Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Appendix D: Laws and Regulations
in an undue burden or fundamental alteration in a program
or activity [12]:
• Deny the opportunity to participate in or benefit from the
aid, benefit, or service
• Afford an opportunity to participate in or benefit that is
not equal to that afforded others
• Provide an aid, benefit, or service that is not as effective as
that provided to others
• Provide different or separate aid, benefit, or service unless
such action is necessary to provide aid, benefit, or service
that is as effective as those provided to others
• Aid or perpetuate discrimination by providing significant
assistance to an agency, organization, or person that discriminates
on the basis of handicap
• Deny the opportunity to participate as a member of planning
or advisory boards
• Otherwise limit the enjoyment of any right, privilege, advantage,
or opportunity enjoyed by others receiving an
aid, benefit, or service
Similarly, under federal law, hospitals cannot take any of the
following actions toward qualified individuals with disabilities,
on the basis of the disability, unless to do so would result
in an undue burden or fundamental alteration in a program
or activity [6]:
• Establish or apply eligibility criteria for receipt of services
or participation in programs or activities that screen out or
tend to screen out individuals with disabilities, unless such
criteria are necessary to meet the objectives of the program
• Provide separate or different benefits, services, or programs
unless it is necessary to ensure that the benefits and
services are equally effective
• Refuse to allow a person with a disability to participate in,
or benefit from, their services, programs or activities
Further, these covered entities must, unless to do so would result
in an undue burden or fundamental alteration in a program
or activity, do the following [6]:
• Provide services and programs in the most integrated setting
appropriate to the needs of qualified individuals with
disabilities.
• Make reasonable modifications in policies, practices, and
procedures to avoid discrimination on the basis of disability.
• Make buildings accessible.
• Provide auxiliary aids, at no additional cost, where necessary
to ensure effective communication with individuals with
hearing, vision, or speech impairments.*
Examples of discrimination on the basis of disability would
include failing to make reasonable modifications, provide auxiliary
aids and services, or remove architectural barriers. Such
failures effectively prevent people with disabilities from enjoying
the goods and services offered in a public space. This
means that hospitals must modify policies, practices, and procedures,
when necessary, to allow people with disabilities to
gain full and equal access to services, unless a requested modification
constitutes a fundamental alteration of the health care
service itself or an undue burden. For example, if a hospital
had a policy of not providing assistance to patients with undressing,
it would have to modify that policy if someone with
mobility impairment required such assistance to receive a
proper examination. Hospitals must also provide auxiliary
aids and services such as sign language interpreters, assistive
listening devices, and written medical information in such alternative
formats as Braille and large print, unless the hospital
can establish that doing so would fundamentally alter the nature
of the health care service or constitute an undue burden.
Finally, hospitals must remove architectural barriers, such as
steps, narrow doorways, and inaccessible toilets, in existing facilities
if doing so is “readily achievable.” New construction
hospitals or those that undertake alterations to existing facilities
must make sure that the new construction or alteration
meets the higher standard of being readily accessible [13].
Section 504 of the
Rehabilitation Act of 1973 and
the ADA: Accessible Medical
Facilities and Equipment
Disability discrimination issues may arise across a broad range
of situations in the hospital setting, including the accessibility
of medical facilities and equipment. Both the HHS Office for
Civil Rights and the DOJ have negotiated settlement
agreements requiring medical facilities to make physical
accessibility improvements. The Washington Hospital Center
agreement presents one of the most comprehensive. Under
the terms of the agreement, Washington Hospital Center
agreed to do the following:
• Create a minimum of 35 fully accessible patient rooms,
with each including an accessible toilet room and an
accessible shower (or access to one)
* Auxiliary aids include such services or devices as: qualified interpreters, assistive listening headsets, television captioning and decoders,
telecommunications devices for the deaf (TDDs), videotext displays, readers, taped texts, Braille materials, and large print materials.
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