Doc liable for not providing interpreter.

[Long Dong]

I was like holy crap: http://www.ama-assn.org/amednews/2009/01/05/prca0105.htm

If you refuse to see such a patient, can you be sued for discrimination too? Is it are you damed if you do and damed if you don't?

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[sandraf]

I was like holy crap: http://www.ama-assn.org/amednews/2009/01/05/prca0105.htm

If you refuse to see such a patient, can you be sued for discrimination too? Is it are you damed if you do and damed if you don't?

OMG!

 

[dragonfly99]

This is nothing new.
I had an internship with the AMA back in 2001 or so and there had recently been a new mandate from the federal civil rights office mandating that any patient who doesn't speak English has to be provided with interpreter services (at the physician's expense) if he/she desires it. You can use a family member, but only if the patient agrees to it. Otherwise you need to pay for an interpreter or some other mechanism (such as one of those interpreter phone services).

I think the $400,000 verdict was definitely excessive in this case. The doc didn't comply with the law, but this was an extremely punitive judgment, which would be enough to put many docs under water (financially).

 

[Long Dong]

OMG!

That's what I said too, and the 400K he has to pay is not covered by mal practice, cause it was discrimination/violation of the disablities act. The Doc has to pay out of his own pocket. The doc pretty much has to pay $150-200 for the interpreter, but only gets paid $49 to see that patient. He pretty much loses $100-150 to see this patient or pay 400k.

 

[Long Dong]

This is nothing new.
I had an internship with the AMA back in 2001 or so and there had recently been a new mandate from the federal civil rights office mandating that any patient who doesn't speak English has to be provided with interpreter services (at the physician's expense) if he/she desires it. You can use a family member, but only if the patient agrees to it. Otherwise you need to pay for an interpreter or some other mechanism (such as one of those interpreter phone services).

So can you refuse to see someone who needs an interpreter? At the county hospital were I did my TY 9 out of 10 times we didn't have an interpreter, I had to use my broken spanglish to get by. Man I can't imagine what would happen if all those guys started sueing because of not having an interpreter. I think lawyers can just start hanging out at any county ED and get a hole bunch of people to join in a class action.

 

[sirus_virus]

Why the AMA can't fight to make the interpreter service costs come out of the government's pocket is beyond me. The AMA has to one of the most worthless haphazard organizations on planet earth.

 

[dragonfly99]

Actually the AMA did try to fight the gov't on this requirement, but basically it's kind of like an executive-type order by the Office of Civil Rights of something. It's not like it is some law that was passed. It was basically the gov't deciding that they would interpret the Civil Rights Act in a more broad way, saying that not providing adequate interpreter services = discrimination according to national or ethnic origin. The AMA and other medical organizations don't really have a way to force the feds to change their opinion. They could try and lobby to get reimbursement for interpreter services, but with the gov't trying to cut Medicare every year and that having to be fought off by the AMA and other medical organizations, our medical organizations have bigger fish to fry.

As far as county hospitals go, it is OK to use hospital staff as interpreters, OK to use the patient's family (ONLY if they are OK with it, which a lot of them are). However, if a patient stated they didn't understand and they asked for interpreter services, then my understanding is that you'd have to provide that, otherwise you are running afoul of the federal Civil Rights Act, technically.

 

[Mosin]

From the article, it sounds to me like initially she agreed that the written notes were enough, and then "changed her mind" after the fact. I dont' understand, if he helped her medically and there were no problems with her care, then why in the world would you take the guy to court and try to ruin him? This is the kind of crap that just amazes me about the American people. For crying out loud, it sounds like she didn't even have to pay for anything out of pocket. So much for gratitude. And if it does come down to this for docs, where they either pay 150 bucks for a visit they get 50 bucks for or not see the patient, can't they just start refusing to see "disabled" patients and instead refer them on down the line? It seems to me that this trend of suing these "rich, evil doctors" is only going to decrease patient satisfaction in the long run, and destroy our healthcare system entirely...

..... man, this really steams me....

 

[Long Dong]

And if it does come down to this for docs, where they either pay 150 bucks for a visit they get 50 bucks for or not see the patient, can't they just start refusing to see "disabled" patients and instead refer them on down the line?....

That's what I'm trying to figure out, if you refuse to see them and refer them to someone else can you get sued for discriminating against their disablity? Or are we like indentured servants and have to pay out of our pockets to treat these patients?

 

[Faebinder]

Yes I saw this back in October, as a result I am happy to say I no longer will see in the clinic "EVER" a deaf patient who can't read and write as well.

 

[Winged Scapula]

Frankly, some of these family interpreters my patients bring speak no more English than the patient does. This is scary stuff.

 

[dragonfly99]

I don't think it's legal to refuse to see a patient because of his/her disability, or the lack of ability to speak English. Basically this (requirement to provide interpreter if the patient needs one) is just another unfunded mandate by the gov't.

 

[Flopotomist]

I'm curious to hear Law2doc's take on all of this, but one question I had - is it legal to bill for the interpreter? I see that the physician must provide the service, fine - but what precludes him from billing the patient directly for this added service? Should the patient be unable or unwilling to pay for the service, then the physician would be well within his right to no longer see the patient, no?

I mean, if this was a case about a plumber, would he be required to replumb a deaf person's house at a financial loss in order to provide an interpreter present while performing his plumbing services?

I see nothing wrong with saying to a patient, " would be happy to communicate with you using the AT&T language line, it will cost you $7.00 per minute, feel free to dial this number and enter your telephone number"

For the deaf patient, just a computer and some typing back and forth would suffice, be reasonable, and be free.

This kind of thing will only happen so much longer before physicians stop seeing patients.

 

[sirus_virus]

This is a situation where you trample on one person's rights to accommodate for another person's rights. Why should a physician have to cough up the cost of protecting the rights of the disabled. We all pay taxes to protect the disabled. Why can't the government fund these types of services? These are the questions the AMA should be asking. I keep saying physicians need to unionize and strike. No other way to protect your rights than to actually fight for them. Sounds ridiculous, but what other real options do physicians have? It’s not like that dog show the AMA is putting up is helping anyone. Even the pts they claim to protect are not benefiting from their circus.

 

[turkeyjerky]

It seems to me that, if a translator is deemed to be a necessary/required part of caring for a deaf/disabled/foreign patient, then it should be paid for by the patient's insurance. What's next--doctors being forced to pay for their patients' medications?

 

[michaelrack]

It seems to me that, if a translator is deemed to be a necessary/required part of caring for a deaf/disabled/foreign patient, then it should be paid for by the patient's insurance. What's next--doctors being forced to pay for their patients' medications?

With Obama, that might be coming next.


Seriously, the translator issue has been discussed extensively on medscape. If a doc gets a deaf patient, the doc has to pay for a certified interpreter if the patient requests it.

The only way to get out of this is to stop taking ALL patients who have the insurance that the deaf person has.

 

[Winged Scapula]

I'm curious to hear Law2doc's take on all of this, but one question I had - is it legal to bill for the interpreter? I see that the physician must provide the service, fine - but what precludes him from billing the patient directly for this added service? Should the patient be unable or unwilling to pay for the service, then the physician would be well within his right to no longer see the patient, no?

I mean, if this was a case about a plumber, would he be required to replumb a deaf person's house at a financial loss in order to provide an interpreter present while performing his plumbing services?

I see nothing wrong with saying to a patient, " would be happy to communicate with you using the AT&T language line, it will cost you $7.00 per minute, feel free to dial this number and enter your telephone number"

For the deaf patient, just a computer and some typing back and forth would suffice, be reasonable, and be free.

This kind of thing will only happen so much longer before physicians stop seeing patients.

Within legal reason, you can bill for pretty much anything you want if there's a CPT code for it (which I doubt there is).

However, you won't get paid for it just because there's a code. I can code for phone conversations with patients, placing a certain pain pump at the time of surgery and for the cost of the office supplies (all of which have codes) but insurance will not reimburse me for these.

Now if the patient were self-pay, that's a separate story, but most aren't.

 

[NotAProgDirector]

This is the power of the ADA law. The theory behind it is actually sound -- If you have a severe disability, you'd find that the world is not terribly accessible. Let's say you're deaf and you need to see a physician. You come and see me, and we have to have a complex decision -- surgery vs not, or steroids vs remicaid, whatever. It's hard to have that discussion in writing -- unless you type really quickly. Asking patients to pay for their own translators is probably unrealistic. There's no way to require the deaf to learn to read lips. If you consider it, it would be REALLY tough to be deaf ad have trouble communicating with a physician, let alone your hairdresser. The ADA law states that physicians (and employers and other businesses) need to make "reasonable accomodations" for the disability -- which seems reasonable.

The problem is defining what is reasonable. The courts look at the entire income of the "company" asked to make the accomodation and the cost of the accomodation, and decide based upon that. The fact that the physician will lose money on this transaction is immaterial (according to the courts). If it's a drop in the bucket compared to their income, then they have to do it. They do not look at the individual transaction, and don't care if the physician loses money -- as long as they can "afford" it which is purely in the court's discretion.

Of course, as others have mentioned, the court tends to ignore the cumulative cost of these interventions.

What I'm waiting for is the flood of irrational but perfectly defensible requests:

1. I have ADD or a learning disability and need an hour long visit instead of 15 minutes.
2. I have severe back pain and must have a nice leather recliner to sit in the waiting room.
3. I have multiple chemical sensitivity syndrome, and cannot be exposed to purfumes or other chemicals. No one in the office can wear any, and no one in the waiting room can either (or I'll need my own waiting room, or have to be put in a room immediately).

...and it's only a matter of time before this hits residency training:

1. I have a sleep disorder (or other chronic medical disorder), and must get 12 hours of sleep each night. You must adjust the schedule to accomodate this.

2. I have carpal tunnel syndrome, and cannot use a computer for more than 30 minutes in a row. You will need to hire someone to use a computer for me.

 

[futuredo32]

3. I have multiple chemical sensitivity syndrome, and cannot be exposed to purfumes or other chemicals. No one in the office can wear any, and no one in the waiting room can either (or I'll need my own waiting room, or have to be put in a room immediately).

During my outpatient OB/Gyn rotation, there was actually a new patient "deathly allergic" to perfumes. She called the day before to say that none of the medical staff could wear any perfume or use scented soap/lotion and she had to be put in a room the second she arrived at the clinic/couldn't wait in the waiting room even to check in. On the day of her appointment, she called the office from her cell phone when she was in the parking lot so she wouldn't have to spend time in the lobby checking in.

 

[Winged Scapula]

...and it's only a matter of time before this hits residency training:

1. I have a sleep disorder (or other chronic medical disorder), and must get 12 hours of sleep each night. You must adjust the schedule to accomodate this.

2. I have carpal tunnel syndrome, and cannot use a computer for more than 30 minutes in a row. You will need to hire someone to use a computer for me.

We already get people here asking about such accomodations (or special accomodations and extra time to pump breast milk during USMLEs! 😉...anyone know if she ever passed her exam and started residency?)

 

[LADoc00]

I was like holy crap: http://www.ama-assn.org/amednews/2009/01/05/prca0105.htm

If you refuse to see such a patient, can you be sued for discrimination too? Is it are you damed if you do and damed if you don't?

Good. I hope every primary care doctor goes out of business. I hope patients like these die in streets as a result.

Reap the whirlwind I say. No other doc should take her as a patient.

 

[BlondeDocteur]

We already get people here asking about such accomodations (or special accomodations and extra time to pump breast milk during USMLEs! 😉...anyone know if she ever passed her exam and started residency?)

I remember thinking it was a very, very fishy story. The article was written in June '07 and Currier was described as being "MD-PhD, '07." There were references to her need to start "her medical residency at MGH in the fall." She had failed Step 2 CK in the spring and needed to retake it pronto. She had also not yet taken CS, but "was planning on it in October."

I know she had matched into pathology (most likely in the fall of 2006, with everyone else, after starting the accelerated 3rd/4th yr MD-PhDs do), but her CK failure meant that she couldn't graduate on time, in June. Evidently MGH gave her some sort of provision to start in November 2007 instead. I'd be interested to know: can you graduate off-cycle at Harvard? And can you graduate without having passed Step 2 CS? And how often do residencies delay the start dates for a matched candidate who is later ineligible to begin (esp at a top-tier program)?

Currently, she is not listed as either a PGY-1 or a PGY-2 on the MGH path website:
http://www2.massgeneral.org/pathology/train/staff.htm#RESFELLOWS#RESFELLOWS

According to the Harvard directory, she is not currently affiliated with the University in any way.

In other places, her partner states that she has "severe, extensive, and duly-documented learning disabilities" and that she made it through undergrad and grad school by having others read to her and take notes. She didn't learn to read until she was 8. Her grades evidently weren't so great in the preclinical years, but she got "many As and A+s on the patient care rotations" (which is practically all that Harvard gives!) and yet she failed Step 2 CK. She was given extra time to take Step 1 as well. She was an unproductive PhD student and frankly seemed to be marginal all the way around. Not to beat up on her, but still... it seems she's been to this rodeo before.

http://talentdevelop.com/articles/HyperGU.html

 

[PeepshowJohnny]

I too would love some updated info on Sophie Currier as well.

Oh, and you know what else I love? Unfunded mandates. Yeesh.

 

[Trifling Jester]

That's what I'm trying to figure out, if you refuse to see them and refer them to someone else can you get sued for discriminating against their disablity? Or are we like indentured servants and have to pay out of our pockets to treat these patients?

You can refuse to see anyone you want. You just have to be creative with the reasoning. "We have no openings in our schedule," should work just fine.

-The Trifling Jester

 

[rkaz]

Hi all,

I had shared this story with my father, who has his own private specialty medical practice. He was very dismayed and surprised to hear this story, as he currently has a deaf patient who he communicates with during appointments with written notes. He was stunned to hear that he could get sued for this, and didn't think it was fair that he should have to find/pay for interpretor services which would be well over his reimbursement costs.

He said that he currently only has one deaf patient, but in future, he may tell his office staff to decline any new deaf patients. I told him that he may then get sued for refusing to see a patient. He said that he would have his office staff inform the patients that he doesn't have resources to address their disabilities, and that was the reason why they couldn't be accommodated... and I told him that I didn't think this would change the situation at all, as they would still sue for him discriminating on them because of their disabilities.

His response was that he wasn't discriminating on them due to disability, as the patients could bring in their own translators, so he isn't discriminating towards them as patients... but I told him that based on this lawsuit, it seems like the doctor is expected to pick up the tab.

We also talked about how many of his patients are Spanish-only speaking, and my father doesn't speak any Spanish. He said that he usually communicates to them through their English-speaking children. I told him that I remembered a lawsuit years ago in which a Spanish-speaking woman sued her physician for misinterpretation between her son and the physician. So depending on relatives of a patient to translate could also set one up for lawsuits.

In both cases, whether it be interpretation needed for deaf patients or Spanish-speaking patients, the patients won their lawsuits. I was telling my father that it seems he is at risk for being sued based on these issues.

What options does he have to get interpreter services? Are their medical interpreter organizations that he could call? I mean, if he needs a translator for Spanish, or ASL, or Chinese or whatever... where the heck is he supposed to find these people? He says he already spends extensive time with his deaf patient (more than with other patients), as it takes a long time writing notes back and forth... but now having to seek out a translator would be excessive hassle. He still doesn't think (and neither do I) that he should have to pay for these interpreters out of his pocket, but in light of these lawsuits, we would like to find out what options are there for physicians in private practice. He was also wondering if he could get sued if the translator mixes things up (although they are paid to translate)... does the translator have to sign off on medical documents? Where would he go about finding all this information?

Any advice would be most appreciated. Thanks!

 

[Faebinder]

Hi all,

I had shared this story with my father, who has his own private specialty medical practice. He was very dismayed and surprised to hear this story, as he currently has a deaf patient who he communicates with during appointments with written notes. He was stunned to hear that he could get sued for this, and didn't think it was fair that he should have to find/pay for interpretor services which would be well over his reimbursement costs.

He said that he currently only has one deaf patient, but in future, he may tell his office staff to decline any new deaf patients. I told him that he may then get sued for refusing to see a patient. He said that he would have his office staff inform the patients that he doesn't have resources to address their disabilities, and that was the reason why they couldn't be accommodated... and I told him that I didn't think this would change the situation at all, as they would still sue for him discriminating on them because of their disabilities.

His response was that he wasn't discriminating on them due to disability, as the patients could bring in their own translators, so he isn't discriminating towards them as patients... but I told him that based on this lawsuit, it seems like the doctor is expected to pick up the tab.

We also talked about how many of his patients are Spanish-only speaking, and my father doesn't speak any Spanish. He said that he usually communicates to them through their English-speaking children. I told him that I remembered a lawsuit years ago in which a Spanish-speaking woman sued her physician for misinterpretation between her son and the physician. So depending on relatives of a patient to translate could also set one up for lawsuits.

In both cases, whether it be interpretation needed for deaf patients or Spanish-speaking patients, the patients won their lawsuits. I was telling my father that it seems he is at risk for being sued based on these issues.

What options does he have to get interpreter services? Are their medical interpreter organizations that he could call? I mean, if he needs a translator for Spanish, or ASL, or Chinese or whatever... where the heck is he supposed to find these people? He says he already spends extensive time with his deaf patient (more than with other patients), as it takes a long time writing notes back and forth... but now having to seek out a translator would be excessive hassle. He still doesn't think (and neither do I) that he should have to pay for these interpreters out of his pocket, but in light of these lawsuits, we would like to find out what options are there for physicians in private practice. He was also wondering if he could get sued if the translator mixes things up (although they are paid to translate)... does the translator have to sign off on medical documents? Where would he go about finding all this information?

Any advice would be most appreciated. Thanks!

I think the judge that ruled in this case did the world of handicaps a major disfavor way more than he/she realizes. This story is wild fire in new jersey.

If your father wants to protect himself he needs to have a cooperative set of staff that will "autodelay" people who are deaf.... but then if everyone does it, they will suspect him and then start to go for specific lawsuit. This case is a disaster and the only way for this risk to end is for the AMA or some equally large organization to do something. There is no way around this, we are in trouble.

 

[Jersey]

How about charging a "Special Accomodation" fee. Saying that any patient that requires special accomodations may incur an additional charge that may or may not be covered by the patient's insurance; that if not covered will be the patiemt's responsibility.

You can bet that an attorney who has to spend additional time with anyone due to that person's diability is not going to suspend their hourly charge.

In fact, now that I think about it, this person who sued the doc should look and see if her attorney charged her more than a non-disabled person because he had to spend more time with her because she was "Disabled"! And then sue his A**...

 

[Jersey]

I'm not a doc yet, close but not yet so I really don't know how these things work. But, why can't the AMA adopt a blanket policy along the lines of: Any expenses incurred in providing care that falls outside of the scope of direct medical care but has a nexus to providing proper care will be the responsibility of the patient.

An attorney will charge for any additional expenses incurred like hiring an investigator, documentation prep and, I bet, hiring an interpretor.

In court, with the backing af the AMA, the docs can say they are not doing anything an attorney wouldn't do to properly represent (treat) their client (patient).

 

[bjolly]

I'm not a doc yet, close but not yet so I really don't know how these things work. But, why can't the AMA adopt a blanket policy along the lines of: Any expenses incurred in providing care that falls outside of the scope of direct medical care but has a nexus to providing proper care will be the responsibility of the patient.

An attorney will charge for any additional expenses incurred like hiring an investigator, documentation prep and, I bet, hiring an interpretor.

In court, with the backing af the AMA, the docs can say they are not doing anything an attorney wouldn't do to properly represent (treat) their client (patient).

The reason why they can't, and why doctors can't charge a "special accomodation" fee as you suggest in your previous post, is that it violates the law. The Americans with Disabilities Act says that the doctor is responsible for providing the interpreter, and can't charge the patient for it. No amount of politely saying "sorry, we don't pay for interpreters" is going to get the doctor off the hook, whether it's said by the doctor or the AMA. For the same reason, the doctor can't cover himself by saying "I can't meet your special needs but I'll refer you to someone who can."

That's the whole point of this discussion we're having - the law places the responsibility on the doctor to provide, and pay for an interpreter.

 

[dragonfly99]

<The reason why they can't, and why doctors can't charge a "special accomodation" fee as you suggest in your previous post, is that it violates the law. The Americans with Disabilities Act says that the doctor is responsible for providing the interpreter, and can't charge the patient for it. No amount of politely saying "sorry, we don't pay for interpreters" is going to get the doctor off the hook, whether it's said by the doctor or the AMA. For the same reason, the doctor can't cover himself by saying "I can't meet your special needs but I'll refer you to someone who can.">

This is correct. The AMA does not have the ability to overpower a federal law.

Also, the Civil Rights Act has been interpreted in recent years to protect non English speaking people by requiring health care providers to provide a translator if the patient needs one. This could be done by one of those foreign language lines (an over-the-phone interpreter) or a staff member who speaks the language. It's not illegal to use a family member IF THE PATIENT IS OK WITH IT. If the patient asks for an interpreter or is uncomfortable using a family member (which could happen if the issue is some sensitive issue r.e. reproductive health, infectious dz, etc.) then the physician (or hospital, etc.) has to provider interpreter services.

To the person above whose father is thinking of turning away deaf patients - if he does that he is begging to be sued. You CANNOT refuse to see a patient because he/she is handicapped. That is illegal discrimination. Communication with his deaf patient via typing or notes, etc. would not necessarily be illegal if the patient is understanding him. If the patient states he/she is having trouble understanding, or requests an interpreter, then he (the doc) would have to provide one unless it's an unreasonable accommodation. If he's a solo doc who doesn't make much money, he might get away with not getting an interpreter, etc. but for most docs they would make enough money that the courts wouldn't consider providing a free interpreter for the occasional deaf patient an "undue burden". If your father contacts the state or local medical society they might have some good information on interpreters (ASL and foreign language) and can likely provide more information on complying with the law. You can also use google...I know a few years ago when I interned w/the AMA as a med student there was definitely stuff on the web. The federal office of civil rights I think is the office that tries to enforce the Civil Rights Act. I don't know about the ADA...

 

[NotAProgDirector]

In fact, now that I think about it, this person who sued the doc should look and see if her attorney charged her more than a non-disabled person because he had to spend more time with her because she was "Disabled"! And then sue his A**...

I believe the ADA would apply to lawyers also. So, if a deaf person goes to see a lawyer, the lawyer would need to provide a translator at their (the lawyer's) expense. The major difference, of course, is that lawyers bill based upon time and can set their rate at whatever they want. So, if a meeting takes 15 minnutes longer because of a translator, I think the lawyer could bill for the extra 15 minutes (but not the translator). I think. But I'm not a lawyer. But L2D is.... hint....

 

[edfig99]

your father can consult with his attorney/risk manager, check with his state medical society, or the state commision for the Deaf and Hard of Hearing as a starting point to learn about available resources for dealing with that patient population and the associated medicolegal issues. There are other ways to communicate available besides a sign interpreter. For other languages, there are commercial phone interpreter services. if he is affiliated with any hospitals/health systems, he can also check with them about available services. there's no reason (or legal basis) to try to exclude patients from his practice, particularly if he participates in government insurance programs. sounds like the folks your dad is taking care of are ok with the care he is providing and the manner in which he communicates with them...unlike the doctor that (rightfully) lost the suit -- who blew off the patient when she felt communication was inadequate.

Hi all,

What options does he have to get interpreter services? Are their medical interpreter organizations that he could call? I mean, if he needs a translator for Spanish, or ASL, or Chinese or whatever... where the heck is he supposed to find these people? He says he already spends extensive time with his deaf patient (more than with other patients), as it takes a long time writing notes back and forth... but now having to seek out a translator would be excessive hassle. He still doesn't think (and neither do I) that he should have to pay for these interpreters out of his pocket, but in light of these lawsuits, we would like to find out what options are there for physicians in private practice. He was also wondering if he could get sued if the translator mixes things up (although they are paid to translate)... does the translator have to sign off on medical documents? Where would he go about finding all this information?

Any advice would be most appreciated. Thanks!

 

[OTD]

...unlike the doctor that (rightfully) lost the suit -- who blew off the patient when she felt communication was inadequate.

So exactly how is extortion (forcing the doc to lose 150 bucks cash each visit) right?

Written and communication with family are perfectly viable forms of communication. Asking for her on personal sign interpreter is unreasonable.

It's like a statute saying you need to provide someone adequate transportation and you get sued because you provided them a cab (perfectly adequate) but they demanded that you buy them a Lexus.

What harm was caused? None because according to the article there was adequate treatment, which means the communication had to be adequate.

Taking money from someone that caused you no harm, and in fact in this case actually HELPED you is stealing, you can call it what you want but it's stealing plain and simple.👎

 

[Coastie]

You can refuse to see any patient in private practice, no questions asked.

I was like holy crap: http://www.ama-assn.org/amednews/2009/01/05/prca0105.htm

If you refuse to see such a patient, can you be sued for discrimination too? Is it are you damed if you do and damed if you don't?

 

[Solideliquid]

I remember seeing this article a few months back. It's really a shame that jury handed down the $400k award, I hope it gets appealed down.

I'm two years away from finishing residency and at this point assuming nothing changes I've been thinking about how I'd handle these patients.

Say a patient walked into my office for an initial evaluation, and I determined the patient has some sort of disability requiring a translator. I would ask them to come back next week, hire the $150-200 translator and do an initial evaluation/consult. I would then explain to the patient through the translator my medical opinion and treatment recommendations. I would then explain that the patient is from now on responsible to bring a translator if he/she wanted to continue seeing me. If the patient cannot afford the service I would simply refer to a larger network or university hospital setting.

Wouldn't that cover me?

Oh and about the woman in the article, it seems that she was simply uneducated enough to understand the English language. So we are now responsible for people who don't want to pay attention in the fourth grade? How does this apply to people with mental ******ation who come into your office alone?

 

[docB]

your father can consult with his attorney/risk manager, check with his state medical society, or the state commision for the Deaf and Hard of Hearing as a starting point to learn about available resources for dealing with that patient population and the associated medicolegal issues. There are other ways to communicate available besides a sign interpreter.

I suggest NOT discussing this with the Deaf and HOH group. You would not want to flag yourself as someone who is in violation and therefore could be targeted for a jackpot lawsuit. Remember that any advocacy orginization like that is not on your side. They are the ones who put through the ADA which is the problem.

So exactly how is extortion (forcing the doc to lose 150 bucks cash each visit) right?

It's not right. It's the law. Big difference.

Written and communication with family are perfectly viable forms of communication. Asking for her on personal sign interpreter is unreasonable.

It's like a statute saying you need to provide someone adequate transportation and you get sued because you provided them a cab (perfectly adequate) but they demanded that you buy them a Lexus.

What harm was caused? None because according to the article there was adequate treatment, which means the communication had to be adequate.

Taking money from someone that caused you no harm, and in fact in this case actually HELPED you is stealing, you can call it what you want but it's stealing plain and simple.👎

I know that the way it's interpreted in my hospitals (corporate houses with high power lawyers and compliance officers) it's not enough to provide some adaquate form of communication. You have to provide a sign interpreter if they prefer that to notes. When they come in here they are pretty belligerent about it. It usually takes us 3+ hours to get the interpreters and it really bogs down the ED.

You can refuse to see any patient in private practice, no questions asked.

Not true. Just try refusing to see every patient of a given ethnicity and see how that goes for you.

 

[bjolly]

Say a patient walked into my office for an initial evaluation, and I determined the patient has some sort of disability requiring a translator. I would ask them to come back next week, hire the $150-200 translator and do an initial evaluation/consult. I would then explain to the patient through the translator my medical opinion and treatment recommendations. I would then explain that the patient is from now on responsible to bring a translator if he/she wanted to continue seeing me. If the patient cannot afford the service I would simply refer to a larger network or university hospital setting.

Wouldn't that cover me?

Again, no, it would not. The law says the doctor has to provide a translator. What you are proposing amounts to saying "I'm going to inform the patient politely and clearly that I am not going to do what the law requires. Wouldn't that cover me?"

People keep posting in this thread saying some variation of this. The law says the doctor must provide the interpreter. Reading comprehension, people.

Considering so many people are arguing a translator is unnecessary since written communication is a perfectly good substitute, the lack of reading comprehension being repeatedly displayed in this thread is pretty ironic.

 

[QofQuimica]

The way I see it, you basically have three choices if you don't want to provide a translator for a deaf patient:

1) You obey the letter and spirit of the law, even though it's a financial loss to you every time you see one of these patients. Maybe you can make it up by charging other patients a little more, and maybe you just have to suck it up and write it off as part of the cost of doing business.

2) You flout the law quietly and hope you don't get caught or that the situation never arises. Maybe you'll luck out and no deaf patients will show up to your practice, or maybe the few you get will be ok with using paper-and-pen communications, or the ones who want translators won't be aware that the law is on their side.

3) You flout the law deliberately and publically with the intention of making a court case out of it. Civil disobedience is always an option when you disagree with a law, but you have to be willing to take the consequences (possible jail time, fines, negative publicity, etc.) if the justice system and the community don't support you. I have to say that I doubt you'd get much sympathy from the community. A lot of people think physicians make too much money as it is, and here you, the money-grubbing doctor, are trying to get out of seeing this poor, disabled person just because they can't pay for the accomodations. (Note: I'm not saying I agree with this position, merely that it's pervasive among laypeople.)

 

[NotAProgDirector]

The AMA has a nice summary of the situation posted here.

 

[OTD]

Again, no, it would not. The law says the doctor has to provide a translator. What you are proposing amounts to saying "I'm going to inform the patient politely and clearly that I am not going to do what the law requires. Wouldn't that cover me?"
People keep posting in this thread saying some variation of this. The law says the doctor must provide the interpreter. Reading comprehension, people.
Considering so many people are arguing a translator is unnecessary since written communication is a perfectly good substitute, the lack of reading comprehension being repeatedly displayed in this thread is pretty ironic.

Well from the reading of the article by the AMA it appears it is you that lacks reading comprehension LOL LOL LOL.

The article plainly states "reasonable accomodations" (since when is written/lip reading/ or family communication unreasonable?)

It also plainly says there is NO hard and fast requirement to provide a signer.

It also says the healthcare provider can determine the mode of communication as long as it is adequate.

So, it seems the quote from the judge "he could afford it" and the decision to disallow information on the good outcome is more telling now than ever since successful treatment would imply adequate communication.

According to the way the AMA and their lawyers say the act is worded he did NOT violate the act but was held up and had his money stolen simply because "he could afford it." 😱😱

 

[Solideliquid]

^

It doesn't really matter what the AMA says, you need a good lawyer since the jury/judge can come up with whatever random craziness they feel like.

In this case, he was seeing this patient monthly and I think I would have let her come in every six months, hire the interpreter and let this patient come to the office around 7pm or so after seeing all the other patients.

 

[mig26x]

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

If this continues I see a very bad future for medicine. People are going to get scared of becoming a doctor.

Im hispanic and I cant understand why would they mandate for a doctor to PAY out of his pocket a translator for a non-english speaking patient.

This is ridiculous!!!

 

[docB]

,,,I cant understand why would they mandate for a doctor to PAY out of his pocket a translator for a non-english speaking patient.

This is ridiculous!!!

You can't understand it or you disagree with it? There's a difference. I find it easy to understand that politicians like to create unfunded mandates that bestow entitlements. Hell, that's just good politics. But then as an EP I work under EMTALA which is the biggest unfunded mandate the medical industry has ever seen.

 

[michaelrack]

The AMA has a nice summary of the situation posted here.

From the AMA summary:

"Last updated: Apr 30, 2007"

The AMA summary is outdated. If a deaf patient asks for a certified interpreter, the doc has to pay for it.

 

[cali-ob]

when you use a translator phone in the hospital is it billed to the patient (or their insurance) or to the hospital? I thought the patient paid in house.
because whenever we have a patient that speaks a language that is hard to get an interpreter for, the patient's will sometimes request a family member translate instead because they don't want to have to pay for the use of the phone. Is this true?
And if so, then when you are hospitalized it is billed to the patient, but in an outpatient setting, billed to the doc?

 

[dragonfly99]

Cali-ob
that is an awesome question.
I'd like to know the answer too. I'll bet that in the hospital, the hospital is eating the cost of the translator, because to bill the patient would be considered discriminatory, but I'm really not sure.

 

[edfig99]

our hospital pays for the language line services. this includes the outpatient clinics, although not necessarily the affiliated private practices. in the private practice setting, the practice i worked for absorbed those costs.

when you use a translator phone in the hospital is it billed to the patient (or their insurance) or to the hospital? I thought the patient paid in house.
because whenever we have a patient that speaks a language that is hard to get an interpreter for, the patient's will sometimes request a family member translate instead because they don't want to have to pay for the use of the phone. Is this true?
And if so, then when you are hospitalized it is billed to the patient, but in an outpatient setting, billed to the doc?

 

[docB]

Where I am the hosptials eat the cost. I know that no patient info is given to the service and no note about the event (other than the docs note about the info gleened via the interaction) is ever recorded. However the language line does ask for the name of the instituion and the staff member requesting the service so they can bill the hospital.

 

[NotAProgDirector]

From the AMA summary:

"Last updated: Apr 30, 2007"

The AMA summary is outdated. If a deaf patient asks for a certified interpreter, the doc has to pay for it.

Actually, even though it is old, I think it's still a good summary.

It makes clear that:

1. Deaf patients (or those with a disability) must be informed that "aurally delivered material" will be made accessible to them.
2. The physician must determine, in consultation with the patient, what mechanism is the best given the situation.
3. When a clinical situation is complex, or an important decision is to be made, then an interpreter is the best choice.
4. The standard is effective communication, which it's the physician's duty to ensure has happened but the patient is the only one able to measure success.
5. The only exceptions are when the use of an interpreter would fundamentally alter the care delivered (which probably is never) or if it causes an undue hardship on the physician.
6. Undue hardship is a legal term, and is NEVER that the reimbursement is less than the cost of the translator

By these rules, if the patient asks for a translator, that equals "I don't understand what you're telling me or I can't ask a question" and automatically triggers a need for a translator.

Well from the reading of the article by the AMA it appears it is you that lacks reading comprehension LOL LOL LOL.

The article plainly states "reasonable accomodations" (since when is written/lip reading/ or family communication unreasonable?)

It also plainly says there is NO hard and fast requirement to provide a signer.

It also says the healthcare provider can determine the mode of communication as long as it is adequate.

So, it seems the quote from the judge "he could afford it" and the decision to disallow information on the good outcome is more telling now than ever since successful treatment would imply adequate communication.

According to the way the AMA and their lawyers say the act is worded he did NOT violate the act but was held up and had his money stolen simply because "he could afford it." 😱😱

The problem here is that you are not reading the wording as legal text.

"There is no hard and fast rrequirement to provide a signer" = it's not written into the law precisely. But the courts have interpreted it this way (as above).

"reasonable accomodations" = you can afford it and it won't alter your business in some major way. not that you think it's "reasonable".

The healthcare provider has the responsibility to determine the mode of communication. However, it is also their responsibility to determine whether that mode has been successful. And a patient asking for a translator = not effective.

Im hispanic and I cant understand why would they mandate for a doctor to PAY out of his pocket a translator for a non-english speaking patient.

Just to be clear, these are to different legal issues. The accomodation for deafness is driven by the ADA. The requirements for addressing those patients with Limited English Proficiency (LEP) is driven by the Civil Rights Act. The outcome may be the same (i.e. a requiremet to provide translators) but the legal issues are different. The AMA also has a summary of the LEP issue.

 

[OTD]

The problem is the treatment was successful that means that the communication was adequate. The "judge" not allowing this is huge.

Put it in terms of cars, if a statute said that you had to provide adequate transportation and you got a cab to take the patient to their destination this would complete the requirements. A cab is adequate transportation by most reasonable peoples standards. She demanded the doctor buy a Lexus for her. Aparently this "judge" decided that she should be able to extort a Lexus from him because "he could afford it".

Theft, pure and simple. You can call it anything you want but they just stole from him just the same as if they had held him up at gunpoint.