Risk Management FAQ's

There is no easy answer to this question. On the one hand, the Americans with Disabilities Act (ADA) entitles hearing impaired and “limited English proficient” (LEP) patients to a “reasonable accommodation” (i.e., assistance to receive healthcare services). On the other hand, many practices lack the resources to provide an interpreter at every patient visit.

Fact: the ADA does not require you to pay for a live interpreter at every patient encounter. Actually, whether you must provide an interpreter (or any other means of communication) is very circumstance dependent. Technically, you don’t have to provide assistance if it would be “unduly burdensome” or “fundamentally alter the nature of the services normally provided.” An undue burden is typically something that involves significant difficulty or expense.

The federal government has defined factors to help doctors determine the extent of their responsibilities. First, how many LEP patients are you likely to see? Second, how often are you likely to see these patients? Third, how important and urgent is the care that you typically provide to these patients. Lastly, what resources are available to your office for various language assistance programs?

After applying this analysis, you may discover that you see so few LEP patients each year that you’re not obligated to provide assistance. Or that the usual scenarios of your visits don’t require a live interpreter, just a list of foreign-language words.

Of course, the ultimate question is, can you communicate with the patient effectively enough to enable you to treat them appropriately. Unfortunately, there is no one-size-fits-all strategy, so a common sense approach is recommended. A side note on using family members and friends as interpreters: it’s permitted at the patient’s request, but should be done with great discretion. Consider the child interpreter who might lack vocabulary or emotional maturity, or an abusive spouse. Because of their relationship with the patient, their effectiveness as interpreters or the patient’s willingness to speak openly, may be greatly diminished.

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