ADA Website Compliance For Acupuncturists

ADA WEBSITE COMPLIANCE: AN AFFORDABLE PLAN FOR ACUPUNCTURISTS

You work all day in your clinic with the best intentions, providing effective therapy with compassion for all. You don’t mean to discriminate or exclude anyone; you serve everyone who comes. Regardless of these good intentions, you may unwittingly be excluding people with various disabilities. And now, that exclusion can get you in trouble.

THE PROBLEM:

Acupuncture Today  claims, “by the end of January 2021, about a hundred healthcare providers including more than two dozen acupuncturists in California had been named in lawsuits alleging ADA violations for unequal access to healthcare services because their public websites did not include or support accessibility programming and software for users with a disability.”

It’s been reported at least 140 acupuncture clinics have been disrupted by demand letters or claims filed against them for website violations and settled out of court.

Seyfarth Shaw LLP reports the total number of federal lawsuits concerning ADA Title III has more than tripled since 2013. Just under 11,000 were filed in 2020. January 2021 saw the most suits ever filed in a single month: 1,108. While these numbers include lawsuits filed on all grounds – physical facilities, websites and apps – they are staggering, and the trend is evident. In 2018, 25% of these suits concerned digital accessibility.

Though this applies to all businesses and commercial websites, those in healthcare are drawing a lot of attention. It’s great that acupuncturists are considered healthcare providers under the law,  but it makes them as vulnerable as gynecologists when it comes to lawsuits of this kind.

While the spirit of the law is good, the ADA has created a potential goldmine for opportunistic lawyers and professional plaintiffs. If you were to be served, you would be liable for any legal fees and the cost of bringing your website into compliance. Whether they win, lose, or settle a case, the lawyers still make their money.

In California and New York, plaintiffs stand to profit as well; they can sue for statutory damages in these states. California Civil Code allows for payment of $4,000 for each denial of public accommodation (i.e., each violation on your site) or three times the “actual damages,” whichever is greater. Their profit could be at your expense.

WHAT IS ADA COMPLIANCE?

The Americans with Disabilities Act was signed into law in 1990. This civil rights law intends to prevent discrimination and ensure access for everyone in all areas of public life. It is a “strict liability law”; there are no excuses for non-compliance. Employment, education and government are all covered under different titles. Title III addresses “places of public accommodation” and is the one we are concerned with.

The focus was on physical limitations to begin with – wheelchairs, parking, restrooms, etc. Because internet access is now essential to navigating the world, most federal judges consider websites “places of public accommodation” as well.

If your business is represented on or accessed through a website, that website is expected to be accessible to all people, regardless of their disability.

According to Online ADA, more than 90% of websites do not meet this standard and are vulnerable to legal action.

How did this happen? Why haven’t websites been built to serve all people? Since rules regarding online access were unclear, and ADA emphasis in the early days was on physical remediation, online compliance was not a priority. Software engineers and web developers focused on increasing sophistication and features for websites – video integration, changing images, and layered visuals. That everyone might not be able to appreciate these features was overlooked.

Inequity and lack of awareness are woven into the fabric of our lives. It affects digital innovation as much as anything else. We are now being pushed to make amends by threats of expensive lawsuits, but remediation is the right thing to do, regardless.

Imagine your eyesight was really poor. How would it be to read web pages with small font, low contrast, and long paragraphs? What if you were actually blind? If a site is not compatible with screen-reader technology that converts text to voice, you’re not going to get anywhere. It’s frustrating for the user and bad for business.

Categories of disability are: visual, auditory, speech, cognitive (like down syndrome), neurological (as in ADHD or seizure disorders), and mobility (i.e., cerebral palsy or amputation). Each of these groups has special considerations that need to be addressed. For instance:

  • Those who are unable to use a mouse require easy navigation with tabs and directional keys.
  • They should not have to tab through repeated text elements (like the footer) on every page.
  • Links should stand out for the visually impaired.
  • Motion on the screen must be modified for the neurologically challenged user.
  • All videos must have captions for the deaf and hard of hearing.
  • There should be a seamless interface between your site and other assistive technologies.

WC3, WAI, WCAG – WHAT?

The ADA –  as it applies to websites – is vague. The Department of Justice’s rule-making process (which would interpret the law) has been on hold since 2017. US Courts have relied on the World Wide Web Consortium (W3C) and its Web Content Accessibility Guidelines (WCAG) to determine compliance.

W3C is a non-profit organization founded in 1994 by Tim Berners-Lee – the same man who invented the web in the first place. W3C’s mission is to “lead the world wide web to its full potential.” Part of reaching that potential is to make sure it’s accessible to everyone.

To that end, they created the Web Accessibility Initiative (WAI), which in turn developed the WCAG.

There have been a few versions of these guidelines, and there will be more in the future. Currently, WCAG 2.1 AA is the standard. (This is important to know. When you choose a program to make your website compliant, be sure they are using  this version and not an older one.)

WCAG includes “natural information” – text, images… things we can see and hear AND the digital code that defines a website’s structure and presentation. This is the sticky part: it’s mainly in the code. In fact, the guidelines are primarily intended for developers, says the W3C.

So you, the expert acupuncturist, need some expert tech support. THIS IS NOT DIY.

HOW IS WEBSITE COMPLIANCE DETERMINED? 

There are 50 criteria in the WCAG 2.1 AA. To be fully compliant, your site must meet all fifty criteria.

What level of compliance is “good enough”? There is no standard answer at this time.

Compliance audits are done either manually (by an expert who evaluates all the relevant code) or with an automated “scan” of your site.

BTW, anyone can use a free scanning tool like WAVE to discover compliance errors. Though we would hope that any complaint comes from a genuinely disabled person who has been frustrated by your site, it may come from a lawyer or “professional plaintiff” just fishing for trouble. Even though WAVE/WebAIM policy expressly states its not meant for legal or litigation purposes, this could be the way trouble starts.

You can scan your own site with the WAVE tool and see what you get. But be aware that this free tool is not regularly supported by paid developers and falls way short of a professional audit. We’ll talk more about automated scans and accessibility overlays in the next section.

YOUR ONLINE ACCESSIBILITY PLAN:

AN AFFORDABLE STRATEGY TO MAINTAIN YOUR ONLINE HEALTH

Find the problems, fix them, and let your visitors know you’re doing your best. Demonstrating due diligence is the best way to avoid unwanted attention.

Unless you’ve received a demand letter concerning ADA compliance, you probably don’t need a full manual audit or certification.

We recommend this proactive, 4-part strategy to bring your website into compliance with the ADA and make it accessible to all your potential patients.

1. WRITE A COMPLIANCE STATEMENT

This is your opportunity to communicate your commitment to accessibility. It’s the DIY part!!

In fact, you could do this first. It’s like posting a “we’re working on it” sign.

  • State your commitment to accessibility
  • Describe your plan for making the site fully accessible. If you are aware of specific problems, mention them.
  • Provide clear contact information. Encourage feedback and ask to be notified if your visitor encounters accessibility challenges.
  • Put the link to your statement in a prominent place, like the footer that shows on every page of your site.

Here’s an example of a simple statement that includes all basic recommendations.

Once you have implemented the rest of our suggestions, update this statement to include:

  • Accessibility standards applied: WCAG 2.1 AA.
  • Conformance status: describe your current status and implementation strategies. For example: “We are fully compliant with WCAG 2.1 AA and scan our website regularly to maintain compliance.”
  • If there are parts of your website that are not fully compliant and may cause frustration for your users, describe them in plain English and include suggestions to remedy the issue.
  • Publication Date: revise this each time you update your statement.

Here are two examples of complete Accessibility Statements:

  • Serene Oaks Dental covers all the bases and adds additional resources. They include accessibility info for Adobe plugins. They list browsers with built-in access tools and links to various screen readers that work well with their site. It feels as though they really want to help.
  • Jory Integrative Medicine is thorough, not DIY, and emphasizes the Audioeye tool and their Accessibility Certification.

2. USE THE BEST ACCESSIBILITY OVERLAY

An overlay is a software package that automatically scans for compliance errors, and may be able to fix some of them. It typically includes an overlay toolbar that helps users with disabilities navigate your site.

Buyer beware! Not all overlays are created equal. The ones that promise you 100% ADA Compliance are overstating their capabilities. Also, the companies that develop these overlays are not likely based in the United States; their knowledge of our specific laws may be lacking.

Buyer beware! Not all overlays are created equal. The ones that promise you 100% ADA Compliance are overstating their capabilities. Also, the companies that develop these overlays are not likely based in the United States; their knowledge of our specific laws may be lacking.

Most overlays cost about $500/year and share the basic features mentioned above. There are a few main players, and with a simple search for “Accessibility Overlays,” you will easily find them.

In our opinion, the best overlay is MAX-ACCESS.

  • It detects all compliance errors.
  • It automatically fixes 70% of them.
  • It gives specific code for the remaining 30%. Give this information to your developer for manual remediation.
  • It scans at regular intervals and reports additional errors.

It also puts an overlay toolbar on your site to adjust the user interface and improve accessibility. The toolbar allows visitors to change font and contrast, highlight links, and more. It also makes your website tab-navigable for those who do not use a mouse.

Online ADA Accessibility Overlay MAX ACCESS

MAX-ACCESS includes a screen reader, training videos to build awareness for your staff, detailed reports for you and the company doing your manual coding work. They also generate a compliance statement you can post on your site.

ADA Online, the company that developed MAX-ACCESS, is based in Eugene, Oregon and keeps current with the US legal landscape.

3. ARRANGE FOR REMEDIATION

Once you have the report of code errors that require manual remediation, get it to your web developer or chosen expert to make the necessary changes.

Ask your developer about their experience with ADA website compliance and the WCAG.

If you’ll be hiring someone new to assist, be sure they are an ADA expert.

4. PLAN FOR ONGOING MAINTENANCE

You will need periodic scans and remediation as your site changes, even in minor ways. Posting a new blog article, video, adding images,  or buttons – basically, anything that adds code to the site – can cause a new error.

An overlay that screens routinely is a good solution. When it finds errors it can’t fix, just send the report to your technical person for remediation.

Remember to update your compliance statements periodically as well.

ADA COMPLIANCE COST

Manual audits cost upward of $3,500, and remediation starts at about $4,500. If you’ve received a demand letter or are involved in litigation, your legal counsel can advise you on the best route to take.

If you are addressing the issue before it becomes a problem, you can save a lot! MAX-ACCESS will cost you about $450 per year, and initial remediation will probably be 5-20 hours’ work for your developer.

Simplified Website Design, offers an ADA Compliance Service Package. We will address your obvious compliance issues without breaking the bank.

You can receive a tax credit to cover the cost of compliance. It’s definitely worth pursuing!

In Closing

We understand if this seems like a lot. It is. As an acupuncturist, you don’t need one more business stressor when your real job is caring for your patients. But accessibility is important… for your protection, and as a contribution to a culture shift toward equity for all.

Many are speaking out these days to make sure our differences are acknowledged and valued. ADA website compliance is another way you – a healer and a business person – can make a stand for what’s right. Follow the steps outlined above; you’ll be on your way. And of course… let us know if we can help.

DISCLAIMER:

These suggestions are not a substitute for legal counsel, nor are they universally accepted. Simplified Website Design provides development and remediation services only.

RESOURCES:

WC3 Accessibility Fundamentals

WCAG Overview

DIY:

WordPress Blog

Microassist Accessibility Checklist

ACCESSIBILITY STATEMENTS:


Author Amy Colo

Author Amy Colo

I’m Amy Colo… SEO Content Writer, Health and Wellness Expert and Outdoor Enthusiast. I write clear, compelling content that gets attention.