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The Americans with Disabilities Act has been in effect for more than four years, but many hospitals still are not in compliance with the act's signage requirements. ADA experts caution risk managers to make sure their facilities are in compliance. If not, they could be subject to federal investigations, lawsuits, and substantial penalties.
"Medical facilities should understand that any member of the public can file a complaint against them," says Jack Catlin, AIA, an architect with Loeble, Schlossman & Hackl in Chicago who specializes in ADA compliance.
The ADA requires removal of both architectural and communication barriers in public facilities, including hospitals. Signage falls under the communications requirement of the ADA.
"If the ADA is understood, it is a reasonable law. It doesn't require that public accommodations spend more money than they can afford to remove existing architectural and communications barriers. It does require that they understand that these barriers are a violation of civil rights of people with disabilities and that they should do as much as they possibly can over a period of time to remove the barriers that exist," Catlin says.
Signage actually is one of the easiest components of the ADA to comply with, but many hospitals overlook the requirement or try to approach it on a piecemeal basis, says Hjordy Johnson, general manager of Kroy Sign Systems in Scottsdale, AZ. "What we try to advise hospitals to do is to establish a long-term plan for compliance."
ADA signage experts say the following is a checklist of key areas of compliance for hospitals:
* Function and directional signage -- Letters on the function and direction signs have to comply with the ADA's standards on character size, proportion, height, and finish. According to Catlin, the characters have to contrast with their background. The preferred contrast level is 70 percent, Catlin says. The finish also must be non-glare.
* Permanent-room signs -- Permanent rooms like offices, clinics, and patient rooms must have tactile signage. Under the ADA, permanent rooms are those that have had the same designation for 30 days, Johnson says.
Hospitals must consistently apply the method of designating permanent rooms. For example, all permanent-room signage can be designated either by name ("Eye Clinic") or room number ("Room 300"), but not both, to avoid confusion and maintain consistency. In addition to complying with standards on size, height, and finish, Catlin says permanent-room signs must be raised to 132 of an inch and have corresponding Braille characters.
The ADA also specifies the placement of permanent room signs, says Joseph Fleischer, president of New Style Signs in New York City. The identifying sign must be placed 60 inches above the floor, measured from the center of the sign.The signs also must be mounted on the side of the door with the latch or door handle and not the hinge side.
* Access signs -- Handicapped-accessible parking spaces, passenger loading zones, and entrances must be identified with the international symbol of access if the entire facility is not accessible. If entrances, parking spaces, and loading zones are inaccessible, hospitals must provide a sign at the inaccessible entrance indicating the location of the accessible entrances, Catlin says. These directional signs also must comply with the ADA requirements on height, size, and contrast. [See symbols marked (a) and (b) on p. 35.]
* Restrooms --- If every restroom in the hospital is accessible for handicapped people, Catlin says the international symbol of access does not have to be used. If only certain restrooms have been fitted for handicap use, Catlin says the access symbol then must be used to demarcate the appropriate facilities.
* Elevators -- Elevator control panels must contain Braille indicators for floor buttons, emergency controls, and alarms. The emergency telephone or speaker system should have tactile signage. The sides of the elevator doors must have two-inch high letters indicating the floor number. The sign also should be raised, in Braille, and be placed 60 inches from the floor to the center of the sign.
* Fire safety -- Fleischer says all fire-safety signs have a Braille component. They should be placed on both sides of doors leading to and from staircases. Each floor must contain these signs.
Some states have additional requirements for staircases, including designating whether the doors are permanently usable or for emergency use. Fleischer advises risk managers to check with an ADA expert in their state to confirm whether any such additional requirements apply.
* Assistive listening devices -- In addition to providing such devices on telephones and in auditoriums, hospitals must properly designate these devices. Catlin says the hospital must provide signage indicating that such devices are provided and where the devices are located. The ADA has specific symbols that must be used to identify telephones or headsets. [See (c) and (d) on p. 35.]
* No smoking -- Fleischer says no-smoking signs are "a gray area" under the ADA. He advises risk managers to make sure that any such signs comply with the act's requirements and include a Braille component.
* Vending machines -- All signs providing information about vending, snack, and soda machines also must comply with the ADA and have a Braille component, Fleischer says.
ADA experts advise risk managers to have an audit of their hospital's signage done if they are not sure whether their facility is in compliance with the act. Most architectural and signage firms can audit a hospital for compliance with the ADA's signage requirements.
Johnson says that depending on the size of the facility, an audit can be done from the facility's blueprints. She says that the survey should show the minimum signage required for ADA compliance. If the facility is large or is part of a complex, Johnson recommends an on-site audit.
The signage auditor should provide the hospital with a document that shows the location of each required sign and the type of sign mandated by the ADA. *
Interested in additional information on complying with the Americans with Disabilities Act? Information is available from the following organizations:
* Office on the American With Disabilities Act, Civil Rights Division, U.S. Department of Justice. Telephone: (202) 514-0301.
* Architectural and Transportation Barriers Compliance Board, Washington, DC. Telephone: (800) USA-ABLE.
* Kroy Sign Systems' ADA Signage Information Booklet is available by calling Deborah Smith at (800) 733-5769.
* Americans with Disabilities Act Accessibility Guidelines "Medical Care Facilities" techsheet is available from the Federal Disability and Technical Assistance Business Centers by calling (800) 949-4ADA. *