How a Federal Ruling on the ADA Shifted the Paradigm for Language Access


Language access is an undisputed necessity for patients when they are seeking medical care, and federal laws protect the right to that access. Title IV of the 1964 Civil Rights Act guarantees language access to limited English proficiency (LEP) patients, and the American with Disabilities Act (ADA) protects language access for Deaf patients. That said, there have been different interpretations of these laws, specifically regarding how language services are provided, and whether the modality provides effective communication and aligns with the preferences of the patient.

This debate was highlighted a few years ago when a Deaf patient filed suit against a Florida hospital, leading to a federal magistrate ruling on the hospital’s obligation to provide language access while considering the patient’s preference. Margaret Weiss, a Deaf patient was pregnant with her second child filed suit against Bethesda Hospital East after her request for an on-site American Sign Language (ASL) interpreter during labor and delivery was denied, and the hospital communicated that interpreting would be provided to her with video remote interpreting (VRI) rather than an on-site interpreter.

How a Federal Ruling on the ADA Shifted the Paradigm for Language Access

VRI had been used during Weiss' previous visits to Bethesda East and it had not gone smoothly, prompting her to request an on-site interpreter for the birth of her second child. However, the hospital provided proof that connection and technology issues that had previously plagued the VRI service had been corrected, and its use during labor and delivery would be sufficient.

After hearing both sides, and reviewing the law requiring interpreting services be "effective," the judge ruled in favor of the hospital’s original plan to use VRI. This ruling emphasized the paradigm shift from considering on-site interpreters as the only alternative to video remote interpreters as part of a language access toolkit. Many in the Deaf community prefer on-site interpreters, but hospitals are learning to balance patient preference, fiscal responsibilities and legal obligations to provide quality and effective language services.

Although Weiss had a strong preference for on-site interpreters during her labor and delivery, the hospital fulfilled its obligation to provide her with effective communication through the use of qualified interpreting. As the use of VRI had been proven to be reliable and not disruptive to communication, accommodating her preference was not mandated by the judge. This ruling by the federal court is a critical turning point not only for the Deaf community, but for hospitals as well.

Oftentimes patient preference for an on-site interpreter is confused with the right to have an on-site interpreter, when in fact the patient’s right is to have effective communication with the provider. By ruling that VRI is an acceptable accommodation, it reinforces the Deaf person’s right to language access and the hospital's right to pull from a toolkit of available methods of providing effective communication.

However, it is important this ruling isn’t misconstrued to assume that VRI is acceptable in all situations or that the patient preference should not be considered. The ADA states, “Title III entities are encouraged to consult with the person with a disability to discuss what aid or service is appropriate. 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.” Bethesda East had appropriately agreed to provide an on-site interpreter if VRI proved to be ineffective, but asserted their right to use VRI during her labor and delivery until proven ineffective.

Communication in medical settings is going through an intense re-calibration, and as hospitals are expanding their language access programs, Deaf patients are being asked to expand their views to embrace multiple modes of receiving ASL interpreting. While Weiss was not in agreement on the use of VRI, her ADA right to effective communication during her labor and delivery was protected. During such a transformative time in communication, it is important to clearly understand the protected rights of individuals and the medical facilities' legal and fiscal responsibilities to ensure quality care and patient safety.

Language access and the law

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