Washington Hospital Center will change policies, rooms and equipment, from exam tables to scales and call buttons, under a sweeping legal agreement announced yesterday to ensure that people with disabilities have equal access to care.
The settlement of a 2003 lawsuit by four former patients, including a quadriplegic who said he was deprived of food and water in the hospital's nationally recognized burn unit, is one of the most comprehensive ever negotiated for medical services under the Americans With Disabilities Act, the U.S. Department of Justice announced.
Its provisions could cost the region's largest private medical center as much as $2 million over the next several years as modifications are made throughout inpatient departments and outpatient clinics and as architectural barriers are removed in public areas. The settlement obligates the 900-bed hospital to appoint an ADA officer to oversee implementation and then compliance in fact and spirit.
But plaintiffs' attorneys say the agreement's effect could be even more far-reaching if other institutions, not just locally but across the country, follow with action.
"These aren't problems that are unique to that hospital or unique to this area," said Jennifer R. Bagosy of Howrey LLP, which served as outside counsel on the case with the Equal Rights Center and Washington Lawyers' Committee for Civil Rights and Urban Affairs.
The plaintiffs said their stays at Washington Hospital Center were made more difficult, if not compromised, because the hospital was ill-equipped to handle their physical limitations.
As she underwent radiation for thyroid cancer, Rosemary Ciotti of Arlington was placed in a jury-rigged room on the orthopedic wing because "there was no accessible unit" for her wheelchair on the oncology floor, she said. Outpatient follow-up was so arduous that she considered canceling appointments.
Christopher Butler, who lives in the District, was admitted in 2002 with second- and third-degree burns from a scalding accident. A previous spinal cord injury had left him without the use of his arms or legs, and he could not use his call button to summon a nurse, much less eat or drink from the meal tray left by his bed.
"The best I could do [was] look at the food and long for the water," he said yesterday at a news conference.
The settlement seeks to protect disabled patients from such situations. For starters, it sets a goal that 10 percent of non-intensive-care hospital rooms will be made wheelchair-accessible. Adjustable-height beds will be moved in and bathrooms retrofitted.
"Accessibility for a person with a disability is meaningless unless it's comprehensive," said Marc Fiedler, who chairs the Equal Rights Center's Disability Rights Council. "It's not good enough just to get into the building."
The equipment changes to be made under the pact are as extensive. The hospital pledged that every examination table bought from today on will lower to 19 inches or less from the floor to allow easier transfer. With an eye toward the same goal, administrators and consultants required by the agreement will survey diagnostic and radiological equipment, lifts and chairs.
"We clearly learned a lot," Washington Hospital Center President James Caldas said of the suit, which concluded after more than a year of negotiations with Justice and plaintiffs' attorneys. Though he stressed that an internal review of the individual complaints about care showed each plaintiff "achieved an excellent clinical outcome," he allowed that "there were definitely some opportunities for improvement" in the accessibility and delivery of that care.
"It's been a valuable experience for us to learn in detail the daily challenge that faces our patients with disabilities," Caldas said yesterday afternoon.
The Justice Department and Equal Rights Center will monitor the pace and degree of improvements. For five years, the hospital will retain an ADA consultant, ADA equipment expert and ADA architectural expert.
Few cases have addressed the issue of the accessibility of medical care for disabled people. The first, a settlement in 2001 in California, committed Kaiser Permanente to installing new equipment and removing barriers in each of its 37 medical centers and 282 medical offices in that state. The company also was to develop a training program for staff on "culturally competent care."
According to a Kaiser Permanente spokeswoman, the improvements are 50 percent complete and have cost "tens of millions of dollars so far."