Americans with Disabilities Act and Hearing Interpreters

The Americans with Disabilities Act (ADA), Public Law 101-336, is the first civil rights measure to address discrimination against disabled persons with respect to employment opportunities and public accommodations. The prohibition against discrimination on the basis of disability includes an obligation to make reasonable accommodations to meet the needs of patients with hearing disabilities.

There is no strict definition of a reasonable accommodation. In some instances, such as when a conversation is particularly important, relative to the care and services being provided, or is particularly complex, effective communication might only be achieved through the use of a qualified interpreter. However, the ADA does not mandate the use of interpreters in every instance. The health care professional can choose alternatives to interpreters as long as the result is effective communication. Acceptable alternatives may include: note taking; written materials; lip reading or telecommunication devices. Physicians should consult with patients and their companions about what constitutes a reasonable accommodation under the existing circumstances.

Physicians are not required to provide qualified interpreters or other accommodations if the accommodation would be an undue burden or would fundamentally alter the nature of the services normally provided. Undue burdens include both financial and administrative hardships. Factors courts use to determine whether providing an interpreter would present an undue burden include the practice or facility's operating income and eligibility for tax credits, and whether it has sources of outside funding or a parent company. Courts also consider the frequency of visits that would require the services of an interpreter. However, the single factor of the cost of an interpreter exceeding the cost of a medical consultation generally has not been found by the courts to be an undue burden. Fundamental alterations may include such concerns as utilizing family members or non-affiliated interpreters to discuss sensitive information.

If the physician must accommodate the patient’s hearing disability, the physician must pay for the cost of an interpreter. The cost of the interpreter should be treated as part of overhead expenses for accounting and tax purposes. Tax relief may be available for expenditures made toward interpreters.