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Are You Compliant?: Deaf and Hard of Hearing Patients

The American Health Lawyers Association published a paper in April 2018 documenting the increase in legal proceedings against health care providers. The reason: non-compliance with the Americans with Disabilities Act (ADA), passed 28 years ago. Are you confident you understand the requirements?

Since July 2012, further efforts have been made to enforce compliance with the Department of Justice’s Barrier-Free Health Care Initiative. In large part, the initiative seeks to uphold ADA regulations regarding deaf and hard of hearing individuals. It requires healthcare entities to supply auxiliary aids and services to effectively communicate with patients and their companions. This applies to hospitals, emergency rooms, professional offices for providers, and state university health services, among others.


“Title III of the ADA requires health care providers to ensure that their communications with people with hearing disabilities are as effective as their communications with people without disabilities.”

With settlements enforcing these regulations at 46 different healthcare providers to date, it’s important to know if your organization is compliant. Use the questions below to get started.


1. What services are required under the Barrier-Free Health Care Initiative?

Many mediums can enable effective communication with deaf and hard of hearing patients. The specific resources a facility may be required to use vary depending on factors such as size, location, and type of service. Nonetheless, all of the services listed by the Barrier-Free Health Care Initiative should be considered for use.

While written notes and forms may be sufficient for conversations that are simple or require little interaction, these are not sufficient for more complicated medical information. American Sign Language (ASL), as well as other sign languages, are structured differently than written and spoken language. It should never be assumed that an individual who uses ASL has the same proficiency in written language as the health care staff.

Qualifying aids and services include interpreters (sign language, cured speech, and oral), teletypewriters (TTY), visual alarms, closed captions for television, and Computer Assisted Real-time Transcription (CART).


2. Does your facility have access to readily available ASL interpreters?

A 2013 press release for the initiative states that eight facilities, “By not providing a sign language interpreter or otherwise communicating effectively with the individuals who are deaf, the facilities and doctors were compromising the overall health of their patients.” As these interpreters must be trained in complex medical vocabulary in order to effectively communicate, a family member or companion of the patient cannot stand in as one under these regulations.

In addition to their qualifications, an ADA Business Brief specifies that interpreters must also be “readily available on a scheduled basis and on an unscheduled basis with minimal delay, including on-call arrangements for after-hours emergencies.”

For smaller facilities, it may be unrealistic to have your own interpreter as a full-time staff member. An option available to these organizations to meet compliance is partnering with an external language vendor that offers video and on-site interpreting.


3. Is your facility or language vendor able to interpret other types of sign language?

While the most commonly used sign language is ASL, with over 500,000 users in the U.S. alone, it is estimated that there are between 138 to 300 different types of sign language used globally.

In choosing which sign language or service to use, the ADA states that “Title II (state and local government) entities are required to give primary consideration to the choice of aid or service requested by the person who has a communication disability.” Although American healthcare providers may not frequently need to use other types of ASL, this statement illustrates the importance of having access to them.

By partnering with an external language vendor, it’s possible to provide other types of sign language to patients.


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Compliance with the Barrier-Free Health Care Initiative varies by facility.

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