The Americans with Disabilities Act

The ADA defines a person as being disabled if they have a physical or mental impairment that substantially limits at least one “major life activity,” has a record of such impairment or is regarded as having such impairment. Major life activities are personal care tasks, manual tasks, hearing, seeing, breathing, thinking, learning and working.

The ADA probably does not affect your employment practices since the labor provisions of the law apply only to businesses that have at least 15 employees. However, your office is considered a public accommodation and, under the law, is generally required to be accessible to disabled patients.

You need to ensure that people with disabilities can use your office building and suite. Barriers to access must be removed if alterations are "readily achievable," which is determined by considering factors such as the nature and cost of the action, the owner's and tenants' financial resources and the impact of the action on the operation of the business. Required accommodations might include installing a ramp, making curb cuts, rearranging furniture, widening door openings or modifying rest rooms. These accommodations are usually at the expense of the building owner.

Another type of accessibility is the communication between you and your patients. Under ADA guidelines, the need for an interpreter depends on the complexity of the medical matter. An exchange of written notes may suffice for a patient with a simple cold. However, if the condition or treatment is more complex, an interpreter may be needed to ensure that you and the patient understand each other fully.

It is normally the physician's obligation to pay for the interpreter unless it can be shown that the cost would impose an undue burden on the physician. The financial resources of both parties and the impact of the cost on the practice are relevant. The cost of the interpreter may exceed your charges for that patient's care, but this alone does not constitute an undue burden. The ultimate decision maker may be a court, so it is safe to err on the side of absorbing the cost. Some physicians have an interpreter in the office regularly, such as one-half day per week, and try to schedule appointments with hearing-impaired patients during this time.

No. The key in determining whether effective communication will result is whether the interpreter is “qualified” not whether he or she has been actually certified by an official licensing body. A qualified interpreter is one who is able to interpret effectively, accurately and impartially, both receptively and expressively, using any necessary specialized vocabulary. An individual does not have to be certified in order to meet this standard. A certified interpreter may not meet this standard in all situations, e.g., where the interpreter is not familiar with the specialized vocabulary involved in the communication at issue.

No. The ADA prohibits discrimination in hiring or maintaining an employee who can perform the essential functions of their job without aid or with the assistance of a reasonable accommodation. Job descriptions should be written with this in mind.

No; however, title VI of the Civil Rights Act does. Title VI of the Civil Rights Act forbids discrimination by any program that receives money from the federal government and requires that health and social service providers give their limited-English-proficient (LEP) patients meaningful access to their services, which may entail offering translation services. These services must be provided to the patients free of charge.

The Department of Health and Human Services (HHS) provides policy guidance for the LEP requirement of Title VI at www.hhs.gov/ocr/lep/guide.html.

In determining the fitness for duty of an employee or prospective employee, a physician must consider four things in relation to to the ADA. These are:

This will require knowledge of the workplace and job functions.

No. The ADA guidelines only allow for you to make necessary accommodations for an employee who tells the employer of AIDS/ HIV status. The employee's status should not be revealed except in the case of exposure of another employee or patient to the virus.

All alterations that could affect the usability of a facility must be made in an accessible manner to the maximum extent feasible. For example, if during renovations a doorway is being relocated, the new doorway must be wide enough to meet the new construction standard for accessibility. When alterations are made to a primary function area, such as the waiting room or exam rooms, an accessible path of travel to the altered area must also be provided. The restrooms, telephones, and drinking fountains serving that area must also be made accessible. These additional accessibility alterations are only required to the extent that the added accessibility costs do not exceed 20% of the cost of the original alteration.