36 CFR Part 1195 Standards for Accessible Medical Diagnostic Equipment - Preamble

b. Transfer Surface Location

The MDE NPRM proposed the same location and transfer sides of the transfer surface for diagnostic equipment used by patients in the supine, prone, or side-lying position (M301) and diagnostic equipment used by patients in the seated position (M302). This transfer surface was located at the end of the diagnostic equipment and provided options to transfer from a mobility device onto one short side and one long side of the transfer surface. (proposed M301.2.3 and M302.2.3, respectively). Numerous commenters objected on the basis that this type of transfer is not always possible for certain types of medical diagnostic equipment; the MDE Advisory Committee agreed with commenter concerns. The Access Board is persuaded by many of the concerns raised by commenters and the MDE Advisory Committee. In the final rule the structure and content of the transfer surface provision has been revised for diagnostic equipment used by patients in the supine, prone, or side-lying positions to provide two types of transfer surfaces; end transfer surfaces and side transfer surfaces. For diagnostic equipment used by patients in the seated position, the Access Board has decided to retain the proposed rule requirements for transfer surface location and transfer sides, but has added an exception to the transfer sides provision in the final rule to address the concerns raised by commenters and the MDE Advisory Committee.

(1) Transfer Surface Location for Diagnostic Equipment Used in the Supine, Prone, or Side-lying Position

Multiple commenters expressed concerns that transfer cannot always occur at the end of the diagnostic equipment as contemplated by the requirements in the proposed rule. One commenter elaborated that stretchers and hospital beds are always entered from one or the other long side of the bed, not the foot end, due to obstructions at the head and foot ends that cannot be removed. Another commenter recommended allowing transfer space at both the center and the end of the transfer surface.

Evidence presented to the MDE Advisory Committee during its deliberations revealed that it is not always possible to transfer from adjoining sides at the end of the diagnostic equipment in the prone, supine, or side-lying position on certain types of equipment such as stretchers and imaging equipment with scanning beds. MDE Advisory Committee Report, 75-82, available at https://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/advisory-committee-final-report. This is because many models of this equipment can be obstructed on the head or foot ends by necessary components such as emergency extraction handles, the gantry design, or integral patient positioning features. Id. For equipment with long patient examination surfaces such as stretchers and the scanning beds of many types of imaging machines, the foot end is not intended as a transfer point; patients transfer onto the surface on either of the long sides, approaching the equipment more towards the center. Id. Additionally, a transfer approach at the foot location may not be practical for many people with disabilities who would have to move themselves or be moved across a significant length of the surface to place their bodies into a position for effective imaging. Id. The MDE Advisory Committee recommended permitting an alternative transfer surface which was rotated in its orientation such that the width paralleled the examination surface’s length and its depth spanned the examination surface’s width, and was located near the center point of the diagnostic equipment surface. Id.

Based on the comments received and the MDE Advisory Committee recommendations, the Access Board has concluded that for diagnostic equipment used by patients in supine, prone, or side-lying positions two transfer surface orientations are possible depending on the intended location from which the transfer is to be made. These orientations are now identified as an end transfer surface and side transfer surface. This necessitated adding the definition of “end transfer surface” and “side transfer surface” to the defined terms (M102.1) in the final rule and resulted in the removal of the proposed M301.2.3 Transfer Sides, as that is now described within the two types of transfer surfaces provided. The end transfer surface accommodates the transfer method conceived of in the proposed rule; where the transfer occurs at one end of the examination surface and allows the patient the option to transfer at the end and on one adjoining side of the examination surface. The side transfer surface responds to the concerns raised by commenters and the MDE Advisory Committee to accommodate diagnostic equipment where transfer occurs within the length of the examination surface and allows patient transfer at the sides of the examination surface. Side transfer surfaces most typically will be imaging equipment, stretchers, hospital beds, and other equipment where the end is obstructed and cannot be used for transfer. Accordingly, the Access Board has reorganized the requirements regarding the transfer surface for M301 into two types based on where the transfer is to occur: “End Transfer” or “Side Transfer.” This revision to provide options for two types of transfer surfaces necessitated adding additional technical criteria addressing transfer surface size (M301.2.3) and transfer supports (M305.2), as well as adding the definition of “end transfer surface” and “side transfer surface” to the defined terms (M102.1) in the final rule. These new requirements are addressed below in the applicable section in the Section-by-Section Analysis.

(2) Transfer Surface Location for Diagnostic Equipment Used in the Seated Position

Commenters also raised concerns with the provisions in the MDE NPRM related to transferring to medical diagnostic equipment used by patients in the seated position. Commenters stated that there is certain diagnostic equipment used by patients in the seated position where transfer at the end of the seat by two adjoining sides is not feasible. Specifically, commenters raised concerns about diagnostic equipment with fixed footrests, such as podiatry and dentistry chairs. Transfer onto these types of diagnostic equipment must be made from either long side, similar to the side transfer surface described above. One commenter explained that fixed footrest chairs are meant to treat patients with their legs extended parallel to the ground. If entered as suggested in the proposed rule the patient would have to enter the chair by positioning themselves onto this fixed footrest section that is at a downward angle and would require the patient to slide up an inclined surface to be properly positioned on the diagnostic equipment.

The MDE Advisory Committee agreed with a majority of the commenters that some examination chairs which have fixed footrests prevent transfer as conceived of in the proposed rule. The Committee noted that:

• the footrests obstruct access to the foot end of the chair. Examples of chairs that fit this category are most dental chairs and podiatry chairs. The current design allows only one long side for transfer, which limits some patient transfers where a patient can use only one side of the body due to paralysis on one side or other such conditions. To address this issue, the recommendation requires chairs with footrest obstructions to allow patient transfers from both [long] sides of the chair. The solution creates the option for either a left or right transfer. MDE Advisory Committee Report, 83, available at https://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/advisory-committee-final-report.

The Access Board agrees that diagnostic equipment used by patients in the seated position with fixed footrests requires a different transfer approach than those without fixed footrests. Therefore, the Access Board has added an exception to the transfer sides provision (M302.2.4) in the final rule to permit diagnostic equipment with fixed footrests to provide options to transfer from opposing sides of the transfer surface.

The American Dental Association proposed a complete exemption of dental chairs from the MDE Standards, asserting that the Access Board has not provided any evidence that dental offices are inaccessible, citing to the national survey in MDE NPRM “that collected information on the types of medical equipment that are most difficult for individuals with disabilities to access and use. The American Dental Association urge[d] the Access Board to refrain from proposing costly new requirements based on examination chairs that are only ‘moderately difficult’ for disabled patients to use.” The American Dental Association explains that “dental chairs already have many accessibility features built in and manufacturers as well as health care providers have an economic incentive to produce and procure accessible medical diagnostic equipment and therefore, the American Dental Association does not believe that additional regulations are necessary, particularly with respect to dental examination chairs.” Comment of American Dental Association, Notice of Proposed Rulemaking for Medical Diagnostic Equipment, (Apr. 4, 2012), available at https://www.regulations.gov/document?D=ATBCB-2012-0003-0037.

The Access Board does not concur with the comment urging that dental chairs should receive a blanket exemption. The record is replete with evidence that individuals with disabilities do encounter barriers to dental care as a result of inaccessible dental chairs. For example, one commenter, a disability rights organization representing 37,000 members, explained that it asked its members “and others with disabilities about the barriers they encounter when seeking medical care and treatment. The most frequent responses involved access to examination chairs, dentist chairs, scales and mammography and colonoscopy equipment.” Comment of United Spinal Association, Notice of Proposed Rulemaking for Medical Diagnostic Equipment, (June 4, 2012), available at https://www.regulations.gov/document?D=ATBCB-2012-0003-0029. Additionally, at the public hearing on May 8, 2012, a commenter raised concerns about the ability to obtain dental care when unable to transfer onto the dental chair. The public hearing transcript is available at https://www.regulations.gov/docket?D=ATBCB-2012-0003. Accordingly, the Access Board has concluded that dental chairs are appropriately covered by this rule.