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Foreign Lauguage and Sign Language Interpreters
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Sue U. Malone In
the last two weeks I have had two calls from physician offices asking
about their responsibility when a patient requests an interpreter. In
each instance, both parents were deaf. In the first instance the parents
made an ap-pointment with their child’s pediatrician with a request
for an interpreter. One week later I received a similar call from a
primary care physician who received a request for an interpreter when
the doctor’s office was notified that the patient was deaf, as was the
patient’s husband. Each time the doctors were given the name of BACA
(Bay Area Com-munication Access) and the amount the organization charges
for an interpreter. There are numerous
federal and state policies prohibiting discrimination on various fronts
against patients with disabilities (or other characteristics such as
race, color, sex, religion, ancestry, or national origin), but for this
discussion I will focus on the requirements regarding public
accommodation. Title VI of the Civil Rights Act of 1964, the
Americans with Disabilities Act of 1990, and a document issued in 2000
by the federal Office of Civil Rights of the Department of Health and
Human Services (DHHS) all address this issue. The policy guidance
in the DHHS document set the stage for DHHS’ long-standing position
that to avoid discrimination against persons with limited English
proficiency (LEP), providers must take adequate steps to ensure that
such persons receive the language assistance necessary to afford them
meaningful access to their services, free of charge. The CMA’s Legal
Handbook addresses commonly asked questions concerning the use of
foreign language interpreters. For instance: Do physicians have
to provide foreign language interpreters?
No, but physicians who receive “federal financial assistance” are
governed by this requirement. Thus physicians who receive payment
from Medi-Cal or Healthy Families programs and other programs involving
federal funds that pay directly from the government, rather than through
a patient (like Medicare, Part B), are covered under this policy. The important aspect
to compliance is effective communication with LEP persons to allow for
meaningful and equal access to health care. Physicians must make
reasonable accommodations to ensure that disabled individuals are able
to enjoy equal services and that they are not denied services.
Compliance is measured on the basis of the individual circumstances. What are covered
physicians required to provide?
Physicians must provide the language assistance necessary to ensure
meaningful access to the services the physician provides, at no cost to
the patient. What about
documentation? The treating
physician needs to review with the patient the auxiliary aids the doctor
intends to use for effective communication and the consultation must be
noted in the patient’s record, including the physician’s
determination as to the aid to be provided. The physician’s
office needs to develop written policies and procedures on language
access to ensure meaningful communication. The physician must also
ensure that the staff understands the policy. It is good policy to have
your patient materials in languages other than English when you have a
patient population in a particular LEP group. Can you close your
practice to LEP patients? No,
such discrimination is prohibited by federal and state law. Do I have to
provide an interpreter for a deaf or hearing-impaired patient?
The law does not mandate the provision of an ASL interpreter in all
cases. An ASL interpreter is
not required when lipreading, or other accommodations such as using a
notepad on which you communicate with the patient, may be sufficient.
You must ask yourself: Is the nature of the service the patient expects
to receive routine? What is the patient’s ability to read and respond
effectively in writing? If you decide that lipreading can be used, be
sure to speak directly to the deaf person, speak clearly, in a normal
tone, and at a normal pace. However, if you need to communicate with a
deaf individual about detailed, lengthy, or complex information, then an
interpreter is required. This, of course, holds true with language
barriers as well. To some extent there
is reimbursement for interpreters for Medi-Cal patients. The Department
of Health Services adopted regulations providing that physicians or
physician groups employing fewer than 15 employees may be reimbursed for
providing sign language interpreter services. Certain health plans
provide interpreter services free-of-charge to their members, but
arrangements for interpreter services typically need to be scheduled in
advance. At times the plan may pay for a PPO patient but not an HMO
patient, so you need to check. I realize that
physicians view these requirements with annoyance, if not downright
aversion; but I think most of your disabled patients are willing to work
with you to accommodate your wishes as well as accommodate the health
care needs of these patients.
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