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My communications with the local chapter of SHHH and the Executive Director of the Tennessee Council f/t Deaf & Hard Of Hearing have struck paydirt! I have here a document you can copy and save or paste into Word Pad, Word Perfect, whatever and print. I will be carring this with me to every doctor and hospital visit. From the NAD ADA website. Check it out!
Doctors
Are Doctors Required to Provide Interpreters for Medical Visits and Other Medical-Related Situations?
The short answer is yes. This is covered under the Title III of the Americans with Disabilities Act (ADA). If you feel that you need an interpreter in order to understand what your doctor/health care provider is telling you, then the doctor/health care provider is required to provide you with one. It is best to contact your doctor/health care provider directly and tell them, prior to your appointment, that you need an interpreter. Do not hire your own interpreter and expect the doctor/health care provider to pay your interpreter for you. You may run into problems that way.
The doctor/health care provider must pay for the cost of an interpreter, even if the cost of the interpreter is more than the cost of your visit. The doctor/health care provider is expected to handle the cost of interpreter as a normal business expense or as part of the overhead costs of operating a business.
If your doctor/health care provider tries to encourage you to bring in a signing family member or a friend as a way to "save costs", say no. Family members and friends cannot be expected to be neutral and sign everything they hear. They may be emotionally or personally involved with you and this may affect their interpreting. Using them as interpreters can also cause problems in maintaining your confidentiality as a patient.
Hospitals and Nursing Homes
Inpatient health care facilities have important responsibilities under federal law to be accessible to deaf and hard of hearing individuals. Failing to provide interpreters and adapted equipment may be discrimination on the basis of disability. In addition, failure to establish effective communication with a deaf patient may expose a health care provider to liability for medical malpractice.
This memorandum addresses the obligations of a hospital to provide qualified interpreters to its deaf and hard of hearing patients. This right is established under two federal laws.
Section 504 of the Rehabilitation Act of 1973
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Š 794, requires federal financial recipients' programs to be equally accessible to handicapped persons. The U.S. Department of Health and Human Services (HHS) regulations to Section 504 require pro vision of necessary auxiliary aids, such as sign language interpreters, to ensure equal access to federal financial recipients' programs. These regulations specify that:
A recipient to which this subpart applies that employs fifteen or more persons shall provide appropriate auxiliary aids to persons with impaired sensory, manual, or speaking skills, where necessary to afford such persons an equal opportunity to benefit from the service in question.
* * *
For the purpose of this paragraph, auxiliary aids may include brailled and taped material, interpreters, and other aids for persons with impaired hearing or vision.
45 C.F.R. Š 84.52(d)
Provision of qualified sign language interpreters is critical to ensure that deaf persons are able to benefit from and participate equally in the program. The Office for Civil Rights of HHS has consistently required hospitals to provide qualified interpreters and TDDs to deaf clients, and has stated:
. . . it would be extremely difficult for the health care provider to demonstrate in certain service settings, that effective communication is being provided in the absence of . . . interpreters.
Section 504, Effective Communications, and Health Care Providers, U.S. Department of Health and Human Services, Region III, Regional Technical Assistance Staff (January, 1982), page 5.
The Department of Health and Human Services, Office for Civil Rights (OCR) has determined that effective communication must be provided at "critical points" during hospitalization. OCR has defined "critical points" as follows:
These would include those points during which critical medical information is communicated, such as at admission, when explaining medical procedures, when an informed consent is required for treatment and at discharge.
U.S. Department of Health and Human Services, Office for Civil Rights, Region III, Letter of Findings, Ref. No. 03913037 (December 12, 1991), at 5.
Moreover, HHS has repeatedly stated that the deaf patient's assessment of his or her communication needs must be given great deference:
In most circumstances, we believe that the hearing impaired person is in the best position to determine what means of communication is necessary to insure an equal opportunity to benefit from health care services. Therefore, the patient's judgment regarding what means of communication is necessary to insure effective communication must be accorded great weight.
* * *
The presumption favoring the hearing impaired patient's self assessed need is not overcome merely by a showing that the hearing impaired patient suffered no harm. Rather, the recipient must demonstrate that the hearing impaired patient actually understood what was being communicated through the alternative communication option.
Stewart, Roma, (Director, HEW Office for Civil Rights), "Memorandum: OCR's Position on the Provision of Auxiliary Aids for Hearing Impaired Patients in Inpatient, Outpatient and Emergency Treatment Settings", (April 21, 1980), page two.
Many physicians wonder why the exchange of written notes will not suffice with a deaf patient. The Department of Health and Human Services recognizes that there is a distinction between English and American Sign Language, and that written communications , or interpreters not skilled in American Sign Language (ASL), will not suffice as effective communication for deaf persons who utilize ASL:
. . . American Sign Language (ASL) [is] a manually communicated language distinct from English and whose idioms and concepts are not directly translatable into English. It uses different sentence structure, grammar and syntax than English, and is as much a foreign language to English speaking persons as is French or German. Conversely, English is equally foreign to most deaf persons who rely on ASL for communication. It is a common misconception that "sign language" is merely a pantomime of the English language and is therefore easily understandable in print if not auditorily. ASL sentences do not follow English sequential patterns. As a result, direct translation of English, as with written notes, into ASL will not necessarily convey the intended message. Similarly, much of English idiomatic speech would be lost on the ASL user whose frame of reference for idiom is significantly different from the hearing person.
U.S. Department of Health and Human Services, Office for Civil Rights, Region III, Letter of Findings, Ref. No. 03913037 (December 12, 1991) at 4.
Please note that there is no distinction between in-patient and out-patient treatment. All services provided by health care facilities must be accessible.
Doctors
Are Doctors Required to Provide Interpreters for Medical Visits and Other Medical-Related Situations?
The short answer is yes. This is covered under the Title III of the Americans with Disabilities Act (ADA). If you feel that you need an interpreter in order to understand what your doctor/health care provider is telling you, then the doctor/health care provider is required to provide you with one. It is best to contact your doctor/health care provider directly and tell them, prior to your appointment, that you need an interpreter. Do not hire your own interpreter and expect the doctor/health care provider to pay your interpreter for you. You may run into problems that way.
The doctor/health care provider must pay for the cost of an interpreter, even if the cost of the interpreter is more than the cost of your visit. The doctor/health care provider is expected to handle the cost of interpreter as a normal business expense or as part of the overhead costs of operating a business.
If your doctor/health care provider tries to encourage you to bring in a signing family member or a friend as a way to "save costs", say no. Family members and friends cannot be expected to be neutral and sign everything they hear. They may be emotionally or personally involved with you and this may affect their interpreting. Using them as interpreters can also cause problems in maintaining your confidentiality as a patient.
Hospitals and Nursing Homes
Inpatient health care facilities have important responsibilities under federal law to be accessible to deaf and hard of hearing individuals. Failing to provide interpreters and adapted equipment may be discrimination on the basis of disability. In addition, failure to establish effective communication with a deaf patient may expose a health care provider to liability for medical malpractice.
This memorandum addresses the obligations of a hospital to provide qualified interpreters to its deaf and hard of hearing patients. This right is established under two federal laws.
Section 504 of the Rehabilitation Act of 1973
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Š 794, requires federal financial recipients' programs to be equally accessible to handicapped persons. The U.S. Department of Health and Human Services (HHS) regulations to Section 504 require pro vision of necessary auxiliary aids, such as sign language interpreters, to ensure equal access to federal financial recipients' programs. These regulations specify that:
A recipient to which this subpart applies that employs fifteen or more persons shall provide appropriate auxiliary aids to persons with impaired sensory, manual, or speaking skills, where necessary to afford such persons an equal opportunity to benefit from the service in question.
* * *
For the purpose of this paragraph, auxiliary aids may include brailled and taped material, interpreters, and other aids for persons with impaired hearing or vision.
45 C.F.R. Š 84.52(d)
Provision of qualified sign language interpreters is critical to ensure that deaf persons are able to benefit from and participate equally in the program. The Office for Civil Rights of HHS has consistently required hospitals to provide qualified interpreters and TDDs to deaf clients, and has stated:
. . . it would be extremely difficult for the health care provider to demonstrate in certain service settings, that effective communication is being provided in the absence of . . . interpreters.
Section 504, Effective Communications, and Health Care Providers, U.S. Department of Health and Human Services, Region III, Regional Technical Assistance Staff (January, 1982), page 5.
The Department of Health and Human Services, Office for Civil Rights (OCR) has determined that effective communication must be provided at "critical points" during hospitalization. OCR has defined "critical points" as follows:
These would include those points during which critical medical information is communicated, such as at admission, when explaining medical procedures, when an informed consent is required for treatment and at discharge.
U.S. Department of Health and Human Services, Office for Civil Rights, Region III, Letter of Findings, Ref. No. 03913037 (December 12, 1991), at 5.
Moreover, HHS has repeatedly stated that the deaf patient's assessment of his or her communication needs must be given great deference:
In most circumstances, we believe that the hearing impaired person is in the best position to determine what means of communication is necessary to insure an equal opportunity to benefit from health care services. Therefore, the patient's judgment regarding what means of communication is necessary to insure effective communication must be accorded great weight.
* * *
The presumption favoring the hearing impaired patient's self assessed need is not overcome merely by a showing that the hearing impaired patient suffered no harm. Rather, the recipient must demonstrate that the hearing impaired patient actually understood what was being communicated through the alternative communication option.
Stewart, Roma, (Director, HEW Office for Civil Rights), "Memorandum: OCR's Position on the Provision of Auxiliary Aids for Hearing Impaired Patients in Inpatient, Outpatient and Emergency Treatment Settings", (April 21, 1980), page two.
Many physicians wonder why the exchange of written notes will not suffice with a deaf patient. The Department of Health and Human Services recognizes that there is a distinction between English and American Sign Language, and that written communications , or interpreters not skilled in American Sign Language (ASL), will not suffice as effective communication for deaf persons who utilize ASL:
. . . American Sign Language (ASL) [is] a manually communicated language distinct from English and whose idioms and concepts are not directly translatable into English. It uses different sentence structure, grammar and syntax than English, and is as much a foreign language to English speaking persons as is French or German. Conversely, English is equally foreign to most deaf persons who rely on ASL for communication. It is a common misconception that "sign language" is merely a pantomime of the English language and is therefore easily understandable in print if not auditorily. ASL sentences do not follow English sequential patterns. As a result, direct translation of English, as with written notes, into ASL will not necessarily convey the intended message. Similarly, much of English idiomatic speech would be lost on the ASL user whose frame of reference for idiom is significantly different from the hearing person.
U.S. Department of Health and Human Services, Office for Civil Rights, Region III, Letter of Findings, Ref. No. 03913037 (December 12, 1991) at 4.
Please note that there is no distinction between in-patient and out-patient treatment. All services provided by health care facilities must be accessible.
