THE MOST CAPTIVE CONSUMERS
Medsger, Betty
The most captive consumers At the mercy of the wheelchair barons He was driving this chair in the cemetery in May 1973 when the right wheel suddenly fell off. Mason was thrown to the ground, and...
...What if E&J, the Bureau's de facto standard setter, had a new chair or a new part, such as a wheel, that needed pre-market approval...
...One VA official, Donald Wright, says, "We shaped the industry...
...Instead, each morning he is lifted into a car, driven to work, and lifted into the power wheelchair he keeps at his office...
...This accident, coupled with many others he experienced while riding the Remarkable Mark 20, eventually caused him to suffer insomnia, loss of appetite, listlessness, and depression...
...Mason concluded his Remarkable Mark 20 was expensive, unreliable, and dangerous...
...They are dependent on wheelchairs whose stagnant design and exorbitant prices have been set by Everest and Jennings and reinforced by decades of Government policy...
...The Veterans Administration led the way...
...The quid pro quo seemed clear: Stop suing, help manufacturers defend themselves against allegations of unsafe chairs, or they won't improve your wheelchairs...
...Only a newly invented wheelchair or a major new wheelchair part must have pre-market approval by the Bureau...
...The public has until June to protest these proposed permanent classifications of wheelchairs...
...Furthermore, E&J has attempted to buy three of the six other companies that have manufactured wheelchairs in the United States since 1950, according to Justice...
...The wheelchair may be the only vehicle besides the wheelbarrow that 'The Justice Department...
...E&J started in the best traditions of Horatio Alger corporate life...
...The suits, still in litigation, make the same claims of monopoly and anti-trust violations made by the Department of Justice...
...Several frightening minutes passed before a passerby pushed the chair off the road...
...f "Patient died of third-degree burns while sitting in wheelchair...
...In a 1975 deposition taken in a lawsuit brought against E&J by a wheelchair user, officials of the company testified under oath that they thought there were no written quality-control programs at their plant and that they knew of no trade association standards for wheelchairs...
...Otherwise, they can't get out of bed, go unassisted to the bathroom, cook, attend school, or go to work...
...In 1967, E&J's attorney wrote to the SEC that "the sole and singular purpose" of capturing the European wheelchair market "was to prevent some other manufacturers, based in Europe, from exporting wheelchairs to the United States in competition with those made by Everest and Jennings, Inc...
...Government...
...Wright and a colleague wrote ten years ago that VA policy "stifles creativity in development and severely restricts the use of new materials and construction methods...
...District Judge Manuel Real in Los Angeles, required no admission of wrong-doing by E&J...
...But normal black bike tires can be used on wheelchairs and are more durable than gray tires...
...The owners sold out to E&J...
...It's the same problem with making buildings accessible...
...The handicapped people don't think about the cost...
...Then, he said, he would be able to tell a manufacturer, for example, "according to regulations a crossbar should not break in a year, but this one broke sooner...
...a pair of black tires costs $7.96 at the Schwinn bicycle shop...
...Wright and others at the VA's Prosthetic Center in New York have been urging the VA for a decade to rewrite its specifications...
...It took 106 days to get it fixed...
...Now, instead of listing exact specifications of construction, it emphasizes standards of performance — how long parts should last...
...His friend, Harry Jennings Sr., a mechanical engineer, built a wheelchair at the workbench of his West Los Angeles garage...
...After forming the European beachhead, E&J went to Canada...
...I don't tell them about anything except E&J," one Northern California dealer said...
...May's oldest chair is no longer functional, so he cannibalizes it for parts to repair his remaining chairs...
...The wheelchair is electric with hand controls...
...The late Harry Jennings Sr...
...Physicians, engineers, manufacturers, dealers, Government representatives, and wheelchair users gathered in Washington to offer recommendations, including such ele'No agency regulates them, and nobody recalls them...' mentary improvements as spring suspension, which would be particularly valuable for users with painful disabilities...
...Recently wheelchair users thought they might get some help from a new Federal agency — the Bureau of Medical Devices of the Food and Drug Administration, created two years ago to regulate medical equipment...
...They injure and immobilize their users...
...To mine the rich VA market, all other companies had to imitate E&J...
...An older couple placing flowers on a grave saw the toppled chair and ran to help...
...Becky Heinrichs, a thirty-one-year-old secretary in Bakersfield, California, a paraplegic since birth, is puzzled by this lack of innovation...
...The proposed consent decree, rejected in December by U.S...
...Later, he said his lawyer advised him not to be interviewed because two other lawsuits were also pending...
...Wheelchair users' lives are shaped by an ironic disparity in technologies...
...He no longer "walks" alone to work...
...As for the wheelchair users, he declared, "They felt society owed it to them because they were handicapped...
...Such lobbying, said Wilson, "would encourage manufacturing organizations to consider the problems of the physically impaired...
...The process is reversed at the end of each working day...
...The result was the prototype of the Everest and Jennings wheelchair...
...A Schwinn bicycle shop sells the same gray tires at retail for $10 a pair...
...Everest and Jennings likes to pretend it is pressed to the wall by tough rivals...
...E&J wanted this approved by the VA, so the standards said steel...
...Patient was a quadriplegic so could not get out of the chair...
...The controller alone on a new power chair marketed last year by Everest and Jennings costs $1,000...
...They found that identical Everest and Jennings manual wheelchairs sold in the United States for more than three times their British price...
...That was an important development — a chair that could fold like a camp stool and be placed in the back of a car to give a disabled person more potential mobility...
...Acid from its battery spilled on him and soaked his clothes...
...By comparison, the technology of making life tolerable for the survivors has been the Government's neglected afterthought...
...The physically disabled, once thought of as a small and hopeless band of aging war veterans and the senile, are, in fact, a growing population...
...The suit had originally called for E&J to divest itself of its foreign subsidiaries...
...Joel Nobel, director of the Institute, said he was approached by a large national organization of disabled people who wanted wheelchairs tested for safety and durability, but they could not provide the $500,000 he said was needed to conduct the testing...
...But whether the stimulus is criminal greed or cruel neglect, the result is the same: Wheelchair users remain the most captive consumers in America...
...The delays benefit the industry, whether intentionally or not: Most American wheelchair users must buy a second chair in order to be mobile during repairs...
...its major patents expired...
...But the standards for such chairs will apply only to the electrical parts, said Roberts, because the chairs are structurally sound...
...The corporation agreed not to prevent its foreign subsidiaries from exporting wheelchairs to the United States if the foreign subsidiaries should choose to do so...
...Nonetheless, the Federal Government — the biggest single customer for wheelchairs — has been a partner in creating monopolistic conditions and lack of innovation during the last forty years...
...Users also found hope in a Federal anti-monopoly suit against E&J — a suit the Justice Department has tried to settle on terms that would leave the corporation's dominant market position even more secure than it was before...
...It took two or three weeks to get it repaired...
...They wanted the VA to describe how a chair should perform and how durable it should be rather than what it should look like or exactly how it should be constructed...
...Each succeeding war provided a larger number of permanent customers...
...But the Bureau of Medical Devices has no plans to require manufacturers to conduct such tests...
...In the light of these tragedies, wheelchair users might be forgiven a moment of bitterness when some of them read, last September, the following UPI dispatch: "Washington — The Consumer Product Safety Commission yesterday announced the recall of 33,500 bicycles...
...The Bureau of Medical Devices of the Food and Drug Administration has created a policy on wheelchairs that says, as the discarded VA policy once did, that every wheelchair must be just like an Everest and Jennings wheelchair...
...But just when the VA is finally trying to open the field to innovation and lower prices, a new Federal regulatory agency created by Congress in 1976 is setting policy that may well block this change...
...In 1955, E&J formed a partnership with an Indiana manufacturer of orthopedic equipment to produce Everest and Jennings wheelchairs in Germany and England...
...I even found a striking difference in the most commonly available part — the bicycle tires used on wheelchairs...
...E&J must now agree to a suffer consent decree or go to trial...
...These people are almost totally dependent on wheelchairs...
...E&J eventually sued almost every other wheelchair maker in the United States for alleged patent infringements...
...While researching this article, I priced common wheelchair parts compatible with E&J chairs at retail auto supply, electronics, and hardware stores in San Francisco...
...Within that time, my second chair broke down twice...
...Hospitals, the usual sources of Institute funding, were uninterested in the project, Nobel added, and he was sure the wheelchair industry could not afford such testing...
...James May, former executive director of the Paralyzed Veterans of America and now director of testing and utilization for the Veterans Administration, has a virtual fleet of E&J chairs — four in all...
...I know science was able to do that...
...But the same dealer named Stainless when asked what brand he would want if he were disabled...
...One day in 1962, according to Justice Department court records, Gerald Jennings, with other E&J officers, walked into the office of the Johnson Wheelchair Co...
...That kind of standard has meant no latitude 'This victim-as-culprit attitude is pervasive' for other companies that wanted to sell to the Government...
...We are now saying," Wright notes, "that not every wheelchair that comes down the pike has to look like an Everest and Jennings wheelchair...
...Our business is growing as medicine advances," Gerald M. Jennings, chairman of the board and president of E&J, told a reporter...
...Their Zimmer Orthopedic Ltd...
...The Justice Department, after amassing a large anti-trust case against Everest and Jennings, has backed off...
...E&J sells replacement twenty-four-inch gray tires for $22 a pair...
...on the outskirts of Toronto and said he wanted to buy the company, then the sole manufacturer of wheelchairs in Canada...
...That same basic frame is still used forty years later even for the E&J power chair, although the batteries and motor-controlling mechanisms add from 70 to 120 pounds and considerable stress to the frame...
...developed the first E&J chair in 1933, using tubular metal with an X-frame under the seat, with sling seat and back...
...f "Recently the control crossbar which holds the wheelchair together broke...
...Recently I had one chair out getting repaired...
...But there has not been a comparable advance in devices that improve life for the survivors...
...The chair caught fire...
...By early last summer, the new Bureau had received at least ten com-plaints about malfunctioning wheelchairs...
...An estimated half million Americans are in wheelchairs today — a number that has more than doubled since 1959 and continues to grow...
...E&J, the chief supplier, charges exorbitant prices for parts — even for simple parts available on the open market...
...He said his company's output had grown from 500 wheelchairs a month at the end of World War II to 10,000 a month in 1977...
...I know it has developed strong, new, light materials...
...Instead, it has been left to the unhampered profit motive of Everest and Jennings...
...Its last annual report to the Securities and Exchange Commission (SEC) claimed the corporation and its subsidiaries "face strenuous competition...
...Jennings, according to the Justice Department, then said he would start a factory "down the street...
...The Bureau is setting specific standards for the performance and durability of medical equipment...
...As for the Government, it is unclear whether the problem is conspiracy or mere casual bureaucratic inertia...
...The Johnson partners said their company was not for sale...
...Some users believe that another make, Stainless Medical, which also includes prescription chairs, is sturdier and lasts longer — but most dealers said they didn't carry it...
...The company went into business at a fortuitous time — shortly before World War II...
...In 1933, a mining engineer, the late Herbert A. Everest, lost the use of his legs in a mine cave-in...
...Ten years later, E&J was a mass producer of wheelchairs...
...The chair designed by Harry Jennings was propelled on two large bicycle wheels and two small casters...
...The cost of the increasingly popular battery-driven chairs ranges from $1,000 to $3,500...
...The simplest repairs can take months...
...Pipari, the consumer safety officer who investigates wheelchair complaints that come to the new Bureau of Medical Devices, says he, too, believes the manufacturers are not the problem — the users are: "We've been out in the plants and I'm convinced," he said, "that in most cases of problems with wheelchairs, the chairs are being used incorrectly by the users...
...Last fall, individual wheelchair users and organizations of users filed class-action suits against Everest and Jennings in California state and Federal courts...
...borders...
...But the Bureau says it will continue to let E&J set the standard for wheelchairs...
...One of my chairs is always in a state of disrepair," he says...
...The crossbar was either weak, defective, or improperly welded...
...But the man who convened the conference, A. Bennett Wilson of Moss Rehabilitation Hospital in Philadelphia, said the most important outcome of the conference was the manufacturers' attempt to recruit wheelchair users to press for legislation that would reduce the premiums on product liability insurance, which protects manufacturers against lawsuits brought by users alleging defective chairs...
...What concerned the corporation most was its one significant innovation — the folding cross-brace — which other manufacturers were now free to use...
...I've sat in my wheelchair and watched men walk on the moon...
...He said he gets a better deal from E&J on bulk purchases...
...They are drawn from every age and social level, from the ranks of all Americans who drive cars, dive into swimming pools, ski, use skateboards, or fall victim to other disabling accidents or illnesses...
...This victim-as-culprit attitude is pervasive...
...One dealer said he either tells a doctor what to write, or the doctor gives him a signed blank prescription form...
...A few years later Everest and Jennings bought control of the major manufacturer of wheelchairs in Mexico, now known as Arva-Everest and Jennings S.A...
...provided...permanent customers' $300 to $2,000...
...These high prices affect one of the most impoverished classes of consumers...
...There was blood on his back...
...It is difficult to explain why industry, medicine, and Government have not taken steps that would dramatically improve this crucial vehicle, this substitute for legs...
...Unlike the more common manual chair, the power chair will have to meet some standards because it is "driven in public and might injure someone" — that is, a pedestrian...
...A national conference convened in December 1977 to discuss wheelchair improvement had a bizarre ending...
...Asked about an E&J chair sold especially for outdoor use but later withdrawn (George Mason's Remarkable Mark 20), an E&J official said there had been no scientific testing of the chair before it was placed on the market...
...But, amazingly, wheelchairs have been put in the same classification as tongue depressors — a category that has no standards...
...The Department of Justice says E&J's profit is more than 50 per cent on prescription chairs and more than 100 per cent on many parts...
...The consent decree did not require this...
...They must simply be produced under "good manufacturing practices" — guidelines that dwell on the atmosphere of the factory and say nothing about specific medical devices...
...There are no more "walks" alone in the park...
...One day it broke in the office...
...Most dealers checked at random in six states said they sold or recommended only E&J...
...The average cost of maintenance and repair for a battery-driven wheelchair is $900 a year...
...Why is the wheelchair I'm sitting in like the one I sat in as a child...
...This was no casual act by the English salespeople...
...But the judge didn't think a college try was good enough and rejected the agreement...
...Frank Pipari, consumer safety officer of the Bureau, said he would be able to do more about wheelchair problems once the Bureau's proposed "good manufacturing practices" were adopted...
...At one point Gerald Jennings agreed to be interviewed if the Justice suit was settled...
...No foreign made chairs have been imported by the taxpayer, nor is it intended that they shall be...
...The answer to her question lies in the history of the wheelchair industry and its profitable relations with the U.S...
...The significant advances in the technology of improved medical treatment are the result of research heavily subsidized by billions of taxpayers' dollars...
...Scientific testing of wheelchairs has not been done even in the most likely place, the Emergency Care Research Institute in Philadelphia, the only private organization that specializes in testing medical equipment...
...E&J's attorney, Walter T. Kuhlmey, told the judge he thought the proposed decree adequate because the E&J foreign subsidiaries would "make a very good college try...
...They don't consider the cost to society...
...Last May, a year after charging E&J with monopoly violations, the Department tentatively agreed not to try the case and to sign an agreement that would leave the company more secure than ever...
...Ivana Roberts is technical adviser in the Bureau office that is classifying rehabilitation and surgical devices...
...de C.V...
...With the completion of these deals, Everest and Jennings had secured the U.S...
...Today its West Los Angeles factory occupies four city blocks...
...has backed off' has basically the same design today it had in 1935...
...Both manual and power chairs need repairs constantly...
...More than 50 per cent of all wheelchairs are bought at least partially with Federal and state funds, which means that taxpayers, as well as disabled people, bear the burden of inflated prices...
...The therapist knew, as did the dealer, that the user's short life expectancy and the nature of her disability made a $200 chair on display more suitable...
...Everest and Jennings is not the only wheelchair manufacturer in the country, but it might as well be...
...Wright, a physiologist and coordinator of evaluation services at the VA's Prosthetic Center in New York, explained how the VA froze improvement of wheelchairs: "All the wheelchair specifications in the earlier VA standards describe the typical E&J chair____ For example, almost all of E&J's chairs are made of steel...
...A few years ago, two curious facts were uncovered by two Americans, one of them a Justice Department attorney, looking at wheelchairs in England...
...Mason was thrown to the ground, and the wheelchair fell on top of him...
...E&J officials also revealed that their products do not undergo life-use (longevity) testing, a common process used prior to the manufacture of many products...
...That's part of the problem...
...The VA had the power to do so because it is the largest single buyer of wheelchairs in the country — 11 per cent of the 1976 total, for example...
...You're dealing with a group of people who are especially embittered...
...The last two decades have produced medical advances which mean that many injuries that once meant death now mean survival in a wheelchair...
...Complainant was thrown to the ground and had to go to the hospital emergency room for treatment...
...For decades the Veterans Administration has helped E&J to perpetuate its obsolete design, unreliable maintenance, exorbitant purchase and repair costs, and dominance of the industry...
...Three months after the wheel fell off, the repaired chair carried Mason part way across a busy Lansing intersection only to stall in the middle of traffic...
...No alien wheelchairs could enter the United States from north or south...
...George Mason is not alone in his frustrations with American wheelchairs...
...In the entire market, which includes the utility wheelchairs used in airports, hotels, and hospitals for the temporarily disabled, E&J has had at least two-thirds of the sales since 1955...
...I obtained them under the Freedom of Information Act, and among them found these: f "Wheelchair caught fire, controls defective, patient loses control of chair...
...Without good wheelchairs they become the stereotype held by too many walking Americans: invalids who will live and die in the back bedrooms of private homes and institutions, sustained by welfare and deteriorating in mind, body, and spirit...
...Some said they had never heard of it...
...Asked how manufacturers of wheelchairs or new major parts would get their products approved, she said the manufacturer "should send us a letter saying, 'This device is just like an E&J.' That would be enough...
...But the company's history and statistics tell a different story...
...It may also fix costs at higher-than-necessary levels...
...To continue to use it, he thought, would be suicidal — so he stopped...
...Gray tires are mounted by the manufacturer because they leave no marks on floors...
...Some dealers skillfully fit chairs and conscientiously protect the user's best interests, but others don't...
...The VA, after years of foot-dragging, recently changed its policy...
...As I get older the desire for that freedom to be alone becomes more and more important to me," Mason says, "but I guess I will never have it...
...Judge Real said the proposed consent decree was "not in the public interest" and "contained no incentives" to the E&J foreign subsidiaries to export wheelchairs to the United States...
...In one West Coast city, an occupational therapist skilled in fitting patients with wheelchairs described what she said is "too typical": She observed a dealer trying to persuade one of her patients to buy a $900 chair...
...One part cost only 6 per cent of the E&J price...
...The part that came closest to E&J's prices cost 69 per cent of the E&J price...
...But when I pointed out to Pipari that the "good manufacturing practices" contain no specific references to a crossbar or any other part of any medical device, and that he would, therefore, have no standards to cite to wheelchair manufacturers, he said, "That's a good point...
...According to the Department of Justice, E&J has more than 90 per cent of the most profitable part of the market, sales of prescription wheelchairs...
...We seem to have a Catch-22...
...E&J now wholly owns wheelchair companies in Germany and England...
...Few doctors know how to fit someone with a wheelchair, despite the fact that they must make the prescription in many states...
...Both The Department of Justice and E&J declined to be interviewed for this story because settlement of the suit was pending...
...The chair most commonly used by the permanently disabled — the prescription manual chair — costs from 'Each succeeding war...
...became the largest wheelchair manufacturer in England, and their Ortopedia GmbH the largest in Germany...
...which it said may have defective pedal cranks which could break and injure the rider____" The recall of 33,500 bicycles was stimulated by one accident...
...Seven of the ten complaints were about Everest and Jennings chairs...
...Luckily, Mason's injuries were minor, but the emotional trauma was more serious...
...In a wheelchair, failure to conduct such tests can and does result in injuries to already injured people...
...No agency regulates them, and nobody recalls them when they are defective...
...The company was less concerned about its domestic rivals than about competition from foreign companies that might export chairs to the United States...
...Because of his disability, he was powerless to get up...
...When they tried to buy E&J chairs, they learned that the chairs made in England would not be sold to anyone who would take them to the United States...
...Wheelchairs break down every day...
...Now he does what he did before he owned it...
...Though some wheelchair parts are available on the open market as well as from E&J, most sales agencies routinely order from E&J...
...Speaking about the power wheelchair, the fastest growing part of the wheelchair market, Fred V. Callahan, executive vice president of E&J, testified in a deposition, "I don't know that we have any competitor...
...In such cases," Roberts, a physical therapist, explained, "they would call and say, 'We have this new wheel.' And unless they said they thought it was unsafe, we'd say, 'Go ahead.' " The new regulatory agency seems to ignore the wheelchair user and worry only about how chairs affect people who walk...
...In return, the Department agreed to recommend that no Federal agency should sue E&J on the charges...
...The proportion of the disabled living in poverty is twice that for the population as a whole, partly because of the high cost of maintaining chairs and other equipment, some of which they need to stay alive...
...The year 1955 was crucial to E&J...
...most of the suits, the Justice Department says, were harassment...
...The development of the wheelchair has not had the benefit of tax-subsidized task forces or vast sums for research and development of new materials and designs...
Vol. 43 • March 1979 • No. 3
