Hiring a person with disabilities in a dental practice

Consultation Agreement Persons with Disabilities and the Dental Office of Drs. Wicklund, Howe and O'Donnell (WHO)

Consultation Agreement: WHO

Drs. Angela Wicklund, Marianne Howe, and Brendan O'Donnell are three general dentists whose practice serves a large suburban community. The practice is open to patients of all ages. In addition to the dentists, the practice includes two full-time and one part-time dental hygienists, three full-time dental assistants, and two full-time office staff. When one of the assistants or office staff is absent, either due to illness or vacation, the practice utilizes the skills of one of their patients, a stay-at-home mom who is a trained dental assistant who welcomes the opportunity for temporary employment.

The employers sought a consultation about employing a person with disabilities. One of the office staff is retiring, and someone will have to be hired to take her place. The dentists have a candidate they are seriously considering, a woman who has had over ten years experience in dental practices. The dentists sought a consultation on persons with disabilities. They had questions about their responsibilities with respect to employment. They wanted to know what the law required them to do and whether there were any tax advantages to the practice associated with hiring a person with disabilities.

The candidate, Mrs. C., had been in a car accident and was seeking employment following her release from the hospital and months of physical therapy. She is wheelchair-bound but has full use of her upper body. Cognition is not impaired. With her bookkeeping background and experience specific to a dental practice, Mrs. C. was the strongest candidate that the dentists interviewed. She has a very pleasant personality and the dentists felt she would work well with other staff members and be an asset in dealing with patients. Drs. Wicklund, Howe, and O'Donnell requested a consultation in order to be better able understand the challenges and responsibilities associated with Mrs. C.'s employment, should they make the final decision to hire her.

Consulting vs. Counseling

A consultant is a subject-matter expert hired by an individual or organization to provide information for decisions. People or organizations that hire consultants (consultees) use the consultants to help them make improvements to products or services that they provide to their clients. In this way, consultants work with clients only indirectly. Counselors, on the other hand, work directly with the individuals or groups that the changes and improvements will benefit. Counselors provide the guidance that their clients need in reaching specific goals.

The dental practice needed a consultant, not a counselor, to provide information and help them navigate the rules and regulations that govern employment of a person with disabilities. I worked directly with the practice in this role, offering a structured decision-making plan.

Consultation

Accessibility and ADA Compliance

The U.S. Department of Justice maintains a website providing information and technical assistance on the Americans with Disabilities Act. I suggested that the principals of the practice familiarize themselves with the information the website provides. The key areas for the practice involve Mrs. C's access to the building and accommodations to her work area.

The dental practice is located in a small, three-story building which houses other professional offices. The parking lot already has designated spaces for the handicapped. It was suggested that since Mrs. C. would be using one of the spaces every day that another space be added to accommodate patients and clients visiting the office building. Mrs. C. would need a van-accessible space; guidelines for delineating this space are available on the ADA's website. The dentists would have to meet with the building's management company to discuss how the creation of the extra parking space would be accomplished. The parking lot is large enough to accommodate a van-accessible space, so no construction would be required. A section of the parking would have to be reconfigured for use by Mrs. C.; this could be accomplished by delineating the new parking spaces with paint and signage. The building management company would hire the contractors for the job, with the dental practice bearing the full cost.

The office building is a new one and therefore has met ADA requirements for access by the handicapped; doorways, hallways and restrooms are all in compliance, so the dental office does not need to do anything further outside its walls to accommodate Mrs. C.

Inside the dental office, there is a large reception area that includes counter space where patients check-in, make appointments, and arrange for payments. There are built-in work counters for the office staff; these will be refitted to accommodate Mrs. C.'s wheelchair. A seldom-used storage closet adjacent to the office area could be opened up to create more space for patient files, which would have to be relocated to shelves newly constructed to accommodate Mrs. C.'s reach. Contractors estimated that the construction work could be completed in two days.

Disability Prevention

I was unable to identify major risk factors for illness and injury in the office of the dental practice. The office building was in compliance with ADA regulations and the practice could achieve compliance with relatively little expense and disruption. Employees of the building are routinely exposed to the public and, because the building houses doctors' offices, there are people regularly using the facilities who present with symptoms of contagious ailments such as cold and flu. The potential risk to Mrs. C. is not any greater than it would be to employees who are not disabled.

Disability Management Programs and Practices

The job-match model for disability management (Pransky, Franche, and Clark, 2004) provides a framework for the dental practice to make the accommodations to the physical space needed to ensure that Mrs. C. would be able to do her work. The biomechanical considerations of the job would be easy to determine, since the routine of the job is well-established and "ergonomic risks are easily defined" (Pransky et al.). The work space was originally designed with efficiency in mind. Any office staff member could easily access the patient window, telephone, computer, and patient files without getting up from the standard office chair on wheels. Although Mrs. C. would need a wider space in which to move, the basic configuration of the office could stay the same.

Consultation Model

The organizational model was best suited for the consultation with the employer. Mrs. C. does not need education and training beyond what would normally be provided any new employee with regard to policies and procedures specific to the practice of Drs. Wicklund, Howe and O'Donnell. The dentists knew about Mrs. C.'s physical limitations and agreed to make the necessary accommodations to the parking lot and the office space where Mrs. Co would be working. Since accommodations required some construction work, part of the consultation involved managing the disruption to the practice and ensuring its effects were minimally experienced by staff and patients.

Consultation Steps

Before

To prepare for the consultation, I would create an outline of issues to be discussed with the principals of the dental practice. As has been shown, these issues would include employer benefits to hiring a person with a disability, sources for guidance to which the dentists could refer, and a discussion of the physical accommodations that would have to be made. I would contact the building management company to find out whether the practice would be responsible for soliciting bids for the parking lot and office modifications or if that was a matter handled by the company. I would find out if the management company already had an established list of contractors they used for this kind of work. I would contact one or more contractors, depending upon requirements of the management company, to get some rough cost estimates for the parking lot and office renovation so that I could present that information to the dentists at the consultation. I would also find out from the management company how they planned to notify other tenants in the building of the proposed changes to the parking lot. I would have to determine whether the management company would handle all matters pursuant to the changes or whether they expected the dental practice to have any role in these actions.

During

During the consultation, I would discuss benefits, accessibility and compliance, disability prevention, and disability management. The consultation would include a detailed inspection of the physical space. I would answer questions raised during the consultation and note any and all questions requiring further research to answer. The dentists were confident in Mrs. C.'s abilities to do the work required of her in the office. Their concerns were with respect to the costs of necessary changes to the parking lot and office space and any tax benefits associated with the renovation. I would provide this information during our meeting.

We would also discuss the best way to implement physical changes with minimum disruption to the practice and other tenants in the building. Before the consultation, I would have spoken to the management company about the parking lot and would have the information I needed to communicate to the dentists about their role in making changes and associated expenses. We would determine during the consultation the best time for construction work to take place in the office

After

After the consultation, I would provide to the consultees a written report summarizing the meeting. The report would include my recommendations, a list of resources, and answers to questions raised during the consultation that were not answered at the time. The consultant's report should consolidate the information needed by the practice to make an informed decision about hiring a person with disabilities.