June 6, 2022
Dr. Jonathan B. Perlin
President and CEO
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Dear Dr. Perlin:
A belated congratulations on assuming the leadership of The Joint Commission this past March! The National Council on Disability (NCD) had the pleasure of working with Dr. Chassin in that role last fall before his departure, along with many others of The Joint Commission’s leadership team to address issues affecting the health equity of people with disabilities. We look forward to continuing that collaboration with your staff under your leadership. The purpose of this letter is to request a meeting with you and your leadership team to continue these critically important conversations.
In case that you are not familiar with NCD, we are an independent federal agency charged with advising the President, his Administration, Congress, and federal agencies on all policy matters affecting people with disabilities in the United States and in our territories. In furtherance of our mission, on February 14, 2022, NCD issued its Health Equity Framework for All People with Disabilities (Health Equity Framework). The Health Equity Framework is a blueprint for our federal leaders to comprehensively address the significant and pervasive health disparities existing between people with disabilities and those without. We recognize, however, the federal government alone cannot achieve health equity for people in disabilities. Certifying and accrediting bodies have a significant role to play in advancing health equity for all people, including people with disabilities.
As we were developing the Health Equity Framework, we met with several members of The Joint Commission’s leadership team to address, inter alia, the absence of comprehensive disability clinical-care curricula and training throughout the entirety of medical students’ undergraduate and graduate education and training, including the absence of such training in residencies and fellowship programs. NCD found it inconceivable that physicians could be board certified across all specialties and not ever have treated a patient with a disability. The absence of such education and training results in persons with disabilities receiving less thorough care than their nondisabled counterparts, diagnostic overshadowing, perpetuates health disparities, and contributes to the paradigm of persons with disabilities utilizing the healthcare system for disease management versus disease prevention. The absence of such education and training significantly compromises patient safety.
We were pleased to learn last October that The Joint Commission was undertaking its own health equity initiative. As part of that initiative, your staff communicated with NCD that inclusion of specific survey elements that measure the accessibility of a healthcare facility subject to The Joint Commission's accreditation and certification may fit well with that initiative. NCD and The Joint Commission continued a dialogue addressing the need to survey the availability and use of accessible examination tables, examination chairs and equipment available for diagnostic procedures; the selection process for determining appropriate auxiliary aids and services for patients who are Deaf and hard of hearing; and the appropriateness of when to utilize video remote interpreting equipment. As of last October, we were informed that a number of our recommendations were being considered for adoption by The Joint Commission.
We also discussed the possibility of including within The Joint Commission’s Standards a tracer of patients with varying disabilities to assess their ability to obtain care and treatment at surveyed facilities. The Joint Commission conveyed to us the challenges of identifying the universe of specific situations to which a standard like that may apply, but that it will continue to educate its surveyors. Suggested clinical prompts to address patients with disabilities and complex co-morbidities might include the creation of treatment plans that address these issues (which may differ from the plans for patients without disabilities presenting with the same diagnosis); identifying atypical communication styles and abilities and being prepared to interpret and respond; identifying the Direct Support Professional, if any, assigned to the patient’s hospital stay and being appraised of their knowledge and familiarity of the patient’s history and abilities; and creating discharge plans that reflect the skills and medical-legal support available at the patients residential destination.
Most importantly, while we understand the challenges associated with revising Standards to address the neglected healthcare needs of people with disabilities, we urge The Joint Commission to at least revise Standard PC.01.01.01, to require hospitals to accept a patient with a disability for care, treatment, and services based on its ability to meet the patient’s needs for which treatment is sought; the ability to perform the sought-after care and treatment with appropriate accommodations; and the ability to demonstrate a sensitivity to the ancillary needs of the patient (including respectful nomenclature, supported decision making, and knowledge of patients’ rights).
As part of this renewed conversation, we want to encourage The Joint Commission to make a meaningful public announcement of its actions and plans to address health equity for persons with disabilities in furtherance of its health equity initiative. We believe that the proper messaging will really move the needle in addressing health equity for people across all categories of disabilities. NCD would be happy to partner with The Joint Commission in any such public announcement and or event. With the 32nd anniversary of the signing of the Americans with Disabilities Act around the corner - July 26 - a public announcement coinciding with that anniversary will be significantly impactful.
Finally, we thank The Joint Commission for recently reaching out to NCD to collaborate in drafting and issuing a Sentinel Alert on strategies to avoid Diagnostic Overshadowing. The over attribution of presenting signs and symptoms to the syndrome or disabling condition (e.g., attributing dementia to a patient with Down syndrome and thus overlooking the potential for a urinary tract infection, which can replicate the same signs and yet is treatable) is pervasive and leads to inadequate care, poor treatment outcomes and increased mortality.
I look forward to hearing your thoughts regarding these requests. Amged Soliman, NCD Senior Attorney Advisor, is our point person on this project. He will call your office on June 15, 2022, to coordinate a date and time for a 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 our continued collaboration.
Andrés J. Gallegos
Cc: Ms. Margaret Van Amringe, The Joint Commission, Executive Vice President, Office of Federal Relations
 Available at: https://ncd.gov/publications/2022/health-equity-framework