Americans with Disability Act (ADA) and its effect on the Medical Field

A hospital is a place of public accommodation covered by Title III of the ADA, 42 U.S.C. § 12181(7) (F). A hospital is committed to satisfy its statutory requirements and fulfill its responsibilities to provide medical services to members of the community without discrimination on the basis of disability.

Every hospital should develop a program for delivering the appropriate auxiliary aids and services that people who are deaf or hard of hearing need to communicate. A hospital employee or office should be designated as the contact for the program.

Sample deaf and hard of hearing policy

Communication Assessment

The first thing that a health care facility can do to meet the needs of a person with hearing loss is adapt its medical and intake forms to indicate a patient who is deaf or hard of hearing. A health care facility should ensure that all personnel coming into contact with a patient who is deaf or hard of hearing know what is necessary to guarantee effective communication. A Communication Assessment needs to be administered by appropriate staff. Once health care personnel are aware of a patient’s hearing loss, they need to make a communication assessment.

A hospital must consult with individual patients who are deaf or hard of hearing, as well as their companions, to determine what type of auxiliary aid or interpretive service is needed to ensure effective communication. While consultation is strongly encouraged, the hospital is required to provide a qualified sign language interpreter when requested. If the patient requests to use an auxiliary aid other than sign language interpreter, the hospital is required to obtain the device, provided that the method chosen results in effective communication.

Factors that should be examined in a communication assessment include:

The nature, length and importance of the communication at hand.
A patient’s communication skills.
A patient’s health status.
A patient's and/or companion's request for an interpreter, this may also include preference shown for on site interpreters versus video remote interpreting.
Foreseeable health care activities of the patient, such as group therapy sessions, medical tests, rehabilitation services, etc.

Interpreters for People who are Deaf or Hard of Hearing

One of the most common accommodations that a health care facility will have to provide to patients who are deaf or hard of hearing is interpreting. In the same manner that passing written notes to a person who speaks Spanish or French would be ineffective, written communication may sometimes be ineffective for people who use American Sign Language (ASL), because ASL is a distinct language.

Listed below is a partial list to give a health care facility an idea of when an interpreter should be provided:

Reviewing a patient's medical history
Asking a patient to describe his or her ailment or injury
Notifying a patient of his or her rights or administering an informed consent or permission form
Explaining the diagnosis or prognosis of ailments or injuries
Explaining procedures, tests, treatment, treatment options or surgery
Explaining medications prescribed (such as dosage, instructions for how and when the medication is to be taken and side effects or food or drug interactions)
Explaining follow-up treatments, therapies, test results or recovery
Conducting blood donations or apheresis (removal of blood components)
Discharging a patient
Utilizing mental health evaluations, group and individual therapy, counseling and other therapeutic activities, including grief counseling and crisis intervention
Clarifying complex billing or insurance issues
Presenting educational presentations, such as classes concerning birthing, nutrition, CPR and weight management
Detailing living wills or powers of attorney (or their availability)
Filing administrative complaints or grievances against a hospital or hospital personnel
Communicating anything that affects privacy, confidentiality, or other rights provided by federal, state or local law

Interpreter Policy

A health care facility should develop a policy for obtaining qualified sign language interpreters. The interpreter service provider used by a health care facility should be able to provide qualified interpreters for a variety of situations. The health care facility should maintain a staff of nationally certified “on-call” interpreters who are available to respond to requests 24 hours a day.

To utilize NCDHH Sign Language Interpreter Referral Service

Family Members as Interpreters

A health care facility should never rely on a family member, friend, caregiver, advocate or companion of a patient to interpret for him or her. Acquaintances are only permitted to interpret if a patient requests them as interpreters and provides a written statement expressing his or her desire to use an acquaintance as an interpreter. Aside from a request from a patient, the only other situation where an acquaintance should be used as interpreter is when a patient is afflicted by a time-sensitive life-threatening condition. In this case, a hospital may rely on interpreting provided by a companion until a qualified interpreter is obtained.

Video Remote Interpreting (VRI)

When qualified on-site interpreters are unavailable, the use of VRI is encouraged. VRI allows nearly instantaneous access to qualified sign language interpreters via videoconferencing equipment.

When selecting a VRI provider, a health care provider should ensure the service provides:

High-quality, clear, delay-free full-motion video and audio over a dedicated high-speed Internet connection;
Clear, sufficiently large, and sharply delineated picture of the interpreter’s and the patient’s head, arms, hands, and fingers, regardless of the body position of the patient
Clear and easily understood audio transmission
Easy-to-use equipment that facility personnel can efficiently set-up and operation.

A health care facility should designate an employee who is trained on how to use VRI equipment, and he or she should be available at the facility at all times. The limitations of VRI technology should also be reviewed by a health care facility. VRI use becomes problematic when patients have limited mobility of their heads, hands or arms, or they have vision problems. Furthermore, if a patient has to remain in an area of a health care facility without Internet access or adequate space to place the VRI equipment, health care facilities should be prepared to address these situations.

Auxiliary Aids for People who are Deaf or Hard of Hearing

Auxiliary aids include technology that people who are deaf or hard of hearing can use to communicate. This includes note takers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed captioning decoders, open and closed captioning, TTYs and videophones.

A health care facility should maintain a complaint process for patients to file grievances in regards to the auxiliary aids and services provided to them. In addition, all aids and services must be provided free of charge to patients who are deaf or hard of hearing.

For more information regarding equipment and technology used by persons with hearing loss, visit the NCDHH Equipment & Technology Web page.

Telephone Modifications for People who are
Deaf or Hard of Hearing

Health care facilities must provide telephones that are accessible to people who are deaf or hard of hearing. Amplified telephones and phones with telecoil settings are required for individuals who are hard of hearing, whereas deaf patients require TTYs.

To learn more about amplified phones and TTYs, visit the NCDHH Equipment & Technology Page.

TTY Requirements

There must be at least one TTY for each unit of two public telephones, per floor of the facility. TTYs must be located near emergency departments, recovery rooms or waiting rooms. If portable TTYs are used in the place of permanently installed TTYs, signs must be posted that indicate the location of the devices.

Telephones in Patient Rooms

Within 30 to 60 minutes of a patient’s arrival in a room, a health care facility should provide an appropriate phone to him or her.

Training Materials

NCDHH field representatives can provide any type of training that your facility needs to educate personnel regarding the needs of patients who are deaf or hard of hearing. Feel free to browse through the materials posted below to see what is included in a NCDHH presentation. If you feel that a training would benefit your facility, contact one of the NCDHH offices to set up an appointment.