burton117

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MEMORANDUM OF THE OBLIGATIONS OF DOCTORS AND OTHER HEALTH CARE PROVIDERS UNDER THE AMERICANS WITH DISABILITIES ACT

Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against deaf and hard of hearing people in places of public accommodation. Included within the definition of places of public accommodation is any “professional office of a health care provider,” regardless of the size of the office or the number of employees. 28 C.F.R. §36.104. The ADA therefore applies to doctors, dentists, psychiatrists and psychologists, hospitals, nursing homes and health clinics, and all other providers of mental and physical health care.

Places of public accommodation must be accessible to individuals with disabilities. For deaf and hard of hearing people, this means that they must remove barriers to communication. Doctors and health care providers must make sure that they can communicate effectively with their deaf patients and clients by providing “auxiliary aids and services” for these individuals:
(c) Effective communication. A public accommodation shall furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities.
28 C.F.R. 36.303.

“Auxiliary aids and services” expressly include qualified interpreters, transcription services, and written materials, as well as the provision of telecommunications devices for the deaf (known as TDDs or text telephones), telephone handset amplifiers, television decoders and telephones compatible with hearing aids.
28 C.F.R. 36.303 (b) (1).

For individuals who use sign language, interpreters are often needed to provide safe and effective medical treatment. Unless a doctor can communicate effectively and accurately with a patient, there is a grave risk of not understanding the patient’s symptoms, misdiagnosing the patient’s problem, and prescribing inadequate or even harmful treatment. Similarly, patients may not understand medical instructions and warnings or prescription guidelines without the provision of an interpreter.

The doctor may not charge the patient for the cost of interpreter service, either directly or by billing the patient’s insurance carrier:
A public accommodation may not impose a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the costs of measures, such as the provision of auxiliary aids, barrier removal…and reasonable modifications…that are required to provide that individual or group with the nondiscriminatory treatment required by the Act or this part.
28 C.F.R. 36.301(c).

The Justice Department regulation defines a “qualified interpreter” as follows:
Qualified interpreter means an interpreter who is able to interpret effectively, accurately and impartially both receptively and expressively, using any necessary specialized vocabulary.
28 C.F.R. 36.104. The Justice Department warns that family members and friends may not be able to provide impartial or confidential interpreting in the medical context, even if they are skilled sign language users:
In certain circumstances, notwithstanding that the family member or friend is able to interpret or is a certified interpreter, the family member or friend may not be qualified to render the necessary interpretation because of factors such as emotional or personal involvement or considerations of confidentiality that may adversely affect the ability to interpret ‘effectively, accurately, and impartially.’
56 Fed. Reg. 35553 (July 26, 1991).

When there is a dispute between the health care provider and the deaf individual as to the appropriate auxiliary aid, the Justice Department strongly urges the doctor to consult with the deaf person about the effectiveness of a proposed auxiliary aid. It also cautions that complex discussions, such as those about health issues, may require interpreter service if that is the communication method used by the deaf individual:
The Department wishes to emphasize that public accommodations must take steps necessary to ensure that an individual with a disability will not be excluded, denied services, segregated or otherwise treated differently from other individuals because of the use of inappropriate or ineffective auxiliary aids. In those situations requiring an interpreter, the public accommodations must secure the services of a qualified interpreter, unless an undue burden would result.

…It is not difficult to imagine a wide range of communications involving areas such as health, legal matters, and finances that would be sufficiently lengthy or complex to require an interpreter for effective communication.
56 Fed. Reg. 35566-67 (July 26, 1991). Typical examples of situations in which interpreters should be present are obtaining a medical history, obtaining informed consent and permission for treatment, explaining diagnoses, treatment and prognosis of an illness, conducting psychotherapy, communicating prior to and after major medical procedures, explaining medication, explaining medical costs and insurance issues, and explaining patient care upon discharge from a medical facility.
 
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burton117

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I am curious as to what your response is to the future obligation of doctors in providing resources for disabled patients..

Both of my parents are deaf, and I know that there are many doctors who did not realize this at various appointments they made.

It is the doctor/hospital's responsibility to provide an interpreter - not the deaf patient's. This includes paying for the interpreter's fees - which can be upwards of $30-$35 an hour with a two hour minimum.

Any thoughts on this?


Note: (Edited 3/5/04)

The purpose of this thread is not to say: "You had better provide an interpreter or else you will be subject to legal action!" Rather, I am posting this to make us future and current doctors aware of this legal issue so that we don't find ourselves in situations where we are involved in discrimination.

Discrimination suits can be very expensive and I know that doctors have too many legal hassles as it is and hopefully this knowledge can save the expense, time and hassle of dealing with noncompliance of this issue.

If in reading this thread, there is only one doctor who provided an interpreter for his/her deaf patient, then the purpose of this thread has been served.
 

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When I was on a radiology rotation, the rad had to hire an interpreter to discuss mammogram results with a deaf patient. The interpreter cost the rad notably more than the reimbursement for the mammo was.
 

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if you want to come see me, you can bet that YOU will be paying for the interpeter. take me to court, and i'll pay then, but only after i make the state hire their own translator.

it's not a doctors job to worry about these types of things when there are real things (such as diagnosing an illness) to worry about. if you cant hear, that's not a doctor's problem, that's your own. It is sad and i would not wish it upon someone, but i didn't contribute to it.

and i guess this also means that the state should hire these people full time interpreters because basically anything a deaf person wants to do necessitates communication (grocery store, school, etc.)

insert "land of the free" comment here
 

typeB-md

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and i'd also like to add... i'll make up a b.s. excuse as to why i can't take on a patient
 
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typeB-md said:
if you want to come see me, you can bet that YOU will be paying for the interpeter. take me to court, and i'll pay then, but only after i make the state hire their own translator.

it's not a doctors job to worry about these types of things when there are real things (such as diagnosing an illness) to worry about. if you cant hear, that's not a doctor's problem, that's your own. It is sad and i would not wish it upon someone, but i didn't contribute to it.

and i guess this also means that the state should hire these people full time interpreters because basically anything a deaf person wants to do necessitates communication (grocery store, school, etc.)

insert "land of the free" comment here
This is a pretty sad statment... I would imagine that establishing effective communication with a patient would definitely be a important part of doing a "real thing" such as diagnosing an illness. Try reading the link below.. Lord knows you need it.

Problems the Deaf Have Talking with their Doctors
 

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typeB-md said:
if you want to come see me, you can bet that YOU will be paying for the interpeter. take me to court, and i'll pay then, but only after i make the state hire their own translator.

it's not a doctors job to worry about these types of things when there are real things (such as diagnosing an illness) to worry about. if you cant hear, that's not a doctor's problem, that's your own. It is sad and i would not wish it upon someone, but i didn't contribute to it.

and i guess this also means that the state should hire these people full time interpreters because basically anything a deaf person wants to do necessitates communication (grocery store, school, etc.)

insert "land of the free" comment here
please tell me that you are joking. i would expect a future doctor to be more sensitive to the needs of a patient. how are you going to diagnose a patient if you can't communicate with them?
 
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typeB-md said:
and i'd also like to add... i'll make up a b.s. excuse as to why i can't take on a patient
I hope this sounds familiar?? :)

The Hippocratic Oath

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."
 

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ndi_amaka said:
It doesn't sound pc but honestly how are you going to make the physician eat the cost of the interpreter? That does not seem fair at all.
Call me crazy, but isnt a pen and piece of paper a lot cheaper? This isnt hellen keller or an illiterate.
 

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Thank you for posting this. I'm (hopefully) giving a talk in a month or so at my school about taking care of patients with disabilities, and communication with deaf and Deaf patients is on my list, as well as other physician/hosptial responsibilities under the American's With Disabilities Act.
 

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Call me crazy, but isnt a pen and piece of paper a lot cheaper? This isnt hellen keller or an illiterate.
ASL isn't a written language (as i'm sure you are all well aware of), with its own grammar structure. its not translated word for word in the same order as english. some deaf people have a very difficult time with spelling and english grammer b/c its kind of like a second language. though this is definitely a much better option than nothing at all.
 

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lilmo said:
ASL isn't a written language (as i'm sure you are all well aware of), with its own grammar structure. its not translated word for word in the same order as english. some deaf people have a very difficult time with spelling and english grammer b/c its kind of like a second language. though this is definitely a much better option than nothing at all.
Thats interesting to know. My reaction was the pen and paper one too. I hadn't thought about it being a 2nd language.

Communicating with patients is obviously of the highest level of importance. But if we're looking at ASL as a different language how can you possible expect a doc to pay for an interpreter for every possible language that comes in. Its definately an obstacle and I'd be curious to see how different docs handle it.
 

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lilmo said:
ASL isn't a written language (as i'm sure you are all well aware of), with its own grammar structure. its not translated word for word in the same order as english. some deaf people have a very difficult time with spelling and english grammer b/c its kind of like a second language. though this is definitely a much better option than nothing at all.
That is interesting. Which makes me wonder... With sign language we had the opportunity to create a truly universal language. I figured the reason why it didnt work was that the sign language syntax varied from language to language. Now that I know that ASL has different syntax than english, it irritates me even more that we have so many different sign language systems.

Also, I figured deaf people still enjoyed reading books and things, so even if they had a harder time phrasing things on paper, I figured they could understand the doc just fine.
 

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Charles Gallaudet (one of the main developers of the language) was French, so ASL has syntax that is a lot closer to French than English.

ASL was my second language in undergrad. It rocks.
 

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It's true that ASL has a different syntax, etc... but c'mon--the words are the same deaf people still read!! While there may be differences how deaf people would write a sentence, those differences will not be a source of misunderstanding. I have known many deaf people in my life, and never has one of them stated that writing is an ineffective way of communication with people who do not know ASL.
 

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burton117 said:
I hope this sounds familiar?? :)

The Hippocratic Oath

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

The Hippocratic Oath is not legally binding, varies from school to school, and is substantially altered from one of many of it's ancient forms, very few of which can be ascribed to Hippocrates or even to the correct century.

The original oath, I believe, also required physicians to train the children of other physicians, to never operate on someone with kidney stones, and to never conduct an abortion.

I suppose most deaf people can read so I would certainly write out what I wanted to tell them if it came to that. But should a private physician be required to have a sign-language interpreter on retainer for his occasional deaf patient. Jeez. Are the deaf helpless? Maybe the patient might consider bringing a hearing friend who can sign as a courtesy to the physician.

It's not that I object to accomodating patients, but should I also have to have an interpreter standing by who speaks Arabic for my occasional arabic patient who doesn't speak english? I've had this happen. The patient's son translated and everything was hunky friggin' dory without having to make a federal case out of it.
 

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burton117 said:
This is a pretty sad statment... I would imagine that establishing effective communication with a patient would definitely be a important part of doing a "real thing" such as diagnosing an illness. Try reading the link below.. Lord knows you need it.

Problems the Deaf Have Talking with their Doctors
you are right, and i assume you'll be hiring german translators, spanish translators, etc. as we are a multi-diverse nation and we wouldn't want to deprive these individuals of being able to take part in teh 'real thing.'
 

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lilmo said:
please tell me that you are joking. i would expect a future doctor to be more sensitive to the needs of a patient. how are you going to diagnose a patient if you can't communicate with them?
i already said... it's my job to know an a$$load of information. it's not my job to pay so that i can help someone who is otherwise capable of providing for their own translator.

everyone has lost their mind with all this p.c. crap. How is it fair to me (the physician) to make ME pay to see a patient? You guys are out of your minds. Yes we should make special accomodations, but don't make me the bad guy because you are all mother teresa.
 

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I have to agree with typeB-md on this one...the difference between a deaf patient and a Spanish-speaking patient is only a matter of mechanism (and, in fact, the deaf patient should find it easier to communicate as s/he should be able to read written English enough to get the meaning as compared to the Spanish-speaking patient). Hospitals hire foreign-language interpreters, but physicians in private practice are never required to see these patients, and if they do see them, I do not think they are legally required to hire a translator.

In private practice, if you are going to have a practice with many ________ (insert patient population here) you should make accomodations for them (i.e. know sign language for hearing-impaired patients, Spanish for Spanish-speaking patients, etc...). The beauty of private practice is that you do not have to see these patients if you do not want to do so, so you can avoid the entire issue by simply not seeing the patients if you are not comfortable with them. Otherwise, the hospital in which you work should have an interpreter on hand. Honestly, the patients are usually very cool about it all and tend to bring their interpreters with them anyway, so it is usually a non-issue.
 

typeB-md

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burton117 said:
I hope this sounds familiar?? :)

The Hippocratic Oath

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

EDIT: i forgot to mention, we should all get together some time to worship the Greek gods

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."
maybe you can come over and we can grow flowers together and run in the grassy meadows under the rainbows.

the Hippocratic oath is as relevant to medicine as the Queen of england is to governing england. The oath you posted is highly revised from the original oath (read: the flower power people of medicine have selectively chosen which aspects they would like to keep while disregarding others).

i love how you guys have all these cheerful mentalities. and in fact, i see that most of you are going to be going overseas to provide pro bono since you are going to care for so many in need and teach the Art to as many as possible.

i almost forgot... when are we setting up the meeting to worship the greek gods?
 

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SocialistMD said:
I have to agree with typeB-md on this one...the difference between a deaf patient and a Spanish-speaking patient is only a matter of mechanism (and, in fact, the deaf patient should find it easier to communicate as s/he should be able to read written English enough to get the meaning as compared to the Spanish-speaking patient). Hospitals hire foreign-language interpreters, but physicians in private practice are never required to see these patients, and if they do see them, I do not think they are legally required to hire a translator.

In private practice, if you are going to have a practice with many ________ (insert patient population here) you should make accomodations for them (i.e. know sign language for hearing-impaired patients, Spanish for Spanish-speaking patients, etc...). The beauty of private practice is that you do not have to see these patients if you do not want to do so, so you can avoid the entire issue by simply not seeing the patients if you are not comfortable with them. Otherwise, the hospital in which you work should have an interpreter on hand. Honestly, the patients are usually very cool about it all and tend to bring their interpreters with them anyway, so it is usually a non-issue.
the response from people is going to be "well spanish isn't a disability"

and while it may not certify under the ADA, the inability to communicate should be looked at collectively not based on whether or not your ears work.

it's private practice, i shouldn't have to go out my way to do things i don't want to.
 
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Doctors Agree to Provide Interpreting Services for Deaf Family Members

Posted November 1999

A couple facing their first pregnancy is going through a frightening and vulnerable time, particularly when the pregnancy is high risk. For a couple in Oregon, the situation became even more difficult when their doctor refused to provide a qualified sign language interpreter for effective communication.

Approximately seven months into the mother's first pregnancy, the last thing the hearing mother-to-be and the deaf father-to-be were thinking about was discrimination based on disability. In July of 1998, tests on their unborn child revealed a congenital heart condition. The couple's obstetrician sent them to an Oregon doctor, Dr. Merrill of Perinatal Associates, P.C., who specializes in high-risk pregnancies.

When the couple contacted Dr. Merrill's office to make an appointment, they requested that an interpreter be provided so that the father-to-be could communicate with Dr. Merrill. The doctor, however, refused to provide an interpreter.

On behalf of the young couple and the Oregon Association of the Deaf, the NAD Law Center and Dennis Steinman, an Oregon attorney, filed suit against Dr. Merrill and Perinatal Associates, P.C. alleging discrimination in violation of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and state law. The United States Department of Justice intervened in the lawsuit.

In November, all of the parties entered into a consent judgement ending the lawsuit. Dr. Merrill and Perinatal Associates agreed to pay the young couple $25,000 and to adopt a policy for effective communication. This policy provides that deaf patients and their companions will be offered auxiliary aids and services at no charge. In addition, patients who are deaf and their associates or family members will be given notice of this policy.

The defendants also agreed to provide a mandatory, in-service training to all of its staff members to make sure that they are aware of and complying with the new policy.

Under the Americans with Disabilities Act and Section 504, doctors are obligated to provide auxiliary aids and services not just to the patients with disabilities, but also to family members with disabilities.

Attorneys from the NAD Law Center are available to give seminars and workshops about the legal rights of people who are deaf and hard of hearing and other related topics. For information, please contact the NAD Law and Advocacy Center at [email protected], 301-587-7731 V/TTY.

Editor's Note: This article appeared in the November 1999 "The NAD Broadcaster."
 
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Deaf Child is Third to Sue Maryland Hospital for Discrimination

Posted May 1997

Latia Falls, an eight-year-old deaf child, and her mother Toschia Falls, filed a lawsuit against Prince George's Hospital Center in Cheverly, Maryland, under the Americans with Disabilities Act (ADA) and other civil rights laws on Thursday, May 8, 1997, in federal district court, alleging that the hospital discriminated against Latia on the basis of her deafness by refusing to provide sign language interpreter services to enable her to understand what was happening to her during her five-day stay at the hospital.


On Christmas Day, 1996, Latia was brought to the emergency room at Prince George's Hospital Center by her mother after she became ill. Her mother immediately informed hospital staff that a sign language interpreter was necessary for hospital personnel to communicate effectively with Latia, who is deaf. But the hospital never provided an interpreter for Latia -- either in the emergency room or at any other time during her five-day stay, despite her mother's repeated requests. Without a means to communicate and understand why she was feeling sick and what was going to happen to her, Latia became frightened, anxious and withdrawn.

In the complaint, Latia and Toschia Falls, represented by Laura Rovner and Marc Charmatz of the National Association of the Deaf Law Center and Lisel Loy and Douglas Parker of the Institute for Public Representation at Georgetown University Law Center, allege that Prince George's Hospital Center's failure to provide interpreter services for Latia discriminates against her on the basis of her deafness in violation of Title II of the ADA and section 504 of the Rehabilitation Act. Under these statutes, state and local government entities and places that receive federal funds, including hospitals, must provide auxiliary aids and services for deaf and hard of hearing individuals to ensure effective communication between the parties.

"Unfortunately, this is not the first time that Prince George's Hospital Center has been the subject of charges of discrimination against deaf people. It's outrageous that this keeps happening," stated Lisel Loy, attorney for Falls. In 1993, the Office of Civil Rights of the U.S. Department of Health and Human Services issued a letter of finding against the hospital for various violations of section 504 of the Rehabilitation Act. That finding was issued after two deaf people filed complaints against the hospital for failing to provide them with sign language interpreter services during hospital visits. Following the letter of finding, the hospital agreed to improve its procedures for providing sign language interpreter services for deaf patients.

By 1995, however, Prince George's Hospital Center had still not resolved its problems with providing sign language interpreter services to deaf patients. In April of 1995, two other deaf people were treated for serious medical conditions at the hospital without sign language interpreter services. James Proctor was brought to the hospital following a motorcycle accident. "His leg was amputated below the knee, but he didn't know that for almost a week after the surgery because the hospital didn't make an interpreter available to him," said Loy. Similarly, Yvette Ward, another deaf patient, was unable to communicate with hospital staff during multiple visits for problems related to her pregnancy, and ultimately, her miscarriage. Both Proctor and Ward have also filed civil rights lawsuits against the hospital in the U.S. District Court for the District of Maryland.
 
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Deaf Father, Hearing Mother Settle Suit Regarding Access to Medical Care for Their Child
Posted November 29, 2001

Settlement was reached in an important lawsuit that alleged discrimination against a family with a deaf father. The civil rights suit alleged that a group of Pennsylvania doctors discriminated on the basis of disability when it refused to provide medical care to a 15-month old child because the child's father is deaf and needs interpreting services.

Under the terms of the settlement, announced November 29, 2001 by the National Association of the Deaf Law Center and the Disabilities Law Project, the medical practice has agreed to follow specific policies and practices that promise equal access for people who are deaf and hard of hearing.

Plaintiffs Darrin and Anna Majocha filed the suit in the Western District of Pennsylvania in March 2000, against Pittsburgh Ear, Nose & Throat Associates. Mr. Majocha is deaf and communicates in American Sign Language. His wife, Anna, and his son D.J. are both hearing. In August 1999, DJ was referred by his pediatrician to Pittsburgh Ear, Nose & Throat Associates for a surgical evaluation related to his recurrent ear infections. The complaint declared that Pittsburgh Ear, Nose & Throat Associates scheduled an appointment for the Majocha family before being told that the child's father, Darrin Majocha, is deaf. After scheduling the appointment, Anna Majocha requested that the practice provide a qualified sign language interpreter so that her husband could attend and participate.

In what plaintiffs alleged was a violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act, Pittsburgh Ear, Nose & Throat Associates refused to provide a sign language interpreter for communication between the doctor and Mr. Majocha. When the Majochas persisted, the complaint alleged that Pittsburgh Ear, Nose & Throat Associates canceled the child's previously scheduled appointment and then sent a letter to the Majocha family informing them that the medical practice would not provide medical care to their child.

In September 2001 , the federal District Court Judge handed plaintiffs a resounding victory and denied a defense motion for summary judgment in its entirety. In his decision, Judge Lee cited the offensive letter denying the Majocha's medical care, writing that the letter was "as close to a smoking gun as it gets in federal court."

The decision set new precedent for civil rights plaintiffs seeking to change discriminatory policies through federal lawsuits. The Majochas are pleased with the settlement, which ensures that Pittsburgh Ear, Nose & Throat Associates will open its doors to everyone regardless of disability.

Specifically, the settlement provides that Pittsburgh Ear, Nose & Throat Associates will ensure that deaf patients and deaf family members of patients will be able to communicate with their doctors, that the practice will provide qualified sign language interpreters and assistive listening devices at no charge to patients, that the practice will thoroughly train all of its staff and physicians on the new policies, and that signs advising patients of their rights and the practice's policies with regard to communication will be clearly posted in each of the Pittsburgh Ear, Nose & Throat Associates' offices around the Pittsburgh area.

Most significantly, Pittsburgh Ear, Nose & Throat Associates, in signing the settlement agreement, effectively rescinded the letter it sent to the Majochas and agreed to provide medical care to the Majocha family. Under the terms of the settlement, a qualified sign language interpreter will be provided for any appointment Darrin Majocha attends with his son.

When asked about the suit, Plaintiff Anna Majocha said, "We just wanted our son to see this fine doctor," With this settlement, the Majochas will get what they requested.


For further information please contact Mark Murphy at the Disabilities Law Project 412-391-5225; or the National Association of the Deaf Law Center 301-587-7731 Voice/TTY, 301-587-0234 Fax, [email protected].

For more information about the NAD Law Center, click on this link.

Information about the Disabilities Law Project can be found at http://www.dlp-pa.org/.

A copy of the decision can be found at Majocha v. Turner, et al., 166 F. Supp.2d 316 (W.D.Pa. 2001).
 
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burton117

burton117

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ADA Questions and Answers for Health Care Providers

Q. Must a health care provider pay for an auxiliary aid or service for a medical appointment if the cost of that aid or service exceeds the provider's charge for the appointment?

A. In some situations, the cost of providing an auxiliary aid or service (e.g., an interpreter) may exceed the charge to the patient for that very same service. A health care provider is expected to treat the costs of providing auxiliary aids and service s as part of the annual overhead costs of operating a business. Accordingly, so long as the provision of the auxiliary aid or service does not impose an undue burden on the provider's business and does not fundamentally alter the provider's services, the provider may be obligated to pay for the auxiliary aid or service in this situation.

Q. Can a health care provider charge a deaf or hard of hearing patient for part or all of the costs of providing an auxiliary aid or service?

A. No. A health care provider cannot charge a patient for the costs of providing auxiliary aids and services, either directly or through the patient's insurance carrier. 28 C.F.R. Š 36.301 (c).

Q. Can health care providers receive any tax credits for the costs of providing auxiliary aids and services?

A. Yes. Businesses may claim a tax credit of up to 50 percent of eligible access expenditures that are over $250, but less than $10,250. The amount credited may be up to $5,000 per tax year. Eligible access expenditures include the costs of interpreters or TTYs, and providing other auxiliary aids and services. Omnibus Budget Reconciliation Act of 1990, P.L. 101-508, Š 44.
 

farrago

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Q. Can a health care provider charge a deaf or hard of hearing patient for part or all of the costs of providing an auxiliary aid or service?

A. No. A health care provider cannot charge a patient for the costs of providing auxiliary aids and services, either directly or through the patient's insurance carrier. 28 C.F.R. Š 36.301 (c).
That's CRAZY.

I hope someone or something saves our country from all the insane people who have somehow found themselves in power.

By this reasoning, we might arrive at the conclusion that a doctor cannot charge a patient for ANYTHING - after all, neither being deaf, nor having a congenital heart abnormality, are the patient's fault!
 

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Being a deaf medical student myself, I have no problem with providing an interpreter. Seriously, how often do you have a deaf patient?

With regard to talking to the deaf man--the child was the patient, not the father. The doctors had no right to deny service. Interpreters are not always necessary, family members can assist. When two parties have a desire to communicate, boundaries can be overcome.

Think about it. Many of you will have children, and it is likely that at least one of you will have a child who's physical faculties are less than normal. If you want your child treated in an accomodating manner with as many opportunities available as possible, shouldn't you provide it to others?
 

U4iA

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orion1978 said:
Being a deaf medical student myself, I have no problem with providing an interpreter. Seriously, how often do you have a deaf patient?

With regard to talking to the deaf man--the child was the patient, not the father. The doctors had no right to deny service. Interpreters are not always necessary, family members can assist. When two parties have a desire to communicate, boundaries can be overcome.

Think about it. Many of you will have children, and it is likely that at least one of you will have a child who's physical faculties are less than normal. If you want your child treated in an accomodating manner with as many opportunities available as possible, shouldn't you provide it to others?
yes, but can't insurance be billed for it? it is ridiculous for a physician to serve a patient at a loss as in Dr. Mom's example. I think we are all on the same side - we ALL want to provide the best care to our patients.

The disagreement arises from the disproportionate amount of costs that physicians are being forced to bear over the years as HMOs and insurance companies are getting rich.
 

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U4iA said:
yes, but can't insurance be billed for it? it is ridiculous for a physician to serve a patient at a loss as in Dr. Mom's example. I think we are all on the same side - we ALL want to provide the best care to our patients.

The disagreement arises from the disproportionate amount of costs that physicians are being forced to bear over the years as HMOs and insurance companies are getting rich.
No. The disagreement is that nobody should have to work for free. Patients should have to pay for their treatment. Ultimately, it is the patients who don't want to pay and many, many people, even those who could afford to pay for their medical care, who view your labor on their behalf as an entitlement.

But seriously, this thread is dumb. I bet most deaf people can read so all you'd have to do is spend a little extra time writing it down. If you get a militant deaf person who wants to make a federal case out of your not keeping a signer on retainer then it is just his bad manners and you will have to suck up the cost of a signer who probably will just spell out all the medical words anyways. (I don't think there is a hand sign for "Aortic Stenosis.")

I believe that if you are in private practice and don't take either medicare or medicaid patients (like many physicians in my city) you can pretty much only take patients who you want to take.
 

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Panda Bear said:
I believe that if you are in private practice and don't take either medicare or medicaid patients (like many physicians in my city) you can pretty much only take patients who you want to take.
Legally this might be true, but I think it's ethically wrong. If everyone did that, patients who are less "fun" to take care of would fnd it difficult to see a good doctor, and would be even more underserved than they are now. We need to discourage other physicians from practicing "botique" medicine-- otherwise those of us doing the right thing will be penalized financially.

I don't have to continue to provide care to people who don't pay, but it's not right to cherry pick-patients before they walk in the door.
 

Newquagmire

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With sign language we had the opportunity to create a truly universal language.
Except for amputees. Not trying to be funny.

My school makes a big deal of this AT&T phone line that provides a translation service (free of charge?) for hospital staff. Of course that probably wouldn't work for ASL, but they do have those nifty typing phone display thingies these days...

Also, in order to meet this particular need, my school has an ASL elective that actually gives med students a stipend in return for fulfilling elective requirements they already have to. Getting paid to serve the underserved. Nice.
 

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fang said:
Legally this might be true, but I think it's ethically wrong. If everyone did that, patients who are less "fun" to take care of would fnd it difficult to see a good doctor, and would be even more underserved than they are now. We need to discourage other physicians from practicing "botique" medicine-- otherwise those of us doing the right thing will be penalized financially.

I don't have to continue to provide care to people who don't pay, but it's not right to cherry pick-patients before they walk in the door.
Let me tell you something else about private practice that I learned on my community medicine month.

Unlike here at our charity hospital, in private practice you can terminate a non-compliant patient. In other words, if your patient refuses to follow your medical advice you send him a polite letter and give him thirty days to find another physician. Some doctors xerox the phone book pages that list other doctors in town but this is not required.

As some of you know, the biggest problem with health care is not access to care but lack of compliance by patients.

Don't get hot under the collar. It is very true that an uninsured patient with MS will have a hard time paying for her interferon. Human monoclonal antibodies are also well beyond the reach of most of the uninsured who depend on "freebies" from the drug companies.

I would say, however, that the great majority of health problems I see in my own patients (at my school we follow our own patients in third and fourth year at our own clinic) are all related to the unholy triad of obesity, hypertension, and diabetes with smoking, drug use, and alcohol thrown in to make things difficult.

None of these problems is particualry expensive to treat. A month's worth of a generic ACE inhibitor (like enalapril) is about 12 bucks. A month of HCTZ costs only slightly more than a pack of smokes. Since most of the Diabetes is NIDDM, weight loss in itself would probably cure most of the cases and if that doesn't work we have programs where our patients can get their generic Glucophage (metformin) for about ten dollars a month. As is, a month of Metformin runs about 20 bucks without the discount.

So it is a myth that medicines are expensive. Sure, the latest formulations put out by the drug companies are pricey and they are no doubt improved from the drugs they replace. On the other hand the old stand-bys still work really well, even if the dosing is not as convenient or the side effect profile is not optimum.

"But Panda Bear," you say, "How can the poor be expected to come up with fifty dollars a month to treat their HTN and NIDDM?"

If you can afford cell phones, expensive hair-dos, make-up, and food, lots of food, not to mention booze and cigarettes you can certainly afford your HCTZ. Unfortunantly, many patients have been bred into dependency and think it is a violation of their rights to pay any money at all for their own health.

Some of my patients who are eligible for free medicine through a drug company program none-the-less end up untreated because they are too lazy to come in every three months to get their new perscriptions.

Additionally, even if you delivered their medication by chariot to their door many of my patients cannot even be bothered to discipline thier lives even to the minor extent required to take a pill or two on a regular schedule.

And yet, when they have nothing better to do they drag themselves into clinic forty minutes late and then wonder why I have done nothing to help them in two years.

Pardon my rant. The physician-patient relationship is a two-way street and I think some of you have an idealized vision of patients.



PS:
I know you can find me some sob story about some rare drug that costs 20 thousand dollars per dose. (Yes, those drugs do exist) On the other hand the vast, corpulent majority of charity patients just need some compliance with their inexpensive and effective meds.
 

orion1978

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Panda Bear said:
No. The disagreement is that nobody should have to work for free. Patients should have to pay for their treatment. Ultimately, it is the patients who don't want to pay and many, many people, even those who could afford to pay for their medical care, who view your labor on their behalf as an entitlement.

But seriously, this thread is dumb. I bet most deaf people can read so all you'd have to do is spend a little extra time writing it down. If you get a militant deaf person who wants to make a federal case out of your not keeping a signer on retainer then it is just his bad manners and you will have to suck up the cost of a signer who probably will just spell out all the medical words anyways. (I don't think there is a hand sign for "Aortic Stenosis.")

I believe that if you are in private practice and don't take either medicare or medicaid patients (like many physicians in my city) you can pretty much only take patients who you want to take.

Most Deaf people (even "oral deaf" who use lipreading and speech) cannot write well. I understand the problems of "working for free"...but people with physical disabilities are excluded from many things which you are not. Only if you are wealthy do you have the ability to pay for accomodations. The idea of the ADA is that people work together to pick up the costs. I agree it should not be solely up to the physician. For major sensory disabilities, I believe the state should (and many do) pickup the costs.

I've been studying too long to make a coherent message.
 

fang

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Panda Bear said:
Let me tell you something else about private practice that I learned on my community medicine month.

Additionally, even if you delivered their medication by chariot to their door many of my patients cannot even be bothered to discipline thier lives even to the minor extent required to take a pill or two on a regular schedule.

Pardon my rant. The physician-patient relationship is a two-way street and I think some of you have an idealized vision of patients.
You're right about all of this. The problem is that your being "right" is not going to help your patients. You have a 1960's view of the doctor-patient relationship-- the updated view is not idealized, it's simply more realistic about the fact that in the end, compliance is better if you negotiate a treatment plan rather than tell someone what to do.
 

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fang said:
You're right about all of this. The problem is that your being "right" is not going to help your patients.
Well said. I agree with Panda Bear in principle, but practically speaking, it seems like part of our job is to forgive patients for being (at times) sloppy and incompliant.
 

farrago

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carrigallen said:
Well said. I agree with Panda Bear in principle, but practically speaking, it seems like part of our job is to forgive patients for being (at times) sloppy and incompliant.
Forgive? Not if someone else is paying for it.

If you're being sloppy and incompliant, while sucking money from your insurance company or the government, then you deserve a kick in the ass.