Dr sued $400k for communicating via writing instead of sign language interpreter

[Retsage]

Back on topic: this woman did not have the option of learning to speak English. She was visiting the doctor about once a month for a year and a half for a serious chronic disease that has a relatively high rate of morbidity and mortality.

While the deaf are usually able to read and write in English, they also tend to have rather poor reading skills. You can imagine that sounding out words is difficult when you have no sounds with which to associate the letters on the page. A large proportion of American's have poor health literacy. It is likely that deaf Americans are even more likely to be poor readers and writers. How do you describe your symptoms and ask questions if you can't spell the words or you feel like your spelling and syntax will make you seem stupid?

This woman had the legal right to an interpreter. She had the legal right to medical treatment; refusal to care for deaf patients because of their deafness is illegal. The doc can dislike the law but the law is the law. Note that this is not medical malpractice and the doctor's insurance doesn't cover this jury award. This is coming out of his personal treasure. Also note that $200,000 in punitive damages means that the jury is punishing the doctor. A judge & jury in a civil suit can't put anyone in jail but they can put a financial squeeze on them and that's what they did in this case. The doctor knew the law but chose to ignore it. The patient may not have known her rights going into the relationship but as she grew more aware of her rights, she became more disgruntled with the doctor's refusal to meet her needs.

Hmm. I hadn't considered this. Very interesting perspective. Especially in regards to health literacy and such. It's somewhat changed my outlook on the situation.

That being said, I think it's still completely unjust for him to incur a loss for his work. I can understand willingly doing charity work, but he should not be forced into such a situation. What if he had dozens of deaf patients? He would not be allowed to turn any of them away, and would be incurring a loss for providing a service to see each one. While it may not bankrupt the doctor, said physician would undoubtedly minimize contact with these disabled patients, to lose as little monetarily as possible. Far worse treatment for them overall.

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[airplanes]

So what? Even if he made that much or more, why should he be required to provide a service for free (or even a net loss in this case)?

Because its the law. He had other options.

 

[MossPoh]

While I think this law suit is ridiculous, this is a horrible statement. American Sign Language is a language in itself - it has a distinct grammar and structure. It is not simply a bunch of hand gestures. Writing should not be a substitute, just like yelling and gesticulating at a hearing person who speaks a different langauge is not a substitute for an interpreter.

I went to a deaf magnet school and had deaf friends and teachers. Just because the language isn't spoken, doesn't mean its not a language in itself and that they don't deserve the same rights as someone that speaks Spanish.

Ok, but if anything, writing is a better alternative. It is a log of everything that is said. Its great that ASL is a language in itself, but you don't write ASL. The person should be able to read. It is a perfectly acceptable means of communication. How many people at your magnet school turned in pictures of their hands or videos for essays? ASL has a structure of its own because it is difficult to convey certain things with a relatively limited amount of gestures (relative to the English language).

 

[tdittyx2x3]

I just became so angry, so quickly. My roommates are afraid

Interesting lawsuit story from high school: An acquaintance of mine "fell through" a glass door at a Wendy's when he slipped on the freshly mopped floor. In actuality, he jumped through the window as a joke. He didn't mean to break the glass, but he surely did. And he surely almost severed an artery in his neck. He nearly died.

His family sued for negligence. $1 million. He received it when he turned eighteen, most of which has since gone to a new Audi and nose candy. We are not acquainted anymore..

 

[chessodoc]

This is an incredibly extreme example...Nuremberg Laws.

Just because it is a law does not mean it is just.

Because its the law. He had other options.

 

[LizzyM]

Ok, but if anything, writing is a better alternative. It is a log of everything that is said. Its great that ASL is a language in itself, but you don't write ASL. The person should be able to read. It is a perfectly acceptable means of communication. How many people at your magnet school turned in pictures of their hands or videos for essays? ASL has a structure of its own because it is difficult to convey certain things with a relatively limited amount of gestures (relative to the English language).

If you read some of the links I provided, you'll learn that the writing was done on the paper cover of the exam table, that the patient wasn't very comfortable with written English and that she often used her domestic partner and her 9 year old child to help with communication. She was still in the dark about what to expect -- for example, she did not know that the steroids prescribed for her condition caused her face to swell. She thought that this was caused by her disease, not by the drug. Steroids have other side effects and one has to wonder if she was well informed at all about her disease, its treatment, and the side effects of treatment.

 

[LizzyM]

This is an incredibly extreme example...Nuremberg Laws.

Just because it is a law does not mean it is just.

What are you talking about? Are you talkiing abou war crimes trials that occured in Nuremberg? In those cases, the physicians on trial justified their actions by saying that everyone was doing it and that there were no laws against what they did. The Nuremberg Code on the conduct of human subjects research came out of that trial but that is another kettle of fish.

 

[JoltOfFuel]

As a portion of operating costs in this physician's case, $150 in business expense is not an unreasonable cost.

It seems pretty unreasonable if you only get $49. That would never fly in any corporation. No company would continue a service that costs them time and money and only benefits one customer. I realize health care isn't the same situation at all, but using business logic here just isn't valid.


Does anyone know what the physician's options are in these cases? You can't turn her away, but don't want to incur a loss for seeing her. Are you obligated to find another physician for her? Or can you just refer her to a large hospital and hope they have an interpreter and accept Medicare?

 

[chessodoc]

What are you talking about? Are you talkiing abou war crimes trials that occured in Nuremberg? In those cases, the physicians on trial justified their actions by saying that everyone was doing it and that there were no laws against what they did. The Nuremberg Code on the conduct of human subjects research came out of that trial but that is another kettle of fish.

No. Nuremberg laws were anti-semetic set of decrees passed in Nazi Germany...an example - it is forbidden to marry a jew, and etc...

I was trying to make the point that people (and yes doctors) should not blindly follows laws. And as I stated previously, Nuremberg laws are an extreme example.

 

[walderness]

Also note that $200,000 in punitive damages means that the jury is punishing the doctor. A judge & jury in a civil suit can't put anyone in jail but they can put a financial squeeze on them and that's what they did in this case.

Bingo. How else do you enforce a civil matter? The state cannot collect a fine or throw them in jail or take away their business license...

 

[copingmethods]

Because its the law. He had other options.

I understand it's the law. If it's true that he could've gotten a tax credit to cover this, that makes all of this a little more understandable. I'm just saying I don't think the law should require someone to provide a service for free.

 

[Retsage]

Chesso, I'm invoking Godwin's Law on you.

Next time, just talk about Henry David Thoreau.

 

[Long Dong]

There is a thread on this in the general residency forums as well. Go there if you want to see what docs are saying about it.

 

[LizzyM]

No. Nuremberg laws were anti-semetic set of decrees passed in Nazi Germany...an example - it is forbidden to marry a jew, and etc...

I was trying to make the point that people (and yes doctors) should not blindly follows laws. And as I stated previously, Nuremberg laws are an extreme example.

Are you suggesting that laws requiring that those who receive Medicare payments are required to accomodate the disabled is like outlawing marriage between a gentile and a Jew?

The doc wasn't going to go broke providing this service to the rare deaf person with a severe rheumatologic condition. His tax return is proof of that. There are some people who are going to cost you more than you are paid to provide the service and there are some who are going to be gravy. If you have the right "case mix" you are going to do just fine when it averages out.

 

[walderness]

It seems pretty unreasonable if you only get $49. That would never fly in any corporation. No company would continue a service that costs them time and money and only benefits one customer. I realize health care isn't the same situation at all, but using business logic here just isn't valid.

I'm not saying it makes sense costwise, marginally, for that one patient. If it did, we wouldn't need regulation. But given the patient volume of this practice, it's not unreasonable.

 

[walderness]

And remember, this is just another operating cost that is probably immaterial to the bottom line of his practice. It's not the same as shelling out a $150 bucks from his wallet each time the patient comes in. The practice can write it off, etc.

 

[beachblonde]

Hmm. I hadn't considered this. Very interesting perspective. Especially in regards to health literacy and such. It's somewhat changed my outlook on the situation.

That being said, I think it's still completely unjust for him to incur a loss for his work. I can understand willingly doing charity work, but he should not be forced into such a situation. What if he had dozens of deaf patients? He would not be allowed to turn any of them away, and would be incurring a loss for providing a service to see each one. While it may not bankrupt the doctor, said physician would undoubtedly minimize contact with these disabled patients, to lose as little monetarily as possible. Far worse treatment for them overall.

Welcome to the world of unfunded government mandates. EMTALA, anyone?

I do think that the doctor should be held responsible for getting an interpreter, and in that sense the verdict is ok, but $400,000? Really? Especially in an instance where there was zero negligance? I wonder what comes next-a patient suing because they don't fully understand what their medications do? In so many of these types of lawsuits, there is zero patient liability and all blame is placed at the physicians' feet. I suppose it's a cultural thing, where people like to find scapegoats and shirk responsibility at all costs.

I'm betting that doctor regrets the day she walked into his office.

On a side note, I realize that it is illegal to stop seeing a patient due to a disability the patient has. But could have the doctor simply said he didn't want her as a patient anymore because of other reasons? Like her being a Medicare patient, or personality differences, or whatever? Doctors do have the right to refuse to see patients in a private practice, right? I might be completely off base here, so I'm curious what is legal/illegal.

 

[cpants]

The physician's tax return in this case showed a net income of $425,000. Even at $150/mo (and a visit with an interpreter every single time may not have been necessary), this would have been small potatoes out of the doc's pocket.

Don't pull that s h i t on a jury or they'll slap you with $200,000 in punitive damages.

The fact that he could afford it is a pretty weak argument. It shouldn't matter what the doctor makes, but let's say he was a family practice doc in a low income area making 110k/year with two kids in college and a mother in assisted living. The law would still be applied the same way. He would still be expected to pay 150 sorely needed dollars every time a deaf person visited him in clinic. The vast, vast majority of doctors make well under 425k/yr, and do not consider thousands of dollars per year insignificant.

This isn't a one time expense, like putting in a wheelchair ramp. This expense has no upper limit, and incentivizes providing less care to a disabled population. I am not arguing that deaf patients don't deserve to communicate with their doctors. I am arguing that doctors should not be forced to eat the cost of that communication.

 

[copingmethods]

Welcome to the world of unfunded government mandates. EMTALA, anyone?

True, but EMTALA is a little bit different, because EM physicians are salaried, right? So even if their patients are unable to pay their medical bills, the doctor still gets compensated.

 

[chessodoc]

Are you suggesting that laws requiring that those who receive Medicare payments are required to accomodate the disabled is like outlawing marriage between a gentile and a Jew?

The doc wasn't going to go broke providing this service to the rare deaf person with a severe rheumatologic condition. His tax return is proof of that. There are some people who are going to cost you more than you are paid to provide the service and there are some who are going to be gravy. If you have the right "case mix" you are going to do just fine when it averages out.

Once again, I stated that the Nuremberg law is an EXTREME example, I was trying to make the point that not all laws are just, the Nuremberg Laws were obviously not just. Forcing a physician to get an interpreter and LOSE money is NOT just. It is the law, and it should be followed, but it is not just. And it does not matter how much the physician makes, be it 50 grand or 5 million. If he makes 5 million and doesn't want to give 150 for an interpreter maybe makes him a bad person, but he should not be FORCED to lose 150 dollars in his business and lets be honest here, medicine IS a business.

Also, the fact that the woman could not get an interpreter is the failure of the society as a whole and of the government. If the fed really cared about the disabled maybe it should have set up a system where sign language interpretors were paid by the government and could be used by a physician in need.

Wow so a paragraph got deleted for some reason so writing it again.

That said, I am thinking of going into private practice as a primary care physician in an immigrant area, and these kinds of frivolous lawsuits are very discouraging, especially since I don't plan on making much money.

 

[LizzyM]

The fact that he could afford it is a pretty weak argument. It shouldn't matter what the doctor makes, but let's say he was a family practice doc in a low income area making 110k/year with two kids in college and a mother in assisted living. The law would still be applied the same way. He would still be expected to pay 150 sorely needed dollars every time a deaf person visited him in clinic. The vast, vast majority of doctors make well under 425k/yr, and do not consider thousands of dollars per year insignificant.

This isn't a one time expense, like putting in a wheelchair ramp. This expense has no upper limit, and incentivizes providing less care to a disabled population. I am not arguing that deaf patients don't deserve to communicate with their doctors. I am arguing that doctors should not be forced to eat the cost of that communication.

Actually, the courts take into consideration the cost of the accommodation in light of the business' income. What the court found to be reasonable in this case might be considered unreasonable in different circumstances. The "drop in the bucket" cost of providing the service is what "did in" Dr. F.

 

[chessodoc]

Chesso, I'm invoking Godwin's Law on you.

Next time, just talk about Henry David Thoreau.

Lol, point taken. But again, I said it was an EXTREME example. How about the Jim Crow laws, again an EXTREME, where a law is the law, but it is unjust.

 

[walderness]

Actually, the courts take into consideration the cost of the accommodation in light of the business' income. What the court found to be reasonable in this case might be considered unreasonable in different circumstances. The "drop in the bucket" cost of providing the service is what "did in" Dr. F.

Yes, and as I mentioned, # of employees is a parameter. A small practice with less than 15 employees is not subject to the ADA. If a dr. is paying 15 salaries, the comparable cost of retaining an interpreter is peanuts.

 

[walderness]

On a side note, I realize that it is illegal to stop seeing a patient due to a disability the patient has. But could have the doctor simply said he didn't want her as a patient anymore because of other reasons? Like her being a Medicare patient, or personality differences, or whatever? Doctors do have the right to refuse to see patients in a private practice, right? I might be completely off base here, so I'm curious what is legal/illegal.

I've been denied care unless I bring my own caretakers to transfer me and theres not a damn thing I can do about it, despite the fact that it violates the ADA.

 

[LizzyM]

Yes, and as I mentioned, # of employees is a parameter. A small practice with less than 15 employees is not subject to the ADA. If a dr. is paying 15 salaries, the comparable cost of retaining an interpreter is peanuts.

The interpreter need not be on the regular payroll. The person can be hired by the hour for the duration of the office visit.

This suit was brought under ADA but the New Jersey Law Against Discrimination and the Rehabilitation Act of 1973 as well, so the 15 employee guideline might be moot.

 

[walderness]

This suit was brought under ADA but the New Jersey Law Against Discrimination and the Rehabilitation Act of 1973 as well, so the 15 employee guideline might be moot.

Hmmm...ok...I still think that # of employees works better as a parameter than the physician's personal income since it pertains to the business rather than he individual. A physician should not be responsible to pay on his own if he has a small practice with a small volume of patients. If the practice has many physicians, the extra operating expense of having an interpreter on hand would not affect the bottom line.

 

[HolyGrail]

LOL... Only in America can someone who doesn't have enough money to pay for health care, and gets health care for free through Medicare, even complain about the care that they get.

Ladies and Gentlemen of the future generation of physicians, let these situations be a reminder, your first job is not to treat patients, it's to watch out for #1.

Physician duties by importance:
1) Watch out for your own ass
2) Fill out paperwork so that #1 is never broken
3) Treat patients in the time between doing 1 and 2

People can feel free to insert things between 2 and 3 at their leisure in the following posts...

 

[Depakote]

Back on topic: this woman did not have the option of learning to speak English. She was visiting the doctor about once a month for a year and a half for a serious chronic disease that has a relatively high rate of morbidity and mortality.

While the deaf are usually able to read and write in English, they also tend to have rather poor reading skills. You can imagine that sounding out words is difficult when you have no sounds with which to associate the letters on the page. A large proportion of American's have poor health literacy. It is likely that deaf Americans are even more likely to be poor readers and writers. How do you describe your symptoms and ask questions if you can't spell the words or you feel like your spelling and syntax will make you seem stupid?

This woman had the legal right to an interpreter. She had the legal right to medical treatment; refusal to care for deaf patients because of their deafness is illegal. The doc can dislike the law but the law is the law. Note that this is not medical malpractice and the doctor's insurance doesn't cover this jury award. This is coming out of his personal treasure. Also note that $200,000 in punitive damages means that the jury is punishing the doctor. A judge & jury in a civil suit can't put anyone in jail but they can put a financial squeeze on them and that's what they did in this case. The doctor knew the law but chose to ignore it. The patient may not have known her rights going into the relationship but as she grew more aware of her rights, she became more disgruntled with the doctor's refusal to meet her needs.

With regard to the care of non-English speaking patients, telephone interpreter services are available for patients who are not fluent in English and who speak a language that is not otherwise not widely spoken. Using family members as interpreters is suboptimal as issues of confidentiality arise (will a patient be forthcoming about issues they wish to keep secret from family members, particularly offspring).

This is what you're taught your first year in medical school. I'm sure it's not so cut and dry in practice, but you're wide open to get burned if you refuse a patient's request like this doc did. He really doesn't have any ground to stand on.

 

[walderness]

LOL... Only in America can someone who doesn't have enough money to pay for health care, and gets health care for free through Medicare, even complain about the care that they get.

Doesn't even have enough money to pay for health care? Try sending in an application for insurance and marking down a debilitating condition and then see if "you even have enough money for health care"? Everyone absolutely has a right to critique the care they're getting, ie getting info on the side effects of medications prescribed IS ABSOLUTELY REQUIRED.

 

[twick121]

I don't have the time to read all 3 pages, so this may have been covered. But I think is what people don't realize here is that English is a foreign language to Deaf people who use american sign language. Sign language has a different sentence structure, grammar, etc. This would be equivalent to writing down orders in english to explain something to someone who only speaks German. Yes, most Deaf people do also know written English, but not all do.

 

[jinx520]

LOL... Only in America can someone who doesn't have enough money to pay for health care, and gets health care for free through Medicare, even complain about the care that they get.

Are you suggesting that Medicare/Medicaid patients are only allowed to expect substandard care and to be happy with it?

Anyhow, the patient had an interpreter service contact the doctor on, I think, 3 different occasions. How hard would it have been for the doc to tell his office manager to look into options for the patient? The state might have had an advocacy agent (or access to one) that might be free for the doctor. As other posters stated, there are a lot of options out there that, it seems, the doctor didn't explore.

 

[cpants]

Actually, the courts take into consideration the cost of the accommodation in light of the business' income. What the court found to be reasonable in this case might be considered unreasonable in different circumstances. The "drop in the bucket" cost of providing the service is what "did in" Dr. F.

Income should not be taken into consideration. Either doctors are required to pay for these services or they aren't. Why would it be OK for a physician making 100k/year to use pen and paper, while it is 200k in punitive damages for a doctor making 425k doing the same? How is the patient injured more or less based on the MD's tax return? It's an unequal standard of the law. It makes no sense. Deaf patients who require translation should pay for it out of pocket if they can afford it, or if not, it should be paid as part of medicare or social security benefits. Alternatively, we could sign into law an act which provides funds for translation or hires state translators to be available for appointments. It isn't the doctor's fault that you have special translation needs, and he should not be penalized for seeing you, regardless of what his income is.

 

[JTubule1386]

Wow...kinda got me rethinking the whole decision to become a doctor. You risk getting sued sending them to another doctor because you can't afford to accommodate them, you risk getting sued trying to accommodate them to the best of your financial abilities, you risk getting sued trying to help them. I wonder what these a**holes would do if all the doctors just decided they were through. I mean clearly doctors don't have to be doctors, they have the brain power to do some other things and still get compensated well enough for it. Maybe everyone should be left to just treat their own illnesses. Well let no good dead go unpunished. You go to school and waste the best years of your life doing so, with the idea that you are going to help people. You are going to spend the next 20-30 years putting up with their BS and attitude trying to help them, just to take the risk of some of them trying to get rich quick off of your years of sacrifice. Oh yeah don't forget they are going to get 12 Joe Schmoes, probably the descendants of the same ignorant Schmoes that ordered that man to pay child support for a kid with type O blood when he himself had type AB blood. And these are the people who decides to punish the doctors. Wow and I thought I was through with being punished by mortal forces after I stole the care at age 16...what was I thinking? Maybe I should've went the business route, but no, I thought it was too cut throat for me...little did I know.

 

[LizzyM]

Income should not be taken into consideration. Either doctors are required to pay for these services or they aren't. Why would it be OK for a physician making 100k/year to use pen and paper, while it is 200k in punitive damages for a doctor making 425k doing the same? How is the patient injured more or less based on the MD's tax return? It's an unequal standard of the law. It makes no sense. Deaf patients who require translation should pay for it out of pocket if they can afford it, or if not, it should be paid as part of medicare or social security benefits. Alternatively, we could sign into law an act which provides funds for translation or hires state translators to be available for appointments. It isn't the doctor's fault that you have special translation needs, and he should not be penalized for seeing you, regardless of what his income is.

You may not like the current law but the current law is that reasonable accommodation must be provided. What is reasonable is determined by looking at the business income/profit and the cost of the accommodation. Something too expensive for a small business might be a drop in the bucket for a major one. The law takes that into account. When a solo practioner reported an income of $425,000/yr the court determined that the accommodation required by the plaintiff was reasonable and could have been provided without undue hardship on the business.

 

[jtimmer1]

Well, I am going to throw in my $.02:

I think the lady is ridiculous, however, the physician should have seen this situation developing. If the patient wasn't satisfied with corresponding via writing, and the physician wasn't willing to pay for the interpretation services, then the physician should have referred her elsewhere. It must have been obvious the disgruntlement the patient had and as her caregiver, he needed to act in the most appropriate way, not just continue in the same fashion. Like I read in a previous post, if I were in Dr.F's predicament, I would have written her a letter discharged her and enclose a list of nearby physicians she may contact. The situation went on for too long and subseqently led to Dr. F's demise and a hefty lawsuit.

In my opinion, the blame should not be just on either party, but both. The physician as well as the patient are both at fault here. The physician should have acted in a diplomatic manner toward the patient without being rude, and the patient should have not been so ridiculous in terms of communication as writing is just as viable as sign-interpretation.

On another note, if Dr. F was forced (somehow) to treat the patient, maybe they could have come to an agreement of sorts to pay for the interpreter. Possibly, each could pay half the cost in order to accommodate the patients disability.

 

[LizzyM]

Well, I am going to throw in my $.02:

I think the lady is ridiculous, however, the physician should have seen this situation developing. If the patient wasn't satisfied with corresponding via writing, and the physician wasn't willing to pay for the interpretation services, then the physician should have referred her elsewhere. It must have been obvious the disgruntlement the patient had and as her caregiver, he needed to act in the most appropriate way, not just continue in the same fashion. Like I read in a previous post, if I were in Dr.F's predicament, I would have written her a letter discharged her and enclose a list of nearby physicians she may contact. The situation went on for too long and subseqently led to Dr. F's demise and a hefty lawsuit.

In my opinion, the blame should not be just on either party, but both. The physician as well as the patient are both at fault here. The physician should have acted in a diplomatic manner toward the patient without being rude, and the patient should have not been so ridiculous in terms of communication as writing is just as viable as sign-interpretation.

On another note, if Dr. F was forced (somehow) to treat the patient, maybe they could have come to an agreement of sorts to pay for the interpreter. Possibly, each could pay half the cost in order to accommodate the patients disability.

The woman sued because she was told to go elsewhere and she felt that this violated her rights as a disabled person. The physician had a legal obligation to provide a reasonable accommodation. He refused to do so. The law prohibits him from billing the patient for the cost, or partial cost, of the accommodation. The court found that in these circumstances, a ASL interpreter was a reasonable accommodation for this particular patient's disability. The court found that because the woman's command of written English was not so good, that writing on the paper exam table cover was not a reasonable accommodation for a business of this size.

 

[jtimmer1]

Oops. I didn't read the article in its entirety. He should have given accommodation in that case.

Let me revise my response then:

If her English was not well, and he did not want to pay out-of-pocket for an interpreter, which was obvious, then he should have given her an accommodation in the form of another physician. I would like to assume that as a caregiver, he would want his patient to be seen and treated effectively. Why he did not refer her to another physician is unacceptable.

However, awarding $400,000 for her claim is also unacceptable in my opinion. Where did they come up with this number?

 

[LizzyM]

Oops. I didn't read the article in its entirety. He should have given accommodation in that case.

Let me revise my response then:

If her English was not well, and he did not want to pay out-of-pocket for an interpreter, which was obvious, then he should have given her an accommodation in the form of another physician. I would like to assume that as a caregiver, he would want his patient to be seen and treated effectively. Why he did not refer her to another physician is unacceptable.

However, awarding $400,000 for her claim is also unacceptable in my opinion. Where did they come up with this number?

He couldn't refer her saying, "I can't treat you because you are deaf." That would have gotten him sued, too. She even went so far as to give him the business card of an interpreter. According to the courts, the business could afford that servicce. His refusal to provide an interpreter, and sending her elsewhere after 20 months, is what got him into $400,000 worth of trouble. Half of that amount was punitive damages, punishment for mistreating the deaf patient. The court awards punitive damages when they want to exact some punishment and send a message to others that such behavior will not be tolerated.

 

[HolyGrail]

Income should not be taken into consideration. Either doctors are required to pay for these services or they aren't. Why would it be OK for a physician making 100k/year to use pen and paper, while it is 200k in punitive damages for a doctor making 425k doing the same? How is the patient injured more or less based on the MD's tax return? It's an unequal standard of the law. It makes no sense. Deaf patients who require translation should pay for it out of pocket if they can afford it, or if not, it should be paid as part of medicare or social security benefits. Alternatively, we could sign into law an act which provides funds for translation or hires state translators to be available for appointments. It isn't the doctor's fault that you have special translation needs, and he should not be penalized for seeing you, regardless of what his income is.

Agreed, I'm just glad someone agrees with me here...

Where do we get off thinking that a Doctor should have to PAY MONEY to see a patient? I don't care if it's even ONE patient. No doctor should EVER be FORCED to see a patient which is completely unprofitable. If a doctor CHOOSES to do charity work(Which there is no shortage of this occurrence), then that is his or her business to do so, highly encouraged, but not FORCED.

If this person had THAT big of a problem, they should have seen another doctor, which they eventually did. I hope this doctor appeals and wins, or at the very least, gets a reasonable settlement with this person.

In the future, as Doctors, for those "Humans" who cannot hear, see, speak, taste, smell, or feel, we'll have to provide an expensive interface for which to communicate what we are doing to this "person".

If it ever came to that point, one would have to question: Is this a reasonable cost of doing business?

I do not think that the Doctor should shoulder the burden of this cost, since this is not a dysfunction in a Doctor's communication with the average patient, only 1.09/1000 babies are born with permanent deafness (CDC source: http://www.cdc.gov/ncbddd/ehdi/FAQ/questionsgeneralHL.htm)... This means that out of every thousand people you see, one person would have the problem of not being able to sound out syllables/consonants as the case was provided above.

My real problem is: Where does this stop? Is this a reasonable cost of doing business?

 

[HolyGrail]

I'd also like to point out that everyone here seems perfectly happy with saying that a Doctor should sacrifice economic profit(not ACCOUNTING profit, which is not the same), in order to treat a patient because they have a disability.

For all of you who are thinking of going to school to be a doctor, and then getting out to work for $5/hr(because, hey, that's profit right!), please raise your hand, I'd like to know your real names. I'd like to sign you up for my new health care company, I make most of the money, pass some off to the patients of course, you all are guaranteed to make at least $.01/hour(That's PROFIT! It's profitable!) as physicians.

For all of the rest of you who don't live in La-La land: This deal reeks, and since to government isn't willing to pay for an interpreter, no business should have a reasonable expectation to shoulder the costs of someone else's disability.

If we want to deal with this as a culture, that's fine, let's do that with reasonable and fair legislation. Dealing with things by saying "Hey, you with the money, pay for this" is not ever a fair way of dealing with things.

 

[pianola]

Wow, LizzyM's knowledge base on this subject is amazing.

If, as walderness suggests, the ADA is disregarded all the time, then perhaps punitive damages weren't out of line.

I also agree with Depakote's idea that Dr. F should have seen this coming and been aware of his obligations. I wonder if he ever tried to settle the case out of court.

Interesting thread.

 

[pianola]

I'd also like to point out that everyone here seems perfectly happy with saying that a Doctor should sacrifice economic profit(not ACCOUNTING profit, which is not the same), in order to treat a patient because they have a disability.

We sacrifice profit all the time. It's not exactly unprecedented. Income taxes, for example (perhaps you don't support those either). The simplistic way that I look at it is that if you have the means to provide for those in need and it isn't an undue burden, then sometimes you have to do it. By law and not by charity.

 

[katarina90]

I just became so angry, so quickly. My roommates are afraid

Interesting lawsuit story from high school: An acquaintance of mine "fell through" a glass door at a Wendy's when he slipped on the freshly mopped floor. In actuality, he jumped through the window as a joke. He didn't mean to break the glass, but he surely did. And he surely almost severed an artery in his neck. He nearly died.

His family sued for negligence. $1 million. He received it when he turned eighteen, most of which has since gone to a new Audi and nose candy. We are not acquainted anymore..

Yikes. I abhor how litigious our society is becoming

<off topic rant>
I don't have a lawsuit story, but I have a non-lawsuit story. I was at a post office when I was five, and was barely tall enough to reach the counter, so I grabbed onto it to try and pull myself up (as little kids often do). They had some faulty wiring underneath the counter, and I got a moderate electric shock when I touched it (not serious, but companies have been sued over much less) Guess what I got as a settlement?

A sincere apology, a candy bar, and a Coke. And hey, I was content with it, so was my mom. And the next time we went there, they had called in an electrician and fixed the thing.

</off topic rant>

I dislike the fact that this progressed to the point of a lawsuit.

But I'm thankful to whoever posted this, because hopefully it will get future doctors to realize that whether you like it or not (and I'm not even going to voice an opinion on the interpretation of the law, whether it was right or wrong, etc.)--you're going to have to deal with this stuff, and making the wrong decision can be costly (both financially, and with regards to reputation).

If it were me, I probably would have just went for the interpreter (or a computer program, which seems the most ideal and economical). Yeah, its an expense, and you might not like it, but its much better than risking your reputation or going to court.

Of course, if you do want to fight the system, you may want to start making some pre-law friends

 

[HolyGrail]

Let me just stay that the AMA News has devoted many column inches to this topic over the years.

It is tough to ask legislators to vote so that physicians get to keep more money while disabled patients get less service. Would you vote for that knowing that you need to face the voters again next year? There are no tax dollars lying around that can go to pay doctors more than they are being paid now and the thought is that the cost is small enough for most practioners that it can easily be absorbed as one of the costs of doing business.

The AMA does want to find affordable ways for physicians to meet their obligations. Keeeping open the option of adaptive devices in place of interpreters would be one example.

This is a cheap way to argue the point LizzyM. The argument is not whether or not a law exists, but whether a law SHOULD exist. You are arguing that a law exists that states that you SHOULD do something. Many of us are arguing that a law should NOT exist for which this is the case.

If you want to make the argument that the law exists, then you win, but I will point out the inherent unfairness of the same law as applied to different businesses:

If I am a tax rebate service, a vacation planning service, an amusement park service etc... If you're telling me that these services all must pay to hire an interpreter to do business with someone who chooses to meet with them, then okay, I guess it's fairly applied across fields, but if this is just the medical field, that's pretty unfair.

Again, where does this stop, and where can I get a copy of this to read?

 

[airplanes]

This is a cheap way to argue the point LizzyM. The argument is not whether or not a law exists, but whether a law SHOULD exist. You are arguing that a law exists that states that you SHOULD do something. Many of us are arguing that a law should NOT exist for which this is the case.

If you want to make the argument that the law exists, then you win, but I will point out the inherent unfairness of the same law as applied to different businesses:

If I am a tax rebate service, a vacation planning service, an amusement park service etc... If you're telling me that these services all must pay to hire an interpreter to do business with someone who chooses to meet with them, then okay, I guess it's fairly applied across fields, but if this is just the medical field, that's pretty unfair.

Again, where does this stop, and where can I get a copy of this to read?

Health care isn't quite the same as your basic everyday commodity. Health care needs are unique...they can happen to anyone, they can happen suddenly, and they are extremely important to whoever is afflicted. It's not an a la carte menu at your local deli or a travel package to the Bahamas. The medical field is a different beast, and I'm sure you know that already.

Where does it stop? It already has stopped. There isn't new legislation in the works.

 

[HolyGrail]

We sacrifice profit all the time. It's not exactly unprecedented. Income taxes, for example (perhaps you don't support those either). The simplistic way that I look at it is that if you have the means to provide for those in need and it isn't an undue burden, then sometimes you have to do it. By law and not by charity.

Your sarcasm is a pathetic attempt at inflammatory rhetoric. Nonetheless, as for the first: Income taxes are a tax, as a cost of doing business. It is assumed that the better you perform in this economy, the more you are capable of contributing. This means that since you've been able to turn a profit, you should be reasonably expected to give a higher amount of money, as someone benefiting from the social rules we've developed. That is not a problem, at least with most people...

This is the constant "Pennies on a dresser" argument that is touted over and over again in legislative circles.

The argument goes:

"Dear legislators, the costs of this service are but such small amounts in comparison to the whole net worth of a company. For such small amounts we will be doing such good for the poor widows and orphans homeless blind mute old deaf people of America. Please support the widows and orphans deaf bill to make equity in America something we strive for once more!"

The problem with this type of argument is that it's not that one of these things, by itself, is overly burdensome. But legislatures all over the country are swamped by these every year, which do end up amounting to a significant cost.

Instead of dealing with things by pushing off responsibilities to others shoulders, legislation of this type needs to make sure that if we value this type of thing as a culture, that we take care of it as a culture, not pushing the costs off onto one group of people because it's convenient.

 

[biogirl215]

If anything, the ADA is not far-reaching enough. Since there is not an ADA “police,” the courts are the ONLY avenue for change and enforcement towards accommodation. This is part of the problem. The justice department must receive 3 letters of complaint about a business or practice before they will contact them to recommend that accommodations be made. Results are essentially useless.

Ditto. Add in vague terms like "reasonable accommodation" (aka "accommodation that we want to give you") and "undue burden" (aka "anything that costs us money") and the law's often utterly useless.

Try sending in an application for insurance and marking down a debilitating condition and then see if "you even have enough money for health care"?

Ditto. I don't know deafness is included, but most disabilities (deaf people don't consider deafness a disability) disqualify a person for health insurance, and high risk pool insurance (in they states that have it) can run between 1,000-2,000 a month for deductible alone.

 

[pianola]

Your sarcasm is a pathetic attempt at inflammatory rhetoric.

Ok, that totally wasn't meant to be inflammatory in any way, shape, or form and I'm sorry if you construed it as such.

I'll have to think about the gist of your argument. It makes sense.

 

[Caesar]

Instead of paying the small fee he is now paying 400k, which is a smart buisness decision?

 

[HolyGrail]

Doesn't even have enough money to pay for health care? Try sending in an application for insurance and marking down a debilitating condition and then see if "you even have enough money for health care"? Everyone absolutely has a right to critique the care they're getting, ie getting info on the side effects of medications prescribed IS ABSOLUTELY REQUIRED.

It's a shame, and a fact of reality, that some people are born with disabilities, or end up developing disabilities. But, as we are slowly finding out, taking care of some of these chronic conditions is increasingly costing a significant portion of the overall GDP.

I'm not advocating we round people up and exterminate them, but I am still trying to discover what I truly believe should be supported, and what should not.

I feel like many of you are copping out on these essential questions if you don't ask yourselves what our responsibilities should be. Many of you are blindly saying "Help everyone! Help the world! Let's all make the world a better place! Let's give health care to everyone for free!!"

Do you know what this means? Who is going to pay for this? What is reasonable? What do we mean by "human dignity?" Should we shoulder an increasing burden as we become more wealthy? Who dictates whether or not someone should do a thing or not?

I'm more or less playing devil's advocate in this thread because it seems like everyone is all for this. For me, I don't know whether or not I support some of these things, while others, as was mentioned above by walderness, seem in desperate need of reform(I'm sure you're well versed on this walderness, from reading your other posts).

I'd like a healthy debate, I need to think about this a lot more.