Doc liable for not providing interpreter.

[BlondeDocteur]

Everyone, please remember your high school civics classes!

It is patent, illegal discrimination to refuse to render goods and services to a member of the public based on their membership in a PROTECTED CLASS (race, gender, sexual orientation, disability, ethnicity, color, country of origin, veteran status).

As a doctor in private practice you are essentially a shopkeeper selling goods to the public. Like any shopkeeper, you're allowed to turn people away if:

1) the item they want is not carried by your store (i.e. they need subspecialty care and you're a generalist)
2) you don't trade in the currency they're offering-- you, for your own inscrutable reasons, accept only gold bullion (i.e. they have insurance and you have a cash-only practice)
3) your store is full/ you've sold out (not accepting new patients at the time)

You, as a shopkeeper, are NOT allowed to refuse to sell your widgets to a respectable, orderly, paying member of the public simply because you don't sell to that race/color/gender/disabled person. That is the HEART of civil rights anti-discrimination law.

So please, no more shockingly ignorant talk of "I just won't treat deaf people" or "you can keep anyone you want out of your private practice." That is WRONG and anti-American. It doesn't matter if there's a perfectly good doc down the street who'll take deaf patients. It didn't matter in the Jim Crow South either.

---

Members don't see this ad.

 

[docB]

So please, no more shockingly ignorant talk of "I just won't treat deaf people" or "you can keep anyone you want out of your private practice." That is WRONG and anti-American. It doesn't matter if there's a perfectly good doc down the street who'll take deaf patients. It didn't matter in the Jim Crow South either.

I don't think it's "anti-American" to be against the ADA. Your reference to Jim Crow illustrates that just because something is law does not mean it's just.

We're talking about a law that mandates that a doc who gets trapped in this situation will lose 3 times the amout of money they make on the transaction. We're not talking about a doc who has some prejudice against some group. We're talking about docs being forced into a situation that makes their businesses unviable. If faced with enough deaf patients the doc will have no choice but to close. Although there are many, many examples of the ADA forcing businesses out of business (eg. $75,000 ramp required to stay open so shop closes) it doesn't make it right and it doesn't make opposition to it immoral.

 

[Flopotomist]

Blondedoc... there is a distinction between discrimination and non-compliance with the ADA. Discrimination involves not providing the same level of service to a protected class (which btw your list is not correct, sexual orientation is not a protected class in every state for example). Compliance with the ADA involves making reasonable accomodations for people with disabilities.

It is possible to argue what a reasonable accomodation is for a solo doc(which is what we are debating) without throwing the term "discrimination" around because we are not asking the doctor to provide the SAME level of care to these people, we are debating if he should be required to provide a DIFFERENT level of care by making special accomodations.

 

[BlondeDocteur]

I don't think it's "anti-American" to be against the ADA. Your reference to Jim Crow illustrates that just because something is law does not mean it's just.

While legality and justice are indeed two separate, intriguing concepts (you're talking to someone who's marrying a specialist in the philosophy of law), I feel that nothing in my post necessitated splitting that particular hair. It is currently illegal to discriminate on the basis of disability, and laying down a rule to the effect that "I won't accept deaf patients" is doing just that. I wasn't invoking Jim Crow as a means of direct legal precedent so much as metaphor.

I know it is the height of anachronism to label something 'un-American' with evident seriousness (for God's sake, I live in Manhattan, native habitat of the world-weary poseur) but having lived and traveled just about everywhere on this planet, I think that the principle of Equality Before the Law of all comers is a distinctively American idea-- borrowed and improved with great success by many other countries-- and at the core of our identity. So in a way... opposing the ADA, when painting with my particular brush, is rather un-American.

We're talking about a law that mandates that a doc who gets trapped in this situation will lose 3 times the amout of money they make on the transaction. We're not talking about a doc who has some prejudice against some group. We're talking about docs being forced into a situation that makes their businesses unviable. If faced with enough deaf patients the doc will have no choice but to close. Although there are many, many examples of the ADA forcing businesses out of business (eg. $75,000 ramp required to stay open so shop closes) it doesn't make it right and it doesn't make opposition to it immoral.

Firstly, I highly doubt this is the case-- that carrying a deaf patient on your practice census will cause the whole ship to go under.

Secondly, as you noted, the letter of the statute is "reasonable accommodation." Any attorney worth his salt could argue for the overwhelmed-by-irrational-deaf-patients-demanding-interpreters doc in your first example, and overturn the injunction that a private business shoulder all costs disproportionate to its ability to pay (including curb-cutting, a public function) in the second.

But simply pointing out an unfortunate example of injustice does not prove or disprove, in any way, the notion of the inherent justice of the law (the ADA). It proves that our court system is not perfectly just, but I doubt anyone will stop the presses for that.

 

[BlondeDocteur]

I quite like what you said until the end. You're right in that the notion of being ADA-compliant turns on the definition of "reasonable" (as in 'reasonable accommodation'). Generally this is predicted by ability to pay (so that a solo doc, as you and others have noted, would presumably be treated with more leniency than a large multi-specialty practice or a hospital). Threshing out exactly what "reasonable" means for different groups of providers would be an interesting question.

However, the solo doc asked to provide a sign language interpreter for a complicated deaf patient is not being asked to provide-- at least in theory-- "a different level of care". Foreign-language patients have the translator phone option and are receiving it. The deaf patient is asking for parity with the non-English speakers, not for anything above and beyond that.

I think that the request itself is reasonable, but the practicality of providing it is person-specific.

Blondedoc... there is a distinction between discrimination and non-compliance with the ADA. Discrimination involves not providing the same level of service to a protected class (which btw your list is not correct, sexual orientation is not a protected class in every state for example). Compliance with the ADA involves making reasonable accomodations for people with disabilities.

It is possible to argue what a reasonable accomodation is for a solo doc(which is what we are debating) without throwing the term "discrimination" around because we are not asking the doctor to provide the SAME level of care to these people, we are debating if he should be required to provide a DIFFERENT level of care by making special accomodations.

 

[EC3]

you don't need to be a 'philosophy of law' specialist to use common sense. just as it was inappropriate in the 1800's, it's still not appropriate now to force someone to spend their own time or money for the benefit of someone else.

unfortunately, though, we live in a society where individuals increasingly favor group rights over rights of the individual. for example, it has become an acceptable practice to engage in otherwise prohibited behavior if the net yield is that of equality or diversity; the argument being that the benefit to the group justifies the otherwise inappropriate treatment of a few individuals. and although several historical societies have favored principles similar to the above, America was never one of those socities.

this type of "reasoning" is similar to the "reasoning" employed when proponents of equality staunchly advocate affirmative action policies such as those based on race or gender. apparently higher education paradoxically ******s the reasoning process in some individuals. "But... It's what's right!"

/Let's talk about our feeeeelings

 

[Trifling Jester]

Everyone, please remember your high school civics classes!

It is patent, illegal discrimination to refuse to render goods and services to a member of the public based on their membership in a PROTECTED CLASS (race, gender, sexual orientation, disability, ethnicity, color, country of origin, veteran status).

As a doctor in private practice you are essentially a shopkeeper selling goods to the public. Like any shopkeeper, you're allowed to turn people away if:

1) the item they want is not carried by your store (i.e. they need subspecialty care and you're a generalist)
2) you don't trade in the currency they're offering-- you, for your own inscrutable reasons, accept only gold bullion (i.e. they have insurance and you have a cash-only practice)
3) your store is full/ you've sold out (not accepting new patients at the time)

You, as a shopkeeper, are NOT allowed to refuse to sell your widgets to a respectable, orderly, paying member of the public simply because you don't sell to that race/color/gender/disabled person. That is the HEART of civil rights anti-discrimination law.

Your shopkeeper analogy falls apart when you consider that the shopkeeper is not required to hire translators to cater to those who refuse to learn English, or people who know sign language to sell their goods to the deaf, etc., etc.

-The Trifling Jester

 

[deleted109597]

Troubling precedent.
We've got a fancy computer television screen that supposedly works for 99% of the people in our area for translating, and the only live people we have are spanish translators. What happens to that extra 1%? What if you can't find a translator for their language? Just go ahead and fork over the cash then?

 

[BlondeDocteur]

Your shopkeeper analogy falls apart when you consider that the shopkeeper is not required to hire translators to cater to those who refuse to learn English, or people who know sign language to sell their goods to the deaf, etc., etc.

-The Trifling Jester

I'm sorry, but it doesn't.

There are many minute ways in which doctors and widget-mongers are dissimilar, one of which being that widget transactions do not require a great deal of nuanced communication. To pick at the differences ignores the pith of the analogy.

Perhaps you are saying that shopkeepers are not forced to undergo personal expense to accommodate differences amongst their customers? I think if you examine that, too, you'll see it's not true. Private businesses often must undergo private expense to accommodate the public, in its whims, preferences, and abilities.

 

[travelbug73]

Maybe an ignorant question, but how is refusing to see a deaf/blind/(insert patient of choice here) different from the new rule that gives health care providers the option of refusing to provide certain types of services because it is against their beliefs? Cannot we potentially invoke the "Right of Conscience" rule. I could easily say that my belief does not allow me to treat a patient who is disabled becuase I will not be allowed in the Pearly Gates. Who is to determine whose conscience is acceptable and whose is not?

 

[Trifling Jester]

I'm sorry, but it doesn't.

There are many minute ways in which doctors and widget-mongers are dissimilar, one of which being that widget transactions do not require a great deal of nuanced communication. To pick at the differences ignores the pith of the analogy.

It is not a minute difference. Doctors are being forced by law to provide interpreters for patients who refuse to learn english, and also to provide sign language translators. This is the entire reason for the discussion.

-The Trifling Jester

 

[NotAProgDirector]

Your shopkeeper analogy falls apart when you consider that the shopkeeper is not required to hire translators to cater to those who refuse to learn English, or people who know sign language to sell their goods to the deaf, etc., etc.

-The Trifling Jester

Actually, I believe all shop keepers are required to do so, to some extent. If the purchase is complex / expensive or otherwise would require extensive communication, then all shopkeepers are held to the same standard.

If a deaf person goes to a coffeeshop and purchases a cup of coffee, then no sign translator is needed. Writing will suffice, as it is a low risk transaction. If a deaf person were to try to buy a car, then the car dealer would likely be required to get a sign translator.

In fact, from here:

Q. How does an automotive sales establishment ensure effective communication with customers who are deaf or hard of hearing or who have speech impairments?

A. According to DOJ, if a deaf individual becomes serious about making a purchase, the services of a qualified interpreter may be necessary because of the complicated nature of the communications involved in buying a car, unless providing one would pose an undue burden.

To locate a qualified sign language interpreter, contact local organizations operated by or for people with disabilities for a referral.

Interpreters are not required if a deaf customer has come into a sales showroom merely to look at the latest models. In this situation, the dealer would be able to communicate general information about models available by providing brochures, exchanging notes by pen and note pad, or taking turns at a computer keyboard. Maintaining face-to-face contact is important for communications with customers who read lips.

It is also important for automotive sales establishments to communicate effectively with customers with speech impairments. Allowing sufficient time for a person with such a disability to express himself or herself or to read a message spelled out on a word board are examples of methods to achieve effective communication.

So, this requirement extends to all but the law tempers the need for a translator based upon the seriousness of the encounter. Problem is, any medical visit could be seen as a complex visit. Most deaf persons I know avoid translators as much as possible, so I expect the actual cost to physicians would be low -- you'd only need a translator when trying to make a complex decision. Bigggest problem is that you never really know if you're going to make a big decision.

 

[rkaz]

The only issue though is that a car dealership stands to gain a few thousand dollars on the sale of a new car, so having a translator (if needed) doesn't seem like a big deal. However, a physician having to pay $150 out of pocket for a visit he/she will be reimbursed $49 doesn't make much sense.

If a physician is willing to do this, all the power to him/her. However, I don't agree with anyone being FORCED by an unfunded mandate to take a loss on a client. If government is going to mandate, then it needs to pick up the tab to provide those services, or insurance needs to cover the cost of translators.

 

[BlondeDocteur]

Maybe an ignorant question, but how is refusing to see a deaf/blind/(insert patient of choice here) different from the new rule that gives health care providers the option of refusing to provide certain types of services because it is against their beliefs? Cannot we potentially invoke the "Right of Conscience" rule. I could easily say that my belief does not allow me to treat a patient who is disabled becuase I will not be allowed in the Pearly Gates. Who is to determine whose conscience is acceptable and whose is not?

The free practice of religion is a firmly enshrined, sacred principle, but it is not a carte blanche, and-- with certain exceptions-- it does not permit discrimination against members of a protected class. Proving your religious beliefs are incompatible with US law is possible, but quite difficult, and is generally held to the same standard by which we distinguish religious beliefs from delusions in psych patients: are these beliefs part of a recognized, enshrined system of belief? Are they generally acceptable in the culture from which you come? Judeo-Christian religious organizations who fire gay clergy, or mosques who force women to use separate rooms and entrances, are allowed to do so due to millennia of well-recognized precedent in their belief systems. You, however, are not allowed to form the Church of Contact with Deaf People Leads to Eternal Damnation, membership: 2, simply because-- coincidentally-- you discovered that taking deaf patients in your private practice causes you to lose money. Won't hold up more than a nanosecond in court, and rightly so.

 

[Substance]

Q. How does an automotive sales establishment ensure effective communication with customers who are deaf or hard of hearing or who have speech impairments?

A. According to DOJ, if a deaf individual becomes serious about making a purchase, the services of a qualified interpreter may be necessary because of the complicated nature of the communications involved in buying a car, unless providing one would pose an undue burden.

Define "undue burden".

 

[dragonfly99]

An undue burden is whatever the jury (or the gov't) decides is an undue burden.

 

[Substance]

Ok, hypothetical situation:

Let's say that you're a fresh-out-of-residency primary care doc.

You open up a practice in the cute little border town of Williwaga.

You start to recruit patients.

The problem is, every patient you recruit does not speak English. Each one, and you have seen 1000 so far, speaks a different language, from Farsi to Spanish to Urdu to Afrikaans to Hebrew to Alsatian to !Kung. All of these people are legal Americans too.

Now, according to the law, you're going to need to get interpreters for each one. If a visit pays 25 to 50 dollars, and an interpreter will cost about twice that, how do you make any income?

This is a huge deal.

Why isn't anyone fighting this? We're not just expected to work for free, but to PAY to work too?

That being said, I appreciate the plight of the disabled. However, their difficulty is a societal issue. Thus, society should be responsible for their integration into society through more efficient use of taxes. The onus should not solely be on individual businesses and practitioners who the disabled people happen to utilize.

 

[Substance]

An undue burden is whatever the jury (or the gov't) decides is an undue burden.

Hypothetically, I wonder if the car dealership would still be required by law to pay for an interpreter if the interpreter cost more than the car was worth?


This is the problem with juries: the average person is just that - average. Holding law to an average standard promotes average values, which are largely based on emotional weight and not logic.

 

[BlondeDocteur]

Americans decided that trial by a jury of one's peers, while imperfect, was the most just way of determining guilt. Other systems relying on the often unsympathetic prejudices, pronouncements and judgments of an educated, ruling elite have abuses in the other direction.

There is a strong difference demarcating the worlds of law and medicine-- one which doctors have difficulty grasping. In medicine we like to pretend at least that we are doing science, and that we are discovering facts about the natural world-- discovering truth, in other words.

In law no one has pretensions to truth. It's justice. Justice which accumulates in a series of entirely man-made case precedents. It is a logical, cohesive, but entirely artificial construct. That's why no one bats an eyelash that laws in France are different than laws in England, though if gravity started working in reverse there would be some raised eyebrows.

An obvious point, yet often missed. As Dragonfly said, definitions are left to consensus, not discovery. And nothing is immutable-- if, in the cosmopolitan melting pot of Williwaga, providing separate interpreters was deemed to be an undue burden, that's the end of it. It doesn't matter what Seattle and Vancouver say.

(Personally, though, I'd just use a translator phone service instead of hiring all those in-house interpreters. Lots cheaper.)

 

[NotAProgDirector]

Define "undue burden".

From the AMA summary linked above:

An undue burden is a significant expense or difficulty to the operation of the facility. Factors courts use to determine whether providing an interpreter would present an undue burden include the practice or facility's operating income and eligibility for tax credits, and whether it has sources of outside funding or a parent company. Courts also consider the frequency of visits that would require the services of an interpreter. However, the single factor of the cost of an interpreter exceeding the cost of a medical consultation generally has not been found by the courts to be an undue burden.​

Ok, hypothetical situation:

Let's say that you're a fresh-out-of-residency primary care doc.

You open up a practice in the cute little border town of Williwaga.

You start to recruit patients.

The problem is, every patient you recruit does not speak English. Each one, and you have seen 1000 so far, speaks a different language, from Farsi to Spanish to Urdu to Afrikaans to Hebrew to Alsatian to !Kung. All of these people are legal Americans too.

Now, according to the law, you're going to need to get interpreters for each one. If a visit pays 25 to 50 dollars, and an interpreter will cost about twice that, how do you make any income?

This is a huge deal.

Why isn't anyone fighting this? We're not just expected to work for free, but to PAY to work too?

That being said, I appreciate the plight of the disabled. However, their difficulty is a societal issue. Thus, society should be responsible for their integration into society through more efficient use of taxes. The onus should not solely be on individual businesses and practitioners who the disabled people happen to utilize.

In this hypothetical case, the courts would likely see it as an undue burden. Basically, if you are making $100,000 per year and have a few deaf patients which will cost $1000 to hire translators for, the courts will see this as a reasonable expense. In your hypothetical case, hiring translators would cause the practice to bankrupt, which is an undue burden.

Hypothetically, I wonder if the car dealership would still be required by law to pay for an interpreter if the interpreter cost more than the car was worth?

The short answer is yes, I think. If you have a car on the lot that is really crappy and is only worth $100, it could cost you more than that to get a translator. You would still have to do this, as long as the rest of your business was fine and you had reasonable profits. That's the key (as far as the courts are concerned) -- they don't look at the individual transaction, they look at the whole business.

 

[docB]

Back to the car dealership analogy I wonder if the dealership could just add the cost of the interpreter into the price of the car. When haggling over the price they could just bump the lowest they'd be willing to accept up by the cost of the interpreter. Their risk would be that if the customer walked away they'd lose the cost of the interp totally as they'd get nothing. They are at an advantage over us in that their prices are negoiatable. Since our reimbursement is set we can't just adjust our prices.

Of note car dealership analogies are wonderful for pointing out the fact that medicine isn't a viable business. If they operated as we do the customer would arrive at the lot and declare that they have an emergent need for a car. They would then drive away in whatever they wanted and the dealership would begin the process of trying to get reimbursed for their car.

 

[geogil]

Back to the car dealership analogy I wonder if the dealership could just add the cost of the interpreter into the price of the car. When haggling over the price they could just bump the lowest they'd be willing to accept up by the cost of the interpreter. Their risk would be that if the customer walked away they'd lose the cost of the interp totally as they'd get nothing. They are at an advantage over us in that their prices are negoiatable. Since our reimbursement is set we can't just adjust our prices.

Of note car dealership analogies are wonderful for pointing out the fact that medicine isn't a viable business. If they operated as we do the customer would arrive at the lot and declare that they have an emergent need for a car. They would then drive away in whatever they wanted and the dealership would begin the process of trying to get reimbursed for their car.

And therein lies the danger of healthcare as a 'right', enshrined already, as you know, by EMTALA.

 

[BlondeDocteur]

Back to the car dealership analogy I wonder if the dealership could just add the cost of the interpreter into the price of the car. When haggling over the price they could just bump the lowest they'd be willing to accept up by the cost of the interpreter. Their risk would be that if the customer walked away they'd lose the cost of the interp totally as they'd get nothing. They are at an advantage over us in that their prices are negoiatable. Since our reimbursement is set we can't just adjust our prices.

Erm, no, not allowed. It seems you will disagree with the inherent justice of the law, but the law as it stands today would see that as discriminating against the deaf customer simply because he happened to be deaf and required an interpreter. You can't charge higher prices to members of a protected class based on their membership in that class-- even if you accrued extra costs.

 

[docB]

Back in the 80s and 90s the federal government decided it needed to protect the spotted owl in the Pacific northwest. Because of the particulars of owl life they had to set up this protection in a new way. Previously when the government decided to protect something it declared whatever land it deemed necessary as a sanctuary. No that was bad if you owned the land as it was now worthless. But the fight and stayed between those hurt by the government's actions and the government. With the spotted owl they did it differently. Wherever a spotted owl was found a given area around that owl was made worthless. That changed the dynamics of the fight. If you could find the owl first and get rid of it your land wouldn't be confiscated. The fight was now between the land owners and the indivual owls. People were owl hunting all the time. Once killed the owls were frequently nailed to Forest Service signs in protest.

These unfunded mandates, undertaken with the best of intentions, always hurt someone else. If enacted in such a way that the battle moves from being between the injured parties and the government and toward being between the injured parties and the beneficiaries of the law there will be friction. This is evidenced by the number of people who have voiced a desire to simply exclude the beneficiaries from their practices and avoid the injury. Clearly the law won't allow that but that's the expected course.

Abuses like this exacerbate the situation.

I work daily under the unfunded mandate of EMTALA which grants free emergency care to everyone. To date I have personally been forced to provide ~$700,000 in free care under this mandate. Relavent thread in EM

The ADA is poorly designed as are most unfunded mandates. It will continue to create animosity between the disabled and those who are hurt trying to comply with the law. It should be reformed and funded.

 

[rkaz]

As far as the car dealership goes, someone gave a good example of this on the pre-medical forum. He/she is disabled, and bought an $18,000 car, and had to pay $35,000 for extra modifications to the car to accommodate his/her disability. (Actually, as a disabled person, he/she was advocating for physicians' to pay out of pocket for interpreters, but his/her own example of the car modification shows the inconsistency.)

If equating this to the medical lawsuit, it would be like the disabled person expecting to only pay $18,000 for the car, and expecting the car dealership to absorb the $35,000 cost of modifying the car since it was due to that person's disability. Obviously the car dealership wouldn't do this, as they have no reason to take a loss on their product....even though it is only a 'drop in the bucket' of the dealership's income (which was the basis of the doctor losing the lawsuit). The disabled person had to pay the $35,000 fees for modification and could not rely on the dealership to absorb those costs.

In fact, if anything, I think the dealership would be better equipped to deal with giving free accommodations to disabled people than physicians... as a car dealership can pass on the associated costs to other customers (by increasing slightly their car retail price), but a doctor wouldn't be able to do this so easily. So it would be easier for a dealership to absorb related costs.

Reasonably, people can understand this situation of the car dealership not paying the costs, but yet don't see the medical lawsuit in the same light. It doesn't make sense. Just because physicians are in the service industry doesn't mean they have to be martyrs and feel guilty for not wanting to lose money on patients. It would seem as ludicrous as to ask the interpreter to work for free, as that person is also helping disabled people, and since the interpreter is making more money than the doctor... then it is only a fraction of the interpreter's income as well to help a disabled person. I don't understand why it's so acceptable to step on a doctor, as other professionals wouldn't take this so well. Just because physicians are in a service field doesn't mean they deserve to be abused by the system.

 

[EC3]

Erm, no, not allowed. It seems you will disagree with the inherent justice of the law, but the law as it stands today would see that as discriminating against the deaf customer simply because he happened to be deaf and required an interpreter. You can't charge higher prices to members of a protected class based on their membership in that class-- even if you accrued extra costs.

Failing to provide something for someone that isn't provided to anyone else isn't a form of descrimination. That's the definition of equality: treating everybody equally.

Only in the bizarro world known as modern society have we contorted the definitions of these words to fit different agendas. Think about how ridiculous it sounds to imply that failing to provide something extra is a form of discrimination. A doctor speaking plain english to all of his patients is about as equal as it comes. Why is it his/her fault that patient can't understand this? Oh, that's right, it's because we favor equality of outcome over equality of opportunity. No longer is it good enough to offer the same services to everybody. It's mandated now that we must offer special services to those in special situations so that these special individuals can achieve the same end-point as the other regular folks. All while being unfunded by the people who impose the mandate. Yep, makes a whole bunch of sense.

This type of stuff shouldn't surprise anyone, though. We've done the similar things with our rights. A right used to be a form of protection from intrusion or unfair treatment. Modern society, however, has decided that rights can also be things that cost money and are actively provided to selective individuals at the expense of other individuals' free choices.

The underlying theme here is to remove the burden of duty from an individual and place it on society (aka other individuals). It will be interested to see how this ends. Not so much because the ending will be unpredictable -- it couldn't be more foreseeable -- but because it will be interesting to watch people delibrately make poor decisions to satisfy an agenda.

 

[8744]

...are we doctors going to get f... in the a.. everytime we do something??? Seems like everyone is going after us from all sides!!!

Get used to it. Not only will you be sodomized by the Government, insurance companies, and your patients but even the organizations ostensibly set up to protect physicians (such as the AMA) are going to get their licks in.

That's just the way the country has turned out. In other words, it is becoming nothing more than a crappy nursing home full of entitled, disabled, and otherwise helpless wards of the state in a mad dash for the bottom of the dependency abyss.

It will take a revolution to change things.

 

[pedidoc]

What I'm having a hard time understanding is that a deaf person certainly has no choice in their disability. They were born that way and in order to have some quality of life the ADA protects them.

If you only speak Spanish that is a choice. You have a country that has medical services available that are conducted in your own language. I think not speaking English is a choice that we are forced to pay for.

It just seems different to me; being deaf is fundamentally different. People who don't speak English came to this country knowing that Spanish isn't our language. Why do we have to provide this for them?

 

[BlondeDocteur]

English is not the national language of the United States. We have no national language since we welcome all comers. Given that 14% of the US population is Hispanic and is possibly Spanish-speaking (http://www.infoplease.com/ipa/A0762156.html), it is reasonable to expect that accommodations for a linguistic minority of that size can be made.

Generally as well first-generation Hispanics learn English fluently. Not knowing English is restricted to foreign-born adults. Ask yourself, if your parents were to move right now to Japan, how good would their Japanese be in 5 years?

This is no novel phenomenon. It's always been the case in our country-- should you have been practicing in New York a century ago and didn't speak Yiddish or Russian, you wouldn't have had many patients; move over to Brooklyn and you better know Italian and Irish Gaelic; venture out West and it's German, Swedish, Czech; and if you make it to the Pacific without knowing Spanish or Chinese you'd be out of luck too.

Honestly, the point has been made so many times that it's trite, but unless you're a native speaker of Pequot or Shawnee or Navajo, you really don't have room to complain. My family came to Virginia Colony in the 1650s and we're just as much of displaced interlopers as people fleeing the Lebanese, Congolese, Chechnyan, etc Civil Wars-- or migrating across our Southern border.

 

[Miami_med]

I think the issue isn't with speaking Spanish. This isn't even about refusal to see Spanish speakers. It seems a bit crazy to expect physicians to have to pay for a translator for someone who doesn't speak the language in which the physician conducts his business.

 

[docB]

Honestly, the point has been made so many times that it's trite, but unless you're a native speaker of Pequot or Shawnee or Navajo, you really don't have room to complain.

It's not as much trite as it is irrelevent in this discussion. We're not talking about the fact that people live here who don't speak English. We're talking about private businesses being saddled with the expensive mandate of providing interpreters for these people. That applys even if that business is not attempting to cater to that group. Do these folks have a right to be here? Apparently (although that's a hotly contested issue as well). Do these folks have a right to benefit from the very expensive entitlement of having interpreters provided for them? Apparently as well but that where many of us feel the law went wrong.

Of note the interpreters for non-English speakers thing is seperate from the ADA. As of yet the non-English speakers are not suing practices out of business over ramps or elevators and no one has made a career out of extortion under the interpreter requirement as they have the ADA.

 

[Trifling Jester]

English is not the national language of the United States. We have no national language since we welcome all comers. Given that 14% of the US population is Hispanic and is possibly Spanish-speaking (http://www.infoplease.com/ipa/A0762156.html), it is reasonable to expect that accommodations for a linguistic minority of that size can be made.

Accommodations can be made but it is unreasonable to expect accommodations free-of-charge.

-The Trifling Jester

 

[dr0277341283141]

... We have no national language since we welcome all comers. ...

That's illogical. The two are unrelated.

The Soviet Union had some huge number of languages within it, I recall that there were some 80 languages spoken, but Russian was the national language because it formed a common ground. Many were multilingual.

Hindi and English have a similar place in India. Is it discriminatory to the Tamil to read a document in Hindi or English because these are their national languages? My Tamil friend told me he preferred to read things in English, anyway, because it's less offensive than having to read Hindi.

Oh and look, some Tamil right now.... http://www.youtube.com/watch?v=sdyC1BrQd6g
(At least that's I've been told.)

 

[BlondeDocteur]

Accommodations can be made but it is unreasonable to expect accommodations free-of-charge.

-The Trifling Jester

Not really. Think about the burden of having chaperones for the female breast/pelvic exam. That's as much of an 'unfunded mandate' as the phone interpreter services, and yet we've deemed it proper and go along.

And it's a win-win-- if shelling out however much it costs per month to subscribe to Pacific Interpreters gives you access to an extra 42 million people (the current Hispanic population of the US), it's worth it. Most businesses would kill for such an easy means to enlarge their customer base.

 

[docB]

Not really. Think about the burden of having chaperones for the female breast/pelvic exam. That's as much of an 'unfunded mandate' as the phone interpreter services, and yet we've deemed it proper and go along.

That's not the same. That is something that was adopted by the medical field as a defense to allegations of misconduct. It was not imposed by legislative whim. It is a symptom of an overly litigous society but that's a seperate discussion.

That argument is like saying that the burden of having people sign out AMA which we do to protect ourselves justifys being forced to absorb the large expense of interpreters.

Since it dovetails into your next point let's also note that providing for female patients represents half of a PMD's patient load and all of a Gyn's.

And it's a win-win-- if shelling out however much it costs per month to subscribe to Pacific Interpreters gives you access to an extra 42 million people (the current Hispanic population of the US), it's worth it. Most businesses would kill for such an easy means to enlarge their customer base.

That's not the situation. The practices with large numbers of deaf or non-English speakers certainly have an impetus to adapt. But there should't be a legal mandate for everyone else to absorb costs that will cause losses. If businesses would kill for it, great. Then they wouldn't have had to make a law to force it.

 

[Trifling Jester]

Not really. Think about the burden of having chaperones for the female breast/pelvic exam. That's as much of an 'unfunded mandate' as the phone interpreter services, and yet we've deemed it proper and go along.

I am unaware of any legal requirement to have a chaperone present during breast/pelvic exams.

And it's a win-win-- if shelling out however much it costs per month to subscribe to Pacific Interpreters gives you access to an extra 42 million people (the current Hispanic population of the US), it's worth it. Most businesses would kill for such an easy means to enlarge their customer base.

Businesses should be free to make their own decisions. If the physician feels that having a free translator is a sound business tactic then providing that service should be their decision. It should not be a mandate from the government just because someone else thinks it makes good business sense.

-The Trifling Jester

 

[SoCuteMD]

Not really. Think about the burden of having chaperones for the female breast/pelvic exam. That's as much of an 'unfunded mandate' as the phone interpreter services, and yet we've deemed it proper and go along.

And it's a win-win-- if shelling out however much it costs per month to subscribe to Pacific Interpreters gives you access to an extra 42 million people (the current Hispanic population of the US), it's worth it. Most businesses would kill for such an easy means to enlarge their customer base.

Ugh. Patients =/= customers.

Also, most businesses want to enlarge their customer base for PAYING customers. In this country if you speak Spanish-only it is unlikely that you have a job that provides health insurance even if you are employed. Thus, it is entirely possible that you could go to all that effort only to find that your new "customers" were not holding up their end of the "self-pay" bargain! That is a risky business venture right there.

 

[BlondeDocteur]

All good points.

It appears that we're arguing from difference premises. Your deductions from Premise A are sound, and I think my deductions from Premise B are perfectly good, but Premises A and B are incompatible and there's not any good way of judging which is actually correct.

Let's agree to move on.

 

[rkaz]

I am unaware of any legal requirement to have a chaperone present during breast/pelvic exams.

My father is a gastroenterologist who has his own private practice (and also makes hospital visits) and if he has to do a rectal exam on a female patient, he just makes sure that a female staff member is present at the room during the actual exam. In his private office, this would simply mean one of his office staff stepping into the exam room for the few minute duration of the exam... or if he's in the hospital, then one of the nurses would simply be present assisting him with the colonoscopy. (I don't know if the 'witness' person needs to be female or not, though he always asks a female staff member to be in the room.) He just does this to protect himself against any alleged charges of misconduct. It doesn't really take much extra time or resources though.

 

[docB]

My father is a gastroenterologist who has his own private practice (and also makes hospital visits) and if he has to do a rectal exam on a female patient, he just makes sure that a female staff member is present at the room during the actual exam. In his private office, this would simply mean one of his office staff stepping into the exam room for the few minute duration of the exam... or if he's in the hospital, then one of the nurses would simply be present assisting him with the colonoscopy. (I don't know if the 'witness' person needs to be female or not, though he always asks a female staff member to be in the room.) He just does this to protect himself against any alleged charges of misconduct. It doesn't really take much extra time or resources though.

But is it a legal requirement to have the chaperone? It is not to my knowledge although it is good practice. The discussion here has focused on whether such burdens should be mandated.

Also your dad should have a chaperone for any rectal exam. Men can accuse men of misconduct too.

 

[BlondeDocteur]

I would say there's a legal requirement in the sense that precedent has been established (i.e. many cases of sexual harassment), though a black-letter statute might not exist.

As an aside, I sat in on Alan Dershowitz's criminal law class when he went through a case of a gynecologist who told a patient up in the stirrups "I'm going to insert an instrument now" and inserted his penis instead. I attribute a great deal of my CYA behavior to that lecture.

 

[EC3]

And it's a win-win-- if shelling out however much it costs per month to subscribe to Pacific Interpreters gives you access to an extra 42 million people (the current Hispanic population of the US), it's worth it. Most businesses would kill for such an easy means to enlarge their customer base.

If it was anything resembling a "win", businesses would've already adopted it. Obviously it's not worth the expense.

 

[bjackrian]

But is it a legal requirement to have the chaperone? It is not to my knowledge although it is good practice. The discussion here has focused on whether such burdens should be mandated.

When I worked in Southern California, it was a state law to have a chaperone for any genital, rectal, or breast exam involving an examiner and patient of different sexes. I think the laws vary by state.