The ADA is a law which seems to attract unintended consequences. I wrote before about Dollywood and its now-abandoned policy to give free admission to people with grave disabilities.
Here are two stories about the intersection between the ADA, the desire to help patients, with one of the stories having a little Medicaid thrown in.
I, too, became a “victim” of the ADA , and I was forced to stop accepting Medicaid because of this. When I suggested that the patient might be better served by going to one of the two local family practice residency programs where there were full-time institutional supported American Sign Language interpreters, I received a letter from an attorney from a local disability advocacy group threatening to sue me if I did not treat this patient. After consulting with two attorneys, I was basically told to “suck it up and see the patient” because I had no defense against an ADA suit.
The patient turned out to be a nice enough person, but I realized that a couple of dozen patients for whom I would have to pay for an interpreter could financially destroy my practice. Even though there are institutional practices in the community with employed interpreters, the ADA states that I am obligated to take any patient like this one unless my practice is closed to all patients. Therefore, my only recourse was to terminate my contract with Medicaid. About 100 patients were forced to find a new doctor so that I could protect my practice from financial ruin.
It is too bad that the ADA has been so poorly designed that it forces physicians to decide between serving patients under Medicad and going out of business.
Is that serious??
I mean, i am a foreigner and i wonder at the reasoning behind such a measure. Is it common to all trades or just for medics? Does everyone need to have ASL interpreters for fear of being sued? couldnt the doctor extra charge the mute/deaf (or be at least reimbursed by either its insurance or the state so a pooling of the risks or disabilities at least exists)?
sorry if my question seems naive, but i find that totally out of touch with common sense.
I was trying to find an article written by a British doctor about the problems of working with patients from Bangladesh who spoke no English. (Failed to find it, irritatingly, because it was interesting stuff: I read it a few months ago.)
Hiring a translator for one patient presumably wouldn’t have broken the doctor’s practice. Yet there seems no good reason why a deaf patient shouldn’t have free choice of doctors as much as a hearing patient. Yet there are good reasons why doctors hate working via translators, and, if they must, prefer a professional translator to a relative/friend of the patient – but a professional translator has to be paid, and who is to pay them?
“Hiring a translator for one patient presumably wouldn’t have broken the doctor’s practice.”
No the problem was when the doctor ended up being so good that the deaf person reccommended him to her friends.
A doctor who gave up 100 patients because of one death person?
Yeah right. Anonymous letters can be so convenient some times.
“death person”?? typo deaf
Sebastian: No the problem was when the doctor ended up being so good that the deaf person reccommended him to her friends.
You’re confusing the two stories. The first doctor says “But my patient has turned out to be a somatisizer. She’s also started recommending me to her friends in the deaf community.” (Having looked up the medical definition of “somatisizer”, it sounds like a medical excuse, to me…)
The second doctor’s story (the one in italics) simply says that s/he gave up over 100 patients, without saying why.
Clearly medical insurance should cover the cost of a professional translator, where one is needed, rather than throwing that cost on the doctor. It’s not specifically, it seems to me, a problem with ADA: it’s a problem with the failure of medical insurance to take translation needs seriously. The British doctor I mentioned had a similiar problem getting the NHS to take his translation needs seriously.
A child who reshovels the sidewalk every 30 minutes and repeatedly asks for $5 despite being told the very first time that he should shovel after the snowfall or he wouldn’t be paid at all?
Yeah right. The story teller is proving unreliable.
I think the 1994 DOJ letter linked to the link is directly relevant:
“One of the most common misconceptions about the ADA is that health care providers are required to provide interpreters whenever they are requested. In fact, title III of the ADA requires public accommodations, including health care providers, to furnish appropriate auxiliary aids and services, including sign language interpreters, where necessary to ensure effective
communication with individuals with disabilities. Health care providers should consult with their patients to determine what type of auxiliary aid or service is appropriate for particular circumstances. However, health care providers are not required
to provide sign language interpreters for deaf patients upon demand. Title III of the ADA does not require a provider to accede to a patient’s specific choice of auxiliary aid or service as long as the provider satisfies his or her obligation to ensure effective communication.
“In determining what constitutes an effective uxiliary aid or service, health care providers must consider, among other things, the length and complexity of the communication involved. For instance, a note pad and written materials may be sufficient means of communication in some routine appointments or when discussing uncomplicated symptoms resulting from minor injuries. Where, however, the information to be conveyed is lengthy or complex, the use of handwritten notes may be inadequate and the use of an interpreter may be the only effective form of communication. Use of interpreter services is not necessarily limited to the most extreme situations — for example, a discussion of whether to undergo surgery or to decide on treatment options for cancer.
‘Health care professionals cannot use an unsubstantiated fear of economic loss as a basis on which to refuse to provide auxiliary aids or to refuse treatment for a person with a disability. A health care provider may not impose a surcharge on any particular individual with a disability to cover the costs of
providing auxiliary aids and services. Instead, the costs should be treated like other overhead expenses that are passed on to all patients. However, the obligation to provide auxiliary aids and services is not unlimited and a health care provider is not
required to provide auxiliary aids and services if doing so would result in an undue burden, that is, a significant difficulty or expense. The factors to be considered in determining whether there is an undue burden include the nature and cost of the action, the type of entity involved, and the overall financial
resources of the entity.
“Finally, as amended in 1990, the Internal Revenue Code permits small businesses to receive a tax credit for certain costs of compliance with the ADA. An eligible small business is one whose gross receipts do not exceed $1,000,000 or whose work force does not consist of more than 30 full-time workers. Qualifying businesses may claim a credit of up to 50 percent of
eligible access expenditures that exceed $250 but do not exceed $10,250. Eligible access expenditures may include the costs of providing auxiliary aids and services to persons with disabilities.
“The flexibility of the auxiliary aids requirement, the undue burden limitation, the ability to spread costs over all patients, and the small business tax credit should minimize any burden on
health care professionals.”
Doubtless ADA and Medicaid have a lot of problems. But there would seem to be solutions to the deaf patient problem. What’s stopping the doctor from learning ASL? Or, why couldn’t he offer pro bono services to a deaf patient in return for translation?
Sure, I realize that this wouldn’t plug all the possible sources of litigation but the main problem here seems to be a lack of imagination at finding a solution.
You are right, I was mixing the two stories in my mind and yet you are wrong because the first story is the same.
Summary:
Had a deaf patient. Traditional insurance paid $50.
When the doctor had a translator ($25 per hour, 2hour minimum) she broke even because $50=$50, so this was basically a charity case.
Deaf patient went to Medicaid which pays less. With cost of translator that means the doctor was not only being charitable with her work time, but also losing money.
This became worse as the patient was a somatizer–thus came in often but did not respond to treatment. Therefore the patient was costing the doctor time and money on a regular basis.
Then the patient reccommended the doctor to her other deaf friends. This means that even more of her time will be given away, and that she will lose money on each case.
And the ADA doesn’t allow her to turn the patients away, even though there is a nearby clinic with full time interpreter services.
The second doctor agreed and said that was why he stopped taking Medicaid patients.
“The second doctor’s story (the one in italics) simply says that s/he gave up over 100 patients, without saying why.”
Wrong. He gave up the patients because he was losing money on enough of the Medicaid patients to make giving up all of the Medicaid patients a good financial decision.
Also a TDD device costs about $400 and I’m pretty certain the IRS would see its purchase as either a business expense or as qualifying for the small business tax credit provided by the ADA. Who knows maybe it qualifies twice.
Sebastian
Are we to assume all of the deaf patients were somatizers?
Also, the blogger states:
“Now, my patient is not illiterate. She could communicate with me through writing, but she prefers sign language.”
But the ADA does not put the ultimate decision in the patients hands:
“Title III of the ADA does not require a provider to
accede to a patient’s specific choice of auxiliary aid or service
as long as the provider satisfies his or her obligation to ensure
effective communication.”
Hmm. As they say in literary circles, the narrator is unreliable.
“What’s stopping the doctor from learning ASL?”
The fact that they don’t have an unlimited amount of time available to devote to work.
CharleyCarp, you are quoting the 1994 DOJ letter which talks about how things ought to work (as interpreted by the DOJ in 1994.) It isn’t how things actually work. Judges go against DOJ reccommendations all the time–think judicial vs. DOJ interpretations of the Patriot Act. The problem is that the doctor’s communication needs weren’t satisfied by the written word. Furthermore doctor’s are put in an ugly litigation vs. care bind because if they hire translators they will be put out of business by costs and if they don’t they will be put out of business by litigators. Furthermore you fail to engage the cost of sucessfully defending against an ADA-grounded suit. If you win, but spend $100,000 winning (which would be a non-shocking figure to spend defending such a case), you just bankrupted a moderately successful medical practice. Worse, if you get an unsypathetic judge you will have bankrupted your practice and still be on the hook for a judgment. (Your insurance is not going to cover you for the lawsuit.)
Sebastian
You said, “The problem is that the doctor’s communication needs weren’t satisfied by the written word.”
Yet I must have over looked that in the original. Could you please point out where the blogger states that?
And the ADA doesn’t allow her to turn the patients away, even though there is a nearby clinic with full time interpreter services.
CharleyCarp has pointed out that ADA does not require the provision of a translator-on-demand. Nor do I consider it reasonable that a deaf patient should not be allowed to choose her or his own physician.
He gave up the patients because he was losing money on enough of the Medicaid patients to make giving up all of the Medicaid patients a good financial decision.
Which, again, looks like a problem with the level of care provided via Medicaid, combined with a lack of imagination about providing translation, combined with ignorance on the part of both doctors on what ADA actually requires. If someone is threatening to sue you and claiming you have no defense because the law requires you to do A, it seems to me that the obvious thing to do is to go look up the law and find out what it actually requires you to do. I’m still not seeing how you blame the whole thing on ADA.
Carsick, don’t take the quote out of context:
“Now, my patient is not illiterate. She could communicate with me through writing, but she prefers sign language. English isn’t her first language, sign language is. And although the portion of the ADA relevant to the hearing impaired includes written materials as an appropriate aid, the reality is that written material may be considered inadequate.”
This alludes to the lawsuit problem.
Addendum, having read Sebastian’s response to CharleyCarp: It’s also occurred to me that both doctors might have been reluctant to face a public lawsuit effectively forcing them to accept a patient they no longer wished to treat. There’s no good resolution to such a suit for a doctor: either they end up with a patient who’s not happy with them (because s/he knows s/he had to sue to make the doctor see her/him) or they end up with a very public declaration that they don’t want to treat deaf patients, which is bad publicity. In practice, of course, a physician should have the right to refuse a patient – but I can’t be alone in thinking that it should be the right to refuse for cause*, not simply because treating a handicapped patient is a nuisance because their handicap is more trouble than their treatment brings in. That’s not patient-centered care: that’s money-centered care.
Medicaid
“While state officials search for a solution, Tuck and 37 other doctors in his medical group have stopped taking new Medicaid patients in Zanesville, near Columbus. Tuck says the doctors had no choice.
“Medicaid is reimbursing us at least 5 percent below our fixed costs for overhead, utilities and nurses’ salaries, not counting our own salaries,” Tuck says. “A third of our practice used to be Medicaid patients, but now it’s down to 10 percent.”
He says the situation doesn’t make sense because Medicaid will pay less for patients to see a private doctor than it will pay for people to seek help in a nearby clinic – even though a physician is often unavailable there.”
*for cause:
A patient who is a threat to the doctor, for example – who threatens or verbally abuses the doctor, or anyone else working for the doctor.
It is not an either/or as your blogger posits it. The legislation lists a number of options and none of them depend upon what the patient “prefers” but upon what the doctor feels is necessary. I understand that what the doctor feels is “necessary” may be to avoid a lawsuits or ADA violations but it is a little tough for me to assume that the issues involved wouldn’t be addressed on a case by case basis instead of the blanket being presented.
Perhaps if the bloggers story was more an illustrative analogy like his obviously contrived intro was.
Many of the problems with the healthcare system in the US could be resolved if there were sufficient motivation to bite the bullet, defy the pharmaceutical companies and insurance companies, and go for a universal health insurance system. There are many models worldwide to choose from, all of which are more effective and cheaper than the current American plan.
This situation isn’t that simply resolveable, because there are so many factors involved. Should a patient have the right to choose which physician to attend? Should a physician be able to deny a patient on the grounds that the patient’s needs are a nuisance? How far can we require that doctors should show imagination and thoughtfulness when dealing with handicapped patients? (Obviously we should wish that doctors should always do so, but it’s hard to require imagination…)
“I understand that what the doctor feels is “necessary” may be to avoid a lawsuits or ADA violations but it is a little tough for me to assume that the issues involved wouldn’t be addressed on a case by case basis instead of the blanket being presented.”
The problem is that dealing with a litigation case on a case by case basis is hugely expensive. A medical practice can’t just eat that cost. It is only necessary to avoid such costs if you want to stay in business. But since we want doctors to stay in business, the scare quotes around ‘necessary’ don’t seem appropriate.
Universal health care isn’t going to solve this problem. Costs have to be paid. If costs aren’t paid, people don’t do the business. If a business that takes 4 years of college plus 4 years of post-grad plus 2-4 years of residency doesn’t pay well, a lot of people won’t put in 10-12 years of their lives training for it. Furthermore universal health isn’t going to give you unlimited choice of doctors–a choice which seems to be assumed in this conversation–without making private (non government paid) practice illegal. And if that is the goal, we end up with all the problems of centralized government control of an industry. I would expand further on that theme, but those on the left claim to have learned the lessons of the Communist failure so I assume it isn’t necessary.
Well look here. Your blogger is implying that ASL must always be used because it is the first language of the deaf yet…
“Approximately 28 million Americans are reported to have severe to profound hearing loss. The percentage of people who are culturally Deaf and use ASL as their primary language, is much smaller. The number is difficult to pin down, but estimates range from 550,000 to one million in the United States and Canada. No exact census figures exist.”
And I know that somatizers are extremely rare. Hmmm
Quite an UNUSUAL case to make blanket arguments with don’t you think?
Also just to make it clear, I wasn’t meaning case by case litigation. I was saying case by case patient care. The doctor decides what communication aids are necessary according to each patient and their potential diagnosis.
“Reasonable Accomodation”
The ADA is a decidedly mixed blessing. It’s not clear to me whether the problem is with the written law or the legal system. But there’s definitely a problem….
As a physician assistant who saw deaf patients when I worked in family practice, this sounds like a bogus tale. I don’t know much ASL, but I had no problems communicating with my patients. (There’s a high tech device called pen and paper the physician in question might want to investigate.)
JKC, I believe that issue was dealt with in the post.
“I was saying case by case patient care.”
Carsick, I know that. But treating people with different disabilities differently is exactly what gets you into ADA lawsuits.
The ADA is, as far as I can tell, the king of unintended consequences. See, e.g., the fact that there are no longer any doorknobs in modern office buildings, the Casey Martin PGA Tour case, the fact that the tension allowed on toilet paper in stalls for handicapped folks is less than the tension allowed in the “regular” stalls, etc.
It’s also not the most well thought out statute in the world. For example, what if making “reasonable accomodations” for one group of Americans with Disabilities makes it harder for another group? I always thought the classic case of this was curb cuts. Curb cuts make it easier for people in wheelchairs to get around, and who could be against that? Well, they also make it harder for the blind who use a cane to tell when the sidewalk ends and the street begins, an obvious problem.
Then I was in San Francisco this weekend. Their solution (for some intersections) was to put in the curb cuts and also also put in, for lack of a better term, the yellow bumpy plastic stuff seen on subway station floors in the middle of the cut. Genius.
“But treating people with different disabilities differently is exactly what gets you into ADA lawsuits.”
Before I make some snarky comment could you rephrase that?
Ugh
I’m not arguing that ADA rules aren’t cumbersome and certainly some need to be changed or modified a great deal.
I’m pointing out that the blogger (not Sebastian but the one he links to) is setting up a poor argument for a serious look at the legislation.
By the way, I once had casts on both arms and later metal braces, I was very happy for those new door handles. Almost got stuck in a parking garage stairwell with knobs once.
“After consulting with two attorneys, I was basically told to “suck it up and see the patient” because I had no defense against an ADA suit.”
Either the doctor in question had the misfortune of running into two absolutely incompetent attorneys, or this statement is a lie. As several people have pointed out, the ADA only requires reasonable accomodations — in the case of a deaf patient, pen and paper communication would suffice. Willingness to communicate with pen and paper would be a defense to any suit for failure to provide an interpreter. While an unreasonable patient with the money to pay a lawyer for a frivolous lawsuit with no prospect of financial recovery might be able to bring a harassing lawsuit under the ADA, that lawsuit would lose.
Lizardbreath
I actually think the blogger made up the story because the combination of events create a sort of perfect storm to back up his point of view …
Culturally deaf (ASL as first language)
plus somatizer
plus on medicaid
plus consulting lawyers who don’t know ADA law
plus equating ALL deaf as needing ASL interpreter
plus written materials (what? pamphlets!) vs. ASL interpreter as only options
plus all the patient’s friends are similarly afflicted (maybe not somatizers – we don’t know – but apparently ALL needing an ASL interpreter and all on medicaid.)
What are the odds that all these things came together in the doctor’s office of a doctor who opposes the ADA and has a blog!
carsick –
Wasn’t trying to refute your (or anyone else’s) point (and those new handles do come in handy for everyone at times). Just would like to know if the legislators who voted for the ADA would still do so if, at the time, they had been informed of some of the actual consequences (which likely would have sounded absurd to them at the time; and still do to people I mention these things to today).
As I have said in at least two previous posts, the problem with ‘reasonable accommadations’ decisions that when fall against the person with the disability is that they invite expensive lawsuits.
The doctor in question didn’t transcribe the conversation with her lawyers, but I’m sure it went something like: If you don’t have a comprehensive policy to sort out different types of disabilities, you can’t risk a suit. Losing some money on some clients isn’t usually a major factor in ‘reasonable accomadations’ because you are expected to deal with it as overhead. You might be able to win after fighting over it for a year, but it will cost $50,000-$100,000, will cause ill-will in the community, and you still have a 20% chance of losing. So my advice is that it would be cheaper not to fight it, and if similar problems happen to a lot of Medicaid patients, just drop them all.
That kind of conversation happens all the time. I’m shocked you find it so implausible.
You also use ‘all’ too much in your characterizations. They don’t all need to be somatizers or even ‘all’ require interpreters. Just enough to make treating them an expensive hassle for those without full-time translators. Also note that there are other disabilities out there…
I may be wrong but I thought ADA is enforceable whether someone takes medicaid patients or not.
Also, in your potential discussion you stated,”Losing some money on some clients isn’t usually a major factor in ‘reasonable accomadations’ because you are expected to deal with it as overhead.”
Doesn’t that partially kill your argument of undue restriction or cost?
Again, as stated above, your argument may be better served by going after medicaid.
carsick –
I think the ADA only applies to employers with over X employees, unless you treat medicaid patients. Likely, the doctor falls below the employee threshold and slips out of the ADA’s grasp once he stops accepting medicaid patients.
“Also, in your potential discussion you stated,”Losing some money on some clients isn’t usually a major factor in ‘reasonable accomadations’ because you are expected to deal with it as overhead.”
Doesn’t that partially kill your argument of undue restriction or cost?”
No. A government expectation that you should cover something as overhead doesn’t transform a cost into something affordable.
Ugh, as has been repeatedly pointed out already in the thread, the problem is not ADA’s requirements for doctors to communicate with patients. The problem would appear to be a couple of unimaginative and unhelpful doctors, combined with a genuine problem with Medicaid underfunding.
Jesurgislac –
Are you referring to my “Just would like to know if the legislators who voted for the ADA would still do so if, at the time, they had been informed of some of the actual consequences” post? If so, I was referring to my previous post on door handles, PGA Tour and toilet paper, not to Sebastian’s example/non-example of ADA problems.
If that’s not what you were referring to, what was it?
Oh and to add to the perfect storm scenario: the blogger doctor has apparently never had a medicaid patient before, “But now, my patient has switched to Medicaid, which pays I don’t know how much for a fifteen minute visit, because I’ve yet to be paid.”
Doesn’t know how much medicaid pays for an office visit?
Hmm. Doesn’t like medicaid; is unfamiliar with medicaid’s fee schedule – obviously whether the patient is this statistically unbelievable patient or an unmarried pregnant mother on welfare, the doctor doesn’t like medicaid and doesn’t like serving medicaid patients.
Again, I think your blogger is faking a visit to support an argument.
Is it plausible? Yes. Did it happen here? Doubtful.
Ugh, I was referring to your post of September 28, 2004 04:20 PM, where (from your comment to Carsick) you seem to think the problem is ADA. From everything that’s been said and cited in this thread, I really don’t see that it is.
Jesurgislac –
Oh. I was just trying to solve carsick’s puzzle as to how the ADA might not apply if the Doctor stopped taking medicaid patients. The “slips out of the ADA’s grasp” comment was meant that it wouldn’t apply to the doctor’s practice generally under my (assumed) description of the ADA if the doctor stopped taking medicaid patients; not that the ADA caused the particular problem the doctor complained about.
“As I have said in at least two previous posts, the problem with ‘reasonable accommadations’ decisions that when fall against the person with the disability is that they invite expensive lawsuits.
The doctor in question didn’t transcribe the conversation with her lawyers, but I’m sure it went something like: If you don’t have a comprehensive policy to sort out different types of disabilities, you can’t risk a suit. Losing some money on some clients isn’t usually a major factor in ‘reasonable accomadations’ because you are expected to deal with it as overhead. You might be able to win after fighting over it for a year, but it will cost $50,000-$100,000, will cause ill-will in the community, and you still have a 20% chance of losing. So my advice is that it would be cheaper not to fight it, and if similar problems happen to a lot of Medicaid patients, just drop them all.”
Now, this just isn’t true. I’m a lawyer, and I’m an expensive New York lawyer. $50,000 is a ludicrous estimate for something like this — there appears to be settled law out there (i.e., the 1994 DOJ interpretation) that communicating in writing is a sufficient accommodation for deaf patients (and if you want to argue that there are actual cases in which an individual medical practice has suffered liability under the ADA for failing to provide an ASL interpreter for every patient, I’d like to see cites.)
The lawsuit that the blogger purports to be afraid of, then, wouldn’t make it past a motion to dismiss — maybe $10,000 at the most. And it would only be brought by a malicious plaintiff with an lawyer willing to engage in frivolous litigation for no monetary reward — this does happen, but it’s not really likely, because either the client has to be malicious and with money to burn, or the lawyer needs to have a screw loose as well.
The story just doesn’t hold together.
Ugh – Sorry, I misunderstood you.
LizardBreath –
I think the ADA has an attorney’s fees provision that allows the plaintiff to collect a certain amount of fees for every day from the time the suit is filed. Thus, no need for the plaintiff to pay his attorney. Also, does a DOJ interpretation have the same force as, say, a final regulation?
I seriously doubt that the mitigating aspects of the DOJ letter are in full force in 2004. From the moderate amount I know about recent ADA complaints, the law is NOT well settled, judges interpret in in wildly different directions, and the accomodations clause tends to get applied against the defendant.
I can confirm that ADA has attorney’s fees provisions which make it lucrative to attempt a scattershot effect in litigation.
The only time a plaintiff can receive damages from a business for ADA violations is when the U.S. Department of Justice is a party to the case (which is quite rare). The fact is that the ADA does NOT provide for any payment of damages to plaintiffs in private lawsuits.
I’m a lurker who has never posted here before. This thread is certainly very interesting. I’ve had a recent experience with the ADA very similar to what is being discussed. Despite all the comments to the contrary, it is very difficult to not provide interpreter services if the patient insists on it.
I am an MRI technologist. I work in a small, private outpatient setting. Our volume of patients in fairly low, maybe 10-12 patients a day.
Several months ago we received a call from a medical clinic at a large, well known hospital in our area (we are based immediately outside of a big city). They had a patient they wished to schedule for a fairly unusual study, and weren’t sure if we could accomodate the patient. We could. We were then told that the patient was deaf and we would be required to provide a sign language interpreter, as the patient did not read lips and was uncomfortable having a family member privy to her medical condition.
We had never heard of this particular provision of the ADA, and innocently asked who was going to pay for the interpreter. The clinic said they would call us right back. No lie, within five minutes of them hanging up, we received (from who we later learned was the patient’s social worker) a six page fax outlining the ADA law, that DOJ directive mentioned in a previous post, a page listing some lawsuits brought against doctors offices who had baulked at providing an interpreter for their patients (it also conveniently listed the fines these offices were forced to pay) and a page listing the names and telephone numbers of area companies providing interpreting services. We sent the papers we were sent to the center attorney and he basically said it would be very difficult to fight providing interpreter services if the patient was insistent and stated that privacy concerns were her main motivation.
We provided the interpreter at our expense. The procedure took twice as long as it normally would (anyone who has dealt with any type of language interpretation will know it is a long, drawn out process), the patient was indeed a medicaid patient, and after paying for three hours of interpretive services, I can tell you we just broke even. You have to take into account the extra time it took to scan the patient using the interpreter, which meant one less patient scanned that day. If we had to do this more than once a month or so, it would have an impact on our practice.
My comment, though, isn’t really with who does or doesn’t pay for these services. It would be nice if the government would pay for this unfunded mandate, but they don’t so we have to eat it. I found it extremely telling and interesting that the medical clinic we dealt with, and the social worker, had a ready list of subtle threats to send to us. My guess is that they intimidate people with their faxed ADA documents frequently, else why would they have this stuff so readily available? Seems to me there is a big business in strong-arming us little offices into meeting the most stringent interpretation of the law. And notice they themselves didn’t scan the patient at any of their hospital centers. When we inquired as to why they were sending the patient to our site, the social worker told us they had determined that the patient’s needs would be “best served” at our outpatient center. Seems like it was ok for them to pass the buck on to us. They weren’t afraid of a lawsuit, they’re big and can afford it. It ISN’T easy for us little guys to fight back.
There is nothing wrong with the law, but it doesn’t happen in a vacuum. The difference between the way the law should work in the best of all possible scenarios, and the way it actually happens in the real world, well lets just say, it sometimes ain’t pretty.
PS: By the way, the patient was lovely, the interpreter was very nice and very good at her job, and the study was successfully performed, but the whole experience left a bad taste in my mouth.
nal2004
“if the patient was insistent and stated that privacy concerns were her main motivation”
Please make clear why you say bringing in a third person as an interpreter solves any privacy issues.
From all I’ve read privacy is the reason why people choose not to have an interpreter present.
Like I said in the beginning of this thread. I doubt the original story. I don’t doubt that ADA compliance can be cumbersome nor that some provisions need to be reexamined.
Amazingly convenient that you popped in today though.
“There is nothing wrong with the law, but it doesn’t happen in a vacuum. The difference between the way the law should work in the best of all possible scenarios, and the way it actually happens in the real world, well lets just say, it sometimes ain’t pretty.”
I can see that — people are imperfect, and sometimes someone with a flawed understanding of the law might overstate its requirements. I can’t really see that as a reason for changing the law, though. Improving education among doctors as to what their obligations under the law are, maybe, but if the law is fine as written, then the law isn’t the problem.
Amazingly convenient that you popped in today though.
Amazingly convenient e-mail address, too.
Amazingly convenient that you popped in today though.
Huh? He (?) said he was a lurker. At the very least, give him the benefit of the doubt.
Thanks for giving me the benefit of the doubt. I followed a lot of the posters from Tacitus over to here. I was surprised to see this particular post, medicolegal posts don’t seem to be a high area of interest in the blogosphere. Believe me, we really had a tough time trying to decide what our best course of action was. Some of the posters here have given us some avenues to explore should we run into this dilemma again. At least we won’t let ourselves be as intimidated next time.
I did say in my post there isn’t anything wrong with the law. It was, IMO, absolutely necessary to have an interpreter for this patient. For as long as the study took with an interpreter, it would have been a nightmare trying to explain the ins and outs of the procedure with pen and paper. As far as privacy is concerned, the patient did not want a family member interpreting, which I can understand since there are things I wouldn’t want my own family to know.
My whole point in posting is that it is easy in the abstract to say how this law should be put to practice, and incredibly difficult to figure out how to apply it in a way that you don’t run afoul of someone. When scheduling this patient, someone from the clinic actually said to us, “you know you can be sued if you don’t provide an interpreter.” Sounds at the least like pressure and at the worst a threat. We had the same problems when instating our new procedures to be in compliance with HIPPA (anyone who has been to a doctor’s office knows the privacy forms you’ve had to sign the last year or so). Everyone has their own interpretation, there is little guidance. We didn’t even know about the interpreter provision in the ADA, but we could have been sued or fined anyway (how’s that go, ignorance of the law is no excuse).
I have a feeling (but no proof) that a whole new cottage industry will spring up threatening legal action on non-compliance with these new laws even though offices like ours are not consciously breaking the law, and even though it can be financially burdensome to comply with said laws. Let me say again that I have no problem with the particular provision of ADA that we almost fell afoul of, but that it seems patently unfair that a government mandated requirement is not funded by said government. After all, we don’t provide free oxygen to our patients who require it (they bring their own) so I don’t think it unreasonable that either the patient or the entity ordering the study be the one who pays for interpreting (lord knows it would have made more sense for the lawmakers passing this stuff to make some kind of provision, there goes that best of all possible worlds scenario again).
By the way, I never leave my real email address, I had to drop a perfectly lovely one after being spammed a million times too many.
nal2004 – Fair enough, and I apologize.
I set up this identity and the e-mail address a year or two ago, for the purpose of avoiding spam when I post on blogs, and to avoid the odd nasty experience from complete lunatics with no respect for privacy. A Yahoo address is free, provides a good level of service, and has a pretty good anti-spam blocker – I recommend it over Hotmail.
OTOH, if you don’t post a lot, it’s not worth your while.
Back on topic:
When scheduling this patient, someone from the clinic actually said to us, “you know you can be sued if you don’t provide an interpreter.” Sounds at the least like pressure and at the worst a threat.
Yes, bad move. I think that “you can be sued” should be subject to a similar usage rule as Godwin’s Law.
But it sounds more and more to me as if the problem with the ADA law isn’t the law itself (Sebastian’s contention in the initial post) it’s the lack of funding to provide what’s required by law, and to a certain extent (from the stories told in the blog Sebastian linked to) a reluctance by some doctors to have to deal with “inconvenient” patients.
“Inconvenient” patients on Medicaid.