator Santorum:
This is in response to your inquiry on behalf of your constituent, xxxxxxxxxxxxxxxxxxxxxxx, who asks whether the Americans with Disabilities Act of 1990 (ADA) requires that hospitals and doctors' offices provide adjustable examining tables for patients with disabilities who cannot use standard-height tables. Please excuse our delay in responding.
Title II of the ADA prohibits discrimination on the basis of disability by public entities, and title III of the ADA prohibits discrimination on the basis of disability by public accommodations. Hospitals and doctors' offices may be either public entities or places of public accommodation. Under the ADA and the Department's implementing regulations, the issue of adjustable examining tables may be addressed under the "policy modification," "barrier removal," and "program accessibility" standards.
Under the policy modification standard, entities subject to the ADA are required to make reasonable modifications in their policies, practices, and procedures if necessary to afford a person with a disability an equal opportunity to participate in the services, facilities, or activities that the entity provides. The regulations provide an exception for modifications that result in a fundamental alteration in the nature of the services, facilities, or activities that are offered. The determination of whether a particular modification meets the conditions of the policy modification standard must be made on a case-by-case basis.
Whether provision of an adjustable examination table is necessary and reasonable and would not fundamentally alter the nature of the services provided is a fact-specific inquiry. Relevant facts include the needs of the patient and the resources of the hospital or doctor's office. Use of a nonadjustable examining table, of suitable height, is another possible policy modification that would alleviate the difficulty that persons with mobility impairments have in using standard examining tables.
Under the barrier removal standard of title III of the ADA, which applies to hospitals and doctors' offices that are public accommodations, a standard-height, nonadjustable examining table constitutes an architectural barrier to persons with certain mobility impairments. Therefore, an adjustable table must be provided if it is readily achievable to do so (that is, easily accomplished and able to be carried out without much expense). If it is not readily achievable to obtain such a table, then an alternative means, such as a lowered height table, must be provided if that means is readily achievable. With respect to hospitals and doctors' offices that are public entities, the "program accessibility" standard of title II of the ADA requires that covered entities make their programs, such as medical services, readily accessible to and usable by persons with disabilities unless to do so can be shown by the covered entity to cause a fundamental alteration in the nature of a service or an undue financial and administrative burden. Once again, under these standards, the Department of Justice makes the determination of whether a particular action is required on a case-by-case basis.
Your constituent's letter addresses the needs of "handicapped and elderly" persons. To be entitled to the protection of the ADA, a person must have a physical or mental impairment that substantially limits one or more of his or her major life activities. Whether an impairment limits a major life activity is a fact-specific inquiry. Old age is not, in and of itself, such an impairment. In the event that your constituent would like to file a complaint against a specific hospital or doctor's office, we have included complaint forms.
We hope this information will be helpful to you in responding to your constituent. Please do not hesitate to contact the Department if we can be of assistance in other matters.
Ralph F. Boyd, Jr.
Assistant Attorney General
Civil Rights Division