June 21, 2021
Dr. Mark Chassin
President and CEO
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Dear Dr. Chassin:
By way of introduction, I am writing to you in my capacity as the Chairman of the National Council on Disability (NCD). We are an independent federal agency charged with advising the President, his administration, Congress, and federal agencies on matters of disability law and policy.
For a number of years, NCD has embarked on an appraisal of healthcare access, treatment, and outcomes in patients with disabilities. Our efforts have been heightened over the last 14+ months due to the pandemic and the detrimental disproportionate effect it has on the disability community. There is robust literature from the United States Surgeon General, the Center for Disease Control and Prevention, the National Institutes of Health, the National Academies of Science, Engineering and Medicine, and leading healthcare institutions and researchers, that acknowledges and confirms the statistically significant sub-optimal treatment for this vulnerable patient population in the healthcare sector. While there is a myriad of contributing factors involved in the health disparities in patients with disabilities (i.e., access, stigma, reimbursement, transportation, economics, and environment), one of the main identified factors is the lack of physician training in the assessment, management, and treatment of patients with disabilities. This lack of training is a noted deficit in both undergraduate medical education as well as post graduate clinical training in residency and fellowship programs conducted in over 1100 teaching hospitals.
The purpose of this communication is to initiate a conversation on how The Joint Commission can play a vital and pivotal role in addressing this national problem. A problem that affects the overall safety and quality of care provided to persons with disabilities. Medical schools do not provide meaningful education in treating patients with disabilities and thus graduates enter residency programs with no skills, knowledge, comfort, confidence, or awareness in the proper treatment of patients with disabilities. These deficits are reflected in adverse clinical outcomes. Residency programs continue that training void and witness the clinicians’ transitioning into practice devoid of any preparation to provide competent and appropriate care to millions of individuals with disabilities. In addition to primary care, the obvious negative consequences are observed daily in every specialty and sub-specialty.
While disability competency training for medical professionals was needed prior to the pandemic, COVID-19 has again demonstrated the need for medical professionals to receive disability cultural competency as many hospitals deprioritized, and in certain instances categorically excluded, persons with disabilities from receiving treatment for the COVID–19. This is a problem that must be remedied. It is a problem that can be remedied.
NCD recently worked with the American Dental Association in revising its Code of Professional Conduct to state that patients cannot be denied care because of their disability (a standard adopted by several states as state law of professional conduct). NCD also worked with the Council on Dental Accreditation (CODA) in revising its standards, which now mandate that dental students must be trained in the assessment, management and treatment of patients with “[sic]special needs” (“special needs” is described by CODA’s published intent as “those patients whose medical, physical, psychological, cognitive or social situations make it necessary to consider a wide range of assessment and care options…these individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly”). Much the same way that those requirements were developed as needed for compliance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, it is equally vital that disability cultural competency training be required of all medical professionals.
It has been said that medical education is not just a program for building knowledge and skills in its recipients, it is also an experience which creates attitudes and expectations. NCD believes these attitudes and expectations form the foundations for introducing the challenges and rewards of treating patients with disabilities to the next generation of clinicians. Both the medical schools and residency programs have an obligation to provide opportunities to students to receive experience that will introduce and promote beneficial attitudes and expectations leading to overall safer outcomes and better quality of care. We believe The Joint Commission can be a key player and instrument in this long overdue initiative, in a somewhat similar manner that it addressed effective communications with patients who are Deaf and hard of hearing in 2010 with the development of standards and elements of performance embodied in its release of Enhancing Effective Communication, Cultural Competence, and Patient – and Family – Center Care A Roadmap for Hospitals.
We would like to meet with you and collaboratively explore the most attractive strategies to achieve health equity, improved safety and enhanced quality of care for the millions of Americans with disabilities across their lifespan. Doing so is in furtherance of The Joint Commission’s stated mission “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value,” and its stated vision “that all people always experience the safest, highest quality, best-value health care across all settings.”
I look forward to learning of your thoughts regarding this request. Amged M. Soliman, NCD Attorney Advisor, is our point person on this project. He will call your office on July 8, 2021, to coordinate a date and time for an initial discussion. If you have any questions or desire to reach me in advance of that call, you can reach me via email at firstname.lastname@example.org. Mr. Soliman can be reached at email@example.com or 202-731-5910. We look forward to further discussion.
Andrés J. Gallegos
Cc: Ms. Margaret Van Amringe, The Joint Commission, Executive Vice President, Office of Federal Relations