Americans with Disabilities Act

Information about the ADA from the AAFP

How does the Americans with Disabilities Act define disability?

The Americans with Disabilites Act (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.

How does the ADA affect a solo family medicine practice?

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 who have disabilities can use your office building and suite. Barriers to access must be removed if alterations are "readily achievable." This 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.

What are the physician's responsibilities regarding deaf patients and obtaining interpreters for them?

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.

Who is responsible for paying the interpreters?

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.

If a sign language interpreter is required for effective communication, must only a certified interpreter be provided?

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.

Does the ADA require that an employer hire or maintain a disabled person who cannot perform the duties required for the position?

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.

Does the ADA require a practice to provide translators for non-English speaking patients?

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(www.hhs.gov).