Deaf and Hard of Hearing Persons' Right to Effective Communication in Health Care Settings

Federal law requires health care facilities to provide information and services in a way that deaf and hard of hearing individuals can access and understand.

The Americans with Disabilities Act (ADA) and other federal laws prohibit health care providers from discriminating against anyone with a disability. If you are deaf or hard of hearing, this means that, among other things, health care providers must furnish you with appropriate "auxiliary aids and services" in order to ensure "effective communication."

Examples of common auxiliary aids and services include qualified interpreters, audio recordings, captioned videos, note takers, teletypewriters, and visual alarms.

Why Are Auxiliary Aids Important?

Clear communication is essential for the provision of safe and effective health care services to all people, including people with hearing disabilities.

Without appropriate auxiliary aids and services, staff often cannot effectively communicate with deaf or hard of hearing people about important health care-related matters, such as:

• medical history and symptoms
• possible diagnoses and treatment options
• results from medical exams and lab tests
• drug interaction warnings
• informed consent
• end-of-life procedures, and
• billing and benefits eligibility.

When health care facilities fail to communicate effectively with deaf and hard of hearing individuals, these individuals face significant difficulty obtaining health care and making health care decisions. Sometimes they receive improper or inadequate care or are denied access to care altogether.

To What Providers and Services Does the Law Apply?

These federal laws apply very broadly to hospitals, nursing homes, doctors' offices, diagnostic centers, health clinics, physical therapy centers, and psychological and psychiatric service providers.

This federal law also applies whether the health care facility is administered by a federal, state, or local government entity or is privately owned and operated. Even if a health care provider's office is located in a private home, the law still applies to the part of the home used for public purposes.

The law applies to all basic health care facility programs and services, whether inpatient or outpatient, including emergency care. The law also covers educational classes and non-medical services or settings, such as cafeteria and gift shop services.

What Does the Law Require?

Federal law requires health care providers to communicate effectively with deaf and hard of hearing people. Health care providers must ensure that no one with a hearing disability is denied services or treated differently than other individuals because of the absence of auxiliary communication aids and services.

Health care providers must offer communication aids and services to any person with a hearing disability that interacts with staff or utilizes the health care facility's services. That includes not only deaf and hard of hearing patients, but also patients' family members and companions, as well as any other visitor, customer, or client with a hearing disability.

For example, a hospital that offers prenatal birth classes must provide a deaf woman attending the class with appropriate communication aids and services so she can have the same access to class content as the hearing individuals. If the prospective mother did not have a hearing disability but attended the class with her deaf partner, the hospital would be required to furnish communication aids and services to the partner.

Which Auxiliary Aids and Services Should Be Provided?

People with hearing disabilities communicate using a number of different possible methods. Which auxiliary aids and services a health care facility should offer, and whether or not they ultimately provide effective communication, will vary according to the context and the specific needs of the deaf or hard of hearing individual.

Health care providers should consult with a deaf or hard of hearing individual to determine what type of auxiliary aids or services he or she needs, to ensure effective communication. However, as long as the end result is effective communication, the provider gets to make the ultimate decision about what aids and services to offer. If the selected aid or service does not actually result in effective communication, though, the provider is violating the law.

Many people with hearing disabilities communicate using sign language. For relatively complicated interactions or exchanges—such as discussions regarding treatment options or informed consent, for example—provision of a qualified sign language interpreter may be the only way to ensure effective communication.

Providing Interpreters

When an interpreter is provided, she must be "qualified," though official certification is not required. To be qualified under the ADA, an interpreter must be able to interpret "effectively, accurately, and impartially, both receptively and expressively" for the specific deaf or hard of hearing individual in question. That means, for example, that a deaf patient who communicates using American Sign Language (ASL) will need an interpreter that is sufficiently fluent in ASL, which uses a different grammar and syntax than English. However, an ASL interpreter may not be qualified to communicate with a deaf patient who only uses Signed English, which is distinct from ASL. Also, an interpreter who is fluent in ASL but unable to translate spoken language into ASL is not qualified.

Generally, staff or other individuals who have only a basic knowledge of sign language are not qualified.

An interpreter may not be necessary for every exchange. For example, gestural communication, such as pointing to an object, may be sufficient under the law for simple exchanges like selecting an item for purchase in the hospital cafeteria or gift shop. Exchanging written notes may be enough to direct a deaf visitor to a particular floor or room in the facility, or for other simple communications. (Note, however, that some people who grew up using ASL as their first language may have some difficulty reading and writing English. In such an instance, written notes would not provide effective communication.)

A health care provider cannot require a deaf or hard of hearing person to bring someone with them to interpret or facilitate communication, and cannot rely on a person's companion to interpret or facilitate communication.

Services Must Be Provided for Free

Health care providers are not permitted to charge a person with a hearing disability for the costs of communication aids and services.