Draft Meeting Minutes 1 **Medical Diagnostic Equipment Accessibility Standards**

**Advisory Committee Minutes** 

**December 3**  **and 4 , 2012**  **U.S. Access Board, Washington, DC** 

**MEMBERS PRESENT:_________________________________________________________**  Carol J. Bradley , Sutter Health Jack DeBraal, Brewer Company Kat Taylor, Equal Rights Center Renee Kielich, Hill

- Rom Company , Inc. Kleo J. King, United Spinal Association Rochelle J. Mendonca, Univ. Sciences Phila Dennis Hancher, VA JB Risk, MPI (via teleconference) Molly Follette Story , FDA June I saacson Kailes, HFCDHP & DREDF Elisabeth George, Philips Healthcare Zita Johnson

- Betts, DOJ Jeffery Baker, MTI Mary Ann Spohrer (via teleconference) Lisa Iezzoni, Boston CIL (Chair) David Hausmann, Hausmann Industries Mark E. Derry , NCIL (via teleconference) Tamara James, Duke Univ . & Medical Ctr. Hans Beinke

, Siemens Medical Solutions Maureen Simonson, PVA Kaylan M. Dunlap, Evan Terry Associates Joseph Drago, Scale

- Tronix, Inc. Don Brandon, ADA National Network ( via teleconference)

**ALTERNATES PRESENT :______________________________________________________**  Austin Schreiber, Stry

ker Medical Janice Carroll

, Sutter Health Richard M. Eaton, MITA Steven Kachelmey er, GE Healthcare Glenn Nygard, Hologic, Inc. Bob Menke, Midmark Corporation Kristen Barry , Equal Rights Center Sarah DeCosse, DOJ

**ACCESS BOARD STAFF PRESENT :_____________________________________________**  Rose Bunales Rex Pace (Committee DFO) David Capozzi James Raggio Marsha Mazz Earlene Sesker

**OTHERS PRESENT:__ _____________________________________________________**  Dennis Monty , Beth Israel Deaconess Med. Ctr. W.E. Martin, Martin Innovations Brian Helms, US Army

HFPA My ra Martin, Martin Innovations Ed Steinfeld, UB IDEA Denise Garcia, INOVA Health Sy stem Michelle Lustr ino, Hologic, Inc. Gloria Romanelli, Amer. Coll. Radiology Ji m Scott, Applied Policy Mary Adams, DOJ Jonathan Young, Midmark Janice Majewski, DOJ Vienal yn Tankiamco Maria Caudill Paul Farber Jim Bostrom, DOJDraft Meeting Minutes 2

Opening Remarks and Approval of Minutes The Committee Chair, L isa Iezzoni, opened the meeting. The committee approved the minutes from its September meeting and did a roll call

. Transfer Surface Size : Presentations and Discussion The Brewer Compan y, Midmark Corporation, and Martin Innovations exhibited exam tables and chairs in the meeting room. Rex Pace gave a P owerP oint presentation review ing the proposed requirements for the size of the transfer surface. He provided informatio n regarding background materials consulted for the proposed dimension s including: comments received from the Disability Rights Education and Defense Fund (DREDF) in response to the U.S. Department of Justice A dvance N otice of P roposed R ulemaking on equipment and furniture ; the dimensions for rectangular seats in roll

- in showers from the 2004 ADA and ABA Accessibility Guidelines ; and the ideal chair width recommended in Architectural Graphic Standards for auditorium seating

. The committee also re viewed anthropometric data from a variety of sources

.

Dr. Edward Steinfeld, Director of the Center of Inclusive Design and Environmental Access at the University

of Buffalo , gave a presentation on the Wheeled Mobility Anthropometry

Project. He provided a brief anal ysis of measurements of individuals using wheeled mobility devices he considered relevant for establishing the width and depth of seating surface s for wheeled mobility device users. Dr. Steinfeld’s data was obtained from subjects seat ed in their mobility devices, not while transferring from one surface to another . Very little data specific to dimensions for transfer surfaces is available to the committee. Nonetheless, the results of the Wheeled Anthropometry

project indicated that a seating surface can have a width of 28 inches and accommodat e the 95 th percentile of the population of wheeled mobility device users studied

. Dr. Steinfeld reported that his research data suggested that a depth of 15 inches would provide an adequate seating surface for the average user in his sample

. Based on the Dr. Steinfeld’s presentation and the dimension s included in the proposed rule , the discussion focused on 28 inches versus 30 inches minimum width. The committee decided that additional i nformation from practitioners is necessary before consensus can be achieved on the width of the exam table transfer surface. The committee also discussed the proposed 15 inch minimum depth. Committee members raised concerns that the proposed depth is too short; they agreed that a 17 inch minimum depth would be more appropriate

.

Committee m embers discussed whether the committee should take into consideration the needs of individuals who are obese in determining the size and capacit y of the transfer surface. Several committee members felt uncomfortable with the word “bariatric” because it presupposes therapeutic choices of persons who are obese . Furthermore, obese individuals require diagnostic services for conditions bey ond their obesit y . Committee members also noted the need to define “obese,” and suggested relying on definitions used by federal agencies, such as the Centers for Disease Control and Prevention. The members decided, although morbidly obese persons can be people with disabilities, th is is a special population with very specific requirements which may not be appropriate for the majority of people with disabilities.Draft Meeting Minutes 3

Permitted Obstructions : Presentation and Discussion Rex Pace gave a P owerP oint presentation outli ning the proposed requirement that the transfe r surface have two unobstructed sides. Mr. Pace focused on the question in the proposed rule about permitting equipment parts located below the transfer surface to extend outward horizontally

for 3 inches maximum. Mr. Pace pre sented an overview of r elevant in formation form “ The Impact of Transfer Setup on the Performance of Independent Wheelchair Transfers ”

, a study by

the University of Pittsburgh and sponsored by the Access Board. The data indicated that a horizontal gap between the wheelchair seat and the transfer surface is more tolerable when the seating surfaces are aligned verticall y. A lthough some committee members expressed

concerns that the sample was not representative of the population of individuals with disabilities

, the committee determined that the 3 inch horizontal gap between the wheelchair seat and the transfer surface in the proposed rule is acceptable provided that the transfer surface height is adjustable allowin g the wheelchair seat to be vertically aligned with the transfer surface. The discussion then moved to equipment that is adjustable and possible low height requirements and associated limitations of the equipment in providing lower heights

. As with the width issue, committee members did not reach consensus regarding an appropriate low height for a transfer surface . They

suggested that input from experienced clinicians could assist decision

- making. The committee agreed that the availability and configuration of transfer supports needs to be addressed in more detail and in conjunction with the transfer surface requirements.

Subcommittees Six subcommittees were proposed at the last meeting: (1) exam chairs and tables; (2) stretchers and beds ; (3) mammography ; (4) imaging equipment with bores; (5) other imaging equipment; and (6) weight scales. After a discussion, the committee decided to proceed with the subcommittees on mammograph y and weight scale equipment. Formation of other subcommitte es was put on hold pending presentations by health care practitioners and imaging equipment experts at the next committee meeting in January 2013.

Committee members volunteered for the subcommittees on mammography and weight scales. Mammograph y subcommittee members are Mary Anne Spohrer, June Kailes, Maureen Simonson and Carol Bradley . Weight Scale subcommittee members are June Kailes, Kleo King, James Drago, John Wells, Kaylan Dunlap, Kat Taylor and Bob Menke. The plan is to notify all committee members about subcommittee meetings, which will be held by teleconference, so
any one can join the discussion.

Public Comment December 3, 2012 Dennis Monty

from the Beth Israel Deaconess Medical Center in Boston reported that his institution formed a patient advisory group with members representing the disability community

. Mr. Monty

also stated that he researched information on the ty pical old exam table and found the width to be 26.5 inches; thus any improvement on that dimension is welcome. Gloria Romanelli from the American College of Radiology suggested that clinician and manufacture presentations be to the entire committee not just subcomm ittees. Dr. Willis Martin described his practice experiences and wh y he designed the exam table and chair on display throughout the meeting. Janice Carroll from Sutter Health stated that they have a value management team that provides input when acquirin g equipment. At the end of this process, which included input fromDraft Meeting Minutes 4

caregivers, patients and clinicians they decided, on tables adjustable within a range of 17 inches to 19 inches in height and that are 28 inches wide. They also suggested that exam tables and weight scales should have a 400 lb. weight capacity. Additionall y, Ms. Carroll voiced concerns for the ergonomic impact on caregivers should the committee recommend a 30 inch wide exam table She also noted that space limitations could preclude the u se of wider exam tables.

Public Comment December 4, 2012 Dennis Monty

from the Beth Israel Deaconess Medical Center in Boston voiced concerns if the recommendations result in ramps to equipment

. Dr. Willis Martin thank ed the committee for the opportunity

to show his equipment and stated that although he owns a very small company

he will support whatever the committee decides. Brad Baker from MTI ( Medical Technology Industries) addressed concerns about a table width of 30 inches minimum and a transfer height of 18 inches. Paul Farber expressed concerns that a requirement for adjustability may prohibit an y incremental manual adjustment.

Future Meetings The committee discussed changing the dates for the next meeting, scheduled for the day after inauguration, because of travel and lodging costs and availability . The committee was given to the end of the week to make travel arrangements and notify Rex Pace or Earlene Sesker of any problems.

Wrap Up and Adjournment The Chair reminded the committee members to make their reservation for the next meeting as soon as possible

. The meeting was adjourned at approximately 2:30.