What does the ADA consider reasonable accomodations?(warning-long)

[psychobunny]

This is not another thread about Southwest Airlines:)
Here is the situation:
I am a doctor and I usually communicate with my deaf patients by writing or with them reading lips. Most of them have been OK with this method. One patient, however, requested a translater. Under ADA rules, this is equivalent to someone who has been arrested asking for a lawyer-no further communication takes place without a translator,paid for by the doctor (by law). We provided a translator for subsequent visits. The translator charges $180 an hour with one hour minimum. Medicare allows me $35 for the patient’s visit (even though I regularly book her for extra time). Each time I see this patient, therefore, I have to pay $145 to take care of her. Now, my patient needs a specialist. When she calls to make an appointment nobody has one available for months (surprise:rolleyes: ). I prevail upon a friend to see her and he also ends up paying for each visit. Now I know that if a disabled person moves into a non-handicapped-accessible building, the owner is required to retrofit, but the new tenant is responsible for the costs. Is it fair to ask me to pay in order to take care of my patients? Should Medicare pay for the translator-or should it be the patient’s responsiblity? FWIW, I am an employee and my employers eat the costs as part of their community responsibility-but if I was in solo practice I could quickly go bankrupt seeing deaf patients.
In a related note, there was a story in the Washington Post (March 31, 2002) about deaf parents who tried and hoped to have a deaf child. While this is certainly their right, should this count as a “disability” under the ADA? If they want their child to experience the “deaf culture” should I as a hearing doctor be forced to subsidize this?

[Monty]

Some communities have a thing called The Language Bank which is staffed by volunteer translators. What’s your approximate location and I’ll see what I can find.

[minty_green]

psychobunny, I would dearly love to see the portion of the ADA, or the administrative regulations implementing it, that say you have to pay a translator because a deaf patient requests one. I’m no ADA expert, but I do have a passing familiarity with the law, and I believe you are wrong.

[El_Zagna]

First things first: IANAL

Under ADA rules, this is equivalent to someone who has been arrested asking for a lawyer-no further communication takes place without a translator,paid for by the doctor (by law).

Where exactly in the ADA rules do you see this? The ADA Home Page makes a big deal about the accomodations for the disabled being reasonable. On their FAQ Page they say this:

MYTH: Restaurants must provide menus in braille.
FACT: Not true. Waiters can read the menu to blind customers.

That seems very similar to your situation unless the patient can’t read. If the patient just has a preference for having a translator that would be her problem.

The ADA is really a good thing in principle, at least, so I am always bothered when something like this comes up which makes both the ADA and the disabled look like asses.

[psychobunny]

Please see this link:
http://www.ama-assn.org/ama/pub/category/4616.html

Although the health care professional makes the final decision regarding use of an interpreter or other alternative, the patient’s choice should be given primary consideration. Also, the reasonableness of a determination not to provide an accommodation may be challenged in court in an enforcement action. If there is a disagreement between the health care professional and the patient over the need for a qualified interpreter, the effectiveness of each viable option should be discussed. Factors or options for consideration include whether an option presents an undue burden to the practice or facility, and what option or options would ensure effective communication. Courts have found an ADA violation where the health care professional decides not to use an interpreter and there is evidence that the method used did not result in effective communication.

The health care professional or facility responsible for the care must pay for the cost of an interpreter. Health care professionals or facilities cannot impose a surcharge on an individual with a disability directly or indirectly to offset the cost of the interpreter.

So I agree that there is not an ABSOLUTE requirement to provide an interpreter but my patient clearly stated that she felt she was not getting effective communication. In that case, the courts have ruled that if I don’t use an interpreter it is an ADA violation. My only other option is to declare it an “undue burden” and refer the patient to another doctor. What I am trying to get at here is not just the money issue but the fact that my patient now may have limited access to care and may have trouble finding a doctor to treat her.

[minty_green]

That article is 4 years old, and it is wholly without reference to any legal authorities. I’m not convinced. In fact, I still think it’s an incorrect assessment of the law.

[El_Zagna]

Here’s an even more appropriate passage from the ADA FAQ page

MYTH: Sign language interpreters are required everywhere.

FACT: The ADA only requires that effective communication notexclude people with disabilities – which in many situations means providing written materials or exchanging notes. The law does not require any measure that would cause an undue financial or administrative burden.

[psychobunny]

OK-but even if interpreters are not required, can we take as a given that I cannot communicate effectively with this patient in any other way? I will admit that I am wrong but I still don’t see how this patient can get medical care if the only way she can communicate effectively is with a translator. I am trying hard but I can’t find specialists to treat her. If they all say that providing an interpreter is not reasonable, who will take care of her?

[Telemark]

If they all say that providing an interpreter is not reasonable, who will take care of her?

Perhaps this could be reworded to:

If she insists that anything but an interpreter is not reasonable, who will take care of her?

I have no real knowledge of the ADA, but the ADA FAQ seems pretty clear about this. Why does the patient feel that written communication is unsufficient?