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By: Georgette Samaritan, RN, MAG Mutual Risk and Patient Safety Department - Senior Risk Consultant
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Physicians treating patients who have hearing impairments may be responsible for providing interpreters for such patients in the medical office at no cost to the patients. These requirements often surprise physicians who note that the cost of an interpreter may exceed the amount billed to the patient for the office visit. Whether a patient is entitled to an interpreter under these requirements, or whether other means of communication will be appropriate, is heavily fact dependent. This article will briefly analyze communication requirements that apply to physicians treating the hearing impaired.
The Americans with Disabilities Act (ADA) of 1990 generally prohibits discrimination on the basis of a person’s disability and applies to services rendered in private physicians’ offices, among other places.1 One of the ADA’s central themes is the obligation to provide reasonable accommodations so persons with disabilities can enjoy access to services offered to the same extent as persons without disabilities. The ADA has been interpreted to require physicians to provide effective means of communication to their hearing-impaired patients through auxiliary aids and services, including interpreters, notes, other written materials, and telecommunications devices.2 The physician may not impose a surcharge on the hearing-impaired patient for the provision of such auxiliary aids and services.3
The ADA contains no requirement that physicians provide and/or pay for a live interpreter for each and every patient encounter. The physician should consult with the patient to determine the most appropriate auxiliary aid or service to employ. Neither the patient nor the physician should unilaterally decide upon the auxiliary aid or service to be employed without consulting with the other. While the final choice of alternatives rests with the physician, a mutual agreement between the physician and patient will render the best result.
Under the ADA, a physician is not required to provide an auxiliary aid or service (e.g., an interpreter) if it would cause the physician an undue burden or would fundamentally alter the nature of the services normally provided.4 An undue burden is something that involves significant difficulty or expense, although cost alone is not determinative.5
Apparently, it is not considered an undue burden if the cost of the auxiliary aid or service exceeds the amount the physician will receive for treating the patient. As a practical matter, it may be difficult to show that use of an interpreter would fundamentally alter the nature of the services normally provided by a physician in most cases.
When the question is which auxiliary aid or service to utilize, physicians should be mindful that the goal is effective communication under the circumstances. With routine office matters, a pen and notepad may suffice. With more complex matters, use of a qualified interpreter may be justified.
Physicians may contract with interpreters from outside interpreter services, hire staff members capable of interpreting for hearing impaired patients, or utilize friends and family of the patient. A friend or family member should be used as an interpreter only when acceptable to the patient and when the person can serve in that capacity effectively. It is clear that engaging in communication with hearing-impaired patients can be accomplished in more than one way. The challenge is finding the most effective method of communicating with the patient considering all the circumstances involved.
Sources:
1 28 CFR 36.104
2 28 CFR 36.303
3 28 CFR 36.301
4 28 CFR 36.303
5 28 CFR 36.104
