Written by Margaret Nightingale, Attorney
Reviewed and Updated March 2002
By Julie Anderson, OAC Attorney.
Federal law prohibits discrimination on the basis of disability by health care
providers. Section 504 of the Rehabilitation Act covers federally funded health
care providers (such as the VA system), Title II of the Americans with Disabilities
Act (ADA) covers state and local government providers (such as county health
clinics) and Title III of the ADA covers private providers (such as private
doctors, clinics and hospitals). These laws apply to both physical and mental
health care, as well as dentistry. Your rights are similar under all these laws,
although a few differences do exist.
Q: For whom must a health care provider offer accommodations?
A: A health care provider must ensure that it does not discriminate against customers, clients, and other individuals with disabilities who are seeking or receiving its services. Such individuals may not always be "patients" of the health care provider. For example, if pre-natal classes are offered as a service to both fathers and mothers, a father who uses a wheelchair must be offered classes in an accessible site that offers him the same opportunity to benefit from the classes as would other fathers. Similarly, a deaf parent of a hearing child may require an auxiliary aid or service to give informed consent for the child's surgery. In addition, visitors to hospitals may need accommodation, such as a blind visitor needing to bring his guide dog, or a visitor needing wheelchair access.
Q: Do the offices and facilities of health care providers have to be physically accessible?
A: Public providers have to make their health care programs accessible when viewed in their entirety. Therefore, they can choose to remove all barriers in all existing facilities or to provide same services at alternate accessible sites.
Private providers have to remove all physical barriers from their existing facilities if removal is "readily achievable" (possible without much expense or difficulty), and offer alternatives (such as house calls) if removal is not.
Health care facilities and offices built, or the areas altered, after 1/26/92, must be readily accessible and usable by individuals with disabilities.
Physical access includes not just the health care office itself, but also the "path of travel" from parking to the building entrance and to the office, restrooms, and the facilities (such as public phones, drinking fountains) available to other users.
Q: What are typical physical accommodations an individual with a disability might need in a health care setting?
A: Individuals with mobility impairments might need ramps, door openers, adapted doorknobs and restrooms with wider stalls, adapted faucets and grab bars.
Individuals with cognitive or visual impairments might need special signage. Those with hearing impairments might need flashing alarm systems.
Q: What is the obligation of health care providers to accommodate differences in how people communicate?
A: Health care providers have a duty to provide auxiliary aids and services that ensure that communication with people who have a disability is as effective as communication with others. The disability that affects communication could be sensory (visual or hearing impairments), physical (such as cerebral palsy affecting speech), cognitive (mental retardation, traumatic brain injury, dyslexia) or psychiatric).
Q: What kinds of auxiliary aids and services are required to ensure effective communication with individuals with disabilities?
A: Appropriate auxiliary aids and services include equipment or services a person needs to understand and communicate. Examples are qualified interpreters, assistive listening devices, note takers, written materials, television decoders, telecommunications devices (TTYs), audio-taped materials, Braille or large print.
The health care provider can choose among various alternatives as long as the result is effective communication. However, since the person with a disability knows best which auxiliary aid or service will achieve effective communication, the health care provider should first consult with the person.
Q: Why are auxiliary aids and services so important in the medical setting?
A: Auxiliary aids and services are often needed to provide safe and effective medical treatment. Without these aids and services, medical staff run the grave risk of not understanding the patient's symptoms, misdiagnosing the patient's medical problem, and prescribing inadequate or even harmful treatment. Similarly, patients may not understand medical instructions and warnings or prescription guidelines.
Q: In what medical situations should a health care provider obtain the services of a qualified sign language interpreter?
A: A qualified interpreter is an interpreter who is able to interpret effectively, accurately, and impartially both receptively and expressively, using any necessary specialized medical vocabulary.
An interpreter should be present in all situations in which the information exchanged is sufficiently lengthy or complex to require an interpreter for effective communication. Examples may include discussing a patient's medical history; obtaining informed consent and permission for treatment; explaining diagnoses, treatment, and prognoses of an illness; conducting psychotherapy; communicating prior to and after major medical procedures; providing complex instructions regarding medication; explaining medical costs and insurance; and explaining patient care upon discharge from a medical facility. For more simple health care interactions, lip reading or written notes might be adequate.
Q: Can health care providers exclude service animals?
A: Providers must make reasonable modifications in their policies, practices and procedures when necessary to provide accommodation to consumers with disabilities. Generally, this includes modifying any no-pets policy to permit use of a service animal by an individual with a disability. Therefore, normally an individual who uses an animal for assistance with hearing, seeing, mobility or emotional support may have that animal accompany them into a health care setting.
However, a service animal could be excluded if its presence would fundamentally alter the nature of the service (such as preventing what should be a sterile environment, such as a surgical suite) or present a threat to others' safety (such as affecting other patients with allergies).
Also, a provider has no duty to supervise or care for a service animal. Therefore, a hospital patient would need to make her own arrangements to have someone feed, water and air the animal throughout the hospital stay.
Q: Can a health care provider charge a patient with a disability for part or all of the costs of providing an accommodation?
A: No. A health care provider cannot charge a patient for the costs of providing accommodations, either directly or through the patient's insurance carrier. A health care provider is expected to treat the costs of providing accommodations as part of the overhead costs of operating a business. Accordingly, so long as the provision of the accommodation does not impose an undue burden on the provider's business and does not fundamentally alter the provider's services, the provider is obligated to pay. The provider may raise its fees for all patients to cover increased overhead, but it cannot pass the cost on only to the patients who need the accommodation.
Q: What can I do if my health care provider won't provide accommodations?
A: First, be sure that you have clearly requested the preferably in writing. Better explanation of the law might lead the provider to agree to Public providers offer informal grievance procedures; ask who their ADA coordinator or 504 compliance officer is and file a complaint with that person. Private also offer a grievance process.
A formal complaints to the federal government is also an option. Contact the Department of Health and Human Services (about public providers). Contact the Disability Rights Section of the Department of Justice (about private providers).
Litigation is also an option. Private or public providers can be required to provide accommodations, and public providers can be ordered to pay compensatory damages. Attorney fees and costs can also be collected if the suit is successful.
Q: If I file a grievance or complaint, can I still obtain services from the provider if I want to?
A: Yes, because dismissing you as a patient would be retaliation. Federal law protects individuals who exercise their rights to accommodation from retaliation by the provider. This includes threats, intimidation or interference. Retaliation is an additional violation of these laws.
(Portions of this article are adapted from "ADA Questions and Answers for Health Care Providers", which focuses on communication accommodations and is available from the National Center for Law and Deafness at Gallaudel University, 800 Florida Ave. NE, Washington D.C., 20002-3695).
If you have questions or need help getting an accommodation, you can call the Oregon Advocacy Center at (503) 243-2081 / 1-800-452-1694 (voice) or (503) 323-9161 / 1-800-556-5351 (TTY).