What your obligations are and are not
Sooner or later, a practice will face a communication challenge when a patient with a hearing impairment schedules an appointment. The protocol on how to deal with this type of disability in an examination has led to some confusion in the past.
First and foremost, an optometric office, regardless of the title ‘private practice,’ is a public accommodation. As a public accommodation, steps to ensure the practice and services are accessible to individuals with disabilities should be taken. Individuals with disabilities, as defined by the September 2008 amended Americans with Disabilities Act (ADA), are those with a physical or mental impairment that substantially limits one of more major life activities of such individual; a record of such an impairment; or being regarded as having such impairment.
Patients with a hearing impairment may request a sign language interpreter, but an optometrist is not required to hire one unless both parties have agreed on it. Other means of communication are an option, like having a family member of the patient or a certified employee interpret, writing a conversation with the patient on a note pad, or using various tools like a computer or phone to communicate. Auxiliary aids or services should be agreed upon prior to the scheduled appointment.
An optometrist is permitted to deny the use of an interpreter if there is proof that the cost or service of the interpreter would be an undue burden. An undue burden is a significant difficulty or expense for the practice. Factors in deciding the inclusion of an interpreter are: cost against financial status of the practice, the need for enhanced communication and the availability of the service desired. If an interpreter is needed, the optometric office is responsible for covering the cost. The patient holds no obligation to incur the fee. Passing this cost along to the patient would be a violation of the ADA, as would refusing to see the patient based on the needs of their disability or referring the person to another physician solely because the patient wants an interpreter.
The person with disability is entitled to only reasonable accommodation and cannot demand an interpreter if other alternative services are available. If no satisfactory services can be found, the practitioner is required to provide an interpreter. The downside to this justification is that ‘satisfactory’ differs for each person, but this means an interpreter is not always necessary. If a reasonable alternative is found, and would otherwise be acceptable, the patient cannot refuse the accommodation.
If hiring an interpreter, the best way to find one would be through a licensed audiologist. Using one of these professionals can ensure premium service and occasionally a discount.
Under the ADA, an optometrist is responsible to accommodate every disabled patient wanting to use the practice’s services, but are not obligated to accommodate with only an interpreter. Exploring all options is beneficial to the practice and the patient, who may assume the only option is an interpreter. Discussing all available auxiliary aids and services with patients helps to reduce financial cost in the long run. A person may not be denied an appointment or referred away from the practice based on their disability or desire to have accommodations made.
