Do I have to provide a sign language interpreter for patients who are hearing impaired?
The Americans with Disabilities Act provides that “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.” 42 U.S.C 12182(a)
Patients who are hearing impaired fall under the Americans with Disabilities Act (ADA), and physician offices are considered places of public accommodation. Regulations pursuant to the Act also state, “A public accommodation shall take such steps that may be necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless the public accommodation can demonstrate that taking such steps would fundamentally alter the nature of the goods, services, facilities, privileges, advantages or accommodations being offered or would result in an undue burden, i.e. significant difficulty or expense.” 28 C.F.R. §36.303(a)
Auxiliary aids include qualified interpreters and note takers as well as other effective methods of communicating to individuals with hearing impairments. 28 C.F.R. §36.303(b)(1) Whether providing these aids is a significant difficulty or expense is determined on a case by case basis. Regulations also provide that “[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(c) Therefore, it should always be the physician’s first priority to ensure that there is effective communication with their patient.
Providers are responsible for incurring all the costs of providing reasonable aid and cannot pass that charge on to the patient or to their insurance company. Some patients may insist on the presence of an interpreter, in which case you must attempt to resolve the issue with the patient.
Ultimately, you need to remember that failure to provide a reasonable aid, either literally or in the patient’s eyes, could result in a discrimination lawsuit. Therefore, you should contact your medical malpractice insurance carrier and your private healthcare attorney for specific advice when this situation arises. In October 2008, a New Jersey jury awarded $400,000 to a patient who sued a physician for refusing to provide a sign language interpreter. See here for more details.
For additional information on the Americans with Disabilities Act:
- Revised ADA Requirements: Effective Communication
- Access to Medical Care for Individuals for Mobility Disabilities
- Frequently Asked Questions about Service Animals and the ADA
- ADA Business Brief: Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings (Oct. 2003),” which is available here.
- ADA Information Line: 1-800-514-0301
- ADA Questions and Answers online.
- U.S. Department of Justice response The letter is available here. to concerns from Senator Phil Gramm (TX) about the obligations and burdens imposed by this law:
- U.S. Department of Justice response This letter is available here. to a letter from Congressman E. Clay Shaw, Jr. (FL) addressing similar issues regarding this law:
- You may also contact ISMA's Legal Department for additional information.
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