Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Appendix D: Laws and Regulations
during hospitalizations appropriate auxiliary aids and services
necessary to ensure effective communication for deaf patients or
deaf family members, including qualified interpreters.* The
Maryland hospital had an older system of video interpreting
services available that did not perform well, if at all. The suit alleged
that hospital staff had difficulty setting up and operating
the system, the picture was at times too blurry for a patient to
clearly distinguish the arms and hands of the video interpreter,
and the video camera could not be adjusted for prone patients
so that the interpreter and the patient could clearly see each
other’s hands, arms, and heads. In addition, the case alleged that
the hospital failed to provide an interpreter for a deaf patient
during hospitalization. The hospital allegedly did not attempt to
communicate with the deaf patient in any way, but rather forced
her hearing mother, who did not know sign language, to function
as a relay person, consecutively exchanging simplistic messages
between her adult daughter and the hospital staff regarding
her daughter’s condition and treatment.
Gillespie v. Dimensions Health Corp., d/b/a Laurel Regional Hospital
[10] was resolved through a comprehensive consent decree
which included detailed provisions for the implementation and
administration of a program to ensure effective communication
with persons with hearing disabilities. The consent decree required
the hospital to continue to provide both on-site interpreters
and interpreters appearing through video interpreting
services where necessary for effective communication; to provide
other auxiliary aids and services as necessary; to modify
medical and intake forms to make sure that once a deaf or
hard-of-hearing patient or family member enters the hospital,
the hospital makes a communication assessment and, if necessary,
a reassessment of the patient or family member; to maintain
a complaint resolution/grievance procedure regarding the
provision of auxiliary aids and services; and to train hospital
personnel to accommodate the communication needs and preferences
of deaf or hard-of-hearing patients and family members.
In addition, DOJ required Laurel Hospital to satisfy
specified performance standards for its video interpreting services
regarding the quality and clarity of the televised video and
audio, regardless of the body position of the patient, and to
train hospital staff to quickly and easily set up and operate the
system. DOJ also made clear that, except in very limited instances,
medical providers should not ask family members or
other representatives to interpret for a person who is deaf or
hard of hearing because of potential emotional involvement,
considerations of confidentiality, and limited interpreting skills.
In 2004, the DOJ settled a lawsuit alleging that Fairview
Health Services failed to provide qualified sign language interpreters
and services to deaf patients in United States v. Fairview
Health Services* [11]. Under the agreement, Fairview agreed to
hire and make available one or more qualified sign language interpreters
24 hours a day, seven days a week, to provide effective
communication at each of its five hospitals in Minnesota, and
to pay $188,000 in damages to four complainants and $20,000
in civil penalties. Fairview also agreed to rewrite its hospital policy
and procedures affecting patients with disabilities, develop
patient and visitor information and notices in forms that are accessible
to deaf and hard-of-hearing patients, and conduct comprehensive
training of hospital personnel. †
Section 504 of the
Rehabilitation Act of 1973 and
the ADA: Other Types of
Prohibited Discrimination
Federal law prohibiting discrimination on the basis of disability
addresses a broad range of issues beyond effective communication.
Section 504 regulates how hospitals that receive federal
funding provide aid, benefit, or service, either directly or through
contractual, licensing, or other arrangements, to individuals with
disabilities. Hospitals are also subject to similar requirements
under the ADA. Title III of the ADA applies to “public accommodations,”
which by definition includes hospitals. Title II of the
ADA covers public hospitals – that is, those operated by state and
local governments -- as programs of public entities.
Such hospitals cannot take the following actions against qualified
individuals with a disability, unless to do so would result
* This case description is from the DOJ Access for All: Five Years of Progress report, available at http://www.ada.gov/5yearadarpt/fiveyearada1.htm.
† The allegations in the Laurel Regional Hospital case illustrate the problems that can result when a hospital fails to take the necessary steps,
through a video interpreting service or otherwise, to ensure effective communication. Hospitals often mistakenly use family members as interpreters
in non-emergency situations and inappropriately rely on lip-reading for complicated medical discussions. In the Laurel Regional Hospital case, one
complainant complained to the DOJ that her mother was often unable to communicate to her what hospital personnel had said, and that because
her mother does not know sign language, the patient was forced, often unsuccessfully, to try to read her mother’s lips. The patient said she felt
frustrated, angry, and ignored by the hospital.
‡ Similar agreements have been reached between DOJ and Greater Southeast Community Hospital in Washington, D.C., St. Francis Healthcare in
Wilmington, Delaware, and South Florida Baptist Hospital in Plant City, Florida.
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