• Auxiliary Aid Requirements For Individuals With Disabilities
  • June 27, 2003
  • Law Firm: Buckingham, Doolittle & Burroughs, LLP - Columbus Office
  • Have you ever wondered what you or your staff would do in order to assist a patient with a speech, hearing or vision impairment that was seeking treatment or services in your office? Better yet, what are you required to do under the law to accommodate individuals with speech, hearing or vision impairments when they seek treatment or services in your office? The answers lie in Title III of the Americans with Disabilities Act. Title III covers businesses that are public accommodations which includes professional offices of health care providers. Under Title III, health care providers must comply with basic nondiscrimination requirements that prohibit exclusion, segregation, and unequal treatment. They also must comply with specific requirements related to effective communication with people with hearing, vision, or speech disabilities.

    In general, professional offices of health care providers must provide auxiliary aids and services that are necessary to ensure equal access to the goods, services, facilities, privileges or accommodations that it offers, unless an undue burden or a fundamental alteration would result.

    The first question that comes to mind is - What is an auxiliary aid? "Auxiliary aids" include a wide range of services and devices that promote effective communication. Examples of auxiliary aids and services for individuals who are deaf or hard of hearing include qualified interpreters, notetakers, computer-aided transcription services, written materials, telephone handset amplifiers, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, telecommunications devices for deaf persons (TDD's), videotext displays, and exchange of written notes. Examples for individuals with vision impairments include qualified readers, taped texts, audio recordings, brailled materials, and assistance in locating items. Examples for individuals with speech impairments include TDD's, computer terminals, speech synthesizers, and communication boards.

    The auxiliary aid requirement is flexible to some degree. For example, a brailled menu is not required in a restaurant if waiters and waitresses are instructed to read the menu to blind customers. The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the length and complexity of the communication involved.

    The second question that arises is - Who is entitled to auxiliary aids? The obligation extends only to individuals with disabilities who have physical or mental impairments - such as vision, hearing or speech impairments that substantially limit the ability to communicate. Obviously, your offices should be able to accommodate those persons with physical disabilities, the wheelchair bound for example.

    Who decides what type of auxiliary aid should be provided? Professional offices of health care providers should consult with individuals with disabilities wherever possible to determine what type of auxiliary aid is needed to ensure effective communication. This should be accomplished at the time the initial appointment is scheduled. In many cases, more than one type of auxiliary aid or service may make effective communication possible. While consultation is strongly encouraged, the ultimate decision as to what measures to take to ensure effective communication rests in the hands of the health care provider - provided the method chosen results in effective communication.

    Of biggest concern to offices of professional health care providers may be the determination of who bears the cost of providing auxiliary aids. For example, a deaf patient arrives at your office and brings her own sign language interpreter without prior consultation with your office. Later, the patient bills the optometrist for the cost of the interpreter. In this example, the optometrist is not required to comply with the unilateral determination made by the patient that an interpreter is necessary. The optometrist must be given an opportunity to consult with the patient and make an independent assessment of what type of auxiliary aid, if any, is necessary to ensure effective communication. Overall, it is the health care professional's responsibility to bear the cost of the accommodation. If the patient believes that the optometrist's decision will not lead to effective communication, then the patient may challenge that decision under Title III by initiating litigation or filing a complaint with the U.S. Department of Justice.

    There are limitations to the auxiliary aid requirement. The ADA does not require the provision of any auxiliary aid that would result in an undue burden - significant difficulty or expense - or in a fundamental alteration in the nature of the goods or services provided by the health care provider. However, health care providers are not relieved from the duty to furnish an alternative auxiliary aid, if available, that would not result in a fundamental alteration or undue burden. Many of these determinations will be made on a case by case basis.