July 11, 2003

Physical therapist ushers in new wheelchair law

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From left, patient Fred Dinwiddie, physical therapist Jenny Robison and Darren Jernigan of Permobil wheelchairs and who is also a patient, were advocates for the new wheelchair law.

Physical therapist ushers in new wheelchair law

Vanderbilt physical therapist Jenny Robison recently saw a year of political activism come to fruition when Tennessee adopted the nation’s first consumer protection law for wheelchair buyers.

Prompted in part by her annual need for a professional project that would help her maintain her standing as a physical therapist IV — the top wrung on the career ladder developed by Rehabilitation Services — Robison took the legislation from concept to law in about a year. She started on her own in spring 2002, then partnering last summer with a like-minded wheelchair manufacturer.

In efforts followed closely by advocates and lawmakers in other states, Robison’s group drafted legislation, hired a lobbyist and generated political support across the state. On May 22, Governor Phil Bredesen signed the Consumer Protection Act for Wheeled Mobility into law.

“Not many people thought it would pass this year,” Robison said.

Before this act, there was no requirement for suppliers to show competence in matching customers with the right wheelchair. Stirred in part by growth in Internet sales, consumer protection for wheelchair buyers has been talked about nationally for a few years among physical therapists, vendors and manufacturers.

Many people spend all day in their wheelchairs and the common problems caused by getting the wrong chair include orthopedic deformation and pressure sores that are painful, debilitating and slow and costly to heal. Prices for rehabilitative power wheelchairs start at around $5,500.

“Every day in our practice we see patients who’ve been given the wrong equipment,” said Robison, who practices in the wheelchair/seating clinic. “Buying your first wheelchair is like buying your first car, only, as I told the senators, when you buy a car you have a sense of what you want, but with a wheelchair you’re at the mercy of the supplier.”

Besides protecting patients, the law protects taxpayers from potential TennCare expenses for treating medical problems caused when enrollees are placed in the wrong wheelchair.

The Tennessee law pertains only to high-end equipment, that is, power chairs, scooters and custom manual wheelchairs. By July, vendors will need someone on staff with at least 15 hours of education in seating and wheelchair mobility, and by 2007 they’ll need to have someone on staff certified as an assistive technology supplier; a standardized test for this certification has been in use since 1995.

In the course of drafting the law, obtaining sponsorship for the bill, lobbying and testifying before lawmakers, Robison became familiar with our political process.

“I learned you’ve got to know people and you’ve got to have some money,” she said. She would have preferred somewhat more stringent and comprehensive protections, but she ultimately backed compromises to help the bill become law more quickly. “It’s a start,” she said. “It’s not perfect, but it’s better than what we had, which was nothing.”

Robison began by gathering therapists and representatives of patient advocacy groups for a series of meetings to draft legislation. Last July, she was contacted by Darren Jernigan, government affairs director at Permobil, a wheelchair manufacturer with U.S. headquarters in Lebanon, Tenn. Jernigan gathered money to hire a lobbyist. During this year’s legislative session, Robison was at the Statehouse weekly to help lobby. The team won sponsorship for the bill from Democratic Rep. Mike Turner and Democratic Sen. Don McLeary.

Fred Dinwiddy, who has quadriplegia, helped draft patients for the letter-writing campaign and was on hand to help lobby legislators. He was confined to his bed for two years after being sold the wrong wheelchair cushion by a salesman who ignored or wrongly interpreted his medical history. He was referred to the VUH subacute care unit for treatment of pressure sores caused by the chair, and to Robison in the wheelchair/seating clinic for help in correcting the cause of the problem. All tolled, his bills for treatment and rehabilitation came to $360,000.

Robison and her group sent every Tennessee legislator the figures from Dinwiddy’s medical bills.

“It got their attention,” she said.

Robison was encouraged early on by medical equipment vendors, nursing homes and home health agencies, but the statewide association representing these groups later formed opposition to the bill.

“They’ll realize the benefits in the long run,” she said.

According to Robison, advocates in a number of states are preparing to follow Tennessee’s lead. Therapists themselves generally are under-trained on matching people with appropriate wheelchairs. Robison hopes for future laws requiring physical therapists to be certified as assistive technology practitioners; Robison is one of only 25 therapists in Tennessee who have completed the certification.