Sign Language Interpreters at Doctors, Dentists, and Hospitals

Good communication at the doctor (or dentist or hospital) is essential. Recognizing this, the authors of the Americans with Disabilities Act (ADA) included specific language regarding communications access for deaf and hard of hearing people. Even so, there have been numerous cases of failure (or outright refusal) of medical establishments to provide sign language interpreters.

This topic has personally impacted me.

Due to ineffective communication, I nearly lost a good tooth to extraction because my dentist did not communicate adequately. I was in the oral surgeon's chair when he took a closer look at my x-rays, called the dentist's office, and determined I did not need the tooth extracted.

Title III of the ADA

Title III of the ADA covers access to places of public accommodation. Subchapter III - Public Accommodations And Services Operated By Private Entities, Section 12181, Definitions, says that the following examples of private entities are considered public accommodations:
(F) a laundromat, dry-cleaner, bank, barber shop, beauty shop, travel service, shoe repair service, funeral parlor, gas station, office of an accountant or lawyer, pharmacy, insurance office, professional office of a health care provider, hospital, or other service establishment;
Furthermore, the Department of Justice's interpretation of Title III states that:
Places of public accommodation include...doctors' offices, hospitals,...
The same interpretation says that public accommodations must "Furnish auxiliary aids when necessary to ensure effective communication, unless an undue burden or fundamental alteration would result." (Fundamental alteration means that it would have a substantial impact on the business. For instance, a doctor would no longer be able to provide medical care).

When Is An Interpreter Necessary?

An "auxiliary aid" as defined by the ADA means "qualified interpreters or other effective methods of making aurally delivered materials available to individuals with hearing impairments." Alternative methods means techniques such as writing back and forth on paper, or using computerized means of communication.
So when is an interpreter necessary? This question is best answered by the Department of Justice ADA Technical Assistance Manual.

The ADA Technical Assistance Manual, answers the question "Who decides what type of auxiliary aid should be provided?" by stating that the place of public accommodation, e.g. the doctor's office, gets to make the "ultimate decision" as to what methodology to use, as long as the method chosen results in effective communication. There can be disagreement over what constitutes effective communication. The Technical Assistance Manual states:

The physician must be given an opportunity to consult with the patient and make an independent assessment of what type of auxiliary aid, if any, is necessary to ensure effective communication. If the patient believes that the physician's decision will not lead to effective communication, then the patient may challenge that decision under title III by initiating litigation or filing a complaint with the Department of Justice...
The Technical Assistance Manual has specific examples of when an interpreter is necessary versus when an interpreter is not necessary. The 1994 supplement to the Technical Assistance Manual cites two examples. In the first example, a deaf person goes to the doctor for a routine checkup; notes and gestures are considered acceptable. In the second example, the same deaf person has just had a stroke and needs a more thorough examination; an interpreter is considered necessary because the communication is more in depth.

Getting Doctors, Dentists, Hospitals to Comply

One barrier to obtaining interpreters is the "undue burden" provision. To combat this, the National Association of the Deaf (NAD) has a fact sheet online that tells deaf people to notify health care providers in advance of appointments, that they need an interpreter. In addition, it states that the health care provider must pay for the interpreter even if the cost of the interpreter is higher than the cost of the visit. At the bottom of the fact sheet there are links to cases the NAD Law and Advocacy Center has been involved in. A related, longer NAD fact sheet, Questions and Answers for Health Care Providers, has other important information such as the fact that the cost of an interpreter to the doctor can be covered by a tax credit.

Mediated Interpreter Cases

The Department of Justice has an ADA Mediation program, where the parties negotiate a mutually acceptable solution. These summarized examples of mediated cases involving interpreters at medical facilities were given on the ADA Mediation Program page:
  • A doctor who refused to pay for an interpreter agreed to hire interpreters.
  • Another doctor agreed to pay for interpreters and maintain a list of qualified interpreters to call.

ADA Cases Involving Interpreters

The Department of Justice publishes an online newsletter, Disability Rights online news, that contains examples of cases involving doctors, dentists, and hospitals. Below are summarized examples found. In some of the hospital cases, the deaf or hearing patients were in the emergency room when they needed but did not get interpreters, and/or did not have interpreters throughout their hospital stay. Frequently deaf patients were administered drugs and procedures without understanding what was going on, or family members were forced into inappropriate roles as ad-hoc interpreters.
  • August 2007: A Rhode Island hospital settled and agrees to provide interpreters.
  • June 2007: A Virginia hospital settled and agrees to provide interpreters for deaf family members of hearing patients.
  • December 2006: A Louisiana hospital settled and agrees to provide interpreters to deaf patients.
  • October 2006: A Florida hospital settled and agreed to provide interpreters.
  • August 2006: A Maryland hospital that was already using video interpreting, agreed to provide more effective video interpreting services.
  • June 2006: Eight cases:
    • An Indiana dental office agreed to provide interpreters for complex procedures.
    • A Minnesota doctor agreed to provide interpreters.
    • A Georgia doctor agreed to provide interpreters.
    • A doctor in a rural Nevada area agreed to provide interpreters.
    • A Florida doctor agreed to provide interpreters.
    • A Michigan doctor agreed to provide interpreters instead of asking the deaf patient to use a family member.
    • A Nevada dentist agreed to provide effective communication.
    • An Illinois medical specialist agreed to provide interpreters.
  • February 2006: A Delaware hospital agreed to provide interpreters. The patient had no interpreter in either the emergency room or throughout his stay.
  • September 2005: A Washington, DC hospital agreed to provide an interpreter or other effective communication.
  • December 2004: Three cases:
    • A Maryland hospital agreed to provide interpreters.
    • In Tennessee, three doctors agreed to provide interpreters for the same deaf client.
    • An Iowa dentist agreed to provide interpreters.
    Sources (accessed 11/21/07):

    ADA Technical Assistance Manual 1994 Supplement, http://www.ada.gov/taman3up.html
    ADA Title III Technical Assistance Manual, http://www.ada.gov/taman3.html
    Americans with Disabilities Act of 1990, http://www.ada.gov/pubs/ada.htm
    Department of Justice ADA Mediation Program, http://www.ada.gov/mediate.htm
    Disability Rights Online News, http://www.usdoj.gov/crt/ada/disabilitynews.htm
    Doctors - National Association of the Deaf, http://www.nad.org/doctors
    Title III Highlights, http://www.ada.gov/t3hilght.htm

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