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

[pianola]

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I don't see the everyone-pitches-in-and-picks-up-the-tab scenario as a realistic option.

Yeah, I guess maybe not in the US. I feel like in Europe where taxes are higher this might be viable.

Reasonable accomodations might be the best they can come up with.

Oh well, it's certainly better than nothing, I guess.

 

[pianola]

You all are coming at this from the perspective of "whats this gonna cost ME in the future." Try the other perspective for once.

👍 Worth hearing.

 

[LizzyM]

There's no need to resort to pet names.

I'm quite old enough, and capable enough, to understand an argument without you trying to persuade me by implying I'm a child.

Your Braille menu is one analogy, your deaf person is another story, you're oversimplifying.

I was more outraged about this before I knew what I know now, it's obvious the article doesn't completely accurately describe the situation that must have transpired.

HolyGrail, I'm old enough to be your mother but I did not intend to imply that you are a child. Please accept my heartfelt apology.

I am glad that you have been more informed as this thread unfolded and that you now have a better understanding of the case and the reason for the court's decision. Don't use AMA news as your sole source of information on a case like this. A quick google of the patient's name turned up several sides of the same story and helped inform me of what went on.

 

[Dr Lyss]

Come on. We live in a civilized society where the law stipulates that services provided on a large scale are provided equally. This physician had a large scale practice and in order to provide equal care to a deaf woman, he needed to bring in an interpreter.

Disabled people carry huge financial burdens of their own let's not forget. I recently bought an $18k car, but in order to drive it, I had to pay $35k to modify it. I couldn't pass this on to other drivers purchasing cars from this dealership. And my disability was caused by an able-bodied bad driver! He's not even paying my bills. Even travelling to med interviews, I had to fly 2 people, me+caretaker, and stay at a hotel v. student accommodations. On top of it all, I lost my job making $60k a year after the accident. We don't go around getting rich off lawsuits. I got stuck in a bathroom at a hospital that was not ADA compliant. It was quite annoying and immasculating, but I can't sue the hospital.

You all are coming at this from the perspective of "whats this gonna cost ME in the future." Try the other perspective for once.

And just because there's not a rational place to cut off income v. undue burden doesn't mean that one shouldn't be in place. (ADA has 15 employee cutoff as I previously mentioned). Suppose we go the other way, hotels don't need to provide disabled equipped rooms (most arent ADA compliant btw), no elevators at doctors offices because they're expensive, etc.

Bottom line. The cost of the interpreter was immaterial to the physician's practice, he refused to pay for it, and he was appropriately punished under the laws in place to provide for equality of service.

👍 thanks for the different perspective, walderness

 

[JJMrK]

The cost of the interpreter was immaterial to the physician's practice, he refused to pay for it, and he was appropriately punished under the laws in place to provide for equality of service.

I completely disagree with this statement, but thanks for being courageous enough to share your story.

 

[ProLogic]

I guess my 3 years of sign language in high school could do me well in the future..? 😀

 

[walderness]

I completely disagree with this statement, but thanks for being courageous enough to share your story.

Well, thankfully, policymakers, juries, and business owners that follow the law disagree with you.

 

[Ailleurs]

walderness, Thanks for your humbling post. Sometimes, it's hard to take another person's perspective as you've never been in that person's shoes before. It's like today, when I asked my mom why she sleeps so much (she has vertigo) and she told me she feels extreme dizziness sometimes. It was callous and insensitive of me to brush her feelings aside thinking, "oh I get really dizzy too, but I get over it. I don't always sleep a lot." But then later today, I was in the car and felt mild car sickness, and realized it probably wasn't as close to what my mom feels on a given day.

So yes, despite my verbosity, having another vantage point is always a humbling experience. 🙂

But perhaps I do think Gerena could have persauded her family to insist the doctor on getting an interpretor. Maybe the doctor is a selfish boor, who knows 🙄

 

[cpants]

Although he was a solo practioner, he did a high volume business. It was estimated that the cost of the interpreter service would equal one-quarter of 1 percent of his income (0.25%). Interpreter service is a business expense just like gauze pads and telephones. The jury decided that it was not unreasonable to expect the practice/doctor to spend 0.25% of income to meet the needs of a disabled person who could not hear and who had a limited ability to understand written English and who had requested an interpreter.

Ok, so you're saying .25% of income is a reasonable expense. So this doctor spends that .25% to hire interpreters. Word gets around that he is accommodating to the deaf community. More and more deaf patients come to see him. .25% per patient adds up pretty quickly. In a short time he could be looking at 3 or 4 percent of his income eaten up by interpreter fees. So when does it become a burden to the physician? After all, even if he was paying 10% of his income, he would still be a rich doctor making over 380K.

I understand the bleeding heart, doctors-are-rich, mentality most of you have, but this just isn't the best way to serve the deaf community. If you set up a system where a doctor loses .25 percent of his income for every deaf patient he takes on, you are giving him an incentive to avoid seeing deaf patients. This could manifest itself through reduced scheduling of office visits, increased referrals, or just a lower level of care given to patients.

 

[LizzyM]

Ok, so you're saying .25% of income is a reasonable expense. So this doctor spends that .25% to hire interpreters. Word gets around that he is accommodating to the deaf community. More and more deaf patients come to see him. .25% per patient adds up pretty quickly. In a short time he could be looking at 3 or 4 percent of his income eaten up by interpreter fees. So when does it become a burden to the physician? After all, even if he was paying 10% of his income, he would still be a rich doctor making over 380K.

I understand the bleeding heart, doctors-are-rich, mentality most of you have, but this just isn't the best way to serve the deaf community. If you set up a system where a doctor loses .25 percent of his income for every deaf patient he takes on, you are giving him an incentive to avoid seeing deaf patients. This could manifest itself through reduced scheduling of office visits, increased referrals, or just a lower level of care given to patients.

It was the jury that decided that 0.25% of income is a reasonable expense to accommodate a disabled patient. The doctor is a rheumatologist so the demand for his services is not the same as those of a primary care provider and he is unlikely to have deaf patients flocking to his practice. An interpreter is not necessary at every visit (review of labs and prescription refill) but might be needed for visits of higher complexity for example, when a new drug is going to be prescribed.

 

[sarahl86]

Ok, so you're saying .25% of income is a reasonable expense. So this doctor spends that .25% to hire interpreters. Word gets around that he is accommodating to the deaf community. More and more deaf patients come to see him. .25% per patient adds up pretty quickly. In a short time he could be looking at 3 or 4 percent of his income eaten up by interpreter fees. So when does it become a burden to the physician? After all, even if he was paying 10% of his income, he would still be a rich doctor making over 380K.

I understand the bleeding heart, doctors-are-rich, mentality most of you have, but this just isn't the best way to serve the deaf community. If you set up a system where a doctor loses .25 percent of his income for every deaf patient he takes on, you are giving him an incentive to avoid seeing deaf patients. This could manifest itself through reduced scheduling of office visits, increased referrals, or just a lower level of care given to patients.

In the real world and among the Deaf community, when word gets out that a doctor is treating Deaf patients (generally primary care, because specialists would have a lower demand and probably use interpreters on a per-appointment basis as needed) a doctor will schedule a day of the month or every few months specifically for Deaf patients.

In my experience, for check-ups there is no issue among the patients for waiting to do this - Deaf people aren't that unreasonable. That being said, the cost of an interpreter per hour varies but for someone highly (not even reasonably) qualified is probably $100-120/hour. 2 interpreters would be hired for the full 8 hour day. In the grand scheme of things and within a private practice consisting of 3+ doctors, if these patients are having a routine visit once or twice a year, its not that big of a deal. For medical emergencies, in this area, Deaf patients go to hospitals known for their ability to accommodate their communication needs either by a live interpreter or video remote interpreting services. And from the Deaf people I know, none of them have had a problem getting an emergency appointment with their primary care doctor who will provide an interpreter as long as they have 1-2 days notice to schedule an interpreter.

The only setting where it might be necessary to have a full-time staff interpreter would be in a medical clinic. Baltimore City has one medical clinic with a full-time staff interpreter that almost every low-income Deaf individual living in the area goes to, and he probably makes $50,000 a year. Really, one go-to place is all that is needed. This is in a clinic with 10 or so doctors, and run by some hospital administration company in PA. I work under another hospital in Baltimore City with staff interpreters in a substance abuse treatment program who also interpret appointments at our hospital's clinic - and guess what they get per appointment: $50. Is that such an unreasonable expense? Granted these are large institutions, its a drop in a bucket but those kind of initiatives make providing healthcare to disabled populations MUCH easier on private practitioners.

Considering I live in an area with a significant Deaf population there appears to be no problems among medical practitioners in providing interpreters for these patients. Clearly these doctors don't find it unreasonable and because they are taking the steps to accommodate the Deaf community, they have earned the community's respect and understanding.

I forgot where I was going with this, except to say there are successful business models that a private practitioner could follow to reasonably account for serving many Deaf patients.

[PS, if you're talking about deaf people who use ASL, it should be capitalized just like any other cultural group = Deaf]

 

[HolyGrail]

Ok, so you're saying .25% of income is a reasonable expense. So this doctor spends that .25% to hire interpreters. Word gets around that he is accommodating to the deaf community. More and more deaf patients come to see him. .25% per patient adds up pretty quickly. In a short time he could be looking at 3 or 4 percent of his income eaten up by interpreter fees. So when does it become a burden to the physician? After all, even if he was paying 10% of his income, he would still be a rich doctor making over 380K.

I understand the bleeding heart, doctors-are-rich, mentality most of you have, but this just isn't the best way to serve the deaf community. If you set up a system where a doctor loses .25 percent of his income for every deaf patient he takes on, you are giving him an incentive to avoid seeing deaf patients. This could manifest itself through reduced scheduling of office visits, increased referrals, or just a lower level of care given to patients.

At first I was thinking the same way you were, but the fact is that at this time, there are not that many deaf people in the world. If deafness suddenly became a regular occurrence, I'm sure the doctor would just learn sign language or there would be another type of legislation enacted...

While it sucks to give up some of your income for this, the marginal benefit lies in the patient being informed, while the marginal costs are relatively low. We're all going to do work for charity at some point, as long as these small costs of doing business don't add up to an appreciable amount, then there is no real need to reform.

 

[closer23]

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[LizzyM]

If accommodation such as this is law, deaf people will have less motivation to fit in to normal society. There's no reason why a deaf person with no other complications couldn't either learn to read/write effectively or learn to speak/read lips effectively.

Your cultural incompetence is showing.

The Deaf are their own culture. You must respect that. You must provide interpreters when necessary, to assure clear communication. Would you tell Native Americans who live on a reservation and who do not speak English that they must fit into "normal society"? Cultural competence, which is getting a lot of play in med schools these days (and for good reason, it seems, as so many pre-meds don't come by this information naturally) requires that you, as a physician, strive to understand and attempt to bridge cultural differences that you may have with your patients in order to provide those patients with the best care possible.

 

[jinx520]

...requires that you, as a physician, strive to understand and attempt to bridge cultural differences that you may have with your patients in order to provide those patients with the best care possible.

And this is why the judgement against the doctor was so high, IMO. You can talk about cultural competence and compassion for those otherly-abled until the cows come home, but some people will just never get it. You CAN, however, hit 'em in the pocketbook in order to demonstrate what type of callous disregard that will not be tolerated.

 

[closer23]

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[jinx520]

Instead, we should encourage them and their individual culture to find their place in our society.

I'm sorry, closer23, but your attitute toward people who are in any way different from you infuriates me. You seem to think that America belongs to you and people just like you, and anyone who is an URM, disabled, obese, or anything else that doesn't define you better suck it up, quit whining, and make themselves be more like you in order to join YOUR SOCIETY.

America is made up of different cultures. That is the reality of the situation. And as long as members of these different cultures are citizens, they are entitled to the same rights as any other American is. Just because a culture is different than the yours does not make it less American. Who decides what identifying elements a culture or group must give up in order to be welcomed into "American society?" You?

If you would take the time to define what you meant by our society in your previous post, maybe you might see that it doesn't include those people who are different than you unless they do their very best to minimize those differences.

 

[closer23]

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[jinx520]

Those two situations are in no way analogous. Indian reservations are nearly separate from society. Deaf culture has much more of a place in our society. However, these types of laws do nothing but strive to isolate their population from our society.

My point is that we shouldn't encourage the deaf society to fall into the same category. Government mandates such as this cause more of the deaf culture (or the Spanish-speaking culture as another example) to become more separate from society (or remain that way). Instead, we should encourage them and their individual culture to find their place in our society. If we continue to put up public signs in both English and Spanish and if we continue to treat the deaf culture differently (by providing mandatory interpreters at the physician's expense) those two cultures will become or remain separate from society. Clearly, this is not the way to encourage a unified nation.

I do not believe that the deaf culture should in any way give up what makes them unique (besides being deaf, of course). Although I believe they should be treated the same as everyone else and therefore encouraged to learn written English and/or spoken English, I do not believe they should or will give up their sign language or anything else that is tied to the deaf culture.

I suspect that you believe the government should continue to put up signs in both English and Spanish in order to be nice to the Spanish immigrants, correct? Will this practice encourage or discourage a united America?



Many different groups have their own culture. However, most have created their individual place in society and realize that they must be able to function in the real world. This does not take anything away from their individuality or culture. Does it?

The Spanish-speaking immigrants have their own culture as well. However, should we encourage them to remain or become nearly separate from our society?

None of this is to say that I would refuse to provide an interpreter or similar accommodation. However, I believe government regulation such as this does nothing but harm to our society as a whole (including the deaf culture) and encourage more frivolous lawsuits in an already law-suit happy society. No one would disagree with me when I say that we need less litigation.



I'm not sure why you continue to insist on beginning your posts addressed to me with some sort of attempt at an insulting remark, but I refuse to play that game.

You're response demonstrates a complete misunderstanding of my post. Many groups have their own individual culture. I do not strive to change that. You do not need to give up your individuality or culture in order to function in the real world. Government mandates such as these do nothing but separate certain cultures from our society as a whole.

And, I do not consider obesity a culture that people strive to remain in or belong to. I have never met a man or woman who wanted to become or remain obese. Therefore, I found that comparison to be completely irrelevant and illogical.

A Deaf person CANNOT communicate effectively in English the same way that you or I can. An obese person may have other issues besides lack of will-power that preclude weight loss on their own. What you fail to see is that you have a profound lack of compassion or empathy for anyone who has a different life story than yours. AND you refuse to see how offensive it is when you expect people to conform to your view of "normal", without any thought of how difficult it might be. Boy, those deaf people and those obese people better quit whining, suck it up, and do whatever they need to fit into your America.

 

[closer23]

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[jinx520]

Are you kidding? I've met deaf people who are more than capable of effective communication in English. Your responses are made up of nothing but misrepresentations of my argument. Take a few minutes to grasp a clear understanding of my posts before your next response. Reading and responding to such a diverse array of misrepresentations and misunderstandings of my position is in no way worth my time.

That doesn't mean that every Deaf person is equally as capable, nor does it mean that every Deaf person must be held to that standard. What about a Deaf person who has dyslexia? What about an able-bodied but illiterate patient? What do you intend to do with patients like that? I'm willing to bet it's something along the lines of "develop some will-power and MAKE yourself be someone I'm more comfortable talking to."

I do have a clear understanding of your posts. I am an URM who is proud of my culture and proud to be an American. I am a Gulf War vet, so please don't even try to lecture me on what it means to be an American. And I am a person who has had, countless times, to fight negative stereotypes against myself or my family because certain types "Americans" think that being American means being just like them. I am just as American as you are, and as different as night is to day.

What I take issue with about your posts is that 1) you seem to think that because Deaf people have a culture unto themselves that it somehow removes their DISABILITY. 2) A unified America necessarily means that people of "different" cultures or ethnicities MUST conform themselves in order to fit into "our society".

Again, I challenge you to define exactly what you mean by "our society", the standards of which Deaf, Spanish-speaking, and any and all others must abide by in order for you to consider them fully contributing members of "our society".

Oh, never mind. You just don't get it. Good day, sir. Or ma'am.

 

[MedicalSonata]

Hmmm...wow.

 

[futureboy]

It's not the same as shelling out a $150 bucks from his wallet each time the patient comes in.

Yes it is. Where else would the $150 come from? Thin air?

 

[THH]

That doesn't mean that every Deaf person is equally as capable, nor does it mean that every Deaf person must be held to that standard. What about a Deaf person who has dyslexia? What about an able-bodied but illiterate patient? What do you intend to do with patients like that? I'm willing to bet it's something along the lines of "develop some will-power and MAKE yourself be someone I'm more comfortable talking to."

I do have a clear understanding of your posts. I am an URM who is proud of my culture and proud to be an American. I am a Gulf War vet, so please don't even try to lecture me on what it means to be an American. And I am a person who has had, countless times, to fight negative stereotypes against myself or my family because certain types "Americans" think that being American means being just like them. I am just as American as you are, and as different as night is to day.

What I take issue with about your posts is that 1) you seem to think that because Deaf people have a culture unto themselves that it somehow removes their DISABILITY. 2) A unified America necessarily means that people of "different" cultures or ethnicities MUST conform themselves in order to fit into "our society".

Again, I challenge you to define exactly what you mean by "our society", the standards of which Deaf, Spanish-speaking, and any and all others must abide by in order for you to consider them fully contributing members of "our society".

Oh, never mind. You just don't get it. Good day, sir. Or ma'am.

I think closer's point is that URMs can maintain their own culture while still finding a place to fit into society at large.

 

[45408]

It's not the disabled person's fault that they are disabled and require accommodations. That's why we have regulation.

whose fault is it then? It's certainly not the doctor's fault. I think the real travesty is that the deaf patient's insurance would not provide the interpreter. It's absurd to expect a physician to see a patient at a loss and punish him for not doing so. If he were willing to do so, then more power to him.

Come on. We live in a civilized society where the law stipulates that services provided on a large scale are provided equally. This physician had a large scale practice and in order to provide equal care to a deaf woman, he needed to bring in an interpreter.

Disabled people carry huge financial burdens of their own let's not forget. I recently bought an $18k car, but in order to drive it, I had to pay $35k to modify it. I couldn't pass this on to other drivers purchasing cars from this dealership.

Bottom line. The cost of the interpreter was immaterial to the physician's practice, he refused to pay for it, and he was appropriately punished under the laws in place to provide for equality of service.

You should sue the dealership for the $35,000 to modify your car. The cost would be immaterial to the dealership, so they should be punished for not doing it. Right? Why not?

 

[pianola]

You should sue the dealership for the $35,000 to modify your car. The cost would be immaterial to the dealership, so they should be punished for not doing it. Right? Why not?

Yeah, but healthcare is a necessity whereas having a car is a luxury. Yes the lines between necessity and luxury can be blurred in some cases, but not here.

 

[LizzyM]

Yes it is. Where else would the $150 come from? Thin air?

There are costs associated with running a business. These are called business expenses and they can be offset against business income. In addition, as pointed out in the article, there are some tax breaks for ASL interpreters such that the there may be no net cost to the medical practice. Health care providers must provide the patient with information about his/her rights under HIPAA. That costs money. Providers must document the patient's visits in a medical record and there are specific ways in which that record must be kept. Those records and their management costs money. Most providers bill for their services and most receive payments from third parties. What goes into collecting those bills costs money. Purchasing the items necessary to practice universal precautions to protect against blood borne illnesses cost money.

As you can see, there are many expenses associated with running a medical practice. The court determined that is was expense of an ASL interpreter was not an undue hardship on that particular medical practice which generated a substantial income (the interpreter coming to 0.25% of income). As I've mentioned, when your mix of patients includes some on whom you lose money and some on which you make (a lot of ) money, it averages out so that you come out ahead in the end.

 

[futureboy]

There are costs associated with running a business. These are called business expenses and they can be offset against business income. In addition, as pointed out in the article, there are some tax breaks for ASL interpreters such that the there may be no net cost to the medical practice. Health care providers must provide the patient with information about his/her rights under HIPAA. That costs money. Providers must document the patient's visits in a medical record and there are specific ways in which that record must be kept. Those records and their management costs money. Most providers bill for their services and most receive payments from third parties. What goes into collecting those bills costs money. Purchasing the items necessary to practice universal precautions to protect against blood borne illnesses cost money.

As you can see, there are many expenses associated with running a medical practice. The court determined that is was expense of an ASL interpreter was not an undue hardship on that particular medical practice which generated a substantial income (the interpreter coming to 0.25% of income). As I've mentioned, when your mix of patients includes some on whom you lose money and some on which you make (a lot of ) money, it averages out so that you come out ahead in the end.

Yes, I know that there are costs associated with running a business. I ran one myself. My post was in response to another post that said that the doctor "wasn't shelling out [$150] from his wallet each time the patient comes in. The practice can write it off, etc." Well, the doctor DOES have to pay the $150 out of his pocket (or his business checking account, or whatever). Yes, he can claim the cost as a business expense and reduce his tax liability a bit, but there still is a cost to him.

That's all I was really saying.

As for the lawsuit, $400,000 is extremely high, especially since the woman didn't suffer any serious harm. I'm not saying the doctor didn't violate the law, but a lesser amount would have compensated her and sent a message. $400,000 is almost an entire year's income for the doctor. The infamous McDonald's coffee case verdict actually made more sense. The lady suffered second (or maybe third) degree burns to her inner thighs, and the punitive damages were only one day of gross coffee sales worldwide. By the way, the McDonald's verdict was reduced on appeal to $600,000.

 

[rkaz]

whose fault is it then? It's certainly not the doctor's fault. I think the real travesty is that the deaf patient's insurance would not provide the interpreter. It's absurd to expect a physician to see a patient at a loss and punish him for not doing so. If he were willing to do so, then more power to him.


You should sue the dealership for the $35,000 to modify your car. The cost would be immaterial to the dealership, so they should be punished for not doing it. Right? Why not?

👍👍👍I couldn't agree more.

It is NOT the physician's fault that the person is disabled. I do think however, that a non-English speaking person does deserve translation support. But that burden does not deserve to be placed on the physician's office, as that should be paid by the patient or his/her insurance.

The car example is excellent, as you wouldn't expect the car dealership to absorb the cost of adjusting your car to meet your needs. Expecting the car company to voluntarily offer to give $35k of fix-up for free to accommodate your disability... that would be extremely generous, but of course you couldn't expect that, as it wouldn't be profitable for the $18k car they were selling you. Maybe they'd do it for 1 disabled person as a token gesture or a PR move, but obviously they couldn't do it for any and every disabled person who came into their dealership. Why is a physician's office any different?

 

[rkaz]

Yeah, but healthcare is a necessity whereas having a car is a luxury. Yes the lines between necessity and luxury can be blurred in some cases, but not here.

Healthcare may be a necessity, but that doesn't mean you can burden individual physicians over it. If healthcare is a right, it is the government's duty to provide for it's population, not individual providers to be forced to take a net loss to see patients. That's not okay.

It's not selfish for us to expect to be paid fairly for our work. Just because we are in the service field doesn't mean that we have to become martyrs. We are spending 4 years of medical school and 3-6 years of residency... and we deserve to be compensated fairly.

It's amazing that people don't have issues with celebrities, or sports players or others making millions of dollars a year.... yet think physicians are greedy for making $150-300,000 a year for a career that we will have put years of hard work and study into. Just because healthcare may be a right doesn't mean that physicians have to get stepped on and taken advantage of. We have rights to earn a fair pay for our work, and not be FORCED to take a loss for our services.

There are other areas like education and public services which people would consider as 'rights'. That doesn't mean that it would be acceptable for you to demand your professors pay for your textbooks, since you have a right to education. You wouldn't waltz into your friendly therapist's office demanding to be seen (at their financial loss) just because you have a mental disability. These things clearly wouldn't work in other fields, so I find it amazing that people expect physicians to lay down and be trampled on just because we went into medicine 'because we care about people'. Other people also choose service fields because they care about people, but would you expect others to take losses for providing services? Of course not.

I wonder if there are a such thing as a physician's union... I don't think the AMA counts as this. It's sad that with these kinds of frivolous lawsuits that we have to always play in the defensive. It's no wonder that people entering medicine wanting to 'help people' get jaded, and just follow specialties with an easier lifestyle and higher pay. No one wants to get stepped on.

 

[LizzyM]

The car example is excellent, as you wouldn't expect the car dealership to absorb the cost of adjusting your car to meet your needs. Why is a physician's office any different?

Because the federal government is paying the patient's medical bill.

Remember: The one who pays the piper, calls the tune. When the feds pay the bill, you can expect a lot of strings to be attached. You can choose to exclude all Medicare and Medicaid patients from your practice. If you are pre-med and you think that this is the way to go, please advise your interviewers that you intend to exclude all poor, elderly, and permanently disabled patients from your practice unless they are able to pay cash for your services.

 

[rkaz]

Because the federal government is paying the patient's medical bill.

Remember: The one who pays the piper, calls the tune. When the feds pay the bill, you can expect a lot of strings to be attached. You can choose to exclude all Medicare and Medicaid patients from your practice. If you are pre-med and you think that this is the way to go, please advise your interviewers that you intend to exclude all poor, elderly, and permanently disabled patients from your practice unless they are able to pay cash for your services.

There is clear contempt in your post for providers who want to protect themselves. It's not that people don't care about the poor, elderly, disabled people. And you certainly can't accuse me of that... as I've spent years of my life volunteering with these groups (not as a means to 'get into' med school, as I was working with them long before I even decided to go to med school). But it's different when someone volunteers to help, versus when someone is FORCED to do something.

I can understand physicians taking cash-only in their offices. Probably because these physicians are sick and tired of seeing their reimbursements going down over the years, and not being compensated fairly. Can you really blame physicians? It doesn't make them selfish or evil to want to be paid fairly for their work. Would you hold it against anyone in any other profession for wanting to be paid fairly?... so why are there unreasonably high standards for physicians? I would think that most of us going into medicine are FAR more humanitarian oriented than the average person.

 

[LizzyM]

There is clear contempt in your post for providers who want to protect themselves.

The jury had $200,000 in contempt for this particular physician. That was the punitive damages award made in this case.

Would you hold it against anyone in any other profession for wanting to be paid fairly?... so why are there unreasonably high standards for physicians? I would think that most of us going into medicine are FAR more humanitarian oriented than the average person.

Did you know that the Americans With Disabilites Act requires lawyers to provide the same reasonable accommodation to the disabled that is required of physicians?

No one wants a doctor to go broke providing accommodations. That's why the law specifies reasonable accommodations. The court made the determination that an accommodation that would cost 0.25% of income was reasonable in this circumstance. That the doctor refused, multiple times, to provide that reasonable accommodation. It is obvious that the jury was angry and they hit the doctor in the pocketbook for his failure to provide a reasonable accommodation to a disabled patient in his care.

 

[futureboy]

The jury had $200,000 in contempt for this particular physician. That was the punitive damages award made in this case.

As previously stated, I think the punitive damages award is way out of line. I wouldn't be surprised if it was reversed or reduced on appeal.

 

[futureboy]

Oh, and by the way, it's an insult that the sign language interpreter's time is worth $150, but the doctor is only reimbursed $50 for the office visit. Nothing against interpreters, but they shouldn't receive 3x the fee that the doctor does. Also, why should the interpreters get paid at all in this situation? Why aren't they forced to provide free services to accomodate those with disabilities who can't afford to pay? Same argument -- they should have enough paying clients to absorb the time/cost of the free services. At $150/hr, the interpreter can afford it. Why should the interpreter get to charge full freight and the doctor takes a $100 loss per visit?

 

[LizzyM]

Oh, and by the way, it's an insult that the sign language interpreter's time is worth $150, but the doctor is only reimbursed $50 for the office visit. Nothing against interpreters, but they shouldn't receive 3x the fee that the doctor does. Also, why should the interpreters get paid at all in this situation? Why aren't they forced to provide free services to accomodate those with disabilities who can't afford to pay? Same argument -- they should have enough paying clients to absorb the time/cost of the free services. At $150/hr, the interpreter can afford it. Why should the interpreter get to charge full freight and the doctor takes a $100 loss per visit?

The interpreter gets $150/hr. The doctor gets $49 for a visit. Do you think that the doctor spends one hour with the pt? It might be more like 10 or 15 minutes face-to-face for an uncomplicated visit. What do you think that people are talking about when they say that reimburement is prohibiting them from spending more than 6-10 minutes with each patient?

Futureboy, your entire argument about the interpreter providing services free of charge is so silly that it defies comment.

 

[ayushman80]

What I don't understand is what kind of precedence is the jury trying to set?

Some sort of medical negligence on the part of the doctor, where he misdiagnosed or caused physical and mental harm, to this woman that would justify a lawsuit and the award. Whats next, requiring other private businesses to give these same services? If this person went to a japanese restaurant for a year and ordered sushi and got sick would she sue them also? Wouldn't a printed sign saying "Consuming Raw meat is dangerous" be sufficient? Or maybe she needs to have an interpreter brought in so the waiter can communicate this message?

Where does this stop? I feel for those with disability and they should have services to make their lives easier. However, if the government will require these services then it should also be their responsibility to provide funding for their rules. Comparatively, it would cost the government a much smaller percentage of its income to fund this service than it would for the doctor to do so.

 

[ayushman80]

The interpreter gets $150/hr. The doctor gets $49 for a visit. Do you think that the doctor spends one hour with the pt? It might be more like 10 or 15 minutes face-to-face for an uncomplicated visit. What do you think that people are talking about when they say that reimburement is prohibiting them from spending more than 6-10 minutes with each patient?

I guess this would depend on when the interpreter would start charging his/her fee🙂 I"m sure the 30-45 minute wait times would also count on the interpreter's clock.

 

[futureboy]

The interpreter gets $150/hr. The doctor gets $49 for a visit. Do you think that the doctor spends one hour with the pt? It might be more like 10 or 15 minutes face-to-face for an uncomplicated visit. What do you think that people are talking about when they say that reimburement is prohibiting them from spending more than 6-10 minutes with each patient?

Futureboy, your entire argument about the interpreter providing services free of charge is so silly that it defies comment.

Actually, the story says that the cost to the doctor for the interpreter was $150 to $200 per VISIT. Apples to apples comparison--$50 to the doctor for the visit, $150-$200 to the interpreter.

Oh, and claiming that an argument is silly is not an actual rebuttal to the argument.

 

[LizzyM]

I stand corrected. Here's what the lawyers would tell you about the law.

You can try to change the law, but in the meantime, failure to adhere to the law could cost you dearly.

http://www.foxrothschild.com/Newsstand/News.aspx?id=8250

 

[edfig99]

LizzyM: I just wanted to say publicly I really enjoy reading your posts. If only the med school and residency applicants I interview demonstrated half your zeal and patient advocacy skills. I definitely thought the discussion in this board was a lot more interesting to read than the one over at the residency board.

Folks please remember that, while there is no question that there are a lot of business aspects to the practice of medicine, it is still viewed as "the noblest of professions" and ultimately held to a higher standard, in all regards. So yes, at times the law demands us to "suck it up" and eat the costs. there is no shortage of patients and over time these things balance out. unfunded mandate? sure. sucks? yes it does. but morally and ethically, it's the right thing to do. the ama of which I am a member, is a pretty useless organization...well, at least useless for patients. it's sole purpose is to lobby against anything that can prevent doctors from getting paid -- at least, that's their public image. And for those that say health is a human right, the United States has not explicitly adopted that viewpoint. If it did, then we would have changed our health system a long time ago.

At the core of it all, this case went as far as it did because the physician didn't listen to his patient. he blew her off and had the audacity to say he couldn't afford to accomodate her, instead relying on a similarly deaf partner, a 9 year old kid, and notes on the "butcher paper" on the exam table. the patient was not a native english speaker and I'm guessing from a cultural perspective she felt initially obligated to stick with this physician because this is who her primary care doc sent her to. whether or not the care he provided was adequate is irrelevant. she was discriminated against.

had this doc taken time out to actually communicate with his patient, or listen to the call from an interpreter service, or negotiate up front re frequency of interpreter use, or heck -- contact someone in his state medical society for guidance, he never would have been in this predicament. he would not have had to pay 200 bucks every time this patient came in because they would have agreed up front re: when it would be a good idea to bring in an interpreter (i.e. significant procedure or change in management) and when they could get by with family and paper (medication refill). And I also highly doubt he was only getting paid $49/visit from Medicare. There's other ways the subspecialists pad the bill when seeing medicare patients by doing additional procedures, as well as he could've billed for extended visit codes.

interestingly enough there's no mention of any action against her primary care doc. nor is there any mention of any action against the rheumatologist who took over her care.

while the award will likely be reduced on appeal, I kinda hope it isn't.

 

[futureboy]

I stand corrected. Here's what the lawyers would tell you about the law.

You can try to change the law, but in the meantime, failure to adhere to the law could cost you dearly.

http://www.foxrothschild.com/Newsstand/News.aspx?id=8250

I am a lawyer, and I am generally familiar with the ADA, though I don't deal with it regularly. I would of course advise a client physician or other professional to just pay for the interpreter, or face potential financial ruin. The law is the law, and it must be followed. That doesn't make the law fair, particularly as applied in this case. As I've stated, the jury award was grossly out of proportion to the harm, if any, to the patient. The case turned on what constitutes "effective communication." While not perfect, the doctor at least tried to communicate in writing and through relatives. The patient agreed to communicate in writing, at least at some point. Unfortunately, "effective communication" apparently isn't defined in the ADA, so it basically it means whatever a jury says it means. This makes it difficult to know ahead of time whether you're in compliance, though prior case decisions can be a guide. Also, the doctor was prohibited from arguing that there was reasonable, effective communication because the patient's treatment was proper. All in all, I think the case was BS.

I am quite aware that interpreters are not required to provide free or reduced cost services. They get to charge what they want, and the doctor just has to pay it. It's not fair. The law needs to be changed, perhaps to cap the interpreter's fee at what the doctor is reimbursed for the visit. That's my opinion. If you think that's silly, then so be it.

 

[45408]

Yeah, but healthcare is a necessity whereas having a car is a luxury. Yes the lines between necessity and luxury can be blurred in some cases, but not here.

And? As a physician, I'm still not going to PAY to see patients. You're blaming the wrong individual. Medicare should provide an interpreter for her if it is deemed necessary, and if it isn't necessary, he shouldn't be punished for not providing one.

 

[pianola]

And? As a physician, I'm still not going to PAY to see patients. You're blaming the wrong individual. Medicare should provide an interpreter for her if it is deemed necessary, and if it isn't necessary, he shouldn't be punished for not providing one.

I dunno. I guess I just see it as equivalent to an additional tax -- the cost of doing business where one is paid well. Do I think Bill Gates should pay higher taxes than I pay? Yeah, probably. He certainly has the means to do so.

Would it possibly be fairer if medicare provided the interpreter? Maybe. <-- But that doesn't necessarily make it unfair that the physician should have to pay.

I dunno, that's the way I see it.

If he had to pay for all of his patients, obviously that'd be a problem. But a quarter of a percentage of someone's income is just not unreasonable.

 

[45408]

I dunno. I guess I just see it as equivalent to an additional tax -- the cost of doing business where one is paid well.

So if he were a pediatrician, he wouldn't have had to cover it? Because they're not well-paid.

But that doesn't necessarily make it unfair that the physician should have to pay.

It's either fair or unfair. You really think it's fair that a physician should pay to see patients?

 

[pianola]

So if he were a pediatrician, he wouldn't have had to cover it? Because they're not well-paid.


It's either fair or unfair. You really think it's fair that a physician should pay to see patients?

Re: pediatrician: If the pediatrician couldn't reasonably afford it, then no, I don't think he would have had to cover it (either legally or morally/ethically). I'm not suggesting all physicians pay for all patients. I think the point is that it's considered a 'reasonable accommodation' for a person with special needs. Maybe it's not reasonable for a pediatrician to pay. Depends on the person, location, practice, and costs.

Re: your second point: Yeah, if the physician can afford to pay to do so, then yes, it's fair. I don't think there's anything wrong with it on principle, if the physician can afford to do so. Where is the limit of reasonable accommodations? I don't know. But a quarter of a percent of his income is very clearly a drop in the bucket.

I guess I just don't think these issues fall into just categories of fair or unfair. I think there's "more fair" and "less fair."

Would it be "more fair" to have a general tax that all people pay to support the needs of the Deaf? Perhaps. But I don't think the current laws are unfair. Reasonable accommodation = reasonable accommodation =/= undue burden.

LizzyM made some good comments about why this isn't going to turn into a 'slippery slope' of physicians eventually paying for all their patients and going bankrupt.

 

[pianola]

^All that said, do I relish the thought of losing some income (as a physician)? Probably not a whole lot. Who likes losing money? Not me.

Trying to put myself in the physician's shoes: In the moment, I might find it unpleasant or difficult to respond to the patient's request. Hard to say, I guess.

But, at least in theory, I think the Deaf patient's request wasn't unreasonable (and it was certainly supported by law).

 

[JJMrK]

Yeah, but healthcare is a necessity whereas having a car is a luxury.

Healthcare is a business, just like selling automobiles.

Remember: The one who pays the piper, calls the tune. When the feds pay the bill, you can expect a lot of strings to be attached. You can choose to exclude all Medicare and Medicaid patients from your practice.

Like I said earlier, set a price and if people don't want to pay it, they don't have to see you. If your prices are too high, someone else will charge lower prices and you'll go out of business. That's how the free market works.

It's possible this is the direction that medicine is heading. Many companies that provide health insurance are going to a high annual deductible policy, where the first 5-10 thousand dollars of medical expenses come out of the patient's own pocket for the year. Basically, this means that the patient is responsible for routine medical expenses, but if emergency surgery has to happen, most of the cost is covered. If you go over your ten thousand dollar limit in February, every other expense until December 31 would be covered. On January 1 of the next year, your deductible resets and you become responsible for the first 10 grand of expenses again for that year.

IMO, this is great for medicine. Primary care docs don't have to deal with insurance companies at every visit and are paid the price they set. People start to look a little closer at their bill, since they are now paying for their own care. If it seems too high they go somewhere else, which will drive prices to a reasonable level.

If you are pre-med and you think that this is the way to go, please advise your interviewers that you intend to exclude all poor, elderly, and permanently disabled patients from your practice unless they are able to pay cash for your services.

This statement is getting old. You're trying to impose your views on others by telling people that they won't get into medical school if they don't believe that same thing you do.

 

[LizzyM]

Medicare and Medicaid don't pay whatever the physician charges. If you agree to accept these patients, you agree to accept payment that the government deems to be "reasonable and customary". This is usually far less than you wish were reasonable and customary. The same goes if you sign on as a preferred provider for Blue Cross/Blue Shield or some of the other insurers. And you can't "balance bill", that is to say, you can't ask the patient to pay the difference between what you charge & what the insurance will pay (other than the co-pay). As I mentioned earlier, if you have a good case mix things will balance out in the end.

Medicine is a highly regulated business and the it doesn't operate on a strictly free market model like selling automobiles.

I just think that how an applicant would like to practice medicine would be of interest to the interviewer. If you've thought it out and have a plan, why be ashamed to talk about it?

 

[closer23]

.