The DOJ has indicated that in determining what constitutes an effective auxiliary aid or service, healthcare providers must consider, among other things, the length and complexity of the communication involved. For example, a note pad and written materials might be sufficient for some routine appointments, to discuss uncomplicated symptoms or minor injuries, or to complete insurance forms or medical history inquiries. When the information is lengthy or complex, however, such as a patient’s discussion of symptoms with medical personnel or a physician’s presentation of diagnosis and treatment options to patients or family members, it might be necessary to provide a qualified sign language interpreter or other interpreter; the use of handwritten notes might be inadequate.
The DOJ also has specified that hospitals should have arrangements in place to ensure that qualified interpreters are readily available on a scheduled basis, and on an unscheduled basis with minimal delay, including on-call arrangements for after-hours emergencies. Larger facilities can choose to have interpreters on staff. Hospitals should develop protocols and provide training to ensure that hospital staff know how to obtain interpreter services and other communication aids and services when needed.
The DOJ has recommended hospitals have signs and other types of notices to advise persons with disabilities that services and assistance are available, along with what they need to do to obtain them. A hospital must be prepared to make and receive relay system calls.
If telephones and televisions are provided in patient rooms, hospitals must provide patients who are deaf or hard of hearing comparable accessible equipment upon request, including TDDs, telephones that are hearing-aid compatible and have volume control, and televisions with closed captioning or decoders. For training or other educational services offered to patients or members of the public, additional aids and services (e.g. note-takers, captioned videos, assistive listening systems) might be necessary for effective communication.
Visual alarms are not required in patient rooms. However, evacuation procedures should include specific measures to ensure the safety of patients and visitors who are deaf or hard of hearing. Certain built-in communication features required for hospitals built or altered after the effective date of the ADA in 1992 include:
- Visual alarms, which must be provided in all public and common-use areas, including restrooms, where audible alarms are provided;
- TDDs, which must be provided at public pay phones serving emergency, recovery, or waiting rooms, and at least one TDD must be provided at other locations where there are four or more pay phones; and
- A certain percentage of public phones that must have other features, such as TDD plug-in capability, volume controls, and hearing-aid compatibility.
Also important: Hospitals and healthcare providers are not allowed to charge patients with a disability to cover the costs of providing auxiliary aids and services. Instead, the costs must be treated as overhead expenses that are passed on to all patients.
New Regulations
Effective March 15, amendments to the ADA regulations will take effect modifying both Title II and Title III. One of the relevant changes to the regulations include video remote interpreting (VRI) services as a kind of auxiliary aid, which could be used to provide effective communication. VRI is an interpreting service that delivers high-quality video images over dedicated lines or wireless technology.
The amended Title II regulations effective March 15 also expand on the explanation of an effective auxiliary aid and provide that “in order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability.” A public entity cannot require an individual with a disability to bring another individual to interpret for him or her, or rely on an adult accompanying an individual with a disability to interpret or facilitate communication, except in the case of an emergency or when the individual with a disability specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances.