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A person calls the office and schedules an appointment for a child.  She asks about an interpreter for the mother of the patient.  The receptionist schedules the appointment and promises to follow-up regarding the interpreter but forgets.   The child (patient) and her mother (who is hearing impaired) arrive as scheduled for the appointment.  The parent learns that NO arrangements have been made for an interpreter.  The parent becomes upset and has the child cancel the appointment. They storm out of the office.  Just a few days later the practice is served a notice from U.S. Department of Health & Human Services (HHS).   

Why was the practice at fault?  The patient’s request for an interpreter was ignored.  The practice provided NO auxiliary aid and did not discuss ANY form of assistance, interpreter or otherwise.  You cannot simply ignore a request for accommodation.  An interpreter is not always the expected or required assistance but an attempt to understand the person’s needs and provide accommodation is expected.  After much work with HHS, the office was able to rectify the situation.

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by any programs or activities receiving federal financial assistance.  For health care practitioners, Section 504 prohibits discrimination by any facilities receiving reimbursement from Medicare or Medicaid.  Section 1557 of the Affordable Care Act prohibits any health care provider that receives funding from the federal government to refuse to treat an individual – or to otherwise discriminate against an individual – based on race, color, national origin, sex, age, or disability in certain health programs or activities.  The Americans with Disabilities Act of 1990 (ADA) is the federal civil rights law that prohibits discrimination against individuals with disabilities in everyday activities, including medical services.  Together, these statutes require practices to provide timely service to individuals with disabilities, to make reasonable modifications to policies, provide auxiliary aids and services when necessary, and to ensure effective communication as well as equal access to those with disabilities.

Take a proactive approach, utilize these tips and access the links below to ensure that your practice is compliant.

10 Tips to Compliance –

  1. Educate Yourself– All staff members should be trained on the law and how it applies.  Your staff should know how to proceed when patients ask about accommodations.  I would also include an ADA policy and procedure in your office handbook.  New employees should review and sign once properly trained.
  2. Do Not Ignore or Delay Action – If a patient requests accommodation, have your resources handy and ensure that your staff is well rehearsed on how to handle the request. Make sure the staff understand the consequences of ignoring or delaying a request.
  3. Provide Auxiliary Aids – If necessary, utilize a staff member as a note-taker or use a computer-aided transcription service, written materials, a white board or handset telephone amplifier. Stock the exam rooms with brochures explaining diagnoses and treatment plans.
  4. Utilize Telecommunication Relay Service (TRA) – ADA states that communication with people with disabilities must be as effective as communication with those without a disability. Telecommunication Relay Services for the deaf (TRA’s) is a nationwide 711 number utilized by the disabled.  Your staff should understand this service and how to utilize it when needed.
  5. Assign at Least One Staff Member to be Contacted if Accommodations are Needed. There should be an expert on-site.  The expert should have contacts and resources to ensure there are no delays in providing the assistance and care the patient needs.
  6. Provide Only Qualified Interpreters – Interpreters, when necessary must competently be able to interpret medical terminology and to accurately describe the condition, care, patient options, diagnosis and treatment. The interpreter must not be impartial, and you must offer a qualified interpreter BEFORE allowing family members to interpret.  It is ill-advised to use children for interpretation.  See #7 below for Limited English Proficiency Patients (LEP).
  7. Prepare for Limited English Proficiency Patients (LEP): The practice should take reasonable steps to ensure access for LEP patients.  To assess the degree of assistance, apply the 4-Factor Analysis:    ) Does the office serve a large proportion of LEP patients?   2.) Do LEP patients communicate with the practice often?  3.) What is the nature of the service provided (emergency or routine)?  4.) What resources are available to the recipient and what are the costs?  The greater the number or proportion of eligible LEP persons; the greater the frequency with which they have contact with the office; and the greater the importance of the service, the more likely enhanced language services will be needed.
  8. Create a List of Interpreters and Resources to Assist You – A healthcare provider is obligated to pay for the auxiliary aid or service so long as it does not result in an undue financial burden to the provider’s office.   There may be times when there is no other option but to hire an interpreter.  The cost should be considered “overhead” and cannot be passed on to the patient.
  9. Document – All efforts to offer accommodations should be documented in the patient’s record. Some persons who are deaf or hard of hearing may prefer or request to use a family member or friend as an interpreter.  Family members or friends of the person should not be used as interpreters unless specifically requested by that individual and after an offer of an interpreter at no charge to the person has been made by the practice.  Such an offer, and their response should be noted in the patient’s record. 
  10. Create a Policy and Communicate It – Post your policy on your website, print it and place it in your reception area. Make it known that you CAN and DO serve patients with disabilities.


Treatment of patients with disabilities or the inability to speak English may be perceived as a financial burden, but it is a legal obligation that must be addressed.  Every practice should develop policies to identify patients in need and have readily available resources.

This information is only a fraction of the information available to you through the resources below.

Resources:  www.ada.gov/1-800-514-0301 (voice) 800-514-0383 (TYY)



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Jennifer Ayres of Core Consulting Services, LLC is a practice management consultant to Optometrists.  You may reach Jennifer at jennifer@coreconsultservices.com.