Patients Who Are Deaf or Hearing Impaired
The federal government requires "appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities."
According to the Department of Justice (DOJ), "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 regulations include "qualified interpreters....available to individuals with hearing impairments..."
The TMA Office of the General Counsel has prepared a whitepaper Americans with Disabilities Act and the Hearing Impaired (members only) that provides guidance on the statutory and regulatory
provisions, penalties, and more.
TMA also has some tips Communicating With Patients Who Are Deaf or Hard of Hearing and guidance in Texas Medicine, Nov 2013: Good Communication - State, Federal Laws Must Be Followed.
The DOJ Civil Rights Division provides information on the ADA requirements for effective communication with people with hearing, vision or speech disabilities.
In certain instances, Medicaid will pay for sign-language interpreting services. For commercial health plans, check with the patient's plan to determine if it provides reimbursement. Refer to our Billing and Payers page for links.
Interpreter Resources and Guidance
A list of Interpreters for the Hearing Impaired in the Houston area.
Is an interpreter the only kind of auxiliary aid a physician's office may use?
The federal government provides the following example of an appropriate accommodation: "The hearing impaired patient goes to the doctor for a bi-weekly check-up, during which the nurse records the patient's blood pressure and weight. Exchanging notes and using gestures are likely to provide an effective means of communication at this type of
However, when the ailment is of sufficient complexity that an interpreter is necessary to ensure effective communication, then the physician must provide a qualified interpreter.
Note that certified interpreters need not be provided and are not required by the ADA - it requires only qualified interpreters. This is potentially a cost saving distinction.
Can a patient's family member be used as the interpreter?
The lack of impartiality may cause the patient to avoid revealing important, but personal, facts. Also, the federal government has imposed requirements upon medical care professionals to refrain from utilizing "a family member, companion, case manager, advocate, or friend" of a deaf individual as an interpreter. Impartiality is one of the elements necessary for an interpreter to be considered qualified.
Who pays for the interpreter?
The physician responsible for the care must pay for the cost of the interpreter and may not impose a surcharge on an individual with a disability directly or indirectly to offset the cost of the interpreter, as it is considered to be an overhead expense. Under certain circumstances, Texas Medicaid will reimburse the physician for some of the costs.
Who gets to choose the appropriate accommodation?
The physician, not the hearing impaired person, chooses the appropriate accommodation, and if an interpreter is needed, the physician chooses the interpreter. A physician "need not accept and pay for the services of a sign-language interpreter who is unilaterally retained by the family of a deaf patient, when the doctor has had no opportunity to make his or her own arrangements." However, the practice would want to consult with the hearing impaired person since the goal is to provide an aid or service that will be effective, given the nature of what is being communicated and the person's method of communicating.
To avoid any problems, practices should teach staff, especially front line staff, about the practice's policies and the ADA's requirements for communicating effectively with people who have communication disabilities.
Patients with Intellectual or Developmental Disabilities
From the Vanderbilt Kennedy Center, the Developmental Disabilities Health Care E-Toolkit Project provides guidance and resources for communicating effectively with adults with intellectual and developmental disabilities.
Patients With Limited English Proficiency (LEP)
Essentially, physicians who receive federal funds must take reasonable steps to ensure patients with limited English proficiency (LEP) have a meaningful opportunity to participate in programs and services to which they otherwise would be entitled.
The TMA Office of the General Counsel provides a summary of the U.S. Department of Health and Human Services (HHS) requirements and has also prepared a whitepaper Accommodation of Persons With Limited English Proficiency (LEP) (members only) that explains what entities are subject to the HHS LEP guidance, to what extent physicians must take reasonable steps to provide meaningful access, who is an LEP individual, the posting of notices and taglines, and more.
TMA has also developed Section 1557 Notice templates which can be customized for your practice.
Interpreter-Translator Resources and Guidance
Crossing the Language Barrier - It's More Than Just Words (TMA)
Tips for Working with Health Care Interpreters
For a list of LEP Interpreters and Translators and the languages for which they provide services.
Section 1557 Resources
The MGMA provides guidance with Section 1557: What your practice needs to know.
Health and Human Services (HHS) on Limited English Proficiency
Fact Sheet on Guidance (HHS) on Section 1557.
Frequently asked questions (HHS)
Sample Notices and Taglines (HHS) and other resources translated into many different languages.
Table showing the top 15 languages (HHS) spoken by individuals with LEP in each state.
Other Topics on Patient-Physician Communication
Cultural Awareness and Health Literacy page (HCMS)
From Difficult to Dangerous: How to Handle Disruptive Patients (TMLT, The Reporter, Q2 2019)
Evaluating and Treating the Suicidal Patient (TMLT, The Reporter, Q1 2019)
9 ways to improve your patient communications (Physicians Practice)
How to say No to unreasonable patient requests (Physicians Practice)
Maintain an attitude of respect and helpfulness toward patients (TMA)
How to handle patient confrontations (TMA)
How to handle patient complaints (TMA)
When patients consult Google... (TMA)
TMA provides more patient/customer service resources.
Electronic Communications with Patients
Electronic communications, such as email or text messaging, can be useful tools in the practice of medicine and can facilitate communication between patients and the physician, but these channels can raise special concerns about privacy and confidentiality.
However, communicating with a patient via a secure patient portal that meets HIPAA requirements provides not only the necessary confidentiality, it also acts as a "firewall" between the patient and the physician.
Any electronic encounters that involve patient care must be documented in the patient's medical record.
The AMA Code of Medical Ethics provides guidance for physicians engaged in electronic communications with patients under Consent, Communication and Decision Making, Opinion 2.3.1 Electronic
Communication With Patients.
The Texas Medical Association (TMA) and Texas Medical Liability Trust (TMLT) recommend that guidelines be developed for appropriate use and management of email and text communications with patients.
Texas Physicians Adjust to Electronic Communication (TMA, Texas Medicine, June 2018 issue)
Guidelines for electronic communications (email) with patients (TMLT)
Sample patient consent form for use of email communications (TMA)
TMA Health Information Technology page for assistance with e-communication and more.
HCMS Health Information Technology page for information on best practices, cybersecurity, risk assessments, and more.